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Lyrio RMDC, Rocha BRA, Corrêa ALRM, Mascarenhas MGS, Santos FL, Maia RDH, Segundo LB, de Almeida PAA, Moreira CMO, Sassi RH. Chemotherapy-induced acute kidney injury: epidemiology, pathophysiology, and therapeutic approaches. FRONTIERS IN NEPHROLOGY 2024; 4:1436896. [PMID: 39185276 PMCID: PMC11341478 DOI: 10.3389/fneph.2024.1436896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/22/2024] [Indexed: 08/27/2024]
Abstract
Despite significant advancements in oncology, conventional chemotherapy remains the primary treatment for diverse malignancies. Acute kidney injury (AKI) stands out as one of the most prevalent and severe adverse effects associated with these cytotoxic agents. While platinum compounds are well-known for their nephrotoxic potential, other drugs including antimetabolites, alkylating agents, and antitumor antibiotics are also associated. The onset of AKI poses substantial risks, including heightened morbidity and mortality rates, prolonged hospital stays, treatment interruptions, and the need for renal replacement therapy, all of which impede optimal patient care. Various proactive measures, such as aggressive hydration and diuresis, have been identified as potential strategies to mitigate AKI; however, preventing its occurrence during chemotherapy remains challenging. Additionally, several factors, including intravascular volume depletion, sepsis, exposure to other nephrotoxic agents, tumor lysis syndrome, and direct damage from cancer's pathophysiology, frequently contribute to or exacerbate kidney injury. This article aims to comprehensively review the epidemiology, mechanisms of injury, diagnosis, treatment options, and prevention strategies for AKI induced by conventional chemotherapy.
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Affiliation(s)
| | | | | | | | - Felipe Luz Santos
- Department of Medicine, Universidade Salvador (UNIFACS), Salvador, Brazil
| | | | | | | | | | - Rafael Hennemann Sassi
- Hematology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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2
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Grignani G, Le Cesne A, Martín-Broto J. Trabectedin as second-line treatment in advanced soft tissue sarcoma: quality of life and safety outcomes. Future Oncol 2022; 18:13-22. [PMID: 36200954 DOI: 10.2217/fon-2022-0518] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The choice of second- and later-line options for advanced soft tissue sarcoma (aSTS) should always be considered from the patient's perspective, taking into account the potential impact of treatment on daily activities and quality of life. This review examines data on the safety of trabectedin in the management of patients with aSTS as reported in clinical trials and real-world studies. Evidence indicates that trabectedin exhibits an acceptable and manageable safety profile and is compatible with daily activities. Trabectedin is associated with low rates of toxicity-related discontinuations, few potentially life-threatening toxicities, a lack of apparent cumulative toxicities and low rates of grade 3/4 nausea, vomiting and fatigue. Trabectedin represents a valuable second-line option for aSTS, including in elderly patients.
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Affiliation(s)
- Giovanni Grignani
- Candiolo Cancer Institute, FPO-IRCCS, SP 142 Km 3.95, 10060 Candiolo, Italy
| | - Axel Le Cesne
- International Department of Medical Oncology, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France
| | - Javier Martín-Broto
- Department of Medical Oncology, University Hospital Fundación Jimenez Diaz, 28040 Madrid, Spain.,University Hospital General de Villalba, 28400 Collado Villalba, Madrid, Spain.,Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD; UAM), 28015 Madrid, Spain
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3
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Maillard M, Chevreau C, Le Louedec F, Cassou M, Delmas C, Gourdain L, Blay JY, Cupissol D, Bompas E, Italiano A, Isambert N, Delcambre-Lair C, Penel N, Bertucci F, Guillemet C, Plenecassagnes J, Foulon S, Chatelut É, Le Cesne A, Thomas F. Pharmacogenetic Study of Trabectedin-Induced Severe Hepatotoxicity in Patients with Advanced Soft Tissue Sarcoma. Cancers (Basel) 2020; 12:E3647. [PMID: 33291741 PMCID: PMC7761985 DOI: 10.3390/cancers12123647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 01/26/2023] Open
Abstract
Hepatotoxicity is an important concern for nearly 40% of the patients treated with trabectedin for advanced soft tissue sarcoma (ASTS). The mechanisms underlying these liver damages have not yet been elucidated but they have been suggested to be related to the production of reactive metabolites. The aim of this pharmacogenetic study was to identify genetic variants of pharmacokinetic genes such as CYP450 and ABC drug transporters that could impair the trabectedin metabolism in hepatocytes. Sixty-three patients with ASTS from the TSAR clinical trial (NCT02672527) were genotyped by next-generation sequencing for 11 genes, and genotype-toxicity association analyses were performed with R package SNPassoc. Among the results, ABCC2 c.1249A allele (rs2273697) and ABCG2 intron variant c.-15994T (rs7699188) were associated with an increased risk of severe cytolysis, whereas ABCC2 c.3563A allele had a protective effect, as well as ABCB1 variants rs2032582 and rs1128503 (p-value < 0.05). Furthermore, CYP3A5*1 rs776746 (c.6986A > G) increased the risk of severe overall hepatotoxicity (p = 0.012, odds ratio (OR) = 5.75), suggesting the implication of metabolites in the hepatotoxicity. However, these results did not remain significant after multiple analysis correction. These findings need to be validated on larger cohorts of patients, with mechanistic studies potentially being able to validate the functional consequences of these variants.
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Affiliation(s)
- Maud Maillard
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm UMR1037, 31059 Toulouse, France; (M.M.); (F.L.L.); (C.D.); (L.G.); (É.C.)
- Université Paul Sabatier—Toulouse III, 31400 Toulouse, France
- Institut Claudius Regaud, Institut Universitaire du Cancer (IUCT)—Oncopole, 31059 Toulouse, France; (C.C.); (M.C.); (J.P.)
| | - Christine Chevreau
- Institut Claudius Regaud, Institut Universitaire du Cancer (IUCT)—Oncopole, 31059 Toulouse, France; (C.C.); (M.C.); (J.P.)
| | - Félicien Le Louedec
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm UMR1037, 31059 Toulouse, France; (M.M.); (F.L.L.); (C.D.); (L.G.); (É.C.)
- Université Paul Sabatier—Toulouse III, 31400 Toulouse, France
- Institut Claudius Regaud, Institut Universitaire du Cancer (IUCT)—Oncopole, 31059 Toulouse, France; (C.C.); (M.C.); (J.P.)
| | - Manon Cassou
- Institut Claudius Regaud, Institut Universitaire du Cancer (IUCT)—Oncopole, 31059 Toulouse, France; (C.C.); (M.C.); (J.P.)
| | - Caroline Delmas
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm UMR1037, 31059 Toulouse, France; (M.M.); (F.L.L.); (C.D.); (L.G.); (É.C.)
- Institut Claudius Regaud, Institut Universitaire du Cancer (IUCT)—Oncopole, 31059 Toulouse, France; (C.C.); (M.C.); (J.P.)
| | - Laure Gourdain
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm UMR1037, 31059 Toulouse, France; (M.M.); (F.L.L.); (C.D.); (L.G.); (É.C.)
- Institut Claudius Regaud, Institut Universitaire du Cancer (IUCT)—Oncopole, 31059 Toulouse, France; (C.C.); (M.C.); (J.P.)
| | - Jean-Yves Blay
- Medical Oncology Department, Centre Léon Bérard, 69008 Lyon, France;
| | - Didier Cupissol
- Medical Oncology Department, Institut Régional du Cancer Val d’Aurelle, 34090 Montpellier, France;
| | - Emmanuelle Bompas
- Medical Oncology Department, Institut de Cancérologie de l’Ouest, 44800 Saint-Herblain, France;
| | - Antoine Italiano
- Medical Oncology Department, Institut Bergonié, 33000 Bordeaux, France;
| | - Nicolas Isambert
- Medical Oncology Department, Centre Georges François Leclerc, 21000 Dijon, France;
| | | | - Nicolas Penel
- Medical Oncology Department, Centre Oscar Lambret—Université de Lille, 59000 Lille, France;
| | - François Bertucci
- Medical Oncology Department, Institut Paoli-Calmettes, 13009 Marseille, France;
| | - Cécile Guillemet
- Medical Oncology Department, Centre Henri Becquerel, 76038 Rouen, France;
| | - Julien Plenecassagnes
- Institut Claudius Regaud, Institut Universitaire du Cancer (IUCT)—Oncopole, 31059 Toulouse, France; (C.C.); (M.C.); (J.P.)
| | - Stéphanie Foulon
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, 94805 Villejuif, France;
- Oncostat U1018, Inserm, University Paris-Saclay, Labeled Ligue Contre le Cancer, 94805 Villejuif, France
| | - Étienne Chatelut
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm UMR1037, 31059 Toulouse, France; (M.M.); (F.L.L.); (C.D.); (L.G.); (É.C.)
- Université Paul Sabatier—Toulouse III, 31400 Toulouse, France
- Institut Claudius Regaud, Institut Universitaire du Cancer (IUCT)—Oncopole, 31059 Toulouse, France; (C.C.); (M.C.); (J.P.)
| | - Axel Le Cesne
- Medical Oncology Department, Gustave Roussy, 94805 Villejuif, France;
| | - Fabienne Thomas
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm UMR1037, 31059 Toulouse, France; (M.M.); (F.L.L.); (C.D.); (L.G.); (É.C.)
- Université Paul Sabatier—Toulouse III, 31400 Toulouse, France
- Institut Claudius Regaud, Institut Universitaire du Cancer (IUCT)—Oncopole, 31059 Toulouse, France; (C.C.); (M.C.); (J.P.)
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Damato A, Larocca M, Rondini E, Menga M, Pinto C, Versari A. Severe Rhabdomyolysis during Treatment with Trabectedin in Combination with a Herbal Drug in a Patient with Metastatic Synovial Sarcoma: A Case Report. Case Rep Oncol 2017; 10:258-264. [PMID: 28512407 PMCID: PMC5422735 DOI: 10.1159/000464440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 12/18/2022] Open
Abstract
Rhabdomyolysis is defined as dissolution of striped muscle characterized by leakage of intracellular muscle components into the circulation, which can ultimately lead to renal failure with a possible fatal outcome. This is an uncommon side effect of trabectedin which is used in second-line therapy of metastatic sarcoma after anthracycline and ifosfamide failure. Here, we describe a case of reversible rhabdomyolysis in a male patient with recurrent metastatic synovial sarcoma of the hand, with marked 18F-FDG uptake into his skeletal muscles, after 4 cycles of trabectedin, and who at the same time was taking an alternative medicine (bioflavonoids) suspected of triggering this adverse event.
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Affiliation(s)
- Angela Damato
- aMedical Oncology Unit, Clinical Cancer Centre, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Mario Larocca
- aMedical Oncology Unit, Clinical Cancer Centre, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Ermanno Rondini
- aMedical Oncology Unit, Clinical Cancer Centre, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Massimo Menga
- bNuclear Medicine Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Carmine Pinto
- aMedical Oncology Unit, Clinical Cancer Centre, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Annibale Versari
- bNuclear Medicine Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
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5
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Recine F, Bongiovanni A, Riva N, Fausti V, De Vita A, Mercatali L, Liverani C, Miserocchi G, Amadori D, Ibrahim T. Update on the role of trabectedin in the treatment of intractable soft tissue sarcomas. Onco Targets Ther 2017; 10:1155-1164. [PMID: 28260930 PMCID: PMC5328291 DOI: 10.2147/ott.s127955] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Soft tissue sarcomas (STS) represent a variety of tumors of mesenchymal origin, accounting for about 1% of all adult cancers. This group of tumors comprises over 60 different histotypes with different biology showing different sensitivity to therapeutic agents. For decades, the standard first-line systemic treatment of metastatic STS has comprised anthracycline based-chemotherapy. Second-line therapy options include agents such as ifosfamide, gemcitabine, and pazopanib, but the optimal sequential therapy for the management of metastatic disease has yet to be defined. Trabectedin is one of the new molecules approved for patients in progression after first-line chemotherapy with anthracyclines or for those unfit for these agents. The compound is characterized by multiple potential mechanisms of action combining cytotoxic, targeted, and immunological effects. This article takes an in-depth look at the role of trabectedin in the management of metastatic STS, including L-sarcoma and non-L-sarcoma.
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Affiliation(s)
- Federica Recine
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alberto Bongiovanni
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Nada Riva
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Valentina Fausti
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessandro De Vita
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Laura Mercatali
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Chiara Liverani
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giacomo Miserocchi
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Dino Amadori
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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6
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Tiwari A, Gupta VG, Bakhshi S. Newer medical therapies for metastatic soft tissue sarcoma. Expert Rev Anticancer Ther 2017; 17:257-270. [PMID: 28103739 DOI: 10.1080/14737140.2017.1285229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Metastatic/advanced soft tissue sarcoma has a poor prognosis conventionally, treatment options have been limited. In recent years, this area has been a rich ground for research with many new drugs being approved and several more in the pipeline. With multiple new treatment options available, it is vital to keep up pace with this rapidly changing field. Areas covered: Recent data regarding use of novel agents in advanced soft tissue sarcoma is reviewed with a focus on clinical applicability. The goal is to guide the clinician into choosing appropriate lines of therapy for the individual patient in light of recent availability of multiple new treatment options. Expert commentary: Patients with advanced soft tissue sarcoma can expect to receive several lines of therapy in the modern era. Tumor histology should ideally guide the choice of therapy. The new FDA approved second line drugs viz, trabectedin, pazopanib and eribulin should be considered first after failure of doxorubicin-based chemotherapy. Additional options have become available, such as antiangiogenic agents, mTOR inhibitors, and several new molecules targeting specific oncogenic pathways. All these agents have a role in treating soft tissue sarcoma, and careful individualization of therapy can help achieve optimal outcomes in these challenging patients.
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Affiliation(s)
- Akash Tiwari
- a Department of Medical Oncology , Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences , New Delhi , India
| | - Vineet Govinda Gupta
- a Department of Medical Oncology , Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences , New Delhi , India
| | - Sameer Bakhshi
- a Department of Medical Oncology , Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences , New Delhi , India
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7
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Lindequist U. Marine-Derived Pharmaceuticals - Challenges and Opportunities. Biomol Ther (Seoul) 2016; 24:561-571. [PMID: 27795450 PMCID: PMC5098534 DOI: 10.4062/biomolther.2016.181] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 01/23/2023] Open
Abstract
Marine biosphere is the largest one of the earth and harbors an enormous number of different organisms. Living conditions differ fundamentally from those in terrestrial environment. The production of specific secondary metabolites is an important adaption mechanism of marine organisms to survive in the sea. These metabolites possess biological activities which make them interesting as possible drugs for human. The review presents sources, chemistry, production and pharmacology of FDA approved marine derived pharmaceuticals arranged according to their therapeutic indication. Four of the presently seven approved drugs are used for the treatment of cancer. Each another one is applicated for treatment of viral diseases, chronic pain and to lower triglyceride level in blood. Some other products are of interest in diagnostic and as experimental tools. Besides, this article describes challenges in drug development from marine sources, especially the supply problem.
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Affiliation(s)
- Ulrike Lindequist
- Department of Pharmaceutical Biology, Institute of Pharmacy, Ernst-Moritz-Arndt University of Greifswald, Greifswald D17489, Germany
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8
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Awada A, Cortés J, Martín M, Aftimos P, Oliveira M, López-Tarruella S, Espie M, Lardelli P, Extremera S, Fernández-García EM, Delaloge S. Phase 2 Study of Trabectedin in Patients With Hormone Receptor–Positive, HER-2–Negative, Advanced Breast Carcinoma According to Expression of Xeroderma Pigmentosum G Gene. Clin Breast Cancer 2016; 16:364-371. [DOI: 10.1016/j.clbc.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/05/2016] [Accepted: 05/09/2016] [Indexed: 11/30/2022]
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9
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Saponara M, Stacchiotti S, Gronchi A. The safety and efficacy of trabectedin for the treatment of liposarcoma or leiomyosarcoma. Expert Rev Anticancer Ther 2016; 16:473-84. [DOI: 10.1080/14737140.2016.1174582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Duffaud F, Maki RG, Jones RL. Treatment of advanced soft tissue sarcoma: efficacy and safety of trabectedin, a multitarget agent, and update on other systemic therapeutic options. Expert Rev Clin Pharmacol 2016; 9:501-512. [DOI: 10.1586/17512433.2016.1152179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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11
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A comprehensive safety evaluation of trabectedin and drug-drug interactions of trabectedin-based combinations. BioDrugs 2015; 28:499-511. [PMID: 25209722 DOI: 10.1007/s40259-014-0100-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Trabectedin (Yondelis(®)) is a potent marine-derived antineoplastic drug with high activity against various soft tissue sarcoma (STS) subtypes as monotherapy, and in combination with pegylated liposomal doxorubicin (PLD) for the treatment of patients with relapsed platinum-sensitive ovarian cancer. This article reviews the safety and pharmacokinetic profiles of trabectedin. Records were identified using predefined search criteria using electronic databases (e.g. PubMed, Cochrane Library Database of Systematic Reviews). Primary peer-reviewed articles published between 1 January 2006 and 1 April 2014 were included. The current safety and tolerability profile of trabectedin, based on the evaluation in clinical trials of patients treated with the recommended treatment regimens for STS and recurrent ovarian cancer, was reviewed. Trabectedin as monotherapy or in combination with PLD, was not associated with cumulative and/or irreversible toxicities, such as cardiac, pulmonary, renal, or oto-toxicities, often observed with other common chemotherapeutic agents. The most common adverse drug reactions (ADRs) were myelosuppression and transient hepatic transaminase increases that were usually not clinically relevant. However, trabectedin administration should be avoided in patients with severe hepatic impairment. Serious and fatal ADRs were likely to be related to pre-existing conditions. Doxorubicin or PLD, carboplatin, gemcitabine, or paclitaxel when administered before trabectedin, did not seem to influence its pharmacokinetics. Cytochrome P450 (CYP) 3A4 has an important role in the metabolism of trabectedin, suggesting a risk of drug-drug interactions with trabectedin used in combination with other CYP3A4 substrates. Trabectedin has a favorable risk/efficacy profile, even during extended treatment in pretreated patients.
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12
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Le Cesne A, Reichardt P. Optimizing the use of trabectedin for advanced soft tissue sarcoma in daily clinical practice. Future Oncol 2015; 11:3-14. [DOI: 10.2217/fon.15.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Compared with conventional chemotherapy for advanced soft tissue sarcoma, trabectedin has several distinguishing characteristics which, when optimized, may maximize clinical benefits for patients. In this review, evidence is examined with the aim of answering some vital questions about the use of trabectedin in clinical practice. Who should be treated? When should patients be treated? For how long should patients be treated? What is the safety profile of trabectedin? How should trabectedin be administered? In brief, trabectedin has shown activity and clinical benefit in nearly all subtypes of soft tissue sarcoma. Improved efficacy outcomes are observed when trabectedin is administered as second-line therapy compared with later-line use. In line with this observation, the European Society for Medical Oncology clinical practice guidelines for soft tissue sarcoma recommend use of trabectedin in the second-line setting. Trabectedin has a role for treatment of elderly patients in whom alternatives are lacking, and can be administered for prolonged periods without cumulative toxicity. A statistically significant improvement in median progression-free survival has been observed when trabectedin is administered uninterrupted until disease progression. The flexibility of trabectedin administration in terms of dose, interval and duration allows for patient-tailored treatment optimization.
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Affiliation(s)
- Axel Le Cesne
- Department of Medical Oncology, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France
| | - Peter Reichardt
- Department of Interdisciplinary Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
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13
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Jordan K, Jahn F, Jordan B, Kegel T, Müller-Tidow C, Rüssel J. Trabectedin: Supportive care strategies and safety profile. Crit Rev Oncol Hematol 2015; 94:279-90. [PMID: 25794812 DOI: 10.1016/j.critrevonc.2015.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 12/21/2014] [Accepted: 02/26/2015] [Indexed: 12/14/2022] Open
Abstract
Trabectedin is an approved antineoplastic agent for the treatment of adult patients with advanced soft tissue sarcomas or in combination with pegylated liposomal doxorubicin (PLD) in patients with relapsed platinum sensitive ovarian cancer. The mechanism of action is still not fully understood but many typical side effects seen with other chemotherapy drugs are less common, mild or unreported. Although this apparent favorable safety profile suggests a well-tolerated and manageable therapeutic option in the palliative care setting, trabectedin does have specific adverse side effects which can be hazardous for individual patients. The most commonly observed toxicities with trabectedin include neutropenia, nausea, vomiting, and increases in liver transaminases, anemia, fatigue, thrombocytopenia, anorexia and diarrhea. However, for most patients the appropriate use of supportive care strategies can reduce or overcome these side effects. We present a concise review of the safety data of trabectedin with the corresponding overview of the supportive care strategies.
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Affiliation(s)
- Karin Jordan
- Department of Hematology/Oncology, University of Halle, Ernst-Grube-Str. 40, Halle 06120, Germany.
| | - Franziska Jahn
- Department of Hematology/Oncology, University of Halle, Ernst-Grube-Str. 40, Halle 06120, Germany
| | - Berit Jordan
- Department of Neurology, University of Halle, Ernst-Grube-Str. 40, Halle 06120, Germany
| | - Thomas Kegel
- Department of Hematology/Oncology, University of Halle, Ernst-Grube-Str. 40, Halle 06120, Germany
| | - Carsten Müller-Tidow
- Department of Hematology/Oncology, University of Halle, Ernst-Grube-Str. 40, Halle 06120, Germany
| | - Jörn Rüssel
- Department of Hematology/Oncology, University of Halle, Ernst-Grube-Str. 40, Halle 06120, Germany
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14
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Reid A, Martin-Liberal J, Benson C. Trabectedin for advanced soft tissue sarcomas: optimizing use. Ther Clin Risk Manag 2014; 10:1003-11. [PMID: 25540587 PMCID: PMC4270297 DOI: 10.2147/tcrm.s49330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients with locally advanced or metastatic soft tissue sarcoma have a poor outlook with median survival in the order of 1 year. There is therefore an urgent need for novel agents to impact this disease. Trabectedin is one such novel agent that has demonstrated activity for patients with advanced soft tissue sarcoma and it was licensed in Europe in 2007 for patients in the second-line setting or first-line in those patients deemed unsuitable to receive cytotoxics. In order to best serve patients with novel agents, it is imperative to understand the mechanism or mechanisms of action and the best ways of assessing response in order to optimize antitumor activity. Frequently, the mechanism of action and the optimal means of assessing response will be different from those of traditional cytotoxics. Trial design should reflect these factors to ensure that active drugs are not wrongly marked as futile. This review discusses a number of factors that may influence the optimization of trabectedin use. These factors include the administration schedule, the optimal timing of trabectedin administration in the disease process, the histopathological and molecular subtypes that may be most sensitive to trabectedin, the challenge of assessing response, particularly using radiology, and, finally, the safety considerations with this agent.
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Affiliation(s)
- Alison Reid
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Charlotte Benson
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
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Laurenty AP, Thomas F, Chatelut E, Bétrian S, Guellec CL, Hennebelle I, Guellec SL, Chevreau C. Irreversible hepatotoxicity after administration of trabectedin to a pleiomorphic sarcoma patient with a rare ABCC2 polymorphism: a case report. Pharmacogenomics 2013; 14:1389-96. [DOI: 10.2217/pgs.13.124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We describe here the case of a 60-year old male patient treated for an extensive local progression of a pleiomorphic sarcoma on the right tibial crest with second-line trabectedin. Two cycles were administrated before a major liver toxicity was retrieved, with both cytolytic and cholestatic hepatitis quickly associated with irreversible jaundice. The radiological, histological, chemistry and pharmacogenetic investigations led us to diagnose chronic hepatobiliary toxicity with portal fibrosis, cholangiolitis damages and chronic hepatopathy. The patient had a deficient variant genotype of ABCC2 (c.-24TT, c.4488CT and c.4544GA), which has been suggested to play a role in excretion of toxic metabolites of trabectedin. This case report is, to our knowledge, the first description of trabectedin‘s irreversible liver toxicity in a human patient. Supported by a thorough review of the literature, this hepatitis is thought to have resulted from a multihit process involving genetic variants of ABC proteins and comedication.
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Affiliation(s)
| | - Fabienne Thomas
- Department of Pharmacology & EA4553, Institut Claudius Regaud, 20–24, rue du Pont St Pierre, 31052 Toulouse Cedex, France
| | - Etienne Chatelut
- Department of Pharmacology & EA4553, Institut Claudius Regaud, 20–24, rue du Pont St Pierre, 31052 Toulouse Cedex, France
| | - Sarah Bétrian
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Chantal Le Guellec
- Department of Molecular Biology, Hôpital Bretonneau, CHRU Tours, Tours, France
| | - Isabelle Hennebelle
- Department of Pharmacology & EA4553, Institut Claudius Regaud, 20–24, rue du Pont St Pierre, 31052 Toulouse Cedex, France
| | - Sophie Le Guellec
- Department of Anatomopathology, Institut Claudius Regaud, Toulouse Cedex, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
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Martin-Liberal J, Judson I. Safety evaluation of trabectedin in treatment of soft-tissue sarcomas. Expert Opin Drug Saf 2013; 12:905-11. [PMID: 23937190 DOI: 10.1517/14740338.2013.829037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Trabectedin gained the approval by the European Medicines Agency (EMA) in 2007 for the treatment of patients affected by soft-tissue sarcomas (STS). Its safety and activity profiles have been assessed in many clinical trials as well as in standard clinical practice for > 10 years. AREAS COVERED This article extensively reviews the most common and specific adverse events associated with trabectedin. Moreover, we compare these toxicity data with other drugs active in STS such as doxorubicin and ifosfamide. Also, we provide a comprehensive view of the special mechanism of action of this drug and its clinical applications. Additionally, we discuss the current role of trabectedin in the treatment of STS and give a future perspective with the review of ongoing clinical trials and potential new indications. EXPERT OPINION Trabectedin is, in general, a well-tolerated drug with a favorable toxicity profile. The majority of its side effects are mild and easily manageable. Specific adverse events such as liver toxicity and rhabdomyolysis do not usually have a significant clinical impact. Overall, trabectedin is a safe and active treatment option in STS.
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Affiliation(s)
- Juan Martin-Liberal
- The Royal Marsden Hospital, Sarcoma Unit , Fulham Road, London, SW3 6JJ , UK
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Strippoli S, Lorusso V, Albano A, Guida M. Herbal-drug interaction induced rhabdomyolysis in a liposarcoma patient receiving trabectedin. Altern Ther Health Med 2013; 13:199. [PMID: 23899130 PMCID: PMC3737021 DOI: 10.1186/1472-6882-13-199] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 07/16/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND Rhabdomyolysis is an uncommon side effect of trabectedin which is used for the second line therapy of metastatic sarcoma after anthracycline and ifosfamide failure. This side effect may be due to pharmacokinetic interactions caused by shared mechanisms of metabolism involving the cytochrome P450 (CYP) system in the liver. Here, for the first time in literature, we describe the unexpected onset of heavy toxicity, including rhabdomyolysis, after the fourth course of trabectedin in a patient with retroperitoneal liposarcoma who at the same time was taking an alternative herbal medicine suspected of triggering this adverse event. CASE PRESENTATION This is the case of a 56 year old Caucasian man affected by a relapsed de-differentiated liposarcoma who, after the fourth cycle of second-line chemotherapy with trabectedin, complained of sudden weakness, difficulty walking and diffuse muscle pain necessitating complete bed rest. Upon admission to our ward the patient showed grade (G) 4 pancytopenia and a marked increase in liver lytic enzymes, serum levels of myoglobin, creatine phosphokinase (CPK) and lactate dehydrogenase. No cardiac or kidney function injuries were present. Based on these clinical and laboratory features, our conclusive diagnosis was of rhabdomyolysis induced by trabectedin.The patient did not report any trauma or muscular overexertion and no co-morbidities were present. He had not received any drugs during treatment with trabectedin, but upon further questioning the patient informed us he had been taking a folk medicine preparation of chokeberry (Aronia melanocarpa) daily during the last course of trabectedin and in the 2 subsequent weeks.One week after hospitalization and cessation of intake of chokeberry extract, CPK and other markers of myolysis slowly returned to standard range, and the patient noted a progressive recovery of muscle strength.The patient was discharged on day 14 when a blood transfusion and parenteral hydration gradually lowered general toxicity. Progressive mobilization of the patient was obtained as well as a complete normalization of the laboratory findings. CONCLUSIONS The level of evidence of drug interaction leading to the adverse event observed in our patient was 2 (probable). Thus our case underlines the importance of understanding rare treatment-related toxicities such as trabectedin-induced rhabdomyolysis and the possible role of the drug-drug interactions in the pathogenesis of this rare side effect. Furthermore, this report draws attention to a potential problem of particular concern, that of nutritional supplements and complementary and alternative drug interactions. These are not widely recognized and can cause treatment failure.
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Clinical benefit of trabectedin in uterine adenosarcoma. Med Oncol 2013; 30:501. [PMID: 23456619 DOI: 10.1007/s12032-013-0501-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
Abstract
Uterine adenosarcoma is an extremely rare uterine malignancy, and the utility of chemotherapy in this disease is not well defined. This study assessed the safety and efficacy of trabectedin in patients with recurrent/metastatic uterine adenosarcoma with sarcomatous overgrowth. A retrospective search of a prospectively maintained database was performed to identify patients with adenosarcoma treated with trabectedin between 2010 and 2012, within a compassionate use trial. Three patients with recurrent/metastatic uterine adenosarcoma treated with trabectedin were identified. All three patients tolerated the drug well. Two patients obtained prolonged clinical benefit from treatment, one having received 17 cycles and another 11 cycles of therapy. Trabectedin is well tolerated and has clinical activity in recurrent/metastatic uterine adenosarcoma.
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Galizia D, Palesandro E, Nuzzo AM, Pignochino Y, Aliberti S, Aglietta M, Grignani G. Prolonged Disease Stability With Trabectedin in a Heavily Pretreated Elderly Patient With Metastatic Leiomyosarcoma of the Thigh and Renal Failure: A Case Report and Review of the Literature. Oncol Res 2012; 20:483-90. [DOI: 10.3727/096504013x13685487925130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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