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FLOX (5-fluorouracil + leucovorin + oxaliplatin) chemotherapy for colorectal cancer leads to long-term orofacial neurotoxicity: a STROBE-guided longitudinal prospective study. Int J Clin Oncol 2020; 25:2066-2074. [PMID: 32761281 DOI: 10.1007/s10147-020-01757-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Colorectal carcinoma (CRC) is widely treated by chemotherapy based on an intensely neurotoxic drug: oxaliplatin (OXL). We objective to evaluate prospectively the orofacial neurotoxicity during FLOX (fluorouracil + leucovorin + OXL) chemotherapy. METHODS So, 46 patients with CRC were prospectively evaluated during FLOX chemotherapy by 3 cycles (C) of 6 weeks (W) each. We weekly applied the orofacial section of the Acute and Chronic Neuropathy Questionnaire of Common Toxicity Criteria for Adverse Events of the National Cancer Institute of the United States of America (Oxaliplatin-specific neurotoxicity scale). Patients were asked the following concerning the severity (scores 0-5) of orofacial symptoms: jaw pain, eyelids drooping, throat discomfort, ear pain, tingling in mouth, difficulty with speech, burning or discomfort of the eyes, loss of any vision, feeling shock/pain down back and problems breathing. We summed the scores (0-50) and evaluated the clinicopathological data. Friedman/Dunn, Chi square and multinomial regression logistic tests were used (SPSS 20.0, p < 0.05). RESULTS There was a significant increase in sum of orofacial neurotoxicity from baseline to C1.W3, C2.W1 and C3.W5 (p < 0.001) due increase in scores of jaw pain (p < 0.001), eyelids drooping (p = 0.034), throat discomfort (p < 0.001), ear pain (p = 0.034), tingling in mouth (p = 0.015), burning/discomfort of your eyes (p < 0.001), loss of any vision (p < 0.001), feeling shock/pain down back (p < 0.001), problems with breathing (p = 0.045), but not difficulty with speech (p = 0.087). Women (p = 0.021) and young patients (p = 0.027) had significant higher prevalence of orofacial neurotoxicity. CONCLUSIONS FLOX-related orofacial neurotoxicity begins acutely and remains long term with increased incidence in women and younger patients.
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Management of hyperbilirubinaemia in pancreatic cancer patients. Eur J Cancer 2018; 94:26-36. [DOI: 10.1016/j.ejca.2018.01.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/12/2018] [Accepted: 01/18/2018] [Indexed: 12/15/2022]
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Abstract
Background The number of individuals aged 65 years and older is growing rapidly, and the majority of cancers are diagnosed in this age group. Age-related changes in physiology can affect chemotherapy pharmacokinetics and pharmacodynamics in older patients. Methods We review the literature regarding the impact of age on the pharmacokinetics of commonly used chemotherapy drugs and discuss age-related changes in physiology and pharmacology that can affect chemotherapy tolerance in older patients. Results The data on age-related changes in chemotherapy pharmacokinetics are conflicting. While a few studies report age-related differences in chemotherapy pharmacokinetics, most found no significant difference or subtle differences in pharmacokinetics with aging. A difference in pharmacodynamics was commonly seen, however, with older patients at increased risk of myelosuppression and toxicity from age-related decline in organ function. The majority of these studies were performed in a small cohort of patients, thus limiting the generalizability of these results. Conclusions Additional studies are needed to address the pharmacokinetics and pharmacodynamics of cancer therapies in the older patient. Multicenter pharmacokinetic studies of adequate sample size, which include a thorough evaluation of physiologic factors and geriatric assessment parameters, would provide further insight into the factors affecting treatment tolerance. These studies would also help to guide appropriate chemotherapy dosing and interventions in order to maximize efficacy and minimize toxicity in the older patient.
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Affiliation(s)
- Arti Hurria
- Cancer and Aging Research Program, City of Hope National Medical Center, Duarte, CA 91010, USA.
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4
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Garrett MJ, Waddell JA, Solimando DA. Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer. Hosp Pharm 2017; 52:341-347. [PMID: 28804149 DOI: 10.1177/0018578717715353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr, President, Oncology Pharmacy Services, Inc, 4201 Wilson Blvd #110-545, Arlington, VA 22203, e-mail: OncRxSvc@comcast.net; or J. Aubrey Waddell, Professor, University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar Alexander Parkway, Maryville, TN 37804, e-mail: waddfour@charter.net. The information presented in this review is based on published data and clinical expertise and includes information not included in the product labeling. Incorporation of such published data provides a more robust assessment of the drugs and assists pharmacists in evaluation of orders for off-label use of these agents.
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Affiliation(s)
| | - J Aubrey Waddell
- Blount Memorial Hospital, Maryville, TN, USA.,Blount Memorial Hospital, Maryville, TN, USA
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Waddell JA, Solimando DA. Leucovorin, Fluorouracil, and Oxaliplatin (FOLFOX 6 and 7) Regimens for Colorectal Cancer. Hosp Pharm 2017. [DOI: 10.1177/001857870504000805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases.
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Affiliation(s)
- J. Aubrey Waddell
- Oncology Pharmacy Residency Program, Department of Pharmacy, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Rm 2P02, Washington, DC 20307
| | - Dominic A. Solimando
- Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203
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Faugeras L, Dili A, Druez A, Krug B, Decoster C, D’Hondt L. Treatment options for metastatic colorectal cancer in patients with liver dysfunction due to malignancy. Crit Rev Oncol Hematol 2017; 115:59-66. [DOI: 10.1016/j.critrevonc.2017.03.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/28/2017] [Accepted: 03/27/2017] [Indexed: 01/11/2023] Open
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Liu L, Zheng YH, Han L, Qin SK. Efficacy and safety of the oxaliplatin-based chemotherapy in the treatment of advanced primary hepatocellular carcinoma: A meta-analysis of prospective studies. Medicine (Baltimore) 2016; 95:e4993. [PMID: 27749557 PMCID: PMC5059059 DOI: 10.1097/md.0000000000004993] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Many clinical studies have demonstrated the survival benefits of oxaliplatin-based chemotherapy for advanced hepatocellular carcinoma patients. Therefore, we aim to evaluate the efficacy and safety of oxaliplatin-based chemotherapy in patients with advanced hepatocellular carcinoma by conducting a meta-analysis of prospective studies. METHODS A comprehensive literature search was performed using the PubMed, Cochrane Library, EMBASE, and Web of Science databases from their inception to June 2016. Only prospective studies evaluating oxaliplatin-based chemotherapy in patients with advanced hepatocellular carcinoma were selected. The main outcomes included objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and main adverse events. RESULTS Ten prospective studies involving 525 patients were included. The pooled ORR, 1-year PFS, and OS were 14.4% (95% confidence interval [CI] 9.2-19.6%), 9.3% (95%CI 10-28%), and 35.7% (95%CI 27-44%), respectively, for oxaliplatin-based chemotherapy. The median PFS and OS were 4.7 and 9.4 months, respectively. The incidences of grade 3/4 toxicities of neutropenia, thrombopenia, anemia, neurotoxicity, diarrhea, and nausea/vomiting were 17.2%, 9.2%, 6.0%, 4.8%, 3.1%, and 1.8%, respectively. Subgroup analysis revealed that the pooled ORR was 13.9% (95%CI 6.8-21%) in Asian patients and 12.8% (95%CI 6.8-18.7%) in Western patients. For Asian patients, the median PFS and OS were 4.2 and 9.2 months, and the 1-year PFS and OS were 12.5% and 30.5%, respectively. For Western patients, the median PFS and OS were 4.7 and 9.5 months, and the 1-year PFS and OS were 19.6% and 42.4%, respectively. There were no significant differences in the ORR, 1-year PFS, and OS (P > 0.05) between Asian and Western patients. CONCLUSIONS Oxaliplatin-based chemotherapy appears to be effective and safe for the treatment of advanced hepatocellular carcinoma.
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Affiliation(s)
- Lin Liu
- Department of Oncology, Zhong-Da Hospital, School of Medicine, Southeast University
- Department of Oncology, 81st Hospital of the Chinese People's Liberation Army, Nanjing, Jiangsu, China
- Correspondence: Lin Liu, Department of Oncology, Zhong-Da Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China (e-mail: ); Shu-Kui Qin, Department of Oncology, the 81 Hospital of the Chinese People's Liberation Army, Nanjing, Jiangsu, China (e-mail: )
| | - Ying-hui Zheng
- Department of Oncology, Zhong-Da Hospital, School of Medicine, Southeast University
| | - Li Han
- Department of Oncology, Zhong-Da Hospital, School of Medicine, Southeast University
| | - Shu-Kui Qin
- Department of Oncology, 81st Hospital of the Chinese People's Liberation Army, Nanjing, Jiangsu, China
- Correspondence: Lin Liu, Department of Oncology, Zhong-Da Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China (e-mail: ); Shu-Kui Qin, Department of Oncology, the 81 Hospital of the Chinese People's Liberation Army, Nanjing, Jiangsu, China (e-mail: )
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Huang CW, Yeh YS, Ma CJ, Tsai HL, Chen CW, Huang MY, Lu CY, Wu JY, Wang JY. Patients with Metastatic Colorectal Cancer and Hyperbilirubinemia Treated with FOLFIRI plus Bevacizumab as First-Line Treatment. Chemotherapy 2016; 62:80-84. [PMID: 27654129 DOI: 10.1159/000447118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/25/2016] [Indexed: 11/19/2022]
Abstract
Metastatic colorectal cancer (mCRC) combined with hyperbilirubinemia is typically considered a contraindication to irinotecan-based therapy, a proven first-line treatment of mCRC. Herein, we present 6 consecutive patients with mCRC combined with hyperbilirubinemia who underwent UGT1A1 genotyping before receiving FOLFIRI plus bevacizumab. Dose escalation of irinotecan was performed according to the results of UGT1A1 genotyping in all patients. Improvement in the serum total bilirubin level to a normal range was noted in all 6 patients. Disease control was 100%. The median progression-free survival was 7.5 months and the median overall survival was 8.5 months. FOLFIRI plus bevacizumab as a first-line chemotherapy may achieve effective disease control and be safe in patients with mCRC and hyperbilirubinemia based on UGT1A1 genotyping. More prospective clinical studies are necessary to evaluate the clinical benefits and safety of this treatment approach.
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Affiliation(s)
- Ching-Wen Huang
- Division of Gastroenterology and General Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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Mansfield AS, Rudek MA, Vulih D, Smith GL, Harris PJ, Ivy SP. The Effect of Hepatic Impairment on Outcomes in Phase I Clinical Trials in Cancer Subjects. Clin Cancer Res 2016; 22:5472-5479. [PMID: 27189163 DOI: 10.1158/1078-0432.ccr-16-0449] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/18/2016] [Accepted: 05/12/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE The NCI Cancer Therapy Evaluation Program sponsors hepatic dysfunction phase I clinical trials (HDCT) and phase 1 clinical trials (P1CT) to determine safe doses and schedules of antineoplastic therapeutics. We sought to compare clinical outcomes between these trial types while stratifying by hepatotoxic agents. EXPERIMENTAL DESIGN Individual subject data were extracted from the records of 51 NCI-sponsored HDCT and P1CT. The NCI's Organ Dysfunction Working Group's hepatic impairment categorization and two drug-induced liver injury (DILI) scales (FDA R ratio and Hy's law) were used to classify subjects. The number of cycles administered and treatment discontinuation reason were also evaluated and compared between groups. RESULTS There were 513 and 1,328 subjects treated on HDCT (n = 9) and P1CT (n = 42), respectively. There were differing patterns of DILI with significant worsening of total bilirubin in subjects on HDCT, and worsening of alanine aminotransferase (ALT) in subjects on P1CT. Cholestatic peak patterns of liver impairment (predominant increases in alkaline phosphatase rather than transaminases) were more frequent in HDCT. Criteria for Hy's law were met by 11 subjects on P1CT, but not by any subjects on HDCT. Disease progression was the most common reason for treatment discontinuation, followed by adverse events at similar frequencies in both HDCT and P1CT. CONCLUSIONS The differential effects on hepatotoxicity suggest that underlying hepatic function may affect susceptibility to and patterns of DILI. The incorporation of additional measures of hepatic function may help identify those at highest risk of hepatotoxicity in future trials because baseline liver tests did not. Clin Cancer Res; 22(22); 5472-9. ©2016 AACR.
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Affiliation(s)
| | - Michelle A Rudek
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Gary L Smith
- Clinical Trials Monitoring Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | - Pamela Jo Harris
- Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | - S Percy Ivy
- Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
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10
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Chemotherapy in the Setting of Severe Liver Dysfunction in Patients with Metastatic Colorectal Cancer. Case Rep Oncol Med 2015; 2015:420159. [PMID: 26090248 PMCID: PMC4454725 DOI: 10.1155/2015/420159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/06/2015] [Accepted: 04/08/2015] [Indexed: 11/24/2022] Open
Abstract
The liver is the dominant site of metastases for patients with metastatic colorectal cancer (mCRC). Depending on the timing of diagnosis and the biology of the disease, it is not uncommon for these patients to present with visceral crisis in the form of severe liver dysfunction. Treatment of these individuals is, however, difficult and challenging. The decision to consider chemotherapy in these dire circumstances entails consideration of numerous factors. If we were to focus on just the metabolism of the different drugs and biologic agents available to treat mCRC, both 5-fluorouracil and oxaliplatin alone or in combination with a monoclonal antibody are reasonable choices. Specifically, FOLFOX is a feasible and safe option in patients with mCRC with severe liver dysfunction. Choice of the biologic agent to add to the doublet chemotherapy could be individualized based on the RAS status and the clinical scenario. Based on the divergent experience of treating 2 cases and other prior reports, a summary of recommendations with a model in the form of a “therapeutic triad” is presented. The paper highlights the therapeutic challenges in patients with mCRC and severe liver dysfunction. The choice of chemotherapeutic agents and reports of other cases/series is also presented.
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11
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Abstract
Understanding core signaling pathways in hepatic carcinogenesis has brought about a new era in the management of hepatocellular carcinoma. Sorafenib was the first molecular targeted therapy to be approved for advanced hepatocellular carcinoma and is the benchmark for all other therapies. Cytotoxic chemotherapy remains the mainstay treatment of advanced cholangiocarcinoma and there are no US Food and Drug Administration-approved molecular targeted therapies. If clinicians are able to minimize the toxicity of therapy by targeting the driving mechanism of cell proliferation, they will be able to significantly improve the survival and quality of life of patients.
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Affiliation(s)
- Vincent Chung
- Department of Medical Oncology and Therapeutics Research, City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA.
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12
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Price TJ, Segelov E, Burge M, Haller DG, Tebbutt NC, Karapetis CS, Punt CJA, Pavlakis N, Arnold D, Gibbs P, Shapiro JD. Current opinion on optimal systemic treatment for metastatic colorectal cancer: outcome of the ACTG/AGITG expert meeting ECCO 2013. Expert Rev Anticancer Ther 2014; 14:1477-93. [PMID: 25138900 DOI: 10.1586/14737140.2014.949678] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The treatment of metastatic colorectal cancer has evolved greatly in the last 15 years, involving combined chemotherapy protocols and, in more recent times, new biologic agents. Clinical benefit from the use of targeted therapy with bevacizumab, aflibercept, cetuximab, panitumumab and regorafenib in the treatment of metastatic colorectal cancer is now well established with median overall survival accepted as over 24 months, and with super selection for extended RAS patients higher again. The optimal timing of treatment options requires careful consideration of predictive biomarkers, and importantly the potential for interactions, to derive the maximal benefit. A group of colorectal subspecialty medical oncologists from Australia, the USA, the Netherlands and Germany met during ECCO 2013 to discuss current practice. Subsequent new data from the American Society of Clinical Oncology were also reviewed. This article reviews the evidence discussed in support of modern treatments for colorectal cancer and the decision-making behind the treatment choices, with their benefits and risks.
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Affiliation(s)
- Timothy J Price
- The Queen Elizabeth Hospital, Adelaide Colorectal Tumour Group and University of Adelaide, Adeaide, Australia
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13
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Grigorian A, O'Brien CB. Hepatotoxicity Secondary to Chemotherapy. J Clin Transl Hepatol 2014; 2:95-102. [PMID: 26357620 PMCID: PMC4521265 DOI: 10.14218/jcth.2014.00011] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/06/2014] [Accepted: 05/22/2014] [Indexed: 12/20/2022] Open
Abstract
The difficult problem faced by multiple generation of practicing physicians is determining the cause of abnormal liver function tests in cancer patients on chemotherapy. Hepatotoxicity from chemotherapy occurs frequently from an unpredictable or idiosyncratic reaction. Despite remarkable advances in our understanding of the mechanisms of action, pharmacodynamics, and interrelationships between the liver and chemotherapy, the underlying etiology of hepatic toxicity for various agents remains unexplained. Here, we present a concise review of the broad differential diagnosis for abnormal liver function tests (LFTs) in oncology patients.
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Affiliation(s)
- Alla Grigorian
- Divisions of Liver and GI Transplantation, University of Miami School of Medicine, Miami, FL, USA
| | - Christopher B O'Brien
- Divisions of Liver and GI Transplantation, University of Miami School of Medicine, Miami, FL, USA
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14
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Chen AS, Solimando DA, Waddell JA. Gefitinib, Fluorouracil, Oxaliplatin, and Leucovorin (IFOX) Regimen for Colorectal Cancer. Hosp Pharm 2013; 48:905-11. [DOI: 10.1310/hpj4811-905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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15
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Price TJ, Segelov E, Burge M, Haller DG, Ackland SP, Tebbutt NC, Karapetis CS, Pavlakis N, Sobrero AF, Cunningham D, Shapiro JD. Current opinion on optimal treatment for colorectal cancer. Expert Rev Anticancer Ther 2013; 13:597-611. [PMID: 23617351 DOI: 10.1586/era.13.37] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The medical treatment of colorectal cancer (CRC) has evolved greatly in the last 10 years, involving complex combined chemotherapy protocols and, in more recent times, new biologic agents. Advances in adjuvant therapy have been limited to the addition of oxaliplatin and the substitution of oral fluoropyrimidine (e.g., capecitabine) for intravenous 5-fluorouracil with no evidence for improved outcome with biological agents. Clinical benefit from the use of the targeted monoclonal antibodies, bevacizumab, cetuximab and panitumumab, in the treatment of metastatic CRC is now well established, but the optimal timing of their use requires careful consideration to derive the maximal benefit. Evidence to date suggests potentially distinct roles for bevacizumab and EGF receptor-targeted biological agents (cetuximab and panitumumab) in the treatment of metastatic CRC. This article reviews the evidence in support of modern treatments for CRC and the decision-making behind the treatment choices, their benefits and toxicities.
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Affiliation(s)
- Timothy J Price
- The Queen Elizabeth Hospital, Adelaide Colorectal Tumour Group and University of Adelaide, Adelaide, South Australia, Australia.
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Peyrade F, Gastaud L, Ré D, Pacquelet-Cheli S, Thyss A. Treatment decisions for elderly patients with haematological malignancies: a dilemma. Lancet Oncol 2012; 13:e344-52. [DOI: 10.1016/s1470-2045(12)70234-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Geurs F, Vandewaeter S, Ponette S, Ponette J, Knape S, Demetter P. Successful and well-tolerated second line therapy with cetuximab, irinotecan, and raltitrexed in progressive liver disease due to metastatic colon cancer. J Gastrointest Cancer 2009; 39:26-8. [PMID: 19418267 DOI: 10.1007/s12029-009-9060-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 03/18/2009] [Indexed: 10/20/2022]
Affiliation(s)
- F Geurs
- Department of Oncology, RZ Sint-Maria, Halle, Belgium.
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18
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Abstract
The liver is fundamentally important in drug metabolism. In oncology, the astute clinician must not only understand the meaning and limitations of commonly ordered liver biochemical tests, but also be aware of which anticancer agents might induce liver dysfunction, and of the strategies for appropriate dosing of patients with pre-existing liver dysfunction. In part I of our Review, we highlighted both the importance and inadequacies of identifying serum biochemical liver abnormalities in oncology; we also discussed a lack of routine formal investigation of liver function. We summarised chemotherapy-related hepatotoxicity and other causes of liver toxic effects in patients with cancer. Here in part II, we discuss trials that have specifically assessed chemotherapy dosing strategies in the setting of overt biochemical liver dysfunction and we note their recommendations. Furthermore, we review other assessments of liver metabolic and excretory function, particularly in the setting of chemotherapy drug handling. We discuss the potential use of these metabolic probes in practice.
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Affiliation(s)
- Kathryn M Field
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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19
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Field KM, Dow C, Michael M. Part I: Liver function in oncology: biochemistry and beyond. Lancet Oncol 2008; 9:1092-101. [DOI: 10.1016/s1470-2045(08)70279-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Nishihori T, Strazzabosco M, Saif MW. Incidence and management of colorectal cancer in liver transplant recipients. Clin Colorectal Cancer 2008; 7:260-6. [PMID: 18650194 DOI: 10.3816/ccc.2008.n.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Liver transplant recipients are at an increased risk of developing de novo malignancies because of the prolonged immunosuppression necessary to avoid acute and chronic rejections. Skin cancers and lymphoproliferative diseases are the most common malignancies, but the overall incidence of colon cancer in this patient population does differ from that of the general population. Therefore, colorectal cancer (CRC) is a major health concern in liver transplant recipients. Furthermore, there are unique subsets of liver transplant recipients, such as those with primary sclerosing cholangitis and inflammatory bowel disease, who are at an increased risk for developing CRC after liver transplantation and might require special screening/surveillance strategies. The similar principles for management of colon cancer can be applied to transplant recipients if the adjustment to maintain the need for the long-term immunosuppression is made. Colectomy can be performed safely during the posttransplantation period. Prophylactic colectomy at the time of liver transplantation has been performed in some patients at high risk or with known premalignant conditions. Chemotherapy with 5- fluorouracil and oxaliplatin has been used in transplant recipients for the treatment of metastatic CRC; however, further research is required to examine the safety, tolerability, and efficacy of combination chemotherapy and biologic agents in this patient population. This review summarizes the incidence, risk factors, diagnosis, and management of de novo CRC in liver transplant recipients.
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Affiliation(s)
- Taiga Nishihori
- Section of Medical Oncology, Yale University School of Medicine, New Haven, CT 06520, USA
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Uhm JE, Park JO, Lee J, Park YS, Park SH, Yoo BC, Paik SW, Koh KC, Kang WK, Lim HY. A phase II study of oxaliplatin in combination with doxorubicin as first-line systemic chemotherapy in patients with inoperable hepatocellular carcinoma. Cancer Chemother Pharmacol 2008; 63:929-35. [PMID: 18726098 DOI: 10.1007/s00280-008-0817-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 07/28/2008] [Indexed: 12/14/2022]
Abstract
PURPOSE We designed a phase II trial of the combination with oxaliplatin and doxorubicin for patients with unresectable HCC to evaluate the overall response rate (ORR) and the toxicity. METHODS Forty patients with inoperable, systemic chemotherapy naive HCC were enrolled. Finally, 32 patients received oxaliplatin (130 mg/m(2)) and doxorubicin (60 mg/m(2)) every 3 weeks. RESULTS Eighty-two treatment cycles were administered (median 2 cycles, range 1-6). There was no treatment-related mortality. The ORR was 15.6% (95% CI, 3.3-28.7) with five partial responses. The median overall survival and median overall progression free survival were 31 weeks (95% CI, 22-40 weeks) and 12 weeks (95% CI, 5-19 weeks). Nausea and peripheral neuropathy were most frequent non-hematologic toxicities (nausea, n = 15; peripheral neuropathy, n = 10). The most frequent grade 3-4 hematologic adverse event was neutropenia (14 of 82 cycles) including three cases of febrile neutropenia. CONCLUSIONS The combination of oxaliplatin and doxorubicin showed modest activity and a tolerable toxicity profile in advanced HCC patients.
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Affiliation(s)
- Ji Eun Uhm
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
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22
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Abstract
This abbreviated review outlines the physiologic changes associated with aging, and examines how these changes may affect the pharmacokinetics and pharmacodynamics of anticancer therapies. We also provide an overview of studies that have been conducted evaluating the pharmacology of anticancer therapies in older adults, and issue a call for further research.
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Affiliation(s)
- A Hurria
- The Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA.
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Ramanathan RK, Egorin MJ, Takimoto CH, Remick SC, Doroshow JH, LoRusso PA, Mulkerin DL, Grem JL, Hamilton A, Murgo AJ, Potter DM, Belani CP, Hayes MJ, Peng B, Ivy SP. Phase I and Pharmacokinetic Study of Imatinib Mesylate in Patients With Advanced Malignancies and Varying Degrees of Liver Dysfunction: A Study by the National Cancer Institute Organ Dysfunction Working Group. J Clin Oncol 2008; 26:563-9. [DOI: 10.1200/jco.2007.11.0304] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To develop dosing guidelines and to evaluate the pharmacokinetics of imatinib in patients with liver dysfunction (LD). Patients and Methods Patients (N = 89) with varying solid tumors and liver function were stratified into four groups according to serum total bilirubin and AST and were treated with escalating doses of imatinib. Plasma and urine were assayed for concentrations of imatinib and its active metabolite, CGP74588 . Results In the mild LD group, dose-limiting toxicity, specifically nausea/vomiting and fatigue, occurred in two patients at the 600 mg/d dose level. In the moderate and severe LD groups, the maximal dose evaluated was 300 mg/d. Grade 3 to 4 toxicities consisted primarily of liver function test elevations (24%), nausea/vomiting (10%), fatigue (6%), and edema (5%). After the first imatinib dose, the mean (± SD) dose-normalized areas under the plasma concentration-time curve from time 0 to infinity (AUC0-∞) were 162 ± 155, 171 ± 72, 182 ± 157, and 185 ± 172 (μg/mL × h)/mg for normal, mild, moderate, and severe LD groups, respectively. Renal excretion of imatinib was less than 10% of the total dose in all groups. Conclusion Imatinib exposure (as measured by the dose-normalized AUC) did not differ between patients with normal liver function and those with LD. The maximal recommended dose of imatinib for patients with mild LD is 500 mg/d. Dosing guidelines for patients with moderate and severe LD remain undetermined.
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Affiliation(s)
- Ramesh K. Ramanathan
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
| | - Merrill J. Egorin
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
| | - Chris H.M. Takimoto
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
| | - Scot C. Remick
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
| | - James H. Doroshow
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
| | - Patricia A. LoRusso
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
| | - Daniel L. Mulkerin
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
| | - Jean L. Grem
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
| | - Anne Hamilton
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
| | - Anthony J. Murgo
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
| | - Douglas M. Potter
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
| | - Chandra P. Belani
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
| | - Michael J. Hayes
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
| | - Bin Peng
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
| | - S. Percy Ivy
- From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine; the Biostatistics Department, University of Pittsburgh Graduate School of Public Health; and the Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA; the University of Texas, San Antonio, TX; Case Western Reserve University, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Wayne State University, Detroit, MI; the University of Wisconsin Paul P
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Superfin D, Iannucci AA, Davies AM. Commentary: Oncologic drugs in patients with organ dysfunction: a summary. Oncologist 2007; 12:1070-83. [PMID: 17914077 DOI: 10.1634/theoncologist.12-9-1070] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
There are few prospective data regarding the pharmacokinetics and clinical toxicity of commonly used chemotherapeutics in cancer patients with organ dysfunction. Although increasing numbers of studies are investigating newer chemotherapeutics in patients with liver or kidney dysfunction, most guidelines for dosing, especially for established agents, remain empiric. This review describes the available data (both prospective and case study) evaluating the impact of renal and hepatic dysfunction on toxicity and dosing of commonly used chemotherapeutics and provides a practical summary for their use in this setting.
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Affiliation(s)
- Diana Superfin
- University of California Davis Cancer Center, 4501 X Street, Sacramento, California 95817, USA
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Abstract
Significant advances in the treatment of colorectal cancer have been observed over the past several years. With the introduction of oxaliplatin combined with infusional 5-fluorouracil and leucovorin, survival for patients with metastatic colorectal cancer has nearly doubled. The incorporation of biologic agents that target angiogenesis (bevacizumab) and tumor growth pathways (cetuximab, panitumimab) extends survival even further, in addition to increasing response rates in patients with metastatic disease. The benefit of these newer drugs is also being realized in the adjuvant setting, where the addition of oxaliplatin to infusional 5-fluorouracil and leucovorin has led to improvements in 3-year disease-free survival. Future challenges with the use of oxaliplatin include defining strategies to optimize its use while avoiding treatment-limiting neurotoxicity and identification of markers predictive of response.
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Affiliation(s)
- George P Kim
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32082, USA.
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Baur M, Drescher A, Gneist M, Dittrich C, Jaehde U. Pharmacokinetics of oxaliplatin in patients with severe hepatic dysfunction. Cancer Chemother Pharmacol 2007; 61:97-104. [PMID: 17396265 DOI: 10.1007/s00280-007-0452-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Accepted: 02/27/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE Data are lacking on the pharmacokinetics of oxaliplatin in patients with severe hepatic dysfunction. The aim of this study was to determine the pharmacokinetic parameters of platinum after administration of oxaliplatin in cancer patients with severe hepatic impairment due to extended metastases into the liver. PATIENTS AND METHODS Two female breast cancer patients and one male colon cancer patient were treated with oxaliplatin monotherapy at 130 mg/m(2) given as a 3-h intravenous infusion. The patients exhibited bilirubin concentrations of 9.6, 22.5 and 41.1 mg/dl indicating severe hepatic dysfunction. Serial blood samples were collected immediately before treatment, and at fixed intervals up to 27 h after start of therapy. Platinum concentrations in plasma, ultrafilterable plasma, and whole blood were determined using a validated flameless atomic absorption spectrometry (FAAS) method. Pharmacokinetic data analysis was performed assuming a two-compartment model. Individual pharmacokinetic parameters were compared with a reference population with normal hepatic function. RESULTS The area under the curve (AUC from 0 to infinity) as well as the elimination half-life of platinum in ultrafilterable plasma were substantially increased and clearance accordingly decreased in the three patients with severe hepatic dysfunction. In plasma and whole blood, the deviations from the reference population were less pronounced. However, partial AUC from 0 up to 2 h after end of infusion reflecting better the exposure with cytotoxic platinum species was not different or only slightly altered. Moreover, no acute oxaliplatin-associated neurotoxicity was observed. CONCLUSIONS The comparable platinum exposure early after administration in conjunction with the lack of acute toxicity do not support a dose reduction of oxaliplatin in patients with markedly elevated bilirubin concentrations. However, a larger number of patients must be examined before valid dose recommendations can be derived.
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Affiliation(s)
- Martina Baur
- Applied Cancer Research-Institution for Translational Research Vienna (ACR-ITR VIEnna), Vienna, Austria
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Hwang SJ, Park JW, Lee SD, Kim GJ, Sin CH, Nam SH, Kim BS. Capecitabine and oxaliplatin (XELOX) for the treatment of patients with metastatic gastric cancer and severe liver dysfunction. Korean J Intern Med 2006; 21:252-5. [PMID: 17249509 PMCID: PMC3891032 DOI: 10.3904/kjim.2006.21.4.252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [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
Gastric cancer patients with severe liver dysfunction secondary to hepatic metastases have limited treatment options. Most cytotoxic drugs have a narrow therapeutic index. Although both capecitabine and oxaliplatin have been well tolerated as single agents for patients with severe hepatic dysfunction, the combination of these drugs has not been investigated. We report here on a case of successful treatment of a patient suffering with severe liver dysfunction and metastatic gastric cancer; the patient was treated with a combination of capecitabine and oxaliplatin (XELOX). The initial bilirubin level of the patient was 10.9 mg/dL. After two cycles of treatment, his bilirubin level decreased to 2.1 mg/dL. He has experienced an excellent radiological response and he has received six cycles of XELOX chemotherapy. XELOX chemotherapy is feasible and it can be associated with positive outcomes for the patients suffering with metastatic gastric cancer and severe liver dysfunction.
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Affiliation(s)
- Seung Jae Hwang
- Department of Internal Medicine, Seoul Veterans Hospital, Seoul, Korea
| | - Jong Won Park
- Department of Internal Medicine, Seoul Veterans Hospital, Seoul, Korea
| | - Sehe Dong Lee
- Department of Internal Medicine, Seoul Veterans Hospital, Seoul, Korea
| | - Gyong Jung Kim
- Department of Internal Medicine, Seoul Veterans Hospital, Seoul, Korea
| | - Cheol Ho Sin
- Department of Internal Medicine, Seoul Veterans Hospital, Seoul, Korea
| | - Seung-Hyun Nam
- Department of Internal Medicine, Seoul Veterans Hospital, Seoul, Korea
| | - Bong-Seog Kim
- Department of Internal Medicine, Seoul Veterans Hospital, Seoul, Korea
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Shibata S, Chow W, Frankel P, Juhasz A, Leong L, Lim D, Margolin K, Morgan R, Newman E, Somlo G, Yen Y, Synold T, Gandara D, Lenz HJ, Doroshow J. A phase I study of oxaliplatin in combination with gemcitabine: correlation of clinical outcome with gene expression. Cancer Chemother Pharmacol 2006; 59:549-57. [PMID: 17051371 DOI: 10.1007/s00280-006-0297-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 07/19/2006] [Indexed: 12/27/2022]
Abstract
PURPOSE Oxaliplatin has in vitro activity similar to or higher than other platinum agents. Preclinically, gemcitabine has demonstrated synergy when combined with platinum compounds. These facts formed the rationale for determining the maximum tolerated dose (MTD) of gemcitabine in combination with oxaliplatin. METHODS Eligible patients with advanced incurable solid tumors were given oxaliplatin 130 mg/m2 as a 2-h infusion on day 1 followed by escalating doses of gemcitabine given over 30 min on day 1 and 8 of a 21-day cycle. RESULTS A total of 43 patients were enrolled, including 30 patients at the MTD in an expanded cohort. At a gemcitabine dose of 800 mg/m2, 1/6 patients had a dose limiting toxicity (DLT) (grade 3 blurred vision and memory loss). At 1,000 mg/m2, 1/6 patients had a DLT (grade 3 increase in AST). At 1,200 mg/m2, 2/3 patients had a DLT (grade 4 thrombocytopenia and grade 3 confusion). The MTD of gemcitabine with 130 mg/m2 of oxaliplatin was therefore 1,000 mg/m2. The clearances of gemcitabine and ultrafilterable platinum are within the ranges previously reported for single agents. A patient with colon cancer had a partial response, and 21 patients had a best response of stable disease. In patients with tumor biopsies treated at the MTD, decreased ribonucleotide reductase M2 expression correlated with response. CONCLUSION Treatment with gemcitabine and oxaliplatin was well tolerated with primarily hematologic toxicity at the MTD. Study of biochemical correlates of response remain of interest thought current results remain exploratory.
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Affiliation(s)
- Stephen Shibata
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
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Siegel-Lakhai WS, Crul M, De Porre P, Zhang S, Chang I, Boot H, Beijnen JH, Schellens JHM. Clinical and Pharmacologic Study of the Farnesyltransferase Inhibitor Tipifarnib in Cancer Patients With Normal or Mildly or Moderately Impaired Hepatic Function. J Clin Oncol 2006; 24:4558-64. [PMID: 17008695 DOI: 10.1200/jco.2006.05.8123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This study explored the feasibility of treating patients with impaired hepatic function with tipifarnib. The safety profile, pharmacokinetics, and relationship between the pharmacokinetics and toxicities were evaluated. Patients and Methods Patients with mildly or moderately impaired hepatic function (Child-Pugh classification) were treated with tipifarnib bid on days 1 to 5 of cycle 1. Further dosing was based on the individual day 5 pharmacokinetic data and absolute neutrophil count. For patients with normal hepatic function, tipifarnib was dosed on days 1 to 14, followed by 1 week of rest. For all patients, in subsequent cycles, tipifarnib was administered for 21 consecutive days out of every 28 days. Results Twenty-eight patients were included in the normal (n = 16), mild (n = 9), and moderate (n = 3) impairment groups. The most important grade 3 to 4 hematologic toxicity was leukocytopenia/neutropenia, which was mostly observed in patients with moderate impairment. Common nonhematologic toxicities were fatigue, nausea, and vomiting. The pharmacokinetic data showed higher plasma concentrations of tipifarnib in patients with liver impairment compared with patients with normal hepatic function. Conclusion In patients with mildly impaired hepatic function, tipifarnib can be administered safely at a starting dose of 200 mg bid, but it is not safe to treat patients with moderate hepatic impairment.
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Fu S, Kavanagh JJ, Hu W, Bast RC. Clinical application of oxaliplatin in epithelial ovarian cancer. Int J Gynecol Cancer 2006; 16:1717-32. [PMID: 17009963 DOI: 10.1111/j.1525-1438.2006.00654.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Platinum remains the most active drug class in ovarian cancer treatment; however, new single-agent and combination therapies are needed to improve the clinical outcome of ovarian cancer therapies. Oxaliplatin, a third-generation platinum derivative, has shown effective antitumor activity and a favorable toxicity profile in epithelial ovarian cancer. Preclinical evidence of the synergistic cytotoxic effect of oxaliplatin in combination with several other chemotherapeutic agents and clinical evidence of the absence of any dose-limiting hematologic toxicity associated with this agent have made oxaliplatin an attractive compound for combination agent therapy. This article reviews the current status of the clinical application of oxaliplatin alone and in a combination regimen in epithelial ovarian cancer treatment.
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Affiliation(s)
- S Fu
- Department of Gynecologic Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX 77230-1439, USA.
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Honecker FU, Brümmendorf TH, Klein O, Bokemeyer C. Safe use of oxaliplatin in a patient with metastatic breast cancer and combined renal and hepatic failure. Oncol Res Treat 2006; 29:273-5. [PMID: 16783902 DOI: 10.1159/000093032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Oxaliplatin has shown activity in several malignancies. In patients with normal renal function, 40-50% of the drug is renally excreted. Increased platinum exposure in patients with impaired renal function is not associated with increased toxicity, and patients with hepatic dysfunction did not show altered clearance of oxaliplatin. No data is available regarding safety of oxaliplatin in patients with combined renal and hepatic dysfunction. CASE REPORT A 64-year-old chemotherapy-naïve woman with metastatic breast cancer was admitted with dyspnea, jaundice, massive peripheral edema and combined renal and hepatic failure. After correction of fluid and electrolyte imbalances, weekly oxaliplatin 50 mg/m2 was started. RESULTS Within 5 weeks of treatment, the performance status improved significantly. Normalization of renal function and improvement of liver function was achieved. Apart from anemia, no toxicities > grade I were observed. After 6 cycles, the patient's condition deteriorated again, with signs of progressive disease. The overall status of the patient declined, and chemotherapy was stopped. CONCLUSION Weekly doses of oxaliplatin could be safely administered to a patient with metastatic breast cancer and combined hepatic and renal failure, achieving a good, albeit transient palliative effect.
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Affiliation(s)
- Friedemann U Honecker
- Zentrum für Innere Medizin, Medizinische Klinik und Poliklkinik, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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Kummar S, Gutierrez M, Doroshow JH, Murgo AJ. Drug development in oncology: classical cytotoxics and molecularly targeted agents. Br J Clin Pharmacol 2006; 62:15-26. [PMID: 16842375 PMCID: PMC1885070 DOI: 10.1111/j.1365-2125.2006.02713.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Accepted: 04/26/2006] [Indexed: 11/29/2022] Open
Abstract
There is an apparent need to improve the speed and efficiency of oncological drug development. Furthermore, strategies traditionally applied to the development of standard cytotoxic chemotherapy may not be appropriate for molecularly targeted agents. This is particularly the case for exploratory Phase 1 and 2 trials. Conventional approaches to determine dose based on maximum tolerability and efficacy based on objective tumour response may not be suitable for targeted agents, since many of them have a wide therapeutic index and inhibit tumour growth without demonstrable cytotoxicity. Instead, exploratory trials of targeted agents may have to focus on other end-points such as pharmacological effects and disease stabilization. Thus, there is an increasing interest in making the best possible use of biomarkers and pharmacogenomics in early phases of drug development.
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Affiliation(s)
- Shivaani Kummar
- Medical Oncology Branch, Center for Cancer Research and Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
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Silva MA, Jambulingam PS, Mirza DF. Colorectal cancer after orthotopic liver transplantation. Crit Rev Oncol Hematol 2005; 56:147-53. [PMID: 16140543 DOI: 10.1016/j.critrevonc.2004.12.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Revised: 11/25/2004] [Accepted: 12/14/2004] [Indexed: 01/28/2023] Open
Abstract
There is an increased incidence of de novo malignancies in post-liver transplant patients, commonly associated with chronic viral infection comprising lymphoproliferative disease and skin cancers, including squamous cell carcinoma and Kaposi's sarcoma. The overall incidence of colorectal cancer however in this population seems to be no different to the age and sex matched general population. In identified high risk patients like those with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD), the incidence of colorectal cancer appears to be higher. In IBD, like other pre-malignant conditions, the risk of developing malignancy increases exponentially with time, raising the question of whether the apparent increase in the incidence of colorectal cancer is the result of liver transplantation and immunosuppression or due to the natural history of IBD. For these PSC recipients, pre-transplant screening with colonoscopy and post-transplant surveillance for malignant change in the large bowel is crucial. The behaviour of inflammatory bowel disease post-liver transplant is largely unpredictable despite immunosuppression. Colorectal cancer when it occurs in the post-liver transplant patient should be managed according to current guidelines, stage for stage as for the population in general coupled with reduction in immunosuppression treatment.
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Affiliation(s)
- Michael A Silva
- The Liver Unit, 3rd Floor, Nuffield House, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham B15 2TH, UK
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Magagnoli M, Masci G, Castagna L, Bramanti S, Morenghi E, Carnaghi C, Santoro A. High incidence of haemostatic interference in cancer patients treated with FOLFOX regimen and concomitant minidose of warfarin. Br J Haematol 2005; 129:709-10. [PMID: 15916696 DOI: 10.1111/j.1365-2141.2005.05523.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Moussavian P, Solimando DA, Waddell JA. Capecitabine plus Oxaliplatin (XelOx/CapOx) Regimen for Colorectal Cancer. Hosp Pharm 2005. [DOI: 10.1177/001857870504000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases.
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Affiliation(s)
- Parvaneh Moussavian
- Oncology Pharmacist, Hematology-Oncology Pharmacy Service, Department of Pharmacy, Walter Reed Army Medical Center, Washington, DC
| | - Dominic A. Solimando
- Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203
| | - J. Aubrey Waddell
- Oncology Pharmacy Residency Program, Department of Pharmacy, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Rm 2P02, Washington, DC 20307
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Grothey A, Goldberg RM. A review of oxaliplatin and its clinical use in colorectal cancer. Expert Opin Pharmacother 2005; 5:2159-70. [PMID: 15461551 DOI: 10.1517/14656566.5.10.2159] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Colorectal cancer is one of the leading causes of death from malignant diseases in the Western world. Worldwide, approximately 50% of patients who present with colorectal cancer will develop metastatic disease and eventually die from this malignancy. Recently, significant advances have been made in the medical treatment of advanced colorectal cancer with the introduction of novel cytotoxic drugs, such as irinotecan and oxaliplatin. Based on the results of recent Phase III trials, combination regimens of infusional 5-fluorouracil/leucovorin and oxaliplatin (FOLFOX) have emerged as a new standard of care in the palliative and adjuvant treatment of colorectal cancer. The addition of biological agents targeting angiogenesis or oncogenes such as epidermal growth factor receptor (EGFR) to FOLFOX will conceivably further enhance the activity of treatment regimens. Making use of all available active therapeutic options in the course of disease has significantly improved median overall survival of metastatic colorectal cancer into a chronic disease, with implications for treatment strategies and pharmacoeconomic considerations.
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Waddell JA, Russell M, Solimando DA. Leucovorin, Fluorouracil, and Oxaliplatin (FOLFOX 4) Regimen for Colorectal Cancer. Hosp Pharm 2005. [DOI: 10.1177/001857870504000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the US Department of the Army or the Department of Defense.
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Affiliation(s)
- J. Aubrey Waddell
- Oncology Pharmacy Residency Program, Department of Pharmacy, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Rm 2P02, Washington, D.C
| | - Martin Russell
- Doctor of Pharmacy candidate at the University of Maryland School of Pharmacy
| | - Dominic A. Solimando
- Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203
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Fakih MG. 5-fluorouracil leucovorin and oxaliplatin (FOLFOX) in the treatment of metastatic colon cancer with severe liver dysfunction. Oncology 2004; 67:222-4. [PMID: 15557782 DOI: 10.1159/000081321] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2003] [Accepted: 03/11/2004] [Indexed: 12/31/2022]
Abstract
Colon cancer patients with severe hepatic dysfunction secondary to liver metastases have limited treatment options. 5-Fluorouracil (5-FU) infusional therapy has been attempted, but data suggesting significant clinical benefit are lacking. Although both 5-FU and oxaliplatin have been well tolerated as single agents in patients with severe hepatic dysfunction, the combination of these drugs in this setting has not been investigated. We report on three patients with severe liver dysfunction secondary to metastatic colon cancer treated with a combination of 5-FU, oxaliplatin, and leucovorin (FOLFOX). All three patients tolerated chemotherapy well without any significant toxicity. Liver function tests improved within 2 weeks from the start of treatment. Clinical outcomes consisted of two partial responses and one disease stabilization. Two patients progressed after 4 and 7 months from FOLFOX initiation while treatment is ongoing in the third patient. FOLFOX chemotherapy is feasible and can be associated with positive outcomes in patients with metastatic colon cancer and severe hepatic dysfunction. This regimen should be investigated further in similar clinical settings.
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