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Sulkowski MS, Moon JS, Sherman KE, Morelli G, Darling JM, Muir AJ, Khalili M, Fishbein DA, Hinestrosa F, Shiffman ML, Di Bisceglie A, Rajender Reddy K, Pearlman B, Lok AS, Fried MW, Stewart PW, Peter J, Wadsworth S, Kixmiller S, Sloan A, Vainorius M, Horne PM, Michael L, Dong M, Evon DM, Segal JB, Nelson DR. A Pragmatic, Randomized Controlled Trial of Oral Antivirals for the Treatment of Chronic Hepatitis C: The PRIORITIZE Study. Hepatology 2021; 74:2952-2964. [PMID: 34255381 PMCID: PMC8639765 DOI: 10.1002/hep.32053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/15/2021] [Accepted: 07/04/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Multiple direct-acting antiviral (DAA) regimens are available to treat HCV genotype 1 infection. However, comparative effectiveness from randomized controlled trials of DAA regimens is unavailable. APPROACH AND RESULTS We conducted a pragmatic randomized controlled trial (NCT02786537) to compare the effectiveness of DAAs for HCV genotype 1a or 1b on viral response, safety, tolerability, and medication nonadherence. Adults with compensated liver disease, HCV genotype 1, not pregnant or breastfeeding, and with health insurance likely to cover ledipasvir/sofosbuvir (LDV/SOF) were recruited from 34 US viral hepatitis clinics. Participants were randomized (± ribavirin) to LDV/SOF, elbasvir/grazoprevir (EBR/GZR), and paritaprevir/ritonavir/ombitasvir+dasabuvir (PrOD; treatment arm stopped early). Primary outcomes included sustained viral response at 12 weeks (SVR12), clinician-recorded adverse events, patient-reported symptoms, and medication nonadherence. Between June 2016 and March 2018, 1,609 participants were randomized. Among 1,128 participants who received ≥1 dose of EBR/GZR or LDV/SOF (± ribavirin), SVR12 was 95.2% (95% CI, 92.8%-97.6%) and 97.4% (95% CI, 95.5%-99.2%), respectively, with a difference estimate of 2.2% (-0.5% to 4.7%), falling within the "equivalence" interval (-5% to 5%). While most (56%) participants experienced adverse events, few were serious (4.2%) or severe (1.8%). In the absence of ribavirin, discontinuations due to adverse events were rare. Patient-reported symptoms and medication nonadherence were similar. Study limitations were dropout due to insurance denial and loss to follow-up after treatment, limiting the ability to measure SVR12. CONCLUSIONS This pragmatic trial demonstrated high SVR12 for participants treated with EBR/GZR and LDV/SOF with few adverse effects. Overall, the two regimens were equivalent in effectiveness. The results support current HCV guidelines that do not distinguish between ribavirin-free EBR/GZR and LDV/SOF.
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Affiliation(s)
- Mark S Sulkowski
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Juhi S Moon
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kenneth E Sherman
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Giuseppe Morelli
- Department of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, FL
| | - Jama M Darling
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew J Muir
- Division of Gastroenterology, Duke University, Durham, NC
| | - Mandana Khalili
- Department of Medicine, University of California San Francisco, Zuckerberg San Francisco General, Hospital and Trauma Center, San Francisco, CA
| | - Dawn A Fishbein
- Infectious Disease, Medstar Health Research Institute, Washington, DC
| | | | | | - Adrian Di Bisceglie
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - K Rajender Reddy
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian Pearlman
- Department of Internal Medicine, Wellstar Health System, Atlanta, GA
| | - Anna S Lok
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Michael W Fried
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Paul W Stewart
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joy Peter
- Department of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, FL
| | | | - Scott Kixmiller
- PRIORITIZE Patient Engagement Group consultant, Greensboro, NC
| | | | - Monika Vainorius
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Patrick M Horne
- Department of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, FL
| | - Larry Michael
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Meichen Dong
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Donna M Evon
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jodi B Segal
- Division of Internal Medicne, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David R Nelson
- Department of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, FL
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Trifan A, Stanciu C, Iliescu L, Sporea I, Baroiu L, Diculescu M, Luca MC, Miftode E, Cijevschi C, Mihai C, Sparchez ZA, Pojoga C, Streinu-Cercel A, Gheorghe L. Effectiveness of 8- and 12-Week Treatment with Ombitasvir/ Paritaprevir/Ritonavir and Dasabuvir in Treatment-Naïve HCV Patients in a Real-Life Setting in Romania: the AMETHYST Study. J Gastrointestin Liver Dis 2021; 30:88-93. [PMID: 33723561 DOI: 10.15403/jgld-3373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/12/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS The 12-week regimen of ombitasvir/paritaprevir/ritonavir and dasabuvir (OPrD) has shown high efficacy and tolerability in clinical trials for the treatment of chronic hepatitis C virus (HCV). The shorter 8-week regimen has been recently incorporated into clinical guidelines and on-label indications, but real-world evidence on its use is limited. Given this knowledge gap, the AMETHYST study aimed to evaluate the effectiveness of the 8- and 12-week regimens of OPrD in treatment-naive patients with HCV with mild to moderate liver fibrosis in Romanian clinical practice. METHODS This was a secondary data collection study analyzing data from a 1-year Patient Support Program in HCV in Romania. Patients received OPrD treatment for 8 or 12 weeks. The effectiveness endpoint was sustained virologic response 12 weeks post-treatment (SVR12). RESULTS A total of 1,835 treatment-naive patients with HCV with mild or moderate fibrosis were included in the study. Of these, 426 and 1,375 completed the 8-week and 12-week regimens, respectively. SVR12 was 98.1% in the 8-week treatment group and 98.7% in the 12-week treatment group. CONCLUSION The study provides real-world evidence that 8-week and 12-week treatment regimens of OPrD are highly effective in treatment-naive patients with HCV with mild to moderate liver fibrosis.
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Affiliation(s)
- Anca Trifan
- Gr. T. Popa Univ. of Medicine and Pharmacy, Institute of Gastroenterol. and Hepatol, Iasi, Romania. .
| | - Carol Stanciu
- Gr. T. Popa Univ. of Medicine and Pharmacy, Institute of Gastroenterol. and Hepatol, Iasi, Romania.
| | - Laura Iliescu
- Dept. of Internal Medicine, Fundeni Clinical Institute, Carol Davila Univ. of Medicine and Pharmacy, Bucharest, Romania.
| | - Ioan Sporea
- Dept. of Gastroenterol. and Hepatol, Victor Babes University of Medicine and Pharmacy, Timișoara, Romania.
| | - Liliana Baroiu
- "Sf. Cuvioasa Parascheva" Clinical Hospital of Infectious Diseases, Galati.
| | - Mircea Diculescu
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest, Carol Davila Univ. of Medicine and Pharmacy, Bucharest, Romania.
| | - Mihaela-Catalina Luca
- Dunarea de Jos University of Galati, Sf Cuv Parascheva, Clinical Hospital of Infectious Disease Galati, Romania.
| | - Egidia Miftode
- Dunarea de Jos University of Galati, Sf Cuv Parascheva, Clinical Hospital of Infectious Disease Galati, Romania.
| | - Cristina Cijevschi
- Gr. T. Popa Univ. of Medicine and Pharmacy, Institute of Gastroenterol. and Hepatol, Iasi, Romania.
| | - Catalina Mihai
- Gr. T. Popa Univ. of Medicine and Pharmacy, Institute of Gastroenterol. and Hepatol, Iasi, Romania.
| | - Zeno-Adrian Sparchez
- Iuliu Hatieganu Univ. of Medicine and Pharmacy, Cluj-Napoca; Prof. Dr. Octavian Fodor Regional Institute of Gastroenterol. and Hepatol, Cluj-Napoca, Romania.
| | - Cristina Pojoga
- Prof. Dr. Octavian Fodor Regional Institute of Gastroenterol. and Hepatol, Cluj-Napoca; Babes- Bolyai Univ, Dept. for Clinical Psychology and Psychotherapy, International Institute for Advanced Studies in Psychotherapy and Applied Mental Health, Cluj- Napoca, Romania.
| | - Adrian Streinu-Cercel
- Prof. Dr. Matei Balș National Institute of Infectious Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Liliana Gheorghe
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest, Carol Davila Univ. of Medicine and Pharmacy, Bucharest, Romania.
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Knikman JE, Gelderblom H, Beijnen JH, Cats A, Guchelaar H, Henricks LM. Individualized Dosing of Fluoropyrimidine-Based Chemotherapy to Prevent Severe Fluoropyrimidine-Related Toxicity: What Are the Options? Clin Pharmacol Ther 2021; 109:591-604. [PMID: 33020924 PMCID: PMC7983939 DOI: 10.1002/cpt.2069] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/18/2020] [Indexed: 12/19/2022]
Abstract
Fluoropyrimidines are widely used in the treatment of several types of solid tumors. Although most often well tolerated, severe toxicity is encountered in ~ 20-30% of the patients. Individualized dosing for these patients can reduce the incidence of severe fluoropyrimidine-related toxicity. However, no consensus has been achieved on which dosing strategy is preferred. The most established strategy for individualized dosing of fluoropyrimidines is upfront genotyping of the DPYD gene. Prospective research has shown that DPYD-guided dose-individualization significantly reduces the incidence of severe toxicity and can be easily applied in routine daily practice. Furthermore, the measurement of the dihydropyrimidine dehydrogenase (DPD) enzyme activity has shown to accurately detect patients with a DPD deficiency. Yet, because this assay is time-consuming and expensive, it is not widely implemented in routine clinical care. Other methods include the measurement of pretreatment endogenous serum uracil concentrations, the uracil/dihydrouracil-ratio, and the 5-fluorouracil (5-FU) degradation rate. These methods have shown mixed results. Next to these methods to detect DPD deficiency, pharmacokinetically guided follow-up of 5-FU could potentially be used as an addition to dosing strategies to further improve the safety of fluoropyrimidines. Furthermore, baseline characteristics, such as sex, age, body composition, and renal function have shown to have a relationship with the development of severe toxicity. Therefore, these baseline characteristics should be considered as a dose-individualization strategy. We present an overview of the current dose-individualization strategies and provide perspectives for a future multiparametric approach.
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Affiliation(s)
- Jonathan E. Knikman
- Division of PharmacologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Hans Gelderblom
- Department of Clinical OncologyLeiden University Medical CenterLeidenThe Netherlands
| | - Jos H. Beijnen
- Division of PharmacologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Annemieke Cats
- Department of Gastroenterology and HepatologyDivision of Medical OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Henk‐Jan Guchelaar
- Department of Clinical Pharmacy and ToxicologyLeiden University Medical CenterLeidenThe Netherlands
| | - Linda M. Henricks
- Department of Clinical Chemistry and Laboratory MedicineLeiden University Medical CenterLeidenThe Netherlands
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Lin WQ, Cai ZJ, Chen T, Liu MB, Li N, Zheng B. Cost-Effectiveness of Dipeptidylpeptidase-4 Inhibitors Added to Metformin in Patients With Type 2 Diabetes in China. Front Endocrinol (Lausanne) 2021; 12:684960. [PMID: 34484112 PMCID: PMC8415028 DOI: 10.3389/fendo.2021.684960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/23/2021] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Dipeptidylpeptidase-4 (DPP-4) inhibitors, including linagliptin, alogliptin, saxagliptin, sitagliptin, and vildagliptin, are used for the treatment of type 2 diabetes mellitus (T2DM) patients in China. This study assessed the economic outcomes of different DPP-4 inhibitors in patients with T2DM inadequately controlled with metformin in the Chinese context. MATERIALS AND METHODS In this study, the validated Chinese Outcomes Model for T2DM (COMT) was conducted to project economic outcomes from the perspective of Chinese healthcare service providers. Efficacy and safety, medical expenditure, and utility data were derived from the literature, which were assigned to model variables. The primary outputs of the model included the lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). One-way and probability sensitivity analysis was conducted to assess the potential uncertainties of parameters. RESULTS Of the five competing strategies, alogliptin 25 mg strategy yielded the most significant health outcome, which associated with improvements in discounted QALY of 0.007, 0.014, 0.011, and 0.022 versus linagliptin 5 mg, saxagliptin 5 mg, sitagliptin 100 mg and vildagliptin50 mg, respectively. The sitagliptin 100 mg strategy was the cheapest option. The ICER of alogliptin 25 mg against sitagliptin 100 mg strategy was $6,952 per additional QALY gained, and the rest of the strategies were dominated or extended dominated. The most influential parameters were the cost of DPP-4 inhibitors and their treatment efficacy. CONCLUSIONS These results suggested that alogliptin was a preferred treatment option compared with other DPP-4 inhibitors for Chinese patients whose T2DM are inadequately controlled on metformin monotherapy.
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Affiliation(s)
- Wen-Qiang Lin
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhong-jie Cai
- Department of Pharmacy, Mindong Hospital of Ningde City, Fu’an, China
| | - Tingting Chen
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- The School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Mao-Bai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- The School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Na Li
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- The School of Pharmacy, Fujian Medical University, Fuzhou, China
- *Correspondence: Na Li, ; Bin Zheng,
| | - Bin Zheng
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- The School of Pharmacy, Fujian Medical University, Fuzhou, China
- *Correspondence: Na Li, ; Bin Zheng,
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Walter T, Hawkins NS, Pollock RF, Colaone F, Shergill S, Ross PJ. Systematic review and network meta-analyses of third-line treatments for metastatic colorectal cancer. J Cancer Res Clin Oncol 2020; 146:2575-2587. [PMID: 32715436 PMCID: PMC7467965 DOI: 10.1007/s00432-020-03315-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limited treatment options are available in chemotherapy-refractory metastatic colorectal cancer (mCRC). The objective was to conduct a systematic literature review (SLR) and exploratory network meta-analysis (NMA) to compare the tolerability and effectiveness of SIRT with Y-90 resin microspheres, regorafenib, TAS-102 (trifluridine/tipiracil), and best supportive care (BSC) as third-line treatment in patients with mCRC. METHODS An SLR was conducted to identify studies comparing two or more of the treatments and reporting overall survival (OS), progression-free survival, tumor response, or adverse event (AE) incidence. An exploratory NMA was conducted to compare hazard ratios (HRs) for OS using Markov chain Monte Carlo (MCMC) techniques. RESULTS Seven studies were identified in the SLR: two double-blind randomized-controlled trials (RCT) for each drug, one open-label RCT, and two non-randomized comparative studies for SIRT. Patient selection criteria differed between studies, with SIRT studies including patients with liver-dominant colorectal metastases. Nausea and vomiting were more frequent with TAS-102 than regorafenib or SIRT; diarrhea was more common with TAS-102 and regorafenib than SIRT. The exploratory NMA suggested that all active treatments improved OS, with HRs of 0.48 (95% CrI 0.30-0.78) for SIRT with Y-90 resin microspheres, 0.63 (0.38-1.03) for TAS-102, and 0.67 (0.40-1.08) for regorafenib each compared to BSC. CONCLUSIONS Regorafenib, TAS-102 and SIRT using Y-90 resin microspheres are more effective than BSC in third-line treatment of mCRC; however, study heterogeneity made comparisons between active treatments challenging. SIRT is a viable treatment for third-line mCRC and its favorable AE profile should be considered in the therapeutic decision-making process.
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Affiliation(s)
- Thomas Walter
- Cancer Research Center of Lyon, University of Lyon, Claude Bernard University, Lyon, France
- Service d'oncologie médicale, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, France
| | - Neil S Hawkins
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | | | | | - Paul J Ross
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Oncology, King's College Hospital NHS Foundation Trust, London, UK
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Hsieh CH, Lin CY, Hsu CL, Fan KH, Huang SF, Liao CT, Lee LY, Ng SK, Yen TC, Chang JTC, Lin JR, Wang HM. Incorporation of Astragalus polysaccharides injection during concurrent chemoradiotherapy in advanced pharyngeal or laryngeal squamous cell carcinoma: preliminary experience of a phase II double-blind, randomized trial. J Cancer Res Clin Oncol 2019; 146:33-41. [PMID: 31728618 DOI: 10.1007/s00432-019-03033-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/18/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Concurrent chemoradiotherapy (CCRT) is one of the standard treatments for patients with advanced head and neck squamous cell carcinoma (HNSCC). However, CCRT may lead to decreased quality of life (QoL) and treatment compliance. This study aimed to determine the effects of PG2 (Astragalus polysaccharides) injection on CCRT-associated adverse events (AEs) and patients' compliance with the CCRT course. METHODS In this phase II double-blind randomized placebo-controlled trial, PG2 injection (sterile powder form) or placebo was administrated three times per week in parallel with CCRT to patients with HNSCC. The chemotherapy regimen included 50 mg/m2 cisplatin every 2 weeks with daily tegafur-uracil (300 mg/m2) and leucovorin (60 mg/day). RESULTS The study was terminated prematurely due to the successful launch of a newly formulated PG2 injection (lyophilized form). A total of 17 patients were enrolled. The baseline demographics and therapeutic compliance were comparable between the CCRT/PG2 and CCRT/placebo groups. During CCRT, severe treatment-associated AEs were less frequent in the CCRT/PG2 group than in the CCRT/placebo group. Furthermore, less QoL fluctuations from the baseline during CCRT were noted in the CCRT/PG2 group than in the CCRT/placebo group, with a significant difference in the pain, appetite loss, and social eating behavior. The tumor response, disease-specific survival and overall survival did not differ between the two groups. CONCLUSION This preliminary study demonstrated PG2 injection exhibited an excellent safety profile, and has potential in ameliorating the deterioration in QoL and the AEs associated with active anticancer treatment among patients with advanced pharyngeal or laryngeal HNSCC under CCRT. Further research in patients with other cancer types or treatment modalities may widen PG2's application in clinical settings.
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Affiliation(s)
- Chia-Hsun Hsieh
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou; College of Medicine, Chang Gung University, No. 5, Fushin St., Gueishan District, Taoyuan, 333, Taiwan, ROC
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Cheng-Lung Hsu
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou; College of Medicine, Chang Gung University, No. 5, Fushin St., Gueishan District, Taoyuan, 333, Taiwan, ROC
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University at Linkou, Taoyuan, Taiwan, ROC
| | - Shu-Kung Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University at Linkou, Taoyuan, Taiwan, ROC
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hung-Ming Wang
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou; College of Medicine, Chang Gung University, No. 5, Fushin St., Gueishan District, Taoyuan, 333, Taiwan, ROC.
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De Pace V, Morelli MC, Ravaioli M, Maggi F, Galli S, Vero V, Re MC, Cescon M, Pistello M. Efficacy, Safety, and Predictors of Direct-acting antivirals in Hepatitis C Virus Patients with Heterogeneous Liver Diseases. New Microbiol 2019; 42:189-196. [PMID: 31609453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 06/10/2023]
Abstract
Safety, efficacy, and predictor factors of sustained-virological-response after 24 weeks of new direct-acting antivirals were evaluated in hepatitis C virus patients with different stages of hepatic disease. 260 patients, median age 60 years, of whom 48.1% cirrhotics, 17.7% liver transplant recipients, and 45.7% naïve were treated with Sofosbuvir+Ribavirine, Sofosbuvir+Simeprevir±Ribavirine, Sofosbuvir+Daclatasvir± Ribavirine, Sofosbuvir+Ledispavir±Ribavirine, Ombitasvir/Paritaprevir/Ritonavir+Ribavirine and Ombitasvir/Paritaprevir/Ritonavir+Dasabuvir±Ribavirine. Therapy outcomes, hematochemical parameters, viral replication, genotype, and resistance-associated-mutations were analyzed retrospectively. Sustained virological response was 90.4% in the whole population, 83.2% in cirrhotics, 85% in patients with previous virological failure, 93.6% in patients >60 years, and 95.6% in liver transplant recipients. SVR24 for each drug regimen was 75% Sofosbuvir+Ribavirine, 80.4% Sofosbuvir+Simeprevir±Ribavirine, 94.3% Sofosbuvir+Daclatasvir±Ribavirine, 98.7% Sofosbuvir+Ledispavir±Ribavirine, 100% Ombitasvir/ Paritaprevir/Ritonavir+Ribavirine and Ombitasvir/Paritaprevir/Ritonavir+Dasabuvir±Ribavirine. The highest sustained virological response rates were obtained with genotype-1b (95.9%). Twenty-five patients, mostly cirrhotics or suffering from severe liver complications, manifested relapse (84%), breakthrough (12%), or non-response (4%). Mild side effects were observed in 41.1% of patients. Model-for-End-Liver- Disease score <10 and alanine aminotransferase ≤20 U/L at week 8 of therapy proved positive predictors of sustained virological response. Direct-acting antiviral therapy is efficacious and safe even in patients with advanced liver disease and/ or previous virological failure; Model-for-End-Liver-Disease <10 and alanine aminotransferase reduction during therapy were found to be reliable predicting markers of sustained-virological-response.
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Affiliation(s)
- Vanessa De Pace
- General and Transplant Surgery Unit, Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Cristina Morelli
- General and Transplant Surgery Unit, Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Matteo Ravaioli
- General and Transplant Surgery Unit, Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Fabrizio Maggi
- Virology Unit, Pisa University Hospital; Virology Section and Retrovirus Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Silvia Galli
- Microbiology and Virology Unit, Department of Experimental Diagnostic and Specialty Medicine, University of Bologna and Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Vittoria Vero
- End-stage Liver Disease Unit, Department of Medical and Surgical Sciences, University of Bologna and Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Carla Re
- Microbiology and Virology Unit, Department of Experimental Diagnostic and Specialty Medicine, University of Bologna and Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Matteo Cescon
- General and Transplant Surgery Unit, Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Mauro Pistello
- Virology Unit, Pisa University Hospital; Virology Section and Retrovirus Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Bekir Hacioglu M, Kostek O, Kurt N, Kucukarda A, Gokyer A, Ustabasioglu FE, Karatas F, Tuncbilek N, Uzunoglu S, Bilici A, Cicin I, Erdogan B. Comparison of skeletal muscle mass loss in patients with metastatic colorectal cancer treated with regorafenib or TAS-102. J BUON 2019; 24:2198-2204. [PMID: 31786894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To assess whether regorafenib and TAS-102 treatments are associated with a change in Skeletal Muscle Area (SMA) as well as to compare Skeletal Muscle Mass (SMM) loss levels between regorafenib and TAS-102 treatments and prognostic significance in the patients with metastatic colorectal cancer (mCRC). METHODS A total of 36 mCRC patients, who received regorafenib or TAS-102 in the third-line and subsequent settings were assessed in the analysis. SMM changes were assessed with CT scans findings, and they were categorized into two groups as SMM-loss (SMM decrease ≥2%) and SMM-stable (SMM change <2%). RESULTS The SMM change after regorafenib therapy was significantly worse compared with TAS-102 therapy (p=0.001). The median overall survival (OS) was longer in SMM-stable group than in SMM-loss group (12.8 months; 95%CI:9.8-15.7) vs. 6.4 months; 95%CI:5.2-7.7, respectively;p=0.04). Cox regression analysis showed that SMM loss was independent prognostic indicator for OS (HR, 2.87; 95%CI: 1.07-7.42, p=0.03). CONCLUSION Although patients who received regorafenib had more SMM loss than those who received TAS-102, there was no difference in OS between drugs.
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Venter WDF, Moorhouse M, Sokhela S, Fairlie L, Mashabane N, Masenya M, Serenata C, Akpomiemie G, Qavi A, Chandiwana N, Norris S, Chersich M, Clayden P, Abrams E, Arulappan N, Vos A, McCann K, Simmons B, Hill A. Dolutegravir plus Two Different Prodrugs of Tenofovir to Treat HIV. N Engl J Med 2019; 381:803-815. [PMID: 31339677 DOI: 10.1056/nejmoa1902824] [Citation(s) in RCA: 394] [Impact Index Per Article: 78.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Two drugs under consideration for inclusion in antiretroviral therapy (ART) regimens for human immunodeficiency virus (HIV) infection are dolutegravir (DTG) and tenofovir alafenamide fumarate (TAF). There are limited data on their use in low- and middle-income countries. METHODS We conducted a 96-week, phase 3, investigator-led, open-label, randomized trial in South Africa, in which we compared a triple-therapy combination of emtricitabine (FTC) and DTG plus either of two tenofovir prodrugs - TAF (TAF-based group) or tenofovir disoproxil fumarate (TDF) (TDF-based group) - against the local standard-of-care regimen of TDF-FTC-efavirenz (standard-care group). Inclusion criteria included an age of 12 years or older, no receipt of ART in the previous 6 months, a creatinine clearance of more than 60 ml per minute (>80 ml per minute in patients younger than 19 years of age), and an HIV type 1 (HIV-1) RNA level of 500 copies or more per milliliter. The primary end point was the percentage of patients with a 48-week HIV-1 RNA level of less than 50 copies per milliliter (as determined with the Snapshot algorithm from the Food and Drug Administration; noninferiority margin, -10 percentage points). We report the primary (48-week) efficacy and safety data. RESULTS A total of 1053 patients underwent randomization from February 2017 through May 2018. More than 99% of the patients were black, and 59% were female. The mean age was 32 years, and the mean CD4 count was 337 cells per cubic millimeter. At week 48, the percentage of patients with an HIV-1 RNA level of less than 50 copies per milliliter was 84% in the TAF-based group, 85% in the TDF-based group, and 79% in the standard-care group, findings that indicate that the DTG-containing regimens were noninferior to the standard-care regimen. The number of patients who discontinued the trial regimen was higher in the standard-care group than in the other two groups. In the per-protocol population, the standard-care regimen had equivalent potency to the other two regimens. The TAF-based regimen had less effect on bone density and renal function than the other regimens. Weight increase (both lean and fat mass) was greatest in the TAF-based group and among female patients (mean increase, 6.4 kg in the TAF-based group, 3.2 kg in the TDF-based group, and 1.7 kg in the standard-care group). No resistance to integrase inhibitors was identified in patients receiving the DTG-containing regimens. CONCLUSIONS Treatment with DTG combined with either of two tenofovir prodrugs (TAF and TDF) showed noninferior efficacy to treatment with the standard-care regimen. There was significantly more weight gain with the DTG-containing regimens, especially in combination with TAF, than with the standard-care regimen. (ADVANCE ClinicalTrials.gov number, NCT03122262.).
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Affiliation(s)
- Willem D F Venter
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Michelle Moorhouse
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Simiso Sokhela
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Lee Fairlie
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Nkuli Mashabane
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Masebole Masenya
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Celicia Serenata
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Godspower Akpomiemie
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Ambar Qavi
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Nomathemba Chandiwana
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Shane Norris
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Matthew Chersich
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Polly Clayden
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Elaine Abrams
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Natasha Arulappan
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Alinda Vos
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Kaitlyn McCann
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Bryony Simmons
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
| | - Andrew Hill
- From Ezintsha (W.D.F.V., M. Moorhouse, S.S., N.M., C.S., G.A., N.C., N.A., A.V.), Wits Reproductive Health and HIV Institute, Faculty of Health Sciences (W.D.F.V., M. Moorhouse, S.S., L.F., N.M., M. Masenya, C.S., G.A., N.C., M.C., N.A., A.V.), and the South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences (S.N.), University of the Witwatersrand, Johannesburg; the Faculty of Medicine, Imperial College London (A.Q., K.M., B.S.), and HIV i-Base (P.C.), London, and the Department of Translational Medicine, Liverpool University, Liverpool (A.H.) - all in the United Kingdom; ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York (E.A.); and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (A.V.)
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Sonbol MB, Benkhadra R, Wang Z, Firwana B, Walden DJ, Mody K, Hubbard JM, Murad MH, Ahn DH, Bekaii-Saab T. A Systematic Review and Network Meta-Analysis of Regorafenib and TAS-102 in Refractory Metastatic Colorectal Cancer. Oncologist 2019; 24:1174-1179. [PMID: 31164455 DOI: 10.1634/theoncologist.2019-0189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/05/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Regorafenib at different dosing strategies and TAS-102 are treatment options for refractory metastatic colorectal cancer (mCRC). We aimed to evaluate the comparative effectiveness evidence supporting these different strategies. MATERIALS AND METHODS We searched different databases for randomized controlled trials evaluating TAS-102 or regorafenib in patients with refractory mCRC who failed prior oxaliplatin, irinotecan, and fluoropyrimidine. Outcomes of interest included overall survival (OS) and progression-free survival (PFS). The overall effect was pooled using the DerSimonian random effects model. We conducted network meta-analysis based on White's multivariate meta-regression to pool evidence from direct and indirect comparisons. RESULTS Six trials at low risk of bias (2,445 patients) were included. Direct comparisons showed that Rego 160 and TAS-102 as monotherapy were superior to best-supportive care (BSC) in terms of PFS (Rego 160: hazard ratio [HR], 0.4; 95% confidence ratio [CI], 0.26-0.63; TAS-102: HR, 0.46 CI, 0.40-0.52) and OS (Rego 160: HR, 0.67; CI, 0.48-0.93; TAS-102: HR, 0.67; CI, 0.57-0.80). Network analysis showed no statistically difference in PFS or OS between Rego 160 and TAS-102. Rego 80+ was superior to BSC in terms of OS (HR, 0.44; CI, 0.23-0.84) and PFS (HR, 0.37; CI, 0.21-0.66). Rego 80+ was associated with statistically nonsignificant improvement in OS and PFS compared with TAS-102 and Rego 160. CONCLUSION Regorafenib 160 and TAS-102 appear to have similar efficacy. Rego 80+ is shown to be superior to BSC. A trend for improved OS was observed with Rego 80+ versus Rego 160 or TAS 102. IMPLICATIONS FOR PRACTICE Regorafenib at a dose of 160 mg and TAS-102 appear to have similar efficacy in patients with refractory metastatic colorectal cancer. Regorafenib with a dose escalation strategy is superior to best-supportive care. Given its tolerability and the observed trend in survival benefit compared with regorafenib 160, dose escalation strategy of regorafenib (80+) may be the preferred option in this setting.
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Affiliation(s)
| | - Raed Benkhadra
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Zhen Wang
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Belal Firwana
- Heartland Cancer Research NCORP, Missouri Baptist Medical Center, St Louis, Missouri, USA
| | - Daniel J Walden
- Mayo Clinic Cancer Center, Mayo Clinic, Phoenix, Arizona, USA
| | - Kabir Mody
- Mayo Clinic Cancer Center, Mayo Clinic, Jacksonville, Florida, USA
| | - Joleen M Hubbard
- Mayo Clinic Cancer Center, Mayo Clinic, Rochester, Minnesota, USA
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel H Ahn
- Mayo Clinic Cancer Center, Mayo Clinic, Phoenix, Arizona, USA
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Lee YC, Hu TH, Hung CH, Lu SN, Chen CH, Wang JH. The change in liver stiffness, controlled attenuation parameter and fibrosis-4 index for chronic hepatitis C patients with direct-acting antivirals. PLoS One 2019; 14:e0214323. [PMID: 30939158 PMCID: PMC6445421 DOI: 10.1371/journal.pone.0214323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/10/2019] [Indexed: 12/17/2022] Open
Abstract
Background and aim Transient elastography and fibrosis-4 index (FIB-4) have been proposed to access hepatic fibrosis and steatosis for patients with chronic liver disease. This study was to determine the changes of liver stiffness (LS), controlled attenuation parameter (CAP) value and FIB-4 and their associated factors for chronic hepatitis C (CHC) patients who underwent direct-acting antivirals (DAAs). Patients and methods Consecutive patients with CHC in advanced fibrosis or compensated cirrhosis undergoing paritaprevir/ritonavir/ombitasvir plus dasabuvir therapy and with LS and CAP before and 12 weeks after treatment were enrolled. The demographics, clinical characteristics and treatment outcomes were reviewed. The changes of LS, FIB-4, CAP and their associated factors were analyzed. Results A total of 213 patients (mean age: 63.7 years) with complete recommended treatment were enrolled. All patients achieved sustained virological response at 12 weeks (SVR12) of follow-up. The mean values of LS, CAP and FIB-4 index before treatment were 18.5kPa, 283dB/m and 5.05 respectively. While there was no significant change in CAP, LS and FIB-4 decreased significantly at the time of SVR12 (p<0.001). Compared with follow-up period, LS and FIB-4 decreased rapidly during DDAs. Multivariate analysis showed that higher baseline LS and FIB-4 were associated with greater reductions at the time of SVR12. Conclusion For CHC patients in advanced fibrosis or compensated cirrhosis, DAAs improved LS and FIB-4 index at SVR12. Higher baseline LS and FIB-4 contributed to greater reductions. However, there was no significant change in CAP value.
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Affiliation(s)
- Yu-Chi Lee
- Division of Hepato-Gastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, Taiwan
| | - Tsung-Hui Hu
- Division of Hepato-Gastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, Taiwan
| | - Chao-Hung Hung
- Division of Hepato-Gastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, Taiwan
- Division of Hepato-Gastroenterology, Department of Medicine, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi City, Taiwan
| | - Sheng-Nan Lu
- Division of Hepato-Gastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, Taiwan
- Division of Hepato-Gastroenterology, Department of Medicine, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi City, Taiwan
| | - Chien-Hung Chen
- Division of Hepato-Gastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, Taiwan
| | - Jing-Houng Wang
- Division of Hepato-Gastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, Taiwan
- * E-mail:
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Grothey A, Marshall JL, Bekaii-Saab T. Sequencing beyond the second-line setting in metastatic colorectal cancer. Clin Adv Hematol Oncol 2019; 17 Suppl 7:1-19. [PMID: 31730588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The standard treatment for patients with metastatic colorectal cancer (mCRC) in the first- and second-line setting is generally chemotherapy, which can be augmented with vascular endothelial growth factor-targeted therapies and, for patients with KRAS wild-type status, epidermal growth factor receptor-targeted therapies. However, nearly all patients ultimately develop disease progression and require later lines of therapy. Traditionally, physicians recycled chemotherapy in the later lines, with many patients showing diminished or no response. However, the past several years have seen the introduction of 2 agents for patients with refractory mCRC entering the third-line setting. The multitargeted tyrosine kinase inhibitor regorafenib and the cytotoxic combination of trifluridine/tipiracil have demonstrated significant improvements in overall survival in patients with refractory mCRC. Although these agents do not seem to induce complete responses, they can lead to durable stable disease. Regorafenib and trifluridine/tipiracil differ in their safety profiles. Physicians and patients must be properly educated on how to recognize and mitigate adverse events. For regorafenib, a dose-escalating strategy improves tolerability without impacting efficacy. When sequencing these agents, physicians should consider patient characteristics, including comorbidities, prior adverse reactions to treatments, and overall performance status. Ongoing studies are further defining the role of regorafenib and trifluridine/tipiracil in the treatment of mCRC.
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Affiliation(s)
- Axel Grothey
- West Cancer Center, University of Tennessee, Memphis, Tennessee
| | - John L Marshall
- Ruesch Center for the Cure of GI Cancers, Georgetown University, Lombardi Comprehensive Cancer Center, Washington, DC
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Takahara M, Shiraiwa T, Katakami N, Maeno Y, Yamamoto K, Shiraiwa Y, Yoshida Y, Matsuoka TA, Shimomura I. Different daily glycemic profiles after switching from once-daily alogliptin plus twice-daily metformin to their once-daily fixed-dose combination in Japanese type 2 diabetic patients. Endocr J 2019; 66:11-17. [PMID: 30305482 DOI: 10.1507/endocrj.ej18-0313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to investigate whether daily glycemic profiles and treatment satisfaction would be changed after switching from once-daily 25-mg alogliptin plus twice-daily 250-mg metformin to the fixed-dose combination of 25-mg alogliptin and 500-mg metformin once daily in type 2 diabetic patients. Twenty adult Japanese type 2 diabetic patients in whom once-daily 25-mg alogliptin plus twice-daily 250-mg metformin were switched to the fixed-dose combination of 25-mg alogliptin and 500-mg metformin once daily participated. Before and one month after the switch, participants were asked to perform one day of seven-point self-monitoring of blood glucose (SMBG), to wear a sensor of flash glucose monitoring for up to 14 days, and to respond to a questionnaire for treatment satisfaction. As a result, the SMBG profiles were significantly changed after the switch (p = 0.021); blood glucose levels 2 hours after breakfast were significantly elevated (p = 0.022), whereas those 2 hours after lunch were significantly reduced (p = 0.036). The flash glucose monitoring also demonstrated a significant change of daily glucose profiles (p < 0.001). The risk of glucose levels <80 mg/dL were decreased from evening to morning, while the risk of glucose levels ≥140 mg/dL were increased. Mean 24-hour glucose values were increased by 5 mg/dL on average (p < 0.001). Treatment satisfaction was significantly improved after the switch (p < 0.001). In conclusion, daily glycemic profiles were significantly changed after switching from once-daily 25-mg alogliptin plus twice-daily 250-mg metformin to the once-daily fixed-dose combination in Japanese type 2 diabetic patients. Treatment satisfaction was significantly improved after the switch.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | | | - Naoto Katakami
- Department of Metabolism and Atherosclerosis, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | | | - Kaoru Yamamoto
- Shiraiwa Medical Clinic, Kashiwara, Osaka 582-0005, Japan
| | - Yuka Shiraiwa
- Shiraiwa Medical Clinic, Kashiwara, Osaka 582-0005, Japan
| | - Yoko Yoshida
- Shiraiwa Medical Clinic, Kashiwara, Osaka 582-0005, Japan
| | - Taka-Aki Matsuoka
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
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Hayashi M, Nakamura K, Terai S, Okamoto K, Sakai S, Kinoshita J, Hayashi H, Oyama K, Miyashita T, Inokuchi M, Tajima H, Takamura H, Ninomiya I, Fushida S, Ohta T. [A Case of Spontaneous Esophageal Rupture That Required Operation during Adjuvant Chemotherapy for Transverse Colon Cancer]. Gan To Kagaku Ryoho 2018; 45:2009-2011. [PMID: 30692427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 75-year-old male underwent adjuvant chemotherapy with tegafur uracil(UFT)plus Leucovorin(LV)after surgery for transverse colon cancer(pT3pN0M0, ly1, v2, pStageⅡ). Although he had diarrhea(Grade 3)and vomiting(Grade 2)from day 15, he continued to take the medicine at his own discretion. He visited a hospital because of acute renal failure from severe dehydration. He went into shock after evacuation, and the computed tomography(CT)finding suggested a diagnosis of spontaneous esophageal rupture at the lower esophagus. We made a diagnosis of intrathoracic perforation of the esophagus by using thoracic drainage. Then, we performed an operation for mediastinal drainage via a transabdominal approach and the lesser omentum. He started ingestion from POD36 and transferred to another hospital on POD85. He had no disease recurrence in our outpatient care. We think that the spontaneous esophageal rupture occurred because of the frequent vomiting caused by the continued chemotherapy despite the severe side effects. Treatments must be selected by considering patients' life background and medical compliance, and common guidance in taking medications must be provided to elderly patients at the start of chemotherapy.
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Affiliation(s)
- Masato Hayashi
- Dept. of Gastroenterological Surgery, Kanazawa University
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Janczewska E, Zarębska-Michaluk D, Berak H, Piekarska A, Gietka A, Dybowska D, Mazur W, Belica-Wdowik T, Dobracki W, Tudrujek-Zdunek M, Deroń Z, Buczyńska I, Sitko M, Czauż-Andrzejuk A, Lorenc B, Białkowska-Warzecha J, Citko J, Laurans Ł, Jaroszewicz J, Socha Ł, Tronina O, Adamek B, Horban A, Halota W, Baka-Ćwierz B, Tomasiewicz K, Simon K, Garlicki A, Wawrzynowicz-Syczewska M, Flisiak R. The efficacy of paritaprevir/ritonavir/ombitasvir+dasabuvir and ledipasvir/sofosbuvir is comparable in patients who failed interferon-based treatment with first generation protease inhibitors - a multicenter cohort study. BMC Infect Dis 2018; 18:580. [PMID: 30445916 PMCID: PMC6240185 DOI: 10.1186/s12879-018-3465-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/31/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND According to the EASL and AASLD guidelines, the recommended treatment for patients who failed to achieve a sustained virologic response (SVR) on prior interferon-based triple therapy with protease inhibitors (PI), is a combination of sofosbuvir and NS5A inhibitors. Polish national recommendations also allow the use of paritaprevir/ritonavir/ombitasvir+dasasbuvir±ribavirin (PrODR) in this group of patients. The aim of the study was to evaluate the efficacy and safety of PrODR vs. ledipasvir/sofosbuvir±RBV (LSR) in PI-experienced patients in real-life setting. METHODS Our analysis included patients registered in the nationwide, investigators initiated, multicentre EpiTer-2 database. Among 4530 patients registered, 335 with genotype 1 (93% 1b) were previously treated with IFN-based regimens with PIs: 127 with boceprevir (BOC), 208 with telaprevir (TVR). Patients with advanced fibrosis (F3/F4) were significantly predominant (BOC 28.4%/61.4%, TVR 18.8%/64.4%, respectively). Subjects were assigned to IFN-free retreatment as follows: BOC - 64 (50.4%) PrODR and 63 (49.6%) LSR; TVR- 103 (49.5%) PrODR and 105 (50.5%) LSR. RESULTS SVR rates were comparable for particular groups: BOC → PrODR- 100%; BOC → LSR - 98%; TVR → PrODR - 97%; TVR → LSR - 96% (intent-to treat analysis-ITT) and BOC → PrODR→100%; BOC → LSR - 99%; TVR → PrODR - 99%; TVR → LSR - 98% (modified intent-to treat analysis-mITT). Both treatment regimens had a favourable safety profile. Adverse events (AEs) were generally mild or moderate in severity. Three deaths were reported. The treatment was stopped due to AEs in five patients (three treated with PrODR and two with LSR). CONCLUSION Efficacy and safety of treatment with PrODR and LSR is comparable in BOC or TVR-experienced patients.
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Affiliation(s)
- Ewa Janczewska
- Department of Basic Medical Sciences, School of Public Health in Bytom, Medical University of Silesia, ID Clinic, Janowska 19, 41-400 Mysłowice, Bytom, Poland
| | | | - Hanna Berak
- Hospital of Infectious Diseases, Warszawa, Poland
| | - Anna Piekarska
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, Łódź, Poland
| | - Andrzej Gietka
- Department of Internal Medicine and Hepatology, Central Clinical Hospital of the MSWiA, Warszawa, Poland
| | - Dorota Dybowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | - Włodzimierz Mazur
- Department of Infectious Diseases, Infectious Hepatology and Acquired Immunodeficiency, Medical University of Silesia in Katowice, Chorzów, Poland
| | - Teresa Belica-Wdowik
- Regional Center for Diagnosis and Treatment of Viral Hepatitis and Hepatology, John Paul II Hospital, Kraków, Poland
| | | | | | - Zbigniew Deroń
- Ward of Infectious Diseases and Hepatology, Biegański Regional Specialist Hospital, Łódź, Poland
| | - Iwona Buczyńska
- Department of Infectious Diseases and Hepatology, Wrocław Medical University, Wrocław, Poland
| | - Marek Sitko
- Department of Infectious and Tropical Diseases, Collegium Medicum, Jagiellonian University, Kraków, Poland
| | - Agnieszka Czauż-Andrzejuk
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland
| | - Beata Lorenc
- Pomeranian Center of Infectious Diseases, Department of Infectious Diseases, Medical University of Gdansk, Gdansk, Poland
| | | | - Jolanta Citko
- Medical Practice of Infections, Regional Hospital, Olsztyn, Poland
| | - Łukasz Laurans
- Department of Infectious Diseases, Hepatology and Liver Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia in Katowice, Bytom, Poland
| | - Łukasz Socha
- Department of Infectious Diseases, Hepatology and Liver Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - Olga Tronina
- Department of Transplantation Medicine, Nephrology, and Internal Diseases, Medical University of Warsaw, Warszawa, Poland
| | - Brygida Adamek
- Department of Basic Medical Sciences, School of Public Health in Bytom, Medical University of Silesia, ID Clinic, Janowska 19, 41-400 Mysłowice, Bytom, Poland
| | - Andrzej Horban
- Warsaw Medical University & Hospital of Infectious Diseases Warszawa, Warszawa, Poland
| | - Waldemar Halota
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | - Barbara Baka-Ćwierz
- Regional Center for Diagnosis and Treatment of Viral Hepatitis and Hepatology, John Paul II Hospital, Kraków, Poland
| | | | - Krzysztof Simon
- Department of Infectious Diseases and Hepatology, Wrocław Medical University, Wrocław, Poland
| | - Aleksander Garlicki
- Department of Infectious and Tropical Diseases, Collegium Medicum, Jagiellonian University, Kraków, Poland
| | - Marta Wawrzynowicz-Syczewska
- Department of Infectious Diseases, Hepatology and Liver Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland
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Kaku K, Kuroda S, Ishida K, Umeda Y. Efficacy and safety of trelagliptin in combination with insulin therapy in Japanese patients with type 2 diabetes: Results from a randomized, Phase IV study. Diabetes Obes Metab 2018; 20:2490-2493. [PMID: 29862617 PMCID: PMC6175153 DOI: 10.1111/dom.13397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/16/2018] [Accepted: 05/26/2018] [Indexed: 11/28/2022]
Abstract
We aimed to explore the efficacy and safety of once-weekly trelagliptin 100 mg as an add-on therapy to insulin in Japanese patients with type 2 diabetes mellitus with inadequate glycaemic control. Patients with haemoglobin A1c (HbA1c) 7.5% to 10.0% who were receiving 8 to 40 units of insulin per day were randomized to receive, with insulin, trelagliptin 100 mg (A/A, n = 116) or placebo (P/A, n = 124) for a 12-week double-blind (DB) phase, after which all received trelagliptin for a 40-week open-label phase. Primary endpoints were HbA1c change from baseline to the end of the DB phase and adverse events (AEs). HbA1c significantly decreased in the A/A group vs the P/A group at the end of the DB phase (least square mean difference, -0.63% [95% CI, -0.83 to -0.44]: P < .0001). The frequency of treatment-emergent AEs during the DB phase was 44.0% in the A/A group and 47.6% in the P/A group. No patient experienced severe hypoglycaemia during trelagliptin treatment. Once-weekly trelagliptin 100 mg therapy with insulin demonstrated a significant reduction in HbA1c. Long-term treatment was well-tolerated, with no clinically significant hypoglycaemia, suggesting that trelagliptin with insulin is a meaningful treatment option in this patient population.
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Affiliation(s)
- Kohei Kaku
- Department of MedicineKawasaki Medical SchoolOkayamaJapan
| | - Shingo Kuroda
- Takeda Development Center JapanTakeda Pharmaceutical Company LimitedOsakaJapan
| | - Kazuyuki Ishida
- Takeda Development Center JapanTakeda Pharmaceutical Company LimitedOsakaJapan
| | - Yuusuke Umeda
- Takeda Development Center JapanTakeda Pharmaceutical Company LimitedOsakaJapan
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Ascione A, De Luca M, Melazzini M, Montilla S, Trotta MP, Petta S, Puoti M, Sangiovanni V, Messina V, Bruno S, Izzi A, Villa E, Aghemo A, Zignego AL, Orlandini A, Fontanella L, Gasbarrini A, Marzioni M, Giannini EG, Craxì A. Safety and efficacy of ombitasvir/paritaprevir/ritonavir/dasabuvir plus ribavirin in patients over 65 years with HCV genotype 1 cirrhosis. Infection 2018; 46:607-615. [PMID: 29808463 DOI: 10.1007/s15010-018-1157-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/22/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To analyse safety and efficacy of treatment based on ombitasvir/paritaprevir/ritonavir/dasabuvir plus ribavirin in the sub-group of GT1 patients older than 65 years. METHODS We collected data extracted from the ABACUS compassionate-use nationwide Italian programme, in patients with cirrhosis due to hepatitis C virus (HCV) Genotype-1 (GT1) or 4 and at high risk of decompensation. GT1-HCV-infected patients received once-daily ombitasvir/paritaprevir, with the pharmacokinetic enhancer ritonavir (25/150/100 mg) and twice-daily dasabuvir (250 mg) plus Ribavirin (RBV) (OBV/PTV/r + DSV + RBV) for 12 (GT1b) or 24 (GT1a) weeks. Endpoints were to evaluate safety and efficacy, the latter defined as HCV RNA negative 12 weeks after the end of treatment (SVR12). RESULTS Patients who suffered any adverse event (AE) were 74/240 (30.8%); 13/240 (5.4%) discontinued the treatment. A multivariate analysis found albumin < 3.5 g/dL (OR 2.04: 95% CI 1.0-4.2, p < 0.05) and hypertension (OR 4.6: 95% CI 2.3-9.2, p < 0.001) as variables independently associated with AE occurrence. The SVR12 was 95% (228/240). Multivariate analysis identified baseline bilirubin < 2 mg/dL (OR 4.9: 95% CI 1.17-20.71, p = 0.029) as the only variable independently associated with SVR12. CONCLUSION Our findings suggest that OBV/PTV/r + DSV + RBV is safe and effective in real-life use in patients with compensated cirrhosis, HCV-GT1 infection, and age over 65.
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Affiliation(s)
- Antonio Ascione
- Department of Medicine, Centre for Liver Disease, Buon Consiglio-Fatebenefratelli Hospital, Via Manzoni 220, 80123, Naples, Italy.
| | | | | | | | | | - Salvatore Petta
- Department of Gastroenterology, DiBiMIS, University of Palermo, Palermo, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, AO Niguarda Ca' Granda Hospital, Milan, Italy
| | | | | | - Savino Bruno
- Humanitas University and IRCCS Clinical Institute Humanitas, Rozzano, Milan, Italy
| | - Antonio Izzi
- Infectious Disease, Cotugno Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Erica Villa
- Gastroenterology Unit, Department of Internal Medicine, AOU Policlinico of Modena, Modena, Italy
| | - Alessio Aghemo
- UO Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Hospital Maggiore Policlinico of Milan, Milan, Italy
| | - Anna Linda Zignego
- Interdepartmental Centre for Systemic Manifestations of Hepatitis Viruses (MaSVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Luca Fontanella
- Department of Medicine, Centre for Liver Disease, Buon Consiglio-Fatebenefratelli Hospital, Via Manzoni 220, 80123, Naples, Italy
| | - Antonio Gasbarrini
- Internal Medicine, Gastroenterology and Hepatology, Agostino Gemelli Hospital, Rome, Italy
| | - Marco Marzioni
- Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche, Ancona, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Antonio Craxì
- Department of Gastroenterology, DiBiMIS, University of Palermo, Palermo, Italy
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Hsieh YC, Jeng WJ, Huang CH, Teng W, Chen WT, Chen YC, Lin SM, Tai DI, Lin CY, Sheen IS. Hepatic decompensation during paritaprevir/ritonavir/ombitasvir/dasabuvir treatment for genotype 1b chronic hepatitis C patients with advanced fibrosis and compensated cirrhosis. PLoS One 2018; 13:e0202777. [PMID: 30138456 PMCID: PMC6107263 DOI: 10.1371/journal.pone.0202777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/08/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIM Hepatic decompensation is a severe on-treatment adverse event for chronic hepatitis C treated with paritaprevir/ritonavir/ombitasvir and dasabuvir (PrOD). Till now, few papers regarding on-treatment hepatic decompensation have been reported. The study aims to analyze the general feature and predictive factors of on-treatment hepatic decompensation in hepatitis C virus (HCV) genotype 1b-infected patients with advanced fibrosis and compensated cirrhosis who receive treatment with PrOD. METHODS A real-word cohort enrolled 189 HCV genotype 1b patients with advanced fibrosis and compensated cirrhosis treated with 12-week PrOD. Clinical and laboratory data were analyzed between patients with and without on-treatment hepatic decompensation. RESULTS The sustained virologic response rate at 12 weeks after treatment was 97.3% in HCV subtype 1b patients with advanced fibrosis and cirrhosis. On-treatment hyperbilirubinemia (total bilirubin >2 mg/dL) occurred in 27 (14.3%) patients, and the incidence of the increase of total and direct form bilirubin was significantly different during treatment between patients with Child-Turcotte-Pugh score 5 and score 6. Five (18.5%) hyperbilirubinemia patients progressed to hepatic decompensation. Older age (adjusted OR: 1.2, 95% CI: 1.0-1.4) and albumin ≤3.6 g/dL (adjusted OR: 10.4, 95% CI: 1.3-81.2) may be two predictors for on-treatment hepatic decompensation by multivariate analysis. CONCLUSIONS PrOD is an effective direct-acting antiviral agent for antiviral therapy in HCV genotype 1b patients with advanced fibrosis and cirrhosis. Hyperbilirubinemia is possibly the early warning feature of on-treatment hepatic decompensation. This serious adverse event of on-treatment hepatic decompensation is not common. Older age and low baseline albumin level may be predictive factors.
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Affiliation(s)
- Yi-Chung Hsieh
- Division of Hepatology, Department of HepatoGastroenterology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Wen-Juei Jeng
- Division of Hepatology, Department of HepatoGastroenterology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Change-Gung University, Taoyuan, Taiwan
| | - Chien-Hao Huang
- Division of Hepatology, Department of HepatoGastroenterology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Wei Teng
- Division of Hepatology, Department of HepatoGastroenterology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Wei-Ting Chen
- Division of Hepatology, Department of HepatoGastroenterology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yi-Cheng Chen
- Division of Hepatology, Department of HepatoGastroenterology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Shi-Ming Lin
- Division of Hepatology, Department of HepatoGastroenterology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Change-Gung University, Taoyuan, Taiwan
| | - Dar-In Tai
- Division of Hepatology, Department of HepatoGastroenterology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Chun-Yen Lin
- Division of Hepatology, Department of HepatoGastroenterology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - I-Shyan Sheen
- Division of Hepatology, Department of HepatoGastroenterology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
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Cavender MA, White WB, Liu Y, Massaro JM, Bergenstal RM, Mehta CR, Zannad F, Heller S, Cushman WC, Cannon CP. Total cardiovascular events analysis of the EXAMINE trial in patients with type 2 diabetes and recent acute coronary syndrome. Clin Cardiol 2018; 41:1022-1027. [PMID: 29652078 DOI: 10.1002/clc.22960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 01/19/2023] Open
Abstract
Alogliptin, a dipeptidyl peptidase-4 inhibitor, is approved for the treatment of patients with type 2 diabetes (T2DM). EXAMINE was a randomized controlled clinical trial designed to demonstrate the cardiovascular (CV) safety of alogliptin. In the trial, 5380 patients with established T2DM who had a recent acute coronary syndrome event (between 15 and 90 days) were randomized to treatment with either alogliptin or placebo. To better understand and describe the CV safety of alogliptin, we analyzed data from the EXAMINE trial to determine whether treatment with alogliptin affected recurrent and total CV events. Poisson regression analysis compared the total number of occurrences of CV death, MI, stroke, unstable angina, and coronary revascularization between all patients randomized to alogliptin vs placebo groups. Patients with recurrent CV events were older and more likely to have renal disease and history of heart failure. There were 1100 first CV events and an additional 666 recurrent events over a median of 18 months of follow-up. There were no significant differences with regard to total number of events in patients treated with alogliptin (n = 873) or placebo (n = 893; P = 0.52). Furthermore, there were no differences in the types of events seen in patients treated with alogliptin or placebo. Alogliptin did not increase the risk of either first or recurrent CV events when compared with placebo in patients with T2DM and recent acute coronary syndrome. These data support the CV safety of alogliptin in patients who are at increased risk of future CV events.
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Affiliation(s)
- Matthew A Cavender
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
- Baim Institute for Clinical Research, Boston, Massachusetts
| | - William B White
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Yuyin Liu
- Baim Institute for Clinical Research, Boston, Massachusetts
| | - Joseph M Massaro
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | | | - Cyrus R Mehta
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Faiez Zannad
- Department of Medicine, INSERM 1143, Université de Lorraine, Nancy, France
| | - Simon Heller
- Department of Medicine, University of Sheffield and Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - William C Cushman
- Department of Medicine, Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, Tennessee
| | - Christopher P Cannon
- Baim Institute for Clinical Research, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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20
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Kubota A, Nakatani E, Tsukahara K, Hasegawa Y, Takemura H, Terada T, Taguchi T, Nagahara K, Nakatani H, Yoshino K, Higaki Y, Iwae S, Beppu T, Hanamure Y, Tomita K, Kohno N, Kawabata K, Teramukai S, Fujii M. Adjuvant chemotherapy with S-1 after curative chemoradiotherapy in patients with locoregionally advanced squamous cell carcinoma of the head and neck: Reanalysis of the ACTS-HNC study. PLoS One 2018; 13:e0198391. [PMID: 29883463 PMCID: PMC5993254 DOI: 10.1371/journal.pone.0198391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/20/2018] [Indexed: 11/18/2022] Open
Abstract
Background Chemoradiotherapy (CRT) has improved organ preservation or overall survival (OS) of locoregionally advanced head and neck squamous cell cancer (LAHNSCC), but in clinical trials of conventional CRT, increasing CRT intensity has not been shown to improve OS. In the Adjuvant ChemoTherapy with S-1 after curative treatment in patients with Head and Neck Cancer (ACTS-HNC) phase III study, OS of curative locoregional treatments improved more with adjuvant chemotherapy with S-1 (tegafur gimeracil oteracil potassium) than with tegafur/uracil (UFT). ACTS HNC study showed the significant efficacy of S-1 after curative radiotherapy in sub-analysis. We explored the efficacy of S-1 after curative CRT in a subset of patients from the ACTS-HNC study. Methods Patients with stage III, IVA, or IVB LAHNSCC were enrolled in this study to evaluate the efficacy of S-1 compared with UFT as adjuvant chemotherapy after curative CRT in the ACTS-HNC study. Patients received S-1 at 80–120 mg/day in two divided doses for 2 weeks, followed by a 1-week rest, or UFT 300 or 400 mg/day in two or three divided doses daily, for 1 year. The endpoints were OS, disease-free survival, locoregional relapse-free survival, distant metastasis-free survival (DMFS), and post-locoregional relapse survival. Results One hundred eighty patients (S-1, n = 87; UFT, n = 93) were included in this study. Clinical characteristics of the S-1 and UFT arms were similar. S-1 after CRT significantly improved OS (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.22–0.93) and DMFS (HR, 0.50; 95% CI, 0.26–0.97) compared with UFT. Conclusion As adjuvant chemotherapy, S-1 demonstrated better efficacy for OS and DMFS than UFT in patients with LAHNSCC after curative CRT and may be considered a treatment option following curative CRT. For this study was not preplanned in the ACTS-HNC study, the results is hypothesis generating but not definitive.
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Affiliation(s)
- Akira Kubota
- Department Head and Neck Surgery, Kanagawa Cancer Center, Yokohama, Japan
- * E-mail:
| | - Eiji Nakatani
- Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - Kiyoaki Tsukahara
- Department of Otolaryngology, Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hideki Takemura
- Department of Otolaryngology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Tomonori Terada
- Department of Otolaryngology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takahide Taguchi
- Department of Otorhinolaryngology, and Head and Neck Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kunihiko Nagahara
- Department of Head and Neck Surgery, Kusatsu General Hospital, Kusatsu, Japan
| | - Hiroaki Nakatani
- Division of Head and Neck Surgery, Tochigi Cancer Center, Utsunomiya, Japan
| | - Kunitoshi Yoshino
- Department of Otolaryngology, Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Yuichiro Higaki
- Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Shigemichi Iwae
- Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Takeshi Beppu
- Department of Head and Neck Surgery, Saitama Cancer Center, Saitama, Japan
| | - Yutaka Hanamure
- Department of Otolaryngology, Kagoshima City Hospital, Kagoshima, Japan
| | - Kichinobu Tomita
- Department of Otolaryngology, Akasaka Surgery Clinic, Fukuoka, Japan
| | - Naoyuki Kohno
- Department of Otolaryngology, Head and Neck Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Kazuyoshi Kawabata
- Division of Head and Neck Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Masato Fujii
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
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21
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Arakawa S, Horiguchi A, Tomishige H, Kawabe N, Nagata H, Ishihara S, Ito M, Asano Y, Ito R, Isetani M, Shimizu K, Kamio K, Kawai T, Yasuoka H, Imaeda Y. [Safety and Efficacy of TAS-102 with Bevacizumab for the Treatment of Unresectable Metastatic Colorectal Cancer - A Case Report]. Gan To Kagaku Ryoho 2018; 45:649-651. [PMID: 29650823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Chemotherapywith TAS-102 with bevacizumab(Bmab)is a new treatment for metastatic colorectal cancer. A 67-year-old male patient with synchronous multiple liver metastases was treated with TAS-102 with Bmab as a fifth-line chemotherapy. It was demonstrated that liver metastases decreased in size by1 3%bycomputed tomography(CT)after 3 months of TAS-102 with Bmab therapy. The Grade 3 or worst adverse event that was experienced was neutropenia. The patient was able to continue treatment with TAS-102 with Bmab for 6 months. TAS-102 with Bmab treatment was safetyand efficacious as a late-line chemotherapytreatment for metastatic colorectal cancer.
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Affiliation(s)
- Satoshi Arakawa
- Dept. of Gastroenterological Surgery, School of Medicine, Fujita Health University Banbuntane Hotokukai Hospital
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22
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Oita M, Miyoshi H, Ono K, Nakamura A, Cho KY, Nomoto H, Yamamoto K, Omori K, Manda N, Kurihara Y, Aoki S, Atsumi T. Satisfaction and efficacy of switching from daily dipeptidyl peptidase-4 inhibitors to weekly trelagliptin in patients with type 2 diabetes-Randomized controlled study. Endocr J 2018; 65:141-150. [PMID: 29093280 DOI: 10.1507/endocrj.ej17-0303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We compared treatment satisfaction between daily dipeptidyl peptidase-4 (DPP-4) inhibitors and a weekly DPP-4 inhibitor in patients with type 2 diabetes. The study was a 12-week, open-label, randomized, multicenter, controlled trial. Participants were Japanese patients with type 2 diabetes who had received daily DPP-4 inhibitors for more than 3 months. Patients were randomly assigned to a treatment cohort: (1) a group that continued taking daily DPP-4 inhibitors (daily group); or (2) a group that switched from daily DPP-4 inhibitors to a weekly DPP-4 inhibitor, trelagliptin (weekly group). The primary outcome was the change in treatment satisfaction levels from baseline to 12 weeks between the two groups, according to Diabetes Treatment Satisfaction Questionnaire (DTSQ) and Diabetes Therapy-Related Quality of Life (DTR-QOL) questionnaire scores. The changes in glycemic control and body weight were also assessed. Of 49 patients initially enrolled in the study, 47 completed the study. The change in DTSQ scores in the weekly group was not significantly different from that in the daily group. However, the improvements in total score and subscale domains 1 and 2 in the DTR-QOL analysis, which relate to burden on social/daily activities and anxiety/dissatisfaction with treatment, were significantly greater in the weekly group than the daily group (p = 0.048, 0.013 and 0.045, respectively). Mean changes in glycated hemoglobin levels and body weight were comparable between the groups. Switching from daily DPP-4 inhibitors to a weekly DPP-4 inhibitor, trelagliptin, could partially improve treatment satisfaction levels in patients with type 2 diabetes without affecting glycemic control.
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Affiliation(s)
- Mayuko Oita
- Division of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan
| | - Hideaki Miyoshi
- Division of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan
| | - Kota Ono
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan
| | - Akinobu Nakamura
- Division of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan
| | - Kyu Yong Cho
- Division of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan
| | - Hiroshi Nomoto
- Division of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan
| | - Kohei Yamamoto
- Division of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan
| | - Kazuno Omori
- Division of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan
| | - Naoki Manda
- Manda Memorial Hospital, South 2, West 1, Chuo-ku, Sapporo 060-0062, Japan
| | - Yoshio Kurihara
- Kurihara Clinic, Athubethuchuo 3-5, Atsubetsu-ku, Sapporo 004-0053, Japan
| | - Shin Aoki
- Aoki Clinic, Nango dori 1, North 1-1, Shiroishi-ku, Sapporo 003-0023, Japan
| | - Tatsuya Atsumi
- Division of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan
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23
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Taramasso L, Di Biagio A, Bovis F, Nicolini LA, Antinori A, Milazzo L, Sollima S, Gubertini G, Niero F, Saracino A, Bruno R, Borghi V, Montagnani F, Cattelan A, Hasson H, Taliani G, D’Arminio Monforte A, Mastroianni C, Di Perri G, Bigoni S, Puoti M, Spinetti A, Gori A, Boffa N, Cacopardo B, Giacometti A, Parruti G, Vullo V, Chirianni A, Teti E, Pasquazzi C, Segala D, Andreoni M. Trend of estimated glomerular filtration rate during ombistasvir/paritaprevir/ritonavir plus dasabuvir ± ribavirin in HIV/HCV co-infected patients. PLoS One 2018; 13:e0192627. [PMID: 29462201 PMCID: PMC5819795 DOI: 10.1371/journal.pone.0192627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/26/2018] [Indexed: 12/13/2022] Open
Abstract
The renal function is a key-issue in HIV/HCV co-infected patients, nevertheless, it has not established so far whether HCV treatment with new direct acting agents could impact on estimated glomerular filtration rate (eGFR) variations. In the present work, we examined the real-life data on renal function that have been prospectively collected in the SIMIT compassionate-use program of ombitasvir/paritaprevir/ritonavir plus dasabuvir (OBV/PTV/r + DSV) in 144 HIV/HCV genotype 1 co-infected patients. The population was 74% male, 30.5% in CDC stage C, with median age of 52 years (48.0-56.5) and median liver stiffness of 7.8 kPa (6.7-9.2). Median baseline eGFR was 102.0 (90.8-108.1), changing to 99.8 (83.5-104.8) at the end of treatment (EoT), and 100.0 (87.3-105.6) 12 weeks after the EoT (FU12), p<0.0001. No patient had grade 3-4 increase of creatinine. At EoT 60/144 (41.7%) patients had ≥ 5% reduction in their eGFR, confirmed at FU12 in 39/60 (65.0%) cases. Longer duration of HCV infection (cut-off 12.9 years), lower HCV-RNA viral load (cut-off 1,970,160 IU/ml) and lower platelet count (cut-off 167,000 x106/L) were significantly associated with eGFR decline at logistic analysis (adjOR 2.9, 95%CI 1.0-8.8, p = 0.05; adjOR 3.5, 95%CI 1.2-10.4, p = 0.02; adjOR 2.8, 95%CI 1.1-6.8, p = 0.03, respectively). After repeating the analysis throughout a mixed model, a higher eGFR decline was highlighted in patients concomitantly treated with tenofovir (p = 0.0001), ribavirin (p = 0.0001), or integrase inhibitors (p <0.0001), with longer duration of HIV (p = 0.0002) and HCV infection (p = 0.035), lower baseline HCV RNA (p <0.0001), previous HCV treatment (p<0.0001), and older age (p<0.0001). In conclusion, our study confirms a good renal safety profile of OBV/PTV/r + DSV treatment in HIV/HCV patients, and the median decline of 2 ml/min in eGFR, albeit statistically significant, is of doubtful clinical significance. The role of aging, concomitant therapies and duration of HIV/HCV infection needs to be further investigated.
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Affiliation(s)
- Lucia Taramasso
- University of Genova (DISSAL), Infectious Diseases Clinic, Policlinico Hospital San Martino, Genova, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Policlinico Hospital San Martino, Genova, Italy
- * E-mail:
| | - Francesca Bovis
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Laura Ambra Nicolini
- University of Genova (DISSAL), Infectious Diseases Clinic, Policlinico Hospital San Martino, Genova, Italy
| | - Andrea Antinori
- Clinical Department, National Institute for Infectious Diseases, INMI L. Spallanzani, Rome, Italy
| | - Laura Milazzo
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Salvatore Sollima
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Guido Gubertini
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Fosca Niero
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Raffaele Bruno
- Division of Infectious and Tropical Diseases, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vanni Borghi
- Infectious Diseases Clinic, University Hospital, Modena, Italy
| | - Francesca Montagnani
- Department of Internal and Specialty Medicine University Infectious Diseases Unit, AOU Senese, Siena, Italy
| | - Annamaria Cattelan
- Department of Infectious and Tropical Diseases, University Hospital, Padova, Italy
| | - Hamid Hasson
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Gloria Taliani
- Department of Clinical Medicine, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Claudio Mastroianni
- Infectious Diseases Unit, Sapienza University of Rome, Latina, Italy, and Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Sara Bigoni
- Division of Infectious Diseases, AO Papa Giovanni XXIII, Bergamo, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, AO Niguarda Ca' Granda Hospital, Milan, Italy
| | - Angiola Spinetti
- Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | - Andrea Gori
- Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital, University of Milan-Bicocca, Milan, Italy
| | - Nicola Boffa
- First Division of Infectious Diseases, S. Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno, Italy
| | - Bruno Cacopardo
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Andrea Giacometti
- Infectious Diseases Unit, Department of Biomedical Sciences and Public Health, Marche Polytechnic University c/o Ospedali Riuniti, Ancona, Italy
| | - Giustino Parruti
- Infectious Disease Unit, Pescara General Hospital, Pescara, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Elisabetta Teti
- Clinical Infectious Diseases, Department. of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Caterina Pasquazzi
- Clinical Infectious Diseases, Sant'Andrea Hospital—Sapienza University of Rome, Rome, Italy
| | - Daniela Segala
- Unit of Infectious Diseases, University Hospital of Ferrara, Ferrara, Italy
| | - Massimo Andreoni
- Clinical Infectious Diseases, Department. of Systems Medicine, Tor Vergata University, Rome, Italy
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Okuno K, Aoyama T, Oba K, Yokoyama N, Matsuhashi N, Kunieda K, Nishimura Y, Akamatsu H, Kobatake T, Morita S, Yoshikawa T, Sakamoto J, Saji S. Randomized phase III trial comparing surgery alone to UFT + PSK for stage II rectal cancer (JFMC38 trial). Cancer Chemother Pharmacol 2017; 81:65-71. [PMID: 29094178 PMCID: PMC5754396 DOI: 10.1007/s00280-017-3466-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 10/16/2017] [Indexed: 11/26/2022]
Abstract
Background We conducted a randomized phase III trial comparing tegafur/uracil (UFT) and Polysaccharide-K (PSK) to surgery alone in curatively resected stage II rectal cancer patients. Methods Patients were randomly assigned to receive either UFT and PSK or surgery alone in a 1:1 ratio with a minimization method to balance the treatment allocation. The primary end point of this study was the disease-free survival (DFS). The secondary end point was the overall survival (OS). Results From October 2011 to February 2013, 111 patients were registered from 62 institutions. The study was prematurely closed due to poor accrual after reaching 20% of its goal. The patients’ characteristics were similar between the UFT and PSK group and the surgery-alone group. The DFS rate was 76.0% at 3 years and 65.1% at 5 years in the UFT and PSK arm and 84.0% at 3 years and 77.2% at 5 years in the surgery-alone arm. The DFS was slightly worse in the UFT + PSK arm than in the surgery-alone arm, but the difference did not reach statistical significance (log rank p = 0.102). The OS rate was 100% at 3 years and 97.9% at 5 years in the UFT + PSK arm, while that was 100% at 3 years and 93.4% at 5 years in the surgery-alone arm. The OS was similar in the UFT + PSK arm and surgery-alone arm (p = 0.533). Conclusion The present study suggests that UFT and PSK are not attractive candidates to advance to the next phase III study because the DFS was slightly worse in the UFT and PSK arm than in the surgery-alone arm.
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Affiliation(s)
- Kiyotaka Okuno
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Toru Aoyama
- Department of Surgery, Yokohama City University Yokoham, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Koji Oba
- Department of Biostatistics, The University of Tokyo, Tokyo, Japan
| | - Noboru Yokoyama
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | | | - Katsuyuki Kunieda
- Department of Surgery, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Yoji Nishimura
- Department of Gastroenterological Surgery, Saitama Cancer Cancer, Saitama, Japan
| | | | - Takaya Kobatake
- Department of Surgery, Shikoku Cancer Center Hospital, Matsuyama, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Junichi Sakamoto
- Japanese Foundation for Multidisciplinary Treatment of Cancer, Tokyo, Japan
- Tokai Central Hospital, Kakamigahara, Japan
| | - Shigetoyo Saji
- Japanese Foundation for Multidisciplinary Treatment of Cancer, Tokyo, Japan
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25
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Silva RC, Liebel S, de Oliveira HHP, Ramsdorf WA, Garcia JRE, Azevedo SMFO, Magalhães VF, Oliveira Ribeiro CA, Filipak Neto F. Cylindrospermopsin effects on cell viability and redox milieu of Neotropical fish Hoplias malabaricus hepatocytes. Fish Physiol Biochem 2017; 43:1237-1244. [PMID: 28389904 DOI: 10.1007/s10695-017-0367-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 03/17/2017] [Indexed: 06/07/2023]
Abstract
Cylindrospermopsin (CYN) is a cyanotoxin that is cytotoxic to a wide variety of cells, particularly to the hepatocytes. In this study, the toxic effects of purified CYN were investigated in primary cultured hepatocytes of Neotropical fish Hoplias malabaricus. After isolation, attachment, and recovery for 72 h, the cells were exposed for 72 h to 0, 0.1, 1.0, 10, and 100 μg l-1 of CYN. Then, cell viability and a set of oxidative stress biomarker responses were determined. Catalase, superoxide dismutase, glucose-6-phosphate dehydrogenase, and glutathione S-transferase activities were not affected by exposure to CYN. Concentration-dependent decrease of glutathione reductase activity occurred for most CYN-exposed groups, whereas non-protein thiol content increased only for the highest CYN concentration. Lipid peroxidation, protein carbonylation, and DNA damage levels were not altered, but reactive oxygen species levels increased in the cells exposed to the highest concentration of CYN. Cell viability decreased in all the groups exposed to CYN. Thus, CYN may cause a slight change in redox balance, but it is not the main cause of cell death in H. malabaricus hepatocytes.
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Affiliation(s)
- R C Silva
- Instituto de Biofísica Carlos Chagas Filho, Centro de Ciências da Saúde, Bloco G, Ilha do Fundão, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21949-900, Brazil
- Departamento de Biologia Estrutural, Molecular e Genética. Bloco M. Setor de Ciências Biológicas e da Saúde, Universidade Estadual de Ponta Grossa, Ponta Grossa, PR, Brazil, CEP 84030-900
| | - S Liebel
- Departamento de Biologia Celular, Universidade Federal do Paraná, Cx. Postal 19031, Curitiba, PR, 81531-990, Brazil
| | - H H P de Oliveira
- Departamento de Biologia Celular, Universidade Federal do Paraná, Cx. Postal 19031, Curitiba, PR, 81531-990, Brazil
| | - W A Ramsdorf
- Departamento de Genética, Universidade Federal do Paraná, Caixa Postal 19031, Curitiba, PR, 81531-990, Brazil
| | - J R E Garcia
- Campus Laranjeiras do Sul, Universidade Federal da Fronteira Sul, Laranjeiras do Sul, PR, 85303-775, Brazil
| | - S M F O Azevedo
- Instituto de Biofísica Carlos Chagas Filho, Centro de Ciências da Saúde, Bloco G, Ilha do Fundão, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21949-900, Brazil
| | - V F Magalhães
- Instituto de Biofísica Carlos Chagas Filho, Centro de Ciências da Saúde, Bloco G, Ilha do Fundão, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21949-900, Brazil.
| | - C A Oliveira Ribeiro
- Departamento de Biologia Celular, Universidade Federal do Paraná, Cx. Postal 19031, Curitiba, PR, 81531-990, Brazil.
| | - F Filipak Neto
- Departamento de Biologia Celular, Universidade Federal do Paraná, Cx. Postal 19031, Curitiba, PR, 81531-990, Brazil
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Abstract
BACKGROUND Patients prefer oral to intravenous (IV) palliative chemotherapy, provided that oral therapy is not less effective. We compared the efficacy and safety of oral and IV fluoropyrimidines for treatment of colorectal cancer (CRC). OBJECTIVES To compare the effects of oral and IV fluoropyrimidine chemotherapy in patients treated with curative or palliative intent for CRC. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 5), along with OVID MEDLINE, OVID Embase, and Web of Science databases, in June 2016. We also searched five clinical trials registers, several conference proceedings, and reference lists from study reports and systematic reviews. We contacted pharmaceutical companies to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing oral and IV fluoropyrimidine chemotherapy in patients treated with curative or palliative intent for CRC. DATA COLLECTION AND ANALYSIS Three review authors extracted data and assessed risk of bias independently. We assessed the seven domains in the Cochrane 'Risk of bias' tool and three additional domains: schedules of outcome assessment and/or follow-up; use of intention-to-treat analysis; and baseline comparability of treatment arms. MAIN RESULTS We included nine RCTs (total of 10,918 participants) that examined treatment with curative intent for CRC with neoadjuvant and/or adjuvant chemotherapy. We included 35 RCTs (total of 12,592 participants) that examined treatment with palliative intent for inoperable advanced or metastatic CRC with chemotherapy (31 first-line studies, two second-line studies, and two studies of first- or second-line chemotherapy). All studies included male and female participants, and no studies included participants younger than 18 years of age. Patients treated with curative intent for CRC with neoadjuvant and/or adjuvant chemotherapy • Disease-free survival (DFS): DFS did not differ between participants treated with oral versus IV fluoropyrimidines (hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.87 to 1.00; seven studies, 8903 participants; moderate-quality evidence).• Overall survival (OS): OS did not differ between participants treated with oral versus IV fluoropyrimidines (HR 0.92, 95% CI 0.84 to 1.00; seven studies, 8902 participants analysed; high-quality evidence).• Grade ≥ 3 adverse events (AEs): Participants treated with oral fluoropyrimidines experienced less grade ≥ 3 neutropenia/granulocytopenia (odds ratio (OR) 0.14, 95% CI 0.11 to 0.16; seven studies, 8087 participants; moderate-quality evidence), stomatitis (OR 0.21, 95% CI 0.14 to 0.30; five studies, 4212 participants; low-quality evidence), and any grade ≥ 3 AEs (OR 0.82, 95% CI 0.74 to 0.90; five studies, 7741 participants; low-quality evidence). There was more grade ≥ 3 hand foot syndrome (OR 4.59, 95% CI 2.97 to 7.10; five studies, 5731 participants; low-quality evidence) in patients treated with oral fluoropyrimidines. There were no differences between participants treated with oral versus IV fluoropyrimidines in occurrence of grade ≥ 3 diarrhoea (OR 1.12, 95% CI 0.99 to 1.25; nine studies, 9551 participants; very low-quality evidence), febrile neutropenia (OR 0.59, 95% CI 0.18 to 1.90; four studies, 2925 participants; low-quality evidence), vomiting (OR 1.05, 95% CI 0.83 to 1.34; eight studies, 9385 participants; low-quality evidence), nausea (OR 1.21, 95% CI 0.97 to 1.51; seven studies, 9233 participants; low-quality evidence), mucositis (OR 0.64, 95% CI 0.25 to 1.62; four studies, 2233 participants; very low-quality evidence), and hyperbilirubinaemia (OR 1.67, 95% CI 0.52 to 5.38; three studies, 2757 participants; very low-quality evidence). Patients treated with palliative intent for inoperable advanced or metastatic CRC with chemotherapy • Progression-free survival (PFS): Overall, PFS was inferior in participants treated with oral versus IV fluoropyrimidines (HR 1.06, 95% CI 1.02 to 1.11; 23 studies, 9927 participants; moderate-quality evidence). Whilst PFS was worse in participants treated with oral compared with IV fluoropyrimidines when UFT/Ftorafur or eniluracil with oral 5-fluorouracil (5-FU) was used, PFS did not differ between individuals treated with oral versus IV fluoropyrimidines when capecitabine, doxifluridine, or S-1 was used.• OS: Overall, OS did not differ between participants treated with oral versus IV fluoropyrimidines (HR 1.02, 95% CI 0.99 to 1.05; 29 studies, 12,079 participants; high-quality evidence). OS was inferior in participants treated with oral versus IV fluoropyrimidines when eniluracil with oral 5-fluorouracil (5-FU) was used.• Time to progression (TTP): TTP was inferior in participants treated with oral versus IV fluoropyrimidines (HR 1.07, 95% CI 1.01 to 1.14; six studies, 1970 participants; moderate-quality evidence).• Objective response rate (ORR): ORR did not differ between participants treated with oral versus IV fluoropyrimidines (OR 0.98, 95% CI 0.90 to 1.06; 32 studies, 11,115 participants; moderate-quality evidence).• Grade ≥ 3 AEs: Participants treated with oral fluoropyrimidines experienced less grade ≥ 3 neutropenia/granulocytopenia (OR 0.17, 95% CI 0.15 to 0.18; 29 studies, 11,794 participants; low-quality evidence), febrile neutropenia (OR 0.27, 95% CI 0.21 to 0.36; 19 studies, 9407 participants; moderate-quality evidence), stomatitis (OR 0.26, 95% CI 0.20 to 0.33; 21 studies, 8718 participants; low-quality evidence), mucositis (OR 0.17, 95% CI 0.12 to 0.24; 12 studies, 4962 participants; low-quality evidence), and any grade ≥ 3 AEs (OR 0.83, 95% CI 0.74 to 0.94; 14 studies, 5436 participants; low-quality evidence). There was more grade ≥ 3 diarrhoea (OR 1.66, 95% CI 1.50 to 1.84; 30 studies, 11,997 participants; low-quality evidence) and hand foot syndrome (OR 3.92, 95% CI 2.84 to 5.43; 18 studies, 6481 participants; moderate-quality evidence) in the oral fluoropyrimidine arm. There were no differences between oral and IV fluoropyrimidine arms in terms of grade ≥ 3 vomiting (OR 1.18, 95% CI 1.00 to 1.40; 23 studies, 9528 participants; low-quality evidence), nausea (OR 1.16, 95% CI 0.99 to 1.36; 25 studies, 9796 participants; low-quality evidence), and hyperbilirubinaemia (OR 1.62, 95% CI 0.99 to 2.64; nine studies, 2699 participants; low-quality evidence). AUTHORS' CONCLUSIONS Results of this review should provide confidence that treatment for CRC with most of the oral fluoropyrimidines commonly used in current clinical practice is similarly efficacious to treatment with IV fluoropyrimidines. Treatment with eniluracil with oral 5-FU was associated with inferior PFS and OS among participants treated with palliative intent for CRC, and eniluracil is no longer being developed. Oral and IV fluoropyrimidines have different patterns of side effects; future research may focus on determining the basis for these differences.
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Affiliation(s)
- Fiona Chionh
- Olivia Newton‐John Cancer Wellness & Research Centre, Austin HospitalOlivia Newton‐John Cancer Research Institute, Level 5145‐163 Studley RdHeidelbergVictoriaAustralia3084
| | - David Lau
- Olivia Newton‐John Cancer Wellness & Research Centre, Austin HospitalOlivia Newton‐John Cancer Research Institute, Level 5145‐163 Studley RdHeidelbergVictoriaAustralia3084
- La Trobe UniversitySchool of Cancer MedicineMelbourneVictoriaAustralia3086
| | - Yvonne Yeung
- Olivia Newton‐John Cancer Wellness & Research Centre, Austin HospitalOlivia Newton‐John Cancer Research Institute, Level 5145‐163 Studley RdHeidelbergVictoriaAustralia3084
| | - Timothy Price
- The Queen Elizabeth Hospital and University of AdelaideMedical OncologyWoodville, AdelaideSouth AustraliaAustralia
| | - Niall Tebbutt
- Olivia Newton‐John Cancer Wellness & Research Centre, Austin HospitalOlivia Newton‐John Cancer Research Institute, Level 5145‐163 Studley RdHeidelbergVictoriaAustralia3084
- La Trobe UniversitySchool of Cancer MedicineMelbourneVictoriaAustralia3086
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Leventer-Roberts M, Hammerman A, Brufman I, Hoshen M, Braun M, Ashur Y, Lieberman N, Balicer R. Effectiveness of dasabuvir/ombitasvir/paritaprevir/ritonavir for hepatitis C virus in clinical practice: A population-based observational study. PLoS One 2017; 12:e0176858. [PMID: 28686590 PMCID: PMC5501432 DOI: 10.1371/journal.pone.0176858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/18/2017] [Indexed: 12/22/2022] Open
Abstract
Background Direct acting antivirals for hepatitis C virus have shown dramatic results in clinical trials. However, their effectiveness has yet to be demonstrated within observational cohorts which lack exclusion criteria found in randomized control trials. Aim To determine the effectiveness of dasabuvir/ombitasvir/paritaprevir/ritonavir in achieving sustained virological response. Methods Retrospective observational cohort study of all Clalit Health Services members with hepatitis C virus genotype 1 who were dispensed dasabuvir/ombitasvir/paritaprevir/ritonavir from January 1, 2015 to-November 31, 2015. Results There were 564 participants during the study period. The average age was 61.9 years, 52.0% were male, and 61.5% were born Eastern/Central Europe or Central Asia. The prevalence of diabetes was 31.7% and 70.3% were overweight/obese. Cirrhosis was present in 41.0% of participants, of whom 52.8% had stage 4 fibrosis. Of the cohort, 416 (74.8%) had follow-up viral load testing at 10 or more weeks after the end of treatment. We report a sustained virological response of 98.8% among those tested. Conclusions Treatment with dasabuvir/ombitasvir/paritaprevir/ritonavir demonstrated a near universal effectiveness in achieving a sustained virological response among HCV patients in a large cohort.
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Affiliation(s)
- Maya Leventer-Roberts
- Clalit Research Institute, Tel Aviv, Israel
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
| | - Ariel Hammerman
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | | | | | - Marius Braun
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
- Liver Unit, Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaffa Ashur
- Hepatology, Clalit Health Services, Tel Aviv, Israel
| | - Nicky Lieberman
- Community Medicine Division, Clalit Health Services, Tel Aviv, Israel
| | - Ran Balicer
- Clalit Research Institute, Tel Aviv, Israel
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
- Department of Epidemiology, Faculty of Health Sciences, Ben Gurion University, Be'er Sheva, Israel
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Li W, Zhao X, Wang H, Liu X, Zhao X, Huang M, Qiu L, Zhang W, Chen Z, Guo W, Li J, Zhu X. Maintenance treatment of Uracil and Tegafur (UFT) in responders following first-line fluorouracil-based chemotherapy in metastatic gastric cancer: a randomized phase II study. Oncotarget 2017; 8:37826-37834. [PMID: 27980221 PMCID: PMC5514953 DOI: 10.18632/oncotarget.13922] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/01/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Maintenance therapy proves to be effective in advanced lung and breast cancer after initial chemotherapy. The purpose of this phase II study was to evaluate the efficacy and safety of Uracil and Tegafur (UFT) maintenance in metastatic gastric cancer patients following the first-line fluorouracil-based chemotherapy. METHODS Metastatic gastric cancer patients with stable disease or a better response after the completion of first-line chemotherapy were randomized to oral UFT (360mg/m2 × 2 weeks) every 3 weeks until disease progression/intolerable toxicity or to observation (OBS). The primary endpoint was progression-free survival (PFS); the secondary endpoints were overall survival (OS) and safety. RESULTS The trial was closed after the interim analysis of the 58 enrolled (120 planned) patients. Median PFS was not improved in the UFT group compared with the OBS group (3.2 months versus 3.6 months, P = 0.752), as well as the median OS (14.2 months for both, P = 0.983). However, subgroup analysis showed that low baseline hemoglobin (< 120 g/L) was associated with poorer PFS with maintenance therapy (P = 0.032), while the normal hemoglobin patients benefit from the UFT treatment (P = 0.008). Grade 3 to 4 toxicities in the UFT group were anemia (3.4%), thrombocytopenia (3.4%) and diarrhea (6.9%). CONCLUSIONS This trial did not show superiority of UFT maintenance in non-selected patients responding to fluorouracil-based first-line chemotherapy. The normal hemoglobin level at baseline is a predictive biomarker for favorable patient subsets from the maintenance treatment.
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Affiliation(s)
- Wenhua Li
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoying Zhao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huijie Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin Liu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinmin Zhao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Mingzhu Huang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lixin Qiu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wen Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhiyu Chen
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weijian Guo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin Li
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaodong Zhu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Lee JJ, Chu E. Adherence, Dosing, and Managing Toxicities With Trifluridine/Tipiracil (TAS-102). Clin Colorectal Cancer 2017; 16:85-92. [PMID: 28242161 PMCID: PMC5743195 DOI: 10.1016/j.clcc.2017.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/02/2017] [Accepted: 01/13/2017] [Indexed: 12/13/2022]
Abstract
Trifluridine/tipiracil (TAS-102) is a new oral combination therapy approved by the US Food and Drug Administration for the treatment of patients with metastatic colorectal cancer who are refractory to or intolerant of standard chemotherapy. This agent consists of a thymidine-based nucleoside analogue (trifluridine) and a thymidine phosphorylase inhibitor (tipiracil), which is included to reduce the degradative breakdown of trifluridine. In the phase III Randomized, double-blind, phase III Study of TAS-102 plus best supportive care [BSC] versus placebo plus BSC in patients with metastatic colorectal cancer [CRC] refractory to standard chemotherapies (RECOURSE) trial, trifluridine/tipiracil showed significant improvement in overall survival compared with placebo. Trifluridine/tipiracil is administered at a 35 mg/m2 dose orally twice daily in a 28-day cycle consisting of 5 treatment days/2 rest days for 2 weeks followed by a rest period of 2 weeks. Because trifluridine/tipiracil is a completely oral chemotherapy regimen, patient adherence to treatment is an important consideration. It is also critical to have strategies in place for managing toxicities, because side effects might have a negative effect on patient adherence. The most frequent adverse events reported in patients with metastatic colorectal cancer receiving trifluridine/tipiracil in the phase III RECOURSE trial were myelosuppression, nausea/vomiting, diarrhea, decreased appetite, and fatigue. In this review we aim to provide clinicians with practical recommendations for facilitating patient adherence to oral chemotherapy, managing trifluridine/tipiracil dosing, and address the most common adverse events in patients who receive trifluridine/tipiracil therapy.
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Affiliation(s)
- James J Lee
- Division of Hematology-Oncology, Department of Medicine, Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Edward Chu
- Division of Hematology-Oncology, Department of Medicine, Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Heller SR, Bergenstal RM, White WB, Kupfer S, Bakris GL, Cushman WC, Mehta CR, Nissen SE, Wilson CA, Zannad F, Liu Y, Gourlie NM, Cannon CP. Relationship of glycated haemoglobin and reported hypoglycaemia to cardiovascular outcomes in patients with type 2 diabetes and recent acute coronary syndrome events: The EXAMINE trial. Diabetes Obes Metab 2017; 19:664-671. [PMID: 28058763 PMCID: PMC5836868 DOI: 10.1111/dom.12871] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/22/2016] [Accepted: 01/03/2017] [Indexed: 12/22/2022]
Abstract
AIMS To investigate relationships between glycated haemoglobin (HbA1c) and reported hypoglycaemia and risk of major adverse cardiovascular events (MACE). METHODS The EXAMINE trial randomized 5380 patients with type 2 diabetes (T2DM) and a recent acute coronary syndrome (ACS) event, in 49 countries, to double-blind treatment with alogliptin or placebo in addition to standard of care. We used Cox proportional hazards models to analyse relationships among MACE, HbA1c levels and hypoglycaemic events. RESULTS Patients randomized to alogliptin achieved lower HbA1c levels than the placebo group in all baseline HbA1c categories without differences in hypoglycaemia rates. No systematic change was found in MACE rates according to baseline HbA1c (Pinteraction = 0.971) or HbA1c category at 1 month. Patients in the combined treatment groups (n = 5380) who experienced serious hypoglycaemia (n = 34) had higher MACE rates than those who did not (35.3% vs 11.4%, adjusted hazard ratio [HR] 2.42, 95% confidence interval [CI] 1.27-4.60; P = .007), although the association was less strong when analysing only events after the hypoglycaemic event (adjusted HR 1.60, 95% CI 0.80, 3.20). CONCLUSIONS There were no relationships between baseline HbA1c levels or HbA1c levels after 1 month of treatment and the risk of MACE. Alogliptin improved glycaemic control without increasing hypoglycaemia. Reported events of hypoglycaemia and serious hypoglycaemia were associated with MACE. These data underscore the safety of alogliptin in improving glycaemic control in T2DM post-ACS. Further study of hypoglycaemia as an independent risk factor for MACE in patients with T2DM and coronary disease is needed.
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Affiliation(s)
| | | | - William B. White
- Calhoun Cardiology CenterUniversity of Connecticut School of MedicineFarmingtonConnecticut
| | - Stuart Kupfer
- Takeda Development Center Americas, IncDeerfieldIllinois
| | | | - William C. Cushman
- University of Tennessee College of Medicine, Memphis Veterans Affairs Medical CenterMemphisTennessee
| | | | | | | | | | - Yuyin Liu
- Harvard Clinical Research InstituteBostonMassachusetts
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Abad S, Vega A, Hernández E, Mérida E, de Sequera P, Albalate M, Macías N, Milla M, López-Gómez JM. Universal Sustained Viral Response to the Combination of Ombitasvir/Paritaprevir/Ritonavir and Dasabuvir with/without Ribavirin in Patients on Hemodialysis Infected with Hepatitis C Virus Genotypes 1 and 4. Am J Nephrol 2017; 45:267-272. [PMID: 28166520 DOI: 10.1159/000454819] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/12/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is highly prevalent among patients on hemodialysis (HD) and is associated with poor prognosis. Treatment with interferon and ribavirin is poorly tolerated, and few data are available on the impact of new direct-acting antivirals (DAAs). This study was intended to analyze the efficacy and safety of treatment with a combination of ombitasvir/paritaprevir/ritonavir and dasabuvir with/without ribavirin in HCV-infected patients on HD from 3 hospitals. METHODS This is a multicentric study. We analyze the clinical course of all patients on HD with HCV infection who had been treated with the combination of ombitasvir/paritaprevir/ritonavir and dasabuvir in 3 hospitals in Madrid, Spain. All patients under treatment had undergone Transient elastography (FibroScan®) and HCV RNA (PCR) and HCV genotype were determined simultaneously. RESULTS Thirty-five patients aged 53.3 ± 8.9 years (68.6% males) and with genotypes 1 and 4 were treated with the DAA regimen, and 17 were also given ribavirin. The most common etiology was glomerular disease. Sustained viral response was achieved in 100% of patients. Adverse effects were negligible, and no patient had to discontinue treatment. The most significant side effect was anemia, which led to a significant increase in the dose of erythropoiesis-stimulating agents. Anemia was more marked in patients receiving ribavirin. No patients required transfusions. CONCLUSION A combination of ombitasvir/paritaprevir/ritonavir and dasabuvir with/without ribavirin for the treatment of HCV in patients on HD is highly effective and causes minimal side effects. This regimen represents a major advance in disease management. A considerable improvement in prognosis seems likely.
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Affiliation(s)
- Soraya Abad
- Service of Nephrology, Hospital Universitario Gregorio Marañón, Madrid, Spain
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Shimoda M, Miyoshi-Takai M, Irie S, Tanabe A, Obata A, Okauchi S, Hirukawa H, Kimura T, Kohara K, Kamei S, Mune T, Kaku K, Kaneto H. Inadequate Triglyceride Management Worsens the Durability of Dipeptidyl Peptidase-4 Inhibitor in Subjects with Type 2 Diabetes Mellitus. J Diabetes Res 2017; 2017:5856475. [PMID: 28626771 PMCID: PMC5463141 DOI: 10.1155/2017/5856475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Dipeptidyl peptidase-4 (DPP-4) inhibitors are often used all over the world and exert various beneficial effects including glucose-lowering effect in many subjects with type 2 diabetes. It is poorly understood, however, which factors are closely related with the durability of glucose-lowering effect by DPP-4 inhibitor. In this study, we examined retrospectively which factors could mainly influence the durability of DPP-4 inhibitor. We enrolled 212 participants with type 2 diabetes to whom DPP-4 inhibitor was administered for over 1 year without an addition or increase of other hypoglycemic agents. Age and baseline HbA1c level were significantly higher in the effective group than those in the ineffective group. The effective group had a tendency of smaller amounts of weight change, average total cholesterol, and average triglyceride compared with the ineffective group. Multiple logistic regression analysis showed that average triglyceride and baseline HbA1c were independent predictors associated with the durability of DPP-4 inhibitor. Moreover, an average triglyceride level contributed to the durability of DPP-4 inhibitor in the obese group (BMI ≥ 25 kg/m2) but not in the nonobese group (BMI < 25 kg/m2). These results suggest the importance of strict triglyceride management to maintain the durability of glucose-lowering effect by DPP-4 inhibitor, especially in obese subjects with type 2 diabetes.
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Affiliation(s)
- Masashi Shimoda
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
- *Masashi Shimoda:
| | - Maiko Miyoshi-Takai
- Division of General Internal Medicine 1, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
| | - Shintaro Irie
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
| | - Akihito Tanabe
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
| | - Atsushi Obata
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
| | - Seizo Okauchi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
| | - Hidenori Hirukawa
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
| | - Tomohiko Kimura
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
| | - Kenji Kohara
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
| | - Shinji Kamei
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
| | - Tomoatsu Mune
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
| | - Kohei Kaku
- Division of General Internal Medicine 1, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
| | - Hideaki Kaneto
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
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Kawai H, Sugimoto R, Iga N, Ikeda H, Yoshida R, Waki N, Ishizaki M, Nishi H, Yamashita K. [A Case of Primary Acinic Cell Carcinoma(ACC)of the Breast]. Gan To Kagaku Ryoho 2016; 43:2019-2021. [PMID: 28133208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A49 -year-old woman presented with a 3.5 cm mass in her right breast. Mammography revealed a lobular mass with poorly defined margins and no microcalcification. Ultrasonography showed a hypoechoic mass with an irregular margin. The tumor was diagnosed as breast carcinoma using a core needle biopsy. The patient underwent a modified radical mastectomy with sentinel lymph node biopsy, and received adjuvant chemotherapy. The tumor consisted of 2 types of carcinoma. The center of the tumor was solid-tubular carcinoma, and the periphery was acinic cell carcinoma(ACC). Histopathologically, the neoplastic cells of the periphery were characterized by widespread acinic cell-like differentiation with a eosinophilic granular or clear cytoplasm, resembling acinic cells of the parotid gland(t3, f[+], ly0, v0, n0, stage II B). Immunohistochemically, the specimens tested positive for salivary gland amylase, and negative for collagen type IV , ER, PgR, and HER2. We administered UFT as adjuvant chemotherapy. Eight months after surgery, local recurrence was observed. ACC of the breast is rare, and has been reported to have a good prognosis. Further investigations are needed to elucidate its true histogenesis the appropriate treatment.
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Hasegawa J, Noura S, Hirota M, Matsumura T, Yasuyama A, Takata A, Koga C, Murakami M, Kameda C, Oda N, Kawabata R, Morishima H, Shimizu J, Matsunami N. [A Case of Metastatic Colorectal Cancer Refractory to Standard Chemotherapies Treated with TAS-102 with Bevacizumab]. Gan To Kagaku Ryoho 2016; 43:2289-2291. [PMID: 28133298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 51-year-oldwoman with lung, liver, andd istant lymph node metastases from sigmoidcolon cancer was treatedusing TAS-102 with bevacizumab as fourth-line chemotherapy. There was a 35%decrease in the size of target lesions after the first 4 cycles of therapy, and disease control has been maintained for 9 months. The only Grade 3 or worse adverse event experiencedwas neutropenia. In patients with refractory colorectal cancer, the combination of TAS-102 with bevacizumab might be an effective andsafe treatment.
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Hu JM, Chou YC, Wu CC, Hsiao CW, Lee CC, Chen CT, Hu SI, Liu WT, Jao SW. Adjuvant chemotherapy with tegafur/uracil for more than 1 year improves disease-free survival for low-risk Stage II colon cancer. J Chin Med Assoc 2016; 79:477-88. [PMID: 27329402 DOI: 10.1016/j.jcma.2016.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 02/01/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND It is uncertain whether adjuvant chemotherapy (CMT) improves survival in patients with low-risk Stage II colon cancer. We aimed to determine the disease-free survival (DFS) and 5-year overall survival (OS) of low-risk Stage II colon cancer patients treated with adjuvant tegafur/uracil (UFUR). METHODS From January 2004 to December 2011, the follow-up status of 278 low-risk Stage II colon cancer patients who underwent surgery in a single medical center was retrospectively analyzed. These patients were divided into three groups based on whether they received adjuvant CMT with UFUR, adjuvant CMT with 5-fluorouracil, or surgery alone. DFS and 5-year OS curves were calculated using Kaplan-Meier survival analysis and Cox proportional hazards regression. RESULTS In the study population, including 278 low-risk Stage II colon cancer patients with a mean age of 68.28 ± 13.01 years, 132 (47.5%) received adjuvant CMT with UFUR, 49 (17.6%) received adjuvant CMT with 5-fluorouracil, and 97 (34.9%) underwent radical surgery alone. At 5 years, the adjusted DFS and OS of low-risk Stage II colon cancer patients were 85.5% and 81.8%, respectively, in the surgery alone group and 97.9% and 96.2%, respectively, in the surgery plus UFUR > 12 months group (p = 0.004 and p = 0.098, respectively). In multivariate analysis, CMT with UFUR for more than 12 months increased DFS over surgery alone. There was no statistical difference in the 5-year OS. CONCLUSION Adjuvant CMT treatment of low-risk Stage II colon cancer patients with UFUR for more than 12 months following surgery improves DFS over surgery alone.
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Affiliation(s)
- Je-Ming Hu
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chang-Chieh Wu
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Cheng-Wen Hsiao
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chia-Cheng Lee
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chun-Ting Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Sheng-I Hu
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wei-Tin Liu
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shu-Wen Jao
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
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Tebboth A, Lee S, Scowcroft A, Bingham-Gardiner P, Spencer W, Bolodeoku J, Hassan SW. Demographic and Clinical Characteristics of Patients With Type 2 Diabetes Mellitus Initiating Dipeptidyl Peptidase 4 Inhibitors: A Retrospective Study of UK General Practice. Clin Ther 2016; 38:1825-1832.e15. [PMID: 27491279 DOI: 10.1016/j.clinthera.2016.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/11/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE The majority of people with type 2 diabetes mellitus (T2DM) will develop chronic kidney disease in their lifetime. Because most dipeptidyl peptidase (DPP)-4 inhibitors require dose adjustment in patients with T2DM and renal impairment, we aimed to understand how these treatments are prescribed in UK clinical practice, and to determine whether recommended dose adjustments are being made at initial prescription. METHODS This retrospective, descriptive cohort study analyzed data from the Clinical Practice Research Datalink (CPRD). Patients of interest were those with T2DM and renal impairment initiated on a DPP-4 inhibitor between 2014 and 2015. Patients under 40 years of age and with type 1 diabetes were excluded. Descriptive statistics were calculated for baseline demographic and clinical characteristics, and the study protocol was approved by the Independent Scientific Advisory Committee for Medicines and Healthcare products Regulatory Agency database research. FINDINGS A total of 3425 patients diagnosed with T2DM and renal impairment and initiated on a DPP-4 inhibitor were identified. The percentages of patients prescribed the high dose of saxagliptin, alogliptin,sitagliptin, and vildagliptin were 48%, 43%, 41%, and 27%, respectively, which is not recommended given their renal dysfunction. These are conservative estimates, as they do not include patients with severe renal impairment on sitagliptin and alogliptin, whose doses should be further reduced. No patients were prescribed an inappropriately high dose of linagliptin, as there is no requirement for dose adjustment in patients with renal impairment. IMPLICATIONS In this study, a considerable number of patients with T2DM and renal impairment were prescribed an inappropriately high dose of saxagliptin, alogliptin, sitagliptin, or vildagliptin for their level of renal impairment at treatment initiation. This prescribing could have been due to the complexity of different dosing requirements, or a lack of awareness of the need for dose adjustment of most DPP-4 inhibitors in patients with renal impairment. Linagliptin may be used in patients with moderate or severe renal impairment without dose adjustment.
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Affiliation(s)
| | - Sally Lee
- Boehringer Ingelheim Ltd, Berkshire, United Kingdom
| | | | | | - Will Spencer
- Boehringer Ingelheim Ltd, Berkshire, United Kingdom
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Sueda T, Sakai D, Kudo T, Sugiura T, Takahashi H, Haraguchi N, Nishimura J, Hata T, Hayashi T, Mizushima T, Doki Y, Mori M, Satoh T. Efficacy and Safety of Regorafenib or TAS-102 in Patients with Metastatic Colorectal Cancer Refractory to Standard Therapies. Anticancer Res 2016; 36:4299-4306. [PMID: 27466548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/13/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Regorafenib and TAS-102 are novel antitumor agents for patients with metastatic colorectal cancer (mCRC) whose disease has progressed after standard therapies. In randomized trials, regorafenib and TAS-102 prolonged survival in patients with mCRC. However, the appropriate selection of regorafenib or TAS-102 in treatment strategy has not yet been established. PATIENTS AND METHODS We performed a retrospective analysis, between March 2013 and July 2015, on the efficacy and safety of regorafenib or TAS-102. RESULTS Thirty-seven patients with mCRC treated with regorafenib or TAS-102 were included. Of these 37 patients, 23 first received regorafenib and 14 received TAS-102. The median progression-free survival and overall survival were 3.0 and 5.8 months, respectively, in the regorafenib group and 2.1 and 6.3 months, respectively, in the TAS-102 group. Drug-related adverse events (AEs) and grade ≥3 AEs were 23 (100%) and 10 (43.5%), respectively, in the regorafenib group and 13 (92.9%) and 2 (14.3%), respectively, in the TAS-102 group. The most frequent grade ≥3 AEs were hepatotoxicity (17.4%) and hand-foot syndrome (13.0%) in the regorafenib group, and neutropenia (14.3%) in the TAS-102 group. In subgroup analysis, the median overall survival was 11.5 months in patients receiving crossover treatment with regorafenib to TAS-102, and 7.6 months in those receiving crossover treatment with TAS-102 to regorafenib. CONCLUSION Our results showed that regorafenib and TAS-102 have comparable efficacy but different toxicity profiles in patients with mCRC. Both are considered new salvage treatment options. Differences in the toxicity profiles between the two treatments will help in choosing regorafenib or TAS-102.
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Affiliation(s)
- Toshinori Sueda
- Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Daisuke Sakai
- Department of Frontier Science for Cancer and Chemotherapy, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Toshihiro Kudo
- Department of Frontier Science for Cancer and Chemotherapy, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Takashi Sugiura
- Department of Medical Oncology, Saito Yukoukai Hospital, Osaka, Japan
| | - Hidekazu Takahashi
- Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Naotsugu Haraguchi
- Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Junichi Nishimura
- Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Taishi Hata
- Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Taro Hayashi
- Department of Surgery, Saito Yukoukai Hospital, Osaka, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Taroh Satoh
- Department of Frontier Science for Cancer and Chemotherapy, Osaka University, Graduate School of Medicine, Osaka, Japan
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Tai H, Wang MY, Zhao YP, Li LB, Dong QY, Liu XG, Kuang JS. The effect of alogliptin on pulmonary function in obese patients with type 2 diabetes inadequately controlled by metformin monotherapy. Medicine (Baltimore) 2016; 95:e4541. [PMID: 27537577 PMCID: PMC5370803 DOI: 10.1097/md.0000000000004541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To observe the effect of alogliptin combined with metformin on pulmonary function in obese patients with type 2 diabetes inadequately controlled by metformin monotherapy (500 mg, bid po, for at least 3 months), and evaluate its efficacy and safety. METHODS After a 2-week screening period, adult patients (aged 36-72 years) entered a 4-week run-in/stabilization period. Then, patients were randomly assigned to either the intervention group (n = 55) or the control group (n = 50) for 26 weeks. The patients in the control group were given metformin (1000 mg, bid po) and the patients in the intervention group were given metformin (500 mg, bid po) combined with alogliptin (25 mg, qd po). All the patients received counseling about diet and exercise from a nutritionist during run-in and treatment periods.The primary endpoints were the between-group differences in the changes in pulmonary function parameters (vital capacity [VC]%, forced vital capacity [FVC]%, forced expiratory volume in 1 second (FEV1)%, peak expiratory force [PEF]%, maximal voluntary ventilation [MVV]%, total lung capacity [TLC%], forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC%], diffusing capacity for carbon monoxide of lung [DLCO]%, and diffusing capacity for carbon monoxide of lung/unit volume [DLCO/VA%]) between pretherapy and posttreatment. The secondary endpoints were changes from baseline to week 26 in glycosylated hemoglobinA1c (HbA1c), FPG, 2hPG, homeostasis model assessment insulin resistance (HOMA-IR), waist circumference (WC), and BMI. The tertiary endpoints were the changes from baseline to week 26 in blood-fat (total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], and triglycerides [TG]). The quartus endpoints were the changes from baseline to week 26 in systolic blood pressure (SBP) and diastolic blood pressure (DBP). The 5th endpoints were the changes from baseline to week 26 in oxidative/antioxidative parameters (reactive oxygen species [ROS], malondialdehyde [MDA], superioxide dismutase [SOD], and glutathione peroxidase [GSH-Px]). In addition, safety endpoints were assessed (AEs, clinical laboratory tests, vital signs, and electrocardiographic readings). RESULTS Eighty-one patients completed our clinical trial: intervention group (n = 44) and control group (n = 37). At week 26, pulmonary function parameters (VC%, FVC%, FEV1%, PEF%, MVV%, TLC%, FEV1/FVC%, DLCO%, and DLCO/VA%) had increased significantly from pretherapy values in both groups (P < 0.05), and the pulmonary function tests were significantly greater (P < 0.05) in intervention group than in controls posttherapy. Pulmonary function (FVC%, FEV1%, PEF%, TLC%, FEV1/FVC%, DLCO%, and DLCO/VA%) was lower in the group with HbA1c levels ≥8.0 at 26 weeks, but VC%, FEV1%, MVV%, and TLC% were not significantly lower (P > 0.05). Pulmonary function parameters were positively correlated with GSH-Px and SOD and negatively correlated with ROS and MDA. Mean declines in HbA1c, FPG, 2hPG, HOMA-IR, and blood-fat (TC, HDL-C, LDL-C, and TG) were significantly greater (P < 0.05) in intervention group compared with the controls, but mean declines in BMI, WC, and BP (SBP, DBP) did not differ significantly between the 2 groups (P > 0.05). SOD and GSH-Px increased more (P < 0.05) in the intervention group, compared with the controls; ROS and MDA declined more (P < 0.05) in intervention group, as compared with the control group. The most common AEs were gastrointestinal events, headaches, skin-related AEs (mostly pruritic events), and hypoglycemia. The incidences of AEs did not differ significantly (P > 0.05) between the 2 groups except for the headache and skin-related adverse events (the incidence of headache was higher in the intervention group than in controls; P < 0.05). No patient died during the study. CONCLUSION In patients with type 2 diabetes mellitus (T2DM) inadequately controlled by metformin monotherapy, the addition of alogliptin contributed to clinically significant increases in pulmonary function through regulating glycemia and improving the imbalance of the oxidative-related substances in the serum, without increasing the incidence of hypoglycemia, dyslipidemia, dysarteriotony, and any notable increase in body weight.
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Affiliation(s)
- He Tai
- Department of Endocrinology and Metabolic, Liaoning Provincial Corps Hospital of Chinese People's Armed Police Forces
| | - Ming-Yue Wang
- Department of Endocrinology and Metabolic, Liaoning Provincial Corps Hospital of Chinese People's Armed Police Forces
| | - Yue-Ping Zhao
- Department of Endocrinology and Metabolic, Liaoning Provincial Corps Hospital of Chinese People's Armed Police Forces
| | - Ling-Bing Li
- Department of Endocrinology and Metabolic, Liaoning Provincial Corps Hospital of Chinese People's Armed Police Forces, Shenyang
| | - Qian-Yan Dong
- Department of Endocrinology and Metabolic, Shenyang the Fourth Hospital of People, Shenyang, Liaoning, China
| | - Xin-Guang Liu
- Department of Endocrinology and Metabolic, Shenyang the Fourth Hospital of People, Shenyang, Liaoning, China
| | - Jin-Song Kuang
- Department of Endocrinology and Metabolic, Shenyang the Fourth Hospital of People, Shenyang, Liaoning, China
- Correspondence: Jin-Song Kuang, Department of Endocrinology and Metabolic, Shenyang the Fourth Hospital of People, No.20 Huanghe Road, Shenyang, Liaoning 110031, China (e-mail: )
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Shiraishi T, Moriya T, Ueno H, Shinto E, Kajiwara Y, Sueyama T, Watanabe T, Yamadera M, Yamamoto J, Hase K. [An Elderly Patient with Multiple Lung Metastases after Colectomy Successfully Treated with a Combination Oral UFT/LV Chemotherapy Regimen]. Gan To Kagaku Ryoho 2016; 43:901-903. [PMID: 27431638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We report an 84-year-old woman with multiple lung metastases from sigmoid colon cancer successfully treated with an oral combination chemotherapeutic agent regimen(UFT/LV).The patient had undergone colectomy for sigmoid colon cancer. Histological examination confirmed a pT4a, pN3, pM1a(LYM), pStage IV tumor.The patient refused adjuvant chemotherapy. However, approximately 9 months postoperatively, she developed a severe cough.Chest radiography and computed tomography(CT)revealed multiple progressive lung metastases.Thereafter, considering her advanced age and general condition, an oral UFT/LV regimen(UFT 300mg/LV 75mg for 7 days every 14 days)was initiated.Two and a half months after initiating chemotherapy, symptom amelioration was observed.Chest radiography and CT showed disappearance of several of the lung metastases, indicating a Partial Response(PR).For the nearly one year to date since diagnosis, she has remained free of cough and the PR has been maintained without chemotherapy-associated adverse events.She is currently being managed on an outpatient basis.The oral UFT/LV regimen is considered to be among the potentially effective and safe treatments for elderly patients with postoperative metastases from colon cancer.
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Del Prato S, Fleck P, Wilson C, Chaudhari P. Comparison of alogliptin and glipizide for composite endpoint of glycated haemoglobin reduction, no hypoglycaemia and no weight gain in type 2 diabetes mellitus. Diabetes Obes Metab 2016; 18:623-7. [PMID: 26865535 DOI: 10.1111/dom.12643] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/14/2015] [Accepted: 02/02/2016] [Indexed: 01/01/2023]
Abstract
This was a post hoc analysis of a 2-year, double-blind study of 2639 patients with type 2 diabetes mellitus (T2DM) inadequately controlled on metformin monotherapy, which assessed achievement of a composite endpoint of sustained glycated haemoglobin (HbA1c) reduction (≤7.0% at week 104 or ≥0.5% decrease from baseline) with no weight gain and no hypoglycaemic events with alogliptin 12.5 and 25 mg daily or glipizide (≤20 mg daily), each added to metformin. With an HbA1c target of ≤7.0%, 24.2 and 26.9% of patients treated with alogliptin 12.5 and 25 mg, respectively, achieved the composite endpoint versus 10.7% of patients treated with glipizide (both p < 0.001). With a criterion of ≥0.5% decrease in HbA1c, the composite endpoint was reached in 22.5, 25.2 and 10.4% of patients treated with alogliptin 12.5 mg, alogliptin 25 mg and glipizide, respectively. Odds ratios for achieving the composite endpoint favoured alogliptin in the primary analysis set and in all subgroups of patients. Patients with T2DM failing metformin monotherapy were more likely to achieve sustained glycaemic control with no hypoglycaemia or weight gain at 2 years with alogliptin than with glipizide.
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Affiliation(s)
- S Del Prato
- Section of Diabetes and Metabolic Diseases, University of Pisa, Pisa, Italy
| | - P Fleck
- Takeda Global Research & Development Center, Inc., Deerfield, IL, USA
| | - C Wilson
- Takeda Global Research & Development Center, Inc., Deerfield, IL, USA
| | - P Chaudhari
- Takeda Global Research & Development Center, Inc., Deerfield, IL, USA
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Bendell JC, Patel MR, Yoshida K, Seraj J, Weaver R, Lemech C, Todaro TG, Pant S, Arkenau HT. Phase 1 study of cardiac safety of TAS-102 in patients with advanced solid tumors. Cancer Chemother Pharmacol 2016; 77:1275-83. [PMID: 27151157 PMCID: PMC4882359 DOI: 10.1007/s00280-016-3031-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/01/2016] [Indexed: 11/25/2022]
Abstract
Purpose TAS-102 is a novel oral agent combining the antineoplastic thymidine-based nucleoside analogue, trifluridine, and the thymidine phosphorylase inhibitor, tipiracil (molar ratio 1:0.5). TAS-102 has shown good activity in refractory metastatic colorectal cancer with acceptable safety. No QT prolongation was seen in clinical studies. This study aimed to investigate TAS-102 cardiac safety for regulatory requirements. Methods This was a phase 1, non-randomized study in adults with advanced solid tumors. Intensive QT assessments were conducted at baseline, placebo, and following single and multiple doses of TAS-102 during a 28-day cycle. Results Following single- and multiple-dose administration (N = 30), the upper bounds of the one-sided 95 % confidence intervals for the difference between TAS-102 and placebo in time-matched baseline-subtracted 12-lead Holter QT intervals did not exceed 20 ms at any prespecified time point. One patient had a change from baseline in QTcI interval ≥60 ms, and one patient had a QTcI interval >500 ms following multiple-dose TAS-102 administration. No patient had an uncorrected QT, QTcF, or QTcB interval >500 ms. Based on the exposure-response analysis between TAS-102 plasma concentrations and the placebo-adjusted QTc intervals, none of the upper bounds of the one-sided 95 % prediction intervals exceeded 20 ms. There were no significant morphological changes for T or U waves. No cardiovascular AEs were reported in cycle 1. Across all cycles, no patient experienced an AE of ventricular tachycardia, ventricular fibrillation, syncope, or seizure. Conclusions There was no clinically relevant relationship between TAS-102 plasma concentrations and QTc interval; TAS-102 had no clinically relevant effects on cardiac repolarization. Clinical trials ClinicalTrials.gov study number: NCT01867879.
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Affiliation(s)
- Johanna C Bendell
- GI Oncology Research, Drug Development Unit, Sarah Cannon Research Institute, 250 25th Avenue N, Suite 100, Nashville, TN, 37203, USA.
| | - Manish R Patel
- Florida Cancer Specialists, 600 N Cattlemen Rd, Suite 200, Sarasota, FL, 34232, USA
| | - Kenichiro Yoshida
- Taiho Oncology Inc, 101 Carnegie Center, Suite 101, Princeton, NJ, 08540, USA
| | - Jabed Seraj
- Taiho Oncology Inc, 101 Carnegie Center, Suite 101, Princeton, NJ, 08540, USA
| | - Racquel Weaver
- Taiho Oncology Inc, 101 Carnegie Center, Suite 101, Princeton, NJ, 08540, USA
| | - Charlotte Lemech
- Sarah Cannon Research Institute UK, 93 Harley Street, London, W1G 6AD, UK
| | | | - Shubham Pant
- Peggy and Charles Stephenson Cancer Center, Science Center, 800 NE 10th Street, Suite 2500, Oklahoma City, OK, 73104, USA
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Sadahiro S, Suzuki T, Tanaka A, Okada K, Saito G, Kamijo A, Nagase H. Increase in Gene Expression of TYMP, DPYD and HIF1A Are Associated with Response to Preoperative Chemoradiotherapy Including S-1 or UFT for Rectal Cancer. Anticancer Res 2016; 36:2433-2440. [PMID: 27127154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/13/2016] [Indexed: 06/05/2023]
Abstract
AIM The aim of the study was to identify biomarkers capable of predicting response to preoperative chemoradiotherapy (CRT) including S-1 or UFT for rectal cancer using biopsy specimens obtained before CRT (Pre-samples) and 7 days after the start of CRT (Day-7 samples). MATERIALS AND METHODS Preoperative CRT including S-1 or UFT was performed in 82 patients with locally advanced rectal cancer. The expression levels of 18 genes related to 5-fluorouracil, folate, and radiation in the Pre-samples and the Day-7 samples were evaluated using reverse transcription polymerase chain reaction (RT-PCR) assay. RESULTS The gene expression levels of hypoxia inducible factor 1 alpha subunit (HIF1A), dihydropyrimidine dehydrogenase (DPYD) and thymidine phosphorylase (TYMP) were found significantly increased in Day-7 samples compared to Pre-samples in responders, but not in non-responders. CONCLUSION Increases in gene expression levels of TYMP, DPYD, and HIF1A in tumor tissues at 7 days after the start of CRT may be useful for predicting the efficacy of CRT including S-1 or UFT.
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Affiliation(s)
- Sotaro Sadahiro
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Toshiyuki Suzuki
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Akira Tanaka
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Kazutake Okada
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Gota Saito
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Akemi Kamijo
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Hideki Nagase
- Applied Pharmacology Lab., Taiho Pharmaceutical Co., Ltd., Tokushima, Japan
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Chen SC, Chang PMH, Yang MH. Cisplatin/Tegafur/Uracil/Irinotecan Triple Combination Therapy for Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma: A Phase I/II Clinical Study. Oncologist 2016; 21:537-8. [PMID: 27091418 PMCID: PMC4861372 DOI: 10.1634/theoncologist.2015-0515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/10/2016] [Indexed: 11/17/2022] Open
Abstract
LESSONS LEARNED Cisplatin/tegafur/uracil/irinotecan triple combination therapy shows moderate response, especially in patients without previous chemoradiotherapy within the 6 months before this combination therapy.Toxicity is tolerable, and quality of life is improved in responders. BACKGROUND The prognosis is poor in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). Triple combination therapy may increase tumor response. METHODS This phase I/II prospective trial first determined the dose-limiting toxicity and recommended dose of irinotecan with cisplatin and tegafur/uracil (UFUR) in phase I. Irinotecan was supplied at doses of 40, 50, 60, and 70 mg/m(2) by using a standard 3+3 design. Doses of cisplatin and UFUR were held stable. In phase II, the recommended dose of irinotecan was administered intravenously (i.v.) over 90 min on day 1, with cisplatin 50 mg/m(2) i.v. over 60 min also on day 1, and oral UFUR 200 mg twice a day for 5 days every 2 weeks a cycle. RESULTS In the phase I portion, 14 patients were enrolled, and the dose level of irinotecan at 60 mg/m(2) was defined as the recommended dose for the phase II portion of the study. Among 43 patients enrolled in the phase II portion, complete response was seen in 2 patients (4.7%) and partial response in 10 patients (23.3%), and the disease control rate was 39.5%. In a subgroup analysis of patients whose prior chemoradiotherapy was more than 6 months earlier, a response rate of 40.7% and disease control rate of 59.3% were observed. CONCLUSION Cisplatin/UFUR/irinotecan triple combination therapy is tolerated and effective for selected patients. Individualized choice of treatment will influence prognosis and quality of life in R/M HNSCC patients.
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Affiliation(s)
- San-Chi Chen
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China Faculty of Medicine, National Yang Ming University, Taipei, Taiwan, Republic of China Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan, Republic of China
| | - Peter Mu-Hsin Chang
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China Faculty of Medicine, National Yang Ming University, Taipei, Taiwan, Republic of China Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan, Republic of China
| | - Muh-Hwa Yang
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China Faculty of Medicine, National Yang Ming University, Taipei, Taiwan, Republic of China Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan, Republic of China
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Bonora E, Cigolini M. DPP-4 inhibitors and cardiovascular disease in type 2 diabetes mellitus. Expectations, observations and perspectives. Nutr Metab Cardiovasc Dis 2016; 26:273-284. [PMID: 27038847 DOI: 10.1016/j.numecd.2016.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 03/04/2016] [Accepted: 03/04/2016] [Indexed: 02/06/2023]
Abstract
AIMS Cardiovascular disease (CVD) is the greatest burden of type 2 diabetes mellitus (T2DM) in terms of morbility, mortality and costs for individuals and societies. Therefore, its prevention is a major goal in diabetes care. Optimal treatment of hyperglycemia is certainly instrumental to CVD prevention. Optimal treatment means both establishing the most appropriate glycemic target for the given individual and selecting the medication(s) with the most favourable benefit/safety ratio. CVD safety, if not a clear CVD benefit, is certainly required for all antidiabetic agents. Dipeptidyl-peptidase-4 (DPP-4) inhibitors are among the classes of antidiabetic agents most recently made available for diabetes care. A major question to be addressed is the effect of these compounds on CVD. Expectations were high for their mechanism of action, which targets also post-prandial glucose and minimize hypoglycemia risk, thereby providing a sort of global glucose control, and for some potentially beneficial extra-glycemic effects. This article reviews the existing literature on this issue. DATA SYNTHESIS Data published so far document that DPP-4 inhibitors have a wide spectrum of glycemic and extra-glycemic effects potentially reducing the risk of CVD as well as favourable effects on intermediate or surrogate CVD endpoints. These data heralded a better CVD outcome. Accordingly, pooling CVD safety data from phase 3 and 4 studies conducted with DPP-4 inhibitors suggested that their use might translate into a better CVD outcome. Data from three CVD outcome RCTs with alogliptin, saxagliptin and sitagliptin documented no harm but did not show any benefit on major CVD events. A modest but significant increased risk of hospitalization for heart failure was observed with saxagliptin and with alogliptin (only in subjects with no history of heart failure before randomization) but not with sitagliptin. A study currently in progress with linagliptin will provide further insights in the issue of CVD safety and benefit. CONCLUSIONS It should be considered that most alternative oral antidiabetic agents generally do not possess a better CVD risk profile than DPP-4 inhibitors and that some of them, indeed, should be used with caution because of potentially adverse effects on heart and vasculature. Overall, the selection of antidiabetic agent(s) with the most favourable CVD profile is mandatory but still challenging in diabetes care.
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Affiliation(s)
- Enzo Bonora
- Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy.
| | - Massimo Cigolini
- Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
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Ziske MA, Pettee KM, Khaing M, Rubinic K, Eisenmann KM. SMIFH2-mediated mDia formin functional inhibition potentiates chemotherapeutic targeting of human ovarian cancer spheroids. Biochem Biophys Res Commun 2016; 472:33-9. [PMID: 26898799 DOI: 10.1016/j.bbrc.2016.02.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/14/2016] [Indexed: 01/02/2023]
Abstract
Due to a lack of effective screening or prevention protocol for epithelial ovarian cancer (EOC), there is a critical unmet need to develop therapeutic interventions for EOC treatment. EOC metastasis is unique. Initial dissemination is not primarily hematogenous, yet is facilitated through shedding of primary tumor cells into the peritoneal fluid and accumulating ascites. Increasingly, isolated patient spheroids point to a clinical role for spheroids in EOC metastasis. EOC spheroids are highly invasive structures that disseminate upon peritoneal mesothelium, and visceral tissues including liver and omentum. Selection for this subset of chemoresistant EOC cells could influence disease progression and/or recurrence. Thus, targeting spheroid integrity/structure may improve the chemotherapeutic responsiveness of EOC. We discovered a critical role for mammalian Diaphanous (mDia)-related formin-2 in maintaining EOC spheroid structure. Both mDia2 and the related mDia1 regulate F-actin networks critical to maintain cell-cell contacts and the integrity of multi-cellular epithelial sheets. We investigated if mDia2 functional inhibition via a small molecule inhibitor SMIFH2 combined with chemotherapeutics, such as taxol and cisplatin, inhibits the viability of EOC monolayers and clinically relevant spheroids. SMIFH2-mediated mDia formin inhibition significantly reduced both ES2 and Skov3 EOC monolayer viability while spheroid viability was minimally impacted only at the highest concentrations. Combining either cisplatin or taxol with SMIFH2 did not significantly enhance the effects of either drug alone in ES2 monolayers, while Skov3 monolayers treated with taxol or cisplatin and SMIFH2 showed significant additive inhibition of viability. ES2 spheroids were highly responsive with clear additive anti-viability effects with dual taxol or cisplatin when combined with SMIFH2 treatments. While combined taxol with SMIFH2 in spheroids showed an additive effect relative to single treatments, Skov3 spheroids showed no additive effects from combined cisplatin and SMIFH2 treatments. Our data indicate that mDia formin inhibition combined with taxol to drive enhanced and/or additive anti-viability effects targeting 3D EOC structures, including ES2 and Skov3 spheroids. Combined mDia formin inhibition with cisplatin may be most effective in EOC spheroids where cisplatin sensitivity is retained at moderate levels, such as ES2 cells.
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Affiliation(s)
- Megan A Ziske
- Department of Biochemistry and Cancer Biology, University of Toledo Health Science Campus, Mail Stop 1010, 3000 Arlington Avenue, Toledo, OH 43614, USA
| | - Krista M Pettee
- Department of Biochemistry and Cancer Biology, University of Toledo Health Science Campus, Mail Stop 1010, 3000 Arlington Avenue, Toledo, OH 43614, USA
| | - MaNada Khaing
- Department of Biochemistry and Cancer Biology, University of Toledo Health Science Campus, Mail Stop 1010, 3000 Arlington Avenue, Toledo, OH 43614, USA
| | - Kaitlin Rubinic
- Department of Biochemistry and Cancer Biology, University of Toledo Health Science Campus, Mail Stop 1010, 3000 Arlington Avenue, Toledo, OH 43614, USA
| | - Kathryn M Eisenmann
- Department of Biochemistry and Cancer Biology, University of Toledo Health Science Campus, Mail Stop 1010, 3000 Arlington Avenue, Toledo, OH 43614, USA.
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Goldberg R. Emerging phase 3 data in relapsed/refractory metastatic colorectal cancer. Clin Adv Hematol Oncol 2016; 14:30-33. [PMID: 27057664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Richard Goldberg
- The Ohio State University, Wexner Medical Center, Columbus, Ohio
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47
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Chen J, Han M, Saif MW. TAS-102 an Emerging Oral Fluoropyrimidine. Anticancer Res 2016; 36:21-26. [PMID: 26722024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Colon cancer is a common type of cancer with high mortality. The standard therapy for colon cancer is 5-FU-based regimen, although the current response rate to 5-FU is only 10-15%. Various approaches have been used to improve the efficacy of 5-FU including inhibition of its degradation enzyme dihydropyrimidine dehydrogenase (DPD) such as S1, UTF, use of 5-FU pro-drug capecitabine to exploit thymidine phosphorylase (TP) and supplementation of reduced folate acid to increase cytotoxicity. TAS-102 is a newly-developed anti-folate drug containing the 5-FU analogue trifluridine (TFD) and tipiracil hydrochloride (TPI). TPI is an inhibitor of TFD degradation enzyme thymidine phosphorylase and thus increases the bioavailability of TFD. In the present review, we summarize recent progress with regard to TAS-102, including pre-clinical tests and clinical trials. We further propose several approaches to further improve the efficacy of TAS-102 including combination with targeted therapy and immune therapy.
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Affiliation(s)
- Jiezhong Chen
- School of Biomedical Sciences, University of Queensland, St. Lucia, Australia
| | - Mei Han
- Illawarra Health and Medical Research Institute, The University of Wollongong, Wollongong, Australia
| | - Muhammad Wasif Saif
- Department of Medicine and Cancer Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, U.S.A.
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Maruyama T, Yasuda K, Sako A, Ueda K, Okumura M. [Study of the Postoperative Adjuvant Chemotherapy with UFT/LV or Capecitabine for Stage III Colorectal Cancer]. Gan To Kagaku Ryoho 2016; 43:69-72. [PMID: 26809528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This study sought to compare UFT/LV with capecitabine as adjuvant chemotherapy for the treatment of stage III colorectal cancer. METHODS We conducted a retrospective analysis of patients with Stage III colorectal cancer who underwent surgical resection, except low rectal resections (Rb), followed by adjuvant chemotherapy with UFT/LV or capecitabine between 2007 and 2009, and evaluated background factors, adverse event profiles, disease free survival (DFS), and overall survival (OS). RESULTS The analysis included 39 patients treated with UFT/LV and 29 with capecitabine, with no significant differences observed between the groups in terms of gender, age, or disease Stage. The most common adverse events were gastrointestinal symptoms in the UFT/LV group, and hand-foot syndrome in the capecitabine group. The 3-year DFS was 69.2 and 64.7% in the UFT/LV and capecitabine groups respectively, and 3-year OS was 89.7 and 92.7% in the UFT/LV and capecitabine groups respectively, indicating no significant differences between the groups. CONCLUSION There were no marked differences in treatment outcomes with UFT/LV or capecitabine when they were used as adjuvant chemotherapy for Stage III colorectal cancer, suggesting that a choice between these 2 agents can be made on the basis of avoiding adverse events.
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49
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Van Genechten D, Duh D. [Not Available]. J Pharm Belg 2015:33-35. [PMID: 26856110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
Failure to respond to the approved combinations of multiple direct-acting antiviral agents is relatively low in hepatitis C virus treatment registration studies, with rates of 1% to 7%, depending on the patients' baseline characteristics. In real life, failure is slightly higher, likely because of lower compliance. Treatment failures are usually related to relapse and less often to on-treatment viral breakthrough. Hepatitis C drug-resistant variants are detected in most patients who do not achieve viral eradication. The risk of developing these variants depends on host- and virus-related factors, the properties of the drugs used, and the treatment strategies applied. Patients who carry resistance-associated variants may not obtain benefits from treatment and are at risk of disease progression and transmission of the variants. Whether hepatitis C resistance-associated variants persist depends on their type: NS3-4A variants often disappear gradually after therapy is stopped, whereas NS5A variants tend to persist for more than 2 years. The best way to prevent emergence of resistant variants is to eliminate the virus at the first treatment using highly potent antivirals with genetic barriers to resistance. In patients failing first-generation protease inhibitors, combination therapies with sofosbuvir and NS5 inhibitors have proven effective. Some salvage regimens can be shortened to 12 weeks by addition of ribavirin. The optimal treatment for patients who fail an NS5A inhibitor and those with multidrug-resistant variants remains to be defined, and research efforts should continue to focus on treatment for these patients.
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Affiliation(s)
- Maria Buti
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
| | - Mar Riveiro-Barciela
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rafael Esteban
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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