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Chan A, Song M, De Guzman Langit MR, Lim TA, Fong W, Tay K, Lim ST, Tang T. Carotid artery inflammation associated with gemcitabine-based therapy: a special report. Future Oncol 2015. [DOI: 10.2217/fon.15.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Vasculitis is an inflammation that can present as acute or chronic in nature, which causes changes in the walls of blood vessels, including thickening, weakening, narrowing and scarring. Gemcitabine, an antimetabolite chemotherapeutic agent, is generally well tolerated with a favorable side effect profile. However, there is increasing evidence that it is associated with vasculitis, which can affect small and large vessels. In this case report, we report a patient who has experienced fever with severe tenderness over right carotid artery, which occurred on the fifth day after the administration of gemcitabine. The exact mechanism of gemcitabine-induced vasculitis is unknown but cessation of gemcitabine and initiation of anti-inflammatory treatment appears to aid in the resolution of the clinical syndrome.
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Affiliation(s)
- Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore
- Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - Mingjun Song
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610
| | | | - Teh Aun Lim
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Warren Fong
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore
| | - Kevin Tay
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610
| | - Tiffany Tang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610
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Keskin S, Tas F, Ekenel M, Kilic L, Sen F, Yildiz I, Karabulut S, Ciftci R, Vatansever S. Biweekly triplet chemotherapy with gemcitabine, cisplatin and vinorelbine for advanced chemotherapy naïve non-small cell lung cancer. TUMORI JOURNAL 2013; 99:463-8. [DOI: 10.1177/030089161309900404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background To investigate the efficacy and tolerability of biweekly scheduled triplet chemotherapy consisting of gemcitabine, cisplatin and vinorelbine for chemotherapy-naïve advanced non-small cell lung cancer. Methods and study design Patients with stage IIIB/IV non-small cell lung cancer and performance status of 0–2 were eligible. Patients who had brain metastasis and of an older age were also enrolled in the study. The triplet combination chemotherapy consisted of gemcitabine, cisplatin and vinorelbine at the doses of 1000 mg/m2, 25 mg/m2 and 50 mg/m2, respectively, were administered on day 1 and 14, every 28 days, up to 6 cycles. Results Thirty patients were enrolled in the study. Median age was 60 years (range, 42–74). Most of the patients (83%) had metastatic disease and 7 patients (23%) had brain metastasis. In assessing 24 patients for response evaluation, none had complete response. Partial responses were achieved in 18 (60%) patients. Four patients (13%) had stable disease and 2 (7%) progressed. Thirteen percent and 20% of the patients developed severe (grade 3–4) neutropenia and anemia, respectively. Febrile neutropenia, severe thrombocytopenia, hepatic and renal toxicity were not seen. Overall and progression-free survival were 8.15 and 7.15 months, respectively. Patients who had no brain metastasis (P = 0.069), who had more than 3 courses of chemotherapy (P <0.001), and who had chemotherapy applied without dose reduction (P = 0.018) had better survivals. Conclusions The biweekly schedule of the triplet chemotherapy combination including gemcitabine, cisplatin and vinorelbine was effective in advanced, mostly metastatic non-small cell lung cancer with acceptable and manageable side effects.
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Affiliation(s)
- Serkan Keskin
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Faruk Tas
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Meltem Ekenel
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Leyla Kilic
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Fatma Sen
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Ibrahim Yildiz
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Senem Karabulut
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Rumeysa Ciftci
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Sezai Vatansever
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
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Hosokawa A, Nakashima T, Ogawa Y, Kozawa K, Kiba T. Coadministration of 5% glucose solution relieves vascular pain in the patients administered gemcitabine immediately. J Oncol Pharm Pract 2012; 19:190-2. [PMID: 22733838 DOI: 10.1177/1078155212449679] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kleinschmidt-DeMasters BK, Damek DM. The imaging and neuropathological effects of Bevacizumab (Avastin) in patients with leptomeningeal carcinomatosis. J Neurooncol 2009; 96:375-84. [DOI: 10.1007/s11060-009-9969-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 07/06/2009] [Indexed: 11/28/2022]
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Trédaniel J, Becht C, Bekradda M, De Cremoux H, Alexandre J, Chomy F, Szyldergemajn S, Yataghene Y, Culine S. An open phase II trial of gemcitabine, oxaliplatin and vinorelbine combination as first-line therapy in advanced non-small cell lung cancer patients. Lung Cancer 2008; 63:259-63. [PMID: 18635285 DOI: 10.1016/j.lungcan.2008.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 05/23/2008] [Accepted: 05/29/2008] [Indexed: 01/03/2023]
Abstract
The purpose of this multicentric Phase II study was to evaluate the safety and efficacy of a gemcitabine/oxaliplatin/vinorelbine combination as first-line therapy in advanced non-small cell lung cancer patients. Patients followed a fortnightly drug schedule, receiving on day 1, vinorelbine 25mg/m(2) (20-min infusion); gemcitabine 700 mg/m(2) (70-min infusion, fixed 10mg/m(2)/min); and on day 2, oxaliplatin 85 mg/m(2) (2-h infusion). Thirty-nine patients with a median age of 58 years received a total of 306 cycles (median 8 cycles); 67% were males. Most had adenocarcinoma (51%), large-cell (23%) and squamous cell carcinoma (21%); 15% had stage IIIB and 85% stage IV. There was one complete response (3%; 95% CI: 0.1-13%), 15 partial responses (PR) (38%; 95% CI: 23-55%), and 13 patients with stable disease (33%; 95% CI: 19-50%) of at least 2 months duration, for an overall non-progression rate of 74%. Median progression-free survival (PFS) was 4.1 months (95% CI: 3.1-8.7) and overall survival was 11.7 months (95% CI: 7.7-19.4). No treatment-related deaths occurred and very few grade 3-4 events were observed. Overall, the regimen was well tolerated and the planned recommended dose intensity was safely delivered to more than 95% of patients. This triple combination therapy study yielded favourable efficacy and toxicity results, which merit further evaluation in prospective randomised trials.
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Affiliation(s)
- J Trédaniel
- Hôpital Saint-Louis, Service d'Oncologie Médicale, Paris, France.
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Giaccone G, Smit E. Lung cancer. ACTA ACUST UNITED AC 2005; 22:413-42. [PMID: 16110623 DOI: 10.1016/s0921-4410(04)22019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Giuseppe Giaccone
- Division of Medical Oncology, Vrijie Universiteit Medical Center, Amsterdam and Martini Hospital , Groningnen, Amsterdam, The Netheslands.
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Chen YM, Perng RP, Shih JF, Tsai CM, Whang-Peng J. A randomized phase II study of vinorelbine plus gemcitabine with/without cisplatin against inoperable non-small-cell lung cancer previously untreated. Lung Cancer 2005; 47:373-80. [PMID: 15713520 DOI: 10.1016/j.lungcan.2004.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Revised: 08/09/2004] [Accepted: 08/18/2004] [Indexed: 11/22/2022]
Abstract
Phase II studies have suggested that vinorelbine (V) plus gemcitabine (G) treatment has a similar response rate and better toxicity profile than cisplatin-based combination chemotherapy in non-small-cell lung cancer (NSCLC). Our aim was to evaluate whether or not the addition of cisplatin (P) to a VG regimen increases the efficacy or toxicities in chemo-naive inoperable NSCLC patients. From April 2002 to October 2003, 86 patients were enrolled. The treatment dose was V 20 mg/m2 plus G 800 mg/m2 intravenous infusion (i.v.) on days 1, 8 and 15, with/without P 60 mg/m2 i.v. on day 15, every 4 weeks. The efficacy and toxicity of the treatment were recorded. In all, 125 cycles of VG and 178 cycles of VGP were given to the patients in the VG and VGP arms, respectively (P = 0.001). The median cycle of treatment was three in the VG arm and five in the VGP arm. There were 10 partial responses (overall 23.3%) in the VG arm and 1 complete response and 19 partial responses (overall 46.5%) in the VGP arm (P = 0.022). Neutropenia, nausea, vomiting, and peripheral neuropathy were more common in the VGP arm (P = 0.023, 0.002, 0.025, 0.001, respectively). The Lung Cancer Symptom Scale showed no difference between the VG and VGP arms after two cycles of treatment or when the patient went off study. We concluded that the addition of P to VG treatment did increase both the tumor response rate and the toxicities. However, the toxicities were tolerable.
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Affiliation(s)
- Yuh-Min Chen
- Chest Department, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan, ROC.
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Barlési F, Villani P, Doddoli C, Gimenez C, Kleisbauer JP. Gemcitabine-induced severe pulmonary toxicity. Fundam Clin Pharmacol 2004; 18:85-91. [PMID: 14748759 DOI: 10.1046/j.0767-3981.2003.00206.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Gemcitabine is a relatively new deoxycytidine analog (2',2'-difluorodeoxycytidine) with structural similarities to cytosine arabinoside (Ara-C). Activity of gemcitabine is demonstrated in the treatment of many solid tumors, like pancreas, ovarian and nonsmall cell lung cancer (NSCLC). Although gemcitabine is considered as a drug with a good safety profile, cases of gemcitabine-induced severe pulmonary toxicity (GISPT) were reported as for Ara-C. We performed a systematic review of reported cases on the GISPT. Twenty-nine clinical trials especially interesting NSCLC patients (21) and 21 reported cases recording 40 patients were analyzed. The incidence of the GISPT varies from 0 to 5%. The clinical presentation is a subacute clinical syndrome and is frequently nonspecific. The predominant radiographic pattern on chest X-ray are reticulo-nodular interstitial infiltrates. It was postulated that the physio-pathological mechanism of the GISPT was an inflammatory reaction of the alveolar capillary wall cytokine-mediated, which created an abnormal permeability of its membrane. After the differential diagnosis were ruled out, the discontinuation of the drug and the early initiation of steroids and diuretics are the most frequently performed treatments. Under these conditions, the outcome was favorable in a delay of few days generally for a majority of patients but 20% of patients died. Some risk factors, as a previous pulmonary disease or a previous thoracic irradiation, for the occurrence of the GISPT were proposed. GISPT is rare but sometimes fatal. Its a necessity to increase awareness about it to enhanced an early and suitable management of patients developing such a toxicity after gemcitabine administration.
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Affiliation(s)
- Fabrice Barlési
- Département des Maladies Respiratoires, Faculty of Medicine, University de la Méditerranée (Aix-Marseille II), Assistance Publique-Hôpitaux de Marseille, France.
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