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Lim W, Moon S, Lee NR, Shin HG, Yu SY, Lee JE, Kim I, Ko KP, Park SK. Group I pharmaceuticals of IARC and associated cancer risks: systematic review and meta-analysis. Sci Rep 2024; 14:413. [PMID: 38172159 PMCID: PMC10764325 DOI: 10.1038/s41598-023-50602-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
We aimed to summarize the cancer risk among patients with indication of group I pharmaceuticals as stated in monographs presented by the International Agency for Research on Cancer working groups. Following the PRISMA guidelines, a comprehensive literature search was conducted using the PubMed database. Pharmaceuticals with few studies on cancer risk were identified in systematic reviews; those with two or more studies were subjected to meta-analysis. For the meta-analysis, a random-effects model was used to calculate the summary relative risks (SRRs) and 95% confidence intervals (95% CIs). Heterogeneity across studies was presented using the Higgins I square value from Cochran's Q test. Among the 12 group I pharmaceuticals selected, three involved a single study [etoposide, thiotepa, and mustargen + oncovin + procarbazine + prednisone (MOPP)], seven had two or more studies [busulfan, cyclosporine, azathioprine, cyclophosphamide, methoxsalen + ultraviolet (UV) radiation therapy, melphalan, and chlorambucil], and two did not have any studies [etoposide + bleomycin + cisplatin and treosulfan]. Cyclosporine and azathioprine reported increased skin cancer risk (SRR = 1.32, 95% CI 1.07-1.62; SRR = 1.56, 95% CI 1.25-1.93) compared to non-use. Cyclophosphamide increased bladder and hematologic cancer risk (SRR = 2.87, 95% CI 1.32-6.23; SRR = 2.43, 95% CI 1.65-3.58). Busulfan increased hematologic cancer risk (SRR = 6.71, 95% CI 2.49-18.08); melphalan was associated with hematologic cancer (SRR = 4.43, 95% CI 1.30-15.15). In the systematic review, methoxsalen + UV and MOPP were associated with an increased risk of skin and lung cancer, respectively. Our results can enhance persistent surveillance of group I pharmaceutical use, establish novel clinical strategies for patients with indications, and provide evidence for re-categorizing current group I pharmaceuticals into other groups.
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Affiliation(s)
- Woojin Lim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, 03080, Republic of Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, 03080, Republic of Korea
| | - Sungji Moon
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, 03080, Republic of Korea
- Interdisciplinary Program in Cancer Biology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Na Rae Lee
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, 04933, Republic of Korea
| | - Ho Gyun Shin
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, 04933, Republic of Korea
| | - Su-Yeon Yu
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, 04933, Republic of Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, Seoul National University College of Human Ecology, Seoul, 08826, Republic of Korea
| | - Inah Kim
- Department of Occupational and Environmental Medicine, Hanyang University College of Medicine, Seoul, 04763, Republic of Korea
| | - Kwang-Pil Ko
- Clinical Preventive Medicine Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
- Cancer Research Institute, Seoul National University, Seoul, 03080, Republic of Korea.
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
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Li Z, Jin J, He W, Long W, Yu H, Gao X, Nakai K, Zou Q, Wei L. CoraL: interpretable contrastive meta-learning for the prediction of cancer-associated ncRNA-encoded small peptides. Brief Bioinform 2023; 24:bbad352. [PMID: 37861173 DOI: 10.1093/bib/bbad352] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/29/2023] [Accepted: 09/17/2023] [Indexed: 10/21/2023] Open
Abstract
NcRNA-encoded small peptides (ncPEPs) have recently emerged as promising targets and biomarkers for cancer immunotherapy. Therefore, identifying cancer-associated ncPEPs is crucial for cancer research. In this work, we propose CoraL, a novel supervised contrastive meta-learning framework for predicting cancer-associated ncPEPs. Specifically, the proposed meta-learning strategy enables our model to learn meta-knowledge from different types of peptides and train a promising predictive model even with few labeled samples. The results show that our model is capable of making high-confidence predictions on unseen cancer biomarkers with only five samples, potentially accelerating the discovery of novel cancer biomarkers for immunotherapy. Moreover, our approach remarkably outperforms existing deep learning models on 15 cancer-associated ncPEPs datasets, demonstrating its effectiveness and robustness. Interestingly, our model exhibits outstanding performance when extended for the identification of short open reading frames derived from ncPEPs, demonstrating the strong prediction ability of CoraL at the transcriptome level. Importantly, our feature interpretation analysis discovers unique sequential patterns as the fingerprint for each cancer-associated ncPEPs, revealing the relationship among certain cancer biomarkers that are validated by relevant literature and motif comparison. Overall, we expect CoraL to be a useful tool to decipher the pathogenesis of cancer and provide valuable information for cancer research. The dataset and source code of our proposed method can be found at https://github.com/Johnsunnn/CoraL.
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Affiliation(s)
- Zhongshen Li
- School of Software, Shandong University, Jinan 250101, China
- Joint SDU-NTU Centre for Artificial Intelligence Research (C-FAIR), Shandong University, Jinan 250101, China
| | - Junru Jin
- School of Software, Shandong University, Jinan 250101, China
- Joint SDU-NTU Centre for Artificial Intelligence Research (C-FAIR), Shandong University, Jinan 250101, China
| | - Wenjia He
- Computer Science Program, Computer, Electrical and Mathematical Sciences and Engineering Division (CEMSE), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
- Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - Wentao Long
- School of Software, Shandong University, Jinan 250101, China
- Joint SDU-NTU Centre for Artificial Intelligence Research (C-FAIR), Shandong University, Jinan 250101, China
| | - Haoqing Yu
- School of Software, Shandong University, Jinan 250101, China
- Joint SDU-NTU Centre for Artificial Intelligence Research (C-FAIR), Shandong University, Jinan 250101, China
| | - Xin Gao
- Computer Science Program, Computer, Electrical and Mathematical Sciences and Engineering Division (CEMSE), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
- Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - Kenta Nakai
- Department of Computational Biology and Medical Sciences, The University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa-shi, Chiba 277-8562, Japan
- Human Genome Center, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai Minato-ku, Tokyo 108-8639, Japan
| | - Quan Zou
- Institute of Fundamental and Frontier Sciences, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Leyi Wei
- School of Software, Shandong University, Jinan 250101, China
- Joint SDU-NTU Centre for Artificial Intelligence Research (C-FAIR), Shandong University, Jinan 250101, China
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Shen C, Zhang K, Yang J, Shi J, Yang C, Sun Y, Yang W. Association between metal(loid)s in serum and leukemia: a systematic review and meta-analysis. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2023; 21:201-213. [PMID: 37159736 PMCID: PMC10163180 DOI: 10.1007/s40201-023-00853-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/14/2023] [Accepted: 01/25/2023] [Indexed: 05/11/2023]
Abstract
Purpose Heavy metals and metalloids are recognized as environmental threats, which are considered highly toxic and carcinogenic. Epidemiologically, their association with leukemia is under debate. We aim to clarify the association between the heavy metal(loid)s in serum and leukemia via a systematic review and meta-analysis. Methods We searched PubMed, Embase, Google Scholar, and CNKI (China National Knowledge Infrastructure) databases for all related articles. The standardized mean difference and its 95% confidence interval was used to evaluate the association of leukemia with heavy metal(loid)s in serum. The statistical heterogeneity among studies was assessed with the Q-test and I 2 statistics. Results Among 4,119 articles related to metal(loid)s and leukemia, 21 studies met our inclusion criteria, which are all cross-sectional studies. These 21 studies involved 1,316 cases and 1,310 controls, based on which we evaluate the association of heavy metals/metalloids in serum with leukemia. Our results indicated positive differences for serum chromium, nickel, and mercury in leukemia patients, while a negative difference for serum manganese in acute lymphocytic leukemia (ALL). Conclusion Our results suggested an elevated trend of serum chromium, nickel, and mercury concentrations in leukemia patients while descending trend of serum manganese concentration in ALL patients. The result of sensitivity analysis between lead, cadmium, and leukemia and publication bias of association between chromium and leukemia also needed attention. Future research work may focus on the dose-response relationship between any of these elements and the leukemia risks, and further elucidation of how these elements are related to leukemia may shed light on the prevention and treatment of leukemia. Supplementary Information The online version contains supplementary material available at 10.1007/s40201-023-00853-2.
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Affiliation(s)
- Chengchen Shen
- Department of Physiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, 610041 Chengdu, Sichuan People’s Republic of China
| | - Kui Zhang
- Department of Forensic Pathology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, 610041 Chengdu, Sichuan People’s Republic of China
| | - Jingxuan Yang
- Department of Physiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, 610041 Chengdu, Sichuan People’s Republic of China
| | - Jingyi Shi
- Department of Physiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, 610041 Chengdu, Sichuan People’s Republic of China
| | - Chan Yang
- Department of Physiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, 610041 Chengdu, Sichuan People’s Republic of China
| | - Yanan Sun
- Department of Physiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, 610041 Chengdu, Sichuan People’s Republic of China
| | - Wenxing Yang
- Department of Physiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, 610041 Chengdu, Sichuan People’s Republic of China
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Deng LJ, Dong Y, Li MM, Sun CG. Co-existing squamous cell carcinoma and chronic myelomonocytic leukemia with ASXL1 and EZH2 gene mutations: A case report. World J Clin Cases 2023; 11:3643-3650. [PMID: 37383892 PMCID: PMC10294182 DOI: 10.12998/wjcc.v11.i15.3643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/07/2023] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Chronic myelomonocytic leukemia (CMML), a rare clonal hematopoietic stem cell disorder characterized by myelodysplastic syndrome and myeloproliferative neoplasms, has a generally poor prognosis, and easily progresses to acute myeloid leukemia. The simultaneous incidence of hematologic malignancies and solid tumors is extremely low, and CMML coinciding with lung malignancies is even rarer. Here, we report a case of CMML, with ASXL1 and EZH2 gene mutations, combined with non-small cell lung cancer (lung squamous cell carcinoma).
CASE SUMMARY A 63-year-old male, suffering from toothache accompanied by coughing, sputum, and bloody sputum for three months, was given a blood test after experiencing continuous bleeding resulting from a tooth extraction at a local hospital. Based on morphological results, the patient was diagnosed with CMML and bronchoscopy was performed in situ to confirm the diagnosis of squamous cell carcinoma in the lower lobe of the lung. After receiving azacitidine, programmed cell death protein 1, and platinum-based chemotherapy drugs, the patient developed severe myelosuppression and eventually fatal leukocyte stasis and dyspnea.
CONCLUSION During the treatment and observation of CMML and be vigilant of the growth of multiple primary malignant tumors.
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Affiliation(s)
- Lai-Jun Deng
- Department of Hematology, Weifang Hospital of Traditional Chinese Medicine, Weifang 261000, Shandong Province, China
| | - Yang Dong
- Department of Clinical Pharmacy, Weifang Hospital of Traditional Chinese Medicine, Weifang 261000, Shandong Province, China
| | - Mi-Mi Li
- Department of Pathology, Weifang Hospital of Traditional Chinese Medicine, Weifang 261000, Shandong Province, China
| | - Chang-Gang Sun
- Department of Hematology, Weifang Hospital of Traditional Chinese Medicine, Weifang 261000, Shandong Province, China
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Anand J, Chiou L, Sciandra C, Zhang X, Hong J, Wu D, Zhou P, Vaziri C. Roles of trans-lesion synthesis (TLS) DNA polymerases in tumorigenesis and cancer therapy. NAR Cancer 2023; 5:zcad005. [PMID: 36755961 PMCID: PMC9900426 DOI: 10.1093/narcan/zcad005] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/10/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
DNA damage tolerance and mutagenesis are hallmarks and enabling characteristics of neoplastic cells that drive tumorigenesis and allow cancer cells to resist therapy. The 'Y-family' trans-lesion synthesis (TLS) DNA polymerases enable cells to replicate damaged genomes, thereby conferring DNA damage tolerance. Moreover, Y-family DNA polymerases are inherently error-prone and cause mutations. Therefore, TLS DNA polymerases are potential mediators of important tumorigenic phenotypes. The skin cancer-propensity syndrome xeroderma pigmentosum-variant (XPV) results from defects in the Y-family DNA Polymerase Pol eta (Polη) and compensatory deployment of alternative inappropriate DNA polymerases. However, the extent to which dysregulated TLS contributes to the underlying etiology of other human cancers is unclear. Here we consider the broad impact of TLS polymerases on tumorigenesis and cancer therapy. We survey the ways in which TLS DNA polymerases are pathologically altered in cancer. We summarize evidence that TLS polymerases shape cancer genomes, and review studies implicating dysregulated TLS as a driver of carcinogenesis. Because many cancer treatment regimens comprise DNA-damaging agents, pharmacological inhibition of TLS is an attractive strategy for sensitizing tumors to genotoxic therapies. Therefore, we discuss the pharmacological tractability of the TLS pathway and summarize recent progress on development of TLS inhibitors for therapeutic purposes.
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Affiliation(s)
- Jay Anand
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, 614 Brinkhous-Bullitt Building, Chapel Hill, NC 27599, USA
| | - Lilly Chiou
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, 614 Brinkhous-Bullitt Building, Chapel Hill, NC 27599, USA
- Curriculum in Genetics and Molecular Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Carly Sciandra
- Department of Biochemistry, Duke University School of Medicine, Durham, NC 27710, USA
| | - Xingyuan Zhang
- Department of Biostatistics, University of North Carolina at Chapel Hill, 135 Dauer Drive, 3101 McGavran-Greenberg Hall, Chapel Hill, NC 27599, USA
| | - Jiyong Hong
- Department of Chemistry, Duke University, Durham, NC 27708, USA
| | - Di Wu
- Department of Biostatistics, University of North Carolina at Chapel Hill, 135 Dauer Drive, 3101 McGavran-Greenberg Hall, Chapel Hill, NC 27599, USA
| | - Pei Zhou
- Department of Biochemistry, Duke University School of Medicine, Durham, NC 27710, USA
| | - Cyrus Vaziri
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, 614 Brinkhous-Bullitt Building, Chapel Hill, NC 27599, USA
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6
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Xu J, Huang C, Wu Z, Xu H, Li J, Chen Y, Wang C, Zhu J, Qin G, Zheng X, Yu Y. Risk Prediction of Second Primary Malignancies in Primary Early-Stage Ovarian Cancer Survivors: A SEER-Based National Population-Based Cohort Study. Front Oncol 2022; 12:875489. [PMID: 35664751 PMCID: PMC9161780 DOI: 10.3389/fonc.2022.875489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aimed to characterize the clinical features of early-stage ovarian cancer (OC) survivors with second primary malignancies (SPMs) and provided a prediction tool for individualized risk of developing SPMs. Methods Data were obtained from the Surveillance, Epidemiology and End Results (SEER) database during 1998-2013. Considering non-SPM death as a competing event, the Fine and Gray model and the corresponding nomogram were used to identify the risk factors for SPMs and predict the SPM probabilities after the initial OC diagnosis. The decision curve analysis (DCA) was performed to evaluate the clinical utility of our proposed model. Results A total of 14,314 qualified patients were enrolled. The diagnosis rate and the cumulative incidence of SPMs were 7.9% and 13.6% [95% confidence interval (CI) = 13.5% to 13.6%], respectively, during the median follow-up of 8.6 years. The multivariable competing risk analysis suggested that older age at initial cancer diagnosis, white race, epithelial histologic subtypes of OC (serous, endometrioid, mucinous, and Brenner tumor), number of lymph nodes examined (<12), and radiotherapy were significantly associated with an elevated SPM risk. The DCA revealed that the net benefit obtained by our proposed model was higher than the all-screening or no-screening scenarios within a wide range of risk thresholds (1% to 23%). Conclusion The competing risk nomogram can be potentially helpful for assisting physicians in identifying patients with different risks of SPMs and scheduling risk-adapted clinical management. More comprehensive data on treatment regimens and patient characteristics may help improve the predictability of the risk model for SPMs.
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Affiliation(s)
- Jiaqin Xu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Chen Huang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Zhenyu Wu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Huilin Xu
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, China
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Yuntao Chen
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Ce Wang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Jingjing Zhu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.,Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China
| | - Xueying Zheng
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Yongfu Yu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.,Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China
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Engineered cellular immunotherapies in cancer and beyond. Nat Med 2022; 28:678-689. [PMID: 35440724 DOI: 10.1038/s41591-022-01765-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/02/2022] [Indexed: 12/11/2022]
Abstract
This year marks the tenth anniversary of cell therapy with chimeric antigen receptor (CAR)-modified T cells for refractory leukemia. The widespread commercial approval of genetically engineered T cells for a variety of blood cancers offers hope for patients with other types of cancer, and the convergence of human genome engineering and cell therapy technology holds great potential for generation of a new class of cellular therapeutics. In this Review, we discuss the goals of cellular immunotherapy in cancer, key challenges facing the field and exciting strategies that are emerging to overcome these obstacles. Finally, we outline how developments in the cancer field are paving the way for cellular immunotherapeutics in other diseases.
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Casper AC, Parsons MW, Chipman J, Burt LM, Suneja G, Maurer KA, Gaffney DK. Risk of secondary malignancies in ovarian cancer survivors: 52,680 patients analyzed with over 40 years of follow-up. Gynecol Oncol 2021; 162:454-460. [PMID: 34092413 DOI: 10.1016/j.ygyno.2021.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Survivors of ovarian cancer are at risk of developing a secondary malignancy (SM). We sought to evaluate the risk of developing SM, stratified by treatment modality. METHODS Standardized incidence ratios (SIR, observed-to-expected [O/E] ratio) were assessed in 52,680 patients diagnosed with ovarian cancer between 1975 and 2016 in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. RESULTS Of the 52,680 patients, 3366 patients (6.4%) developed SM, which was more than the endemic rate (O/E 1.13; p < .05). Patients who received any radiation (RT) had an increased risk of overall SM compared to those who didn't (O/E 1.42 vs 1.11; p < .05), and specifically, in the bladder (O/E 2.81). Patients who received any chemotherapy (CT) had an increased risk of leukemia (O/E 3.06), and a similar risk of overall SM compared to those not treated with CT (O/E 1.11 vs 1.14; p < .05). The excess risk of developing a solid tumor SM was greatest at latencies of 10-20 years. Patients younger than 50 had the highest risk of developing SM. Non-White patients had a higher risk of SM compared to White patients. CONCLUSIONS This is the largest study to examine the risk of SM in patients with ovarian cancer and has the longest follow-up. Risk of SM was increased after ovarian cancer and varied with treatment modality, race, latency, and age. These results may help inform SM screening protocols for women diagnosed with ovarian cancer.
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Affiliation(s)
- Anthony C Casper
- Rocky Vista University College of Osteopathic Medicine, 255 E Center St, Ivins, UT 84738, USA; Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 2000 Circle of Hope Drive #1950, Salt Lake City, UT 84112, USA.
| | - Matthew W Parsons
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 2000 Circle of Hope Drive #1950, Salt Lake City, UT 84112, USA.
| | - Jonathan Chipman
- University of Utah, Huntsman Cancer Institute, 2000 Circle of Hope Drive #1950, Salt Lake City, UT 84112, USA.
| | - Lindsay M Burt
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 2000 Circle of Hope Drive #1950, Salt Lake City, UT 84112, USA.
| | - Gita Suneja
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 2000 Circle of Hope Drive #1950, Salt Lake City, UT 84112, USA.
| | - Kathryn A Maurer
- University of Utah, Huntsman Cancer Institute, 2000 Circle of Hope Drive #1950, Salt Lake City, UT 84112, USA.
| | - David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 2000 Circle of Hope Drive #1950, Salt Lake City, UT 84112, USA.
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Guru Murthy GS, Abedin S. Myeloid malignancies after treatment for solid tumours. Best Pract Res Clin Haematol 2019; 32:40-46. [PMID: 30927974 DOI: 10.1016/j.beha.2019.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/18/2019] [Accepted: 02/22/2019] [Indexed: 12/21/2022]
Abstract
The cure rate for several solid tumour malignancies including breast cancers, head and neck cancers, bone cancers, and sarcoma has improved remarkably with the advent of neoadjuvant and adjuvant therapies. Unfortunately, exposure to chemotherapy or radiation as a part of these treatments exposes patients to the risk of subsequent myeloid malignancies. Therapy related myeloid malignancies have certain characteristic findings. They typically arise within 10 years of treatment exposure, they are seen in younger patients, and the greatest risk is in patients who receive therapy with alkylating agents or topoisomerase II inhibitors. Solid tumours whose therapies utilize these agents at higher doses, namely bone/soft tissue cancers, testicular cancer, anal cancer, and brain tumours, appear to be the groups at highest risk for T-MN. Beyond these patients, emerging populations diagnosed with T-MN include prior platinum exposure, and patients requiring G-CSF support with chemotherapy.
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Affiliation(s)
- Guru Subramanian Guru Murthy
- Division of Haematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA; Instructor of Medicine, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA.
| | - Sameem Abedin
- Division of Haematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
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Salvagno L, Simonato L, Sorarù M, Bianco A, Chiarion-Sileni V, Aversa SM, Camporese R, Garofolin P, Fiorentino M. Secondary Leukemia following Treatment for Hodgkin's Disease. TUMORI JOURNAL 2018; 79:103-7. [PMID: 8346559 DOI: 10.1177/030089169307900204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Patients treated for Hodgkin's disease with chemotherapy or with the association of chemotherapy and radiotherapy have an increased risk of secondary leukemia. The aim of this study was to evaluate the leukemogenic risk due to these treatment modalities. Methods We performed a case-control study on a population of 1410 patients treated for Hodgkin's disease from 1970 to 1990 in our Institute. Among these patients, we identified 25 cases of secondary leukemia and 3 cases of myelodysplasia, all occurring more than one year after the diagnosis of Hodgkin's disease. Three cases occurred among the patients treated with radiotherapy alone. When we analyzed the risk in relation to the type of treatment (radiotherapy, chemotherapy, or both), the comparisons were relative to patients treated with radiotherapy alone. Results We found that chemotherapy alone is associated with a fivefold increased risk (odds ratio = 5.4) compared with radiotherapy alone. When both treatments are used, the risk is not further increased (odds ratio = 4.4). Patients receiving more than 6 courses of chemotherapy have an excess risk (relative risk = 2.5) compared with those treated with 6 courses or less. No increased risk was observed after splenectomy. Conclusions This study confirms an increased incidence of secondary leukemia occurring in patients treated for Hodgkin's disease. The increased risk seems to be correlated with the number of courses of alkylating agent therapy, whereas it is unaffected by the addition of radiotherapy.
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Affiliation(s)
- L Salvagno
- Divisione di Oncologia Medica, Centro Oncologico Regionale, Padua, Italy
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Retroviral and Lentiviral Safety Analysis of Gene-Modified T Cell Products and Infused HIV and Oncology Patients. Mol Ther 2017; 26:269-279. [PMID: 29203150 DOI: 10.1016/j.ymthe.2017.10.012] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 01/14/2023] Open
Abstract
Replication-competent retrovirus/lentivirus (RCR/L) and insertional oncogenesis are potential safety risks with integrating viruses in gene-modified cell therapies. As such, the Food and Drug Administration guidances outline RCR/L-monitoring methods throughout the entire gene therapy treatment cycle. We present data for 17 vector lots, 375 manufactured T cell products, and 308 patients post-infusion across both HIV and oncology indications, showing no evidence of RCR/L. Given our data, a Poisson probability model estimates that a single patient, or a group of patients, would need to be followed for at least 52.8 years to observe one positive RCR/L event, highlighting the unlikelihood of RCR/L development. Additionally, we estimate the median time for lentivirus-modified T cell products to fall below the 1% vector sequence threshold in peripheral or whole blood that would trigger vector integration site analysis. These estimated times are 1.4 months in hematologic malignancies, 0.66 month in solid tumors, and 0.92 month in HIV. Based on these considerable safety data in HIV and oncology and recent Biologics License Applications filed for lentiviral-modified T cell products for hematologic malignancies, this may be an opportune time to re-evaluate the current guidelines for T cell gene therapy product testing and long-term patient monitoring.
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Chang EL, Ting CY, Hsu PH, Lin YC, Liao EC, Huang CY, Chang YC, Chan HL, Chiang CS, Liu HL, Wei KC, Fan CH, Yeh CK. Angiogenesis-targeting microbubbles combined with ultrasound-mediated gene therapy in brain tumors. J Control Release 2017; 255:164-175. [DOI: 10.1016/j.jconrel.2017.04.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 02/05/2017] [Accepted: 04/09/2017] [Indexed: 01/21/2023]
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13
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Tsutsumi E, Momonami A, Hori H, Kitagawa Y. Evaluation of single-dose RBC Pig-a and PIGRET assays in detecting the mutagenicity of thiotepa in rats. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2016; 811:123-128. [PMID: 27931805 DOI: 10.1016/j.mrgentox.2016.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
The Pig-a assay, which uses reticulocytes (PIGRET assay) as target cells, is anticipated to detect mutagenicity at earlier time points than the RBC Pig-a assay, which uses all red blood cells as target cells. As part of a collaborative study conducted by the Mammalian Mutagenicity Study (MMS) Group, we evaluated the PIGRET and RBC Pig-a assays to detect Pig-a gene mutations induced by the carcinogen thiotepa. A single dose of thiotepa at 7.5, 15, and 30mg/kg was administered to 8-week-old male Sprague-Dawley rats by oral gavage. PIGRET and RBC Pig-a assays were performed using peripheral blood collected from rats 7, 14, and 28days after thiotepa administration (Day 0 as the day of administration), and the resulting Pig-a mutant frequencies (MFs) were compared. Increased Pig-a MF was observed from Day 7 onwards using the PIGRET assay. Pig-a MF remained fairly constant thereafter until Day 28 in the 30mg/kg group, whereas it peaked on Day 14 in the 7.5 and 15mg/kg groups. Using the RBC Pig-a assay, on the other hand, no significant increase in MF was observed at any of the dosages on Days 7, 14, or 28. These findings show that Pig-a gene mutations following a single dose of thiotepa were detected using the PIGRET assay but not the RBC Pig-a assay, which suggests that PIGRET assay is more suitable than RBC Pig-a assay for evaluating the in vivo mutagenicity by a single dose.
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Affiliation(s)
- Eri Tsutsumi
- Quality Assurance Division, Safety Science Institute, Suntory Business Expert Limited, 8-1-1 Seikadai, Seika-cho, Soraku-gun, Kyoto 619-0284, Japan
| | - Ayaka Momonami
- Quality Assurance Division, Safety Science Institute, Suntory Business Expert Limited, 8-1-1 Seikadai, Seika-cho, Soraku-gun, Kyoto 619-0284, Japan
| | - Hisako Hori
- Quality Assurance Division, Safety Science Institute, Suntory Business Expert Limited, 8-1-1 Seikadai, Seika-cho, Soraku-gun, Kyoto 619-0284, Japan.
| | - Yoshinori Kitagawa
- Quality Assurance Division, Safety Science Institute, Suntory Business Expert Limited, 8-1-1 Seikadai, Seika-cho, Soraku-gun, Kyoto 619-0284, Japan
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14
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Focused ultrasound enhanced molecular imaging and gene therapy for multifusion reporter gene in glioma-bearing rat model. Oncotarget 2016; 6:36260-8. [PMID: 26429860 PMCID: PMC4742175 DOI: 10.18632/oncotarget.5389] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 09/14/2015] [Indexed: 11/25/2022] Open
Abstract
The ability to monitor the responses of and inhibit the growth of brain tumors during gene therapy has been severely limited due to the blood-brain barrier (BBB). A previous study has demonstrated the feasibility of noninvasive in vivo imaging with 123I-2′-fluoro-2′-deoxy-5-iodo-1-β-D-arabinofuranosyluracil (123I-FIAU) for monitoring herpes simplex virus type 1 thymidine kinase (HSV1-tk) cancer gene expression in an experimental animal model. Here, we tested the enhancement of SPECT with 123I-FIAU and ganciclovir (GCV) treatment in brain tumors after BBB disruption induced by focused ultrasound (FUS) in the presence of microbubbles. We established an orthotopic F98 glioma-bearing rat model with trifusion reporter genes. The results of this study showed that the rat model of HSV1-tk-expressing glioma cells could be successfully detected by SPECT imaging after FUS-induced BBB disruption on day 10 after implantation. Compared to the control group, animals receiving the GCV with or without sonication exhibited a significant antitumor activity (P < 0.05) of glioma cells on day 16 after implantation. Moreover, combining sonication with GCV significantly inhibited tumor growth compared with GCV alone. This study demonstrated that FUS may be used to deliver a wide variety of theranostic agents to the brain for molecular imaging and gene therapy in brain diseases.
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15
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Sulkes A, Ruchlemer R, Neria SB, Leizerowitz R, Abeliovich D, Polliack A. Acute Monoblastic Leukemia with t(9;11) in a Patient Receiving Chemotherapy for Ovarian Cancer: Secondary Leukemia or Fortuitous Association of Two Neoplasias? Leuk Lymphoma 2016; 4:405-9. [PMID: 27467675 DOI: 10.3109/10428199109068093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We describe the clinical course of a 61 years old patient who developed fulminant acute monoblastic leukemia (MSA, FAB) while still on systemic chemotherapy for an advanced adenocarcinoma of the ovary. The leukemia developed following chemotherapy with Cyclophosphamide and Cisplatin (9 cycles), and then Cyclophosphamide and Carboplatin (6 cycles) resulting in a partial remission of the ovarian tumor. Survival from the onset of acute leukemia was extremely short and the cause of death was intracerebral bleeding. Cytogenetic analysis of the leukemic cells revealed a 9:11 translocation, a pattern usually occurring in de novo leukemias. The literature on the association of solid tumors, particularly ovarian cancer, with acute leukemia is reviewed; while systemic chemotherapy for ovarian cancer definitely increases the risk of secondary leukemia, especially if alkylating agents are administered, the occurrence of leukemia during the administration of chemotherapy for the solid tumor is distinctly unusual. Our patient seems to be an additional example of a recently described therapy-related variant of acute leukemia developing shortly after the onset of chemotherapy and characterized by a rapidly downhill clinical course, a monocytic lineage and a cytogenetic rearrangement t(9;11)(p22;q23). While the number of these newly described cases is still small, this additional example should increase the awareness of this potential association in Cisplatin-treated patients.
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Affiliation(s)
- A Sulkes
- a Sharett Institute of Oncology, Lymphoma-Leukemia Unit, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - R Ruchlemer
- b Department of Hematology, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - S B Neria
- c Department of Human Genetics, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - R Leizerowitz
- b Department of Hematology, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - D Abeliovich
- c Department of Human Genetics, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - A Polliack
- b Department of Hematology, Hebrew University-Hadassah Medical School, Jerusalem, Israel
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16
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WANG CHUNYAN, YU PEIFA, HE XIAOBING, FANG YONGXIANG, CHENG WENYU, JING ZHIZHONG. αβ T-cell receptor bias in disease and therapy (Review). Int J Oncol 2016; 48:2247-56. [DOI: 10.3892/ijo.2016.3492] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 03/21/2016] [Indexed: 11/06/2022] Open
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17
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Blackadar CB. Historical review of the causes of cancer. World J Clin Oncol 2016; 7:54-86. [PMID: 26862491 PMCID: PMC4734938 DOI: 10.5306/wjco.v7.i1.54] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/31/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
In the early 1900s, numerous seminal publications reported that high rates of cancer occurred in certain occupations. During this period, work with infectious agents produced only meager results which seemed irrelevant to humans. Then in the 1980s ground breaking evidence began to emerge that a variety of viruses also cause cancer in humans. There is now sufficient evidence of carcinogenicity in humans for human T-cell lymphotrophic virus, human immunodeficiency virus, hepatitis B virus, hepatitis C virus, human papillomavirus, Epstein-Barr virus, and human herpes virus 8 according to the International Agency for Research on Cancer (IARC). Many other causes of cancer have also been identified by the IARC, which include: Sunlight, tobacco, pharmaceuticals, hormones, alcohol, parasites, fungi, bacteria, salted fish, wood dust, and herbs. The World Cancer Research Fund and the American Institute for Cancer Research have determined additional causes of cancer, which include beta carotene, red meat, processed meats, low fibre diets, not breast feeding, obesity, increased adult height and sedentary lifestyles. In brief, a historical review of the discoveries of the causes of human cancer is presented with extended discussions of the difficulties encountered in identifying viral causes of cancer.
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Abstract
Adoptive T cell transfer for cancer, chronic infection, and autoimmunity is an emerging field that shows promise in recent trials. Using the principles of synthetic biology, advances in cell culture and genetic engineering have made it possible to generate human T cells that display desired specificities and enhanced functionalities compared with the natural immune system. The prospects for widespread availability of engineered T cells have changed dramatically, given the recent entry of the pharmaceutical industry to this arena. Here, we discuss some of the challenges--such as regulatory, cost, and manufacturing--and opportunities, including personalized gene-modified T cells, that face the field of adoptive cellular therapy.
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Affiliation(s)
- Carl H June
- Center for Cellular Immunotherapies and the Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-5156, USA.
| | - Stanley R Riddell
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA 98109, USA.
| | - Ton N Schumacher
- Division of Immunology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, Netherlands.
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19
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Glomerular diseases and cancer: evaluation of underlying malignancy. J Nephrol 2015; 29:143-152. [PMID: 26498294 PMCID: PMC4792341 DOI: 10.1007/s40620-015-0234-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/12/2015] [Indexed: 01/21/2023]
Abstract
Onconephrology is an emerging medical subspecialty focused on the numerous interconnections between cancer and kidney diseases. Patient with malignancies commonly experience kidney problems including acute kidney injury, tumor lysis syndrome, fluid and electrolyte disorders and chronic kidney disease, often as a consequence of the anti-cancer treatment. Conversely, a number of glomerulopathies, tubulopathies and vascular renal diseases can early signal the presence of an underlying cancer. Furthermore, the administration of immunosuppressive drugs, especially cytotoxic drugs and calcineurin inhibitors, may strongly impair the immune response increasing the risk of cancer. The objective of this review article is to: (i) discuss paraneoplastic glomerular disease, (ii) review cancer as an adverse effect of immunosuppressive agents used to treat glomerulopathies, and (iii) in the absence of international approved guidelines, propose a screening program based on expert opinion aimed at guiding nephrologists to early detect malignancies during their clinical practice.
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20
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Dertinger SD, Avlasevich SL, Torous DK, Bemis JC, Phonethepswath S, Labash C, Carlson K, Mereness J, Cottom J, Palis J, MacGregor JT. Persistence of cisplatin-induced mutagenicity in hematopoietic stem cells: implications for secondary cancer risk following chemotherapy. Toxicol Sci 2014; 140:307-14. [PMID: 24798381 DOI: 10.1093/toxsci/kfu078] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cisplatin is a cytostatic agent used in the treatment of many types of cancer, but its use is associated with increased incidences of secondary leukemia. We evaluated cisplatin's in vivo genotoxic potential by analyzing peripheral blood for Pig-a mutant phenotype erythrocytes and for chromosomal damage in the form of micronuclei. Mutant phenotype reticuloyte and erythrocyte frequencies, based on anti-CD59 antibody labeling and flow cytometric analysis, were determined in male Sprague Dawley rats treated for 28 consecutive days (days 1-28) with up to 0.4 mg cisplatin/kg/day, and sampled on days -4, 15, 29, and 56. Vehicle and highest dose groups were evaluated at additional time points post-treatment up to 6 months. Day 4 and 29 blood samples were also analyzed for micronucleated reticulocyte frequency using flow cytometry and anti-CD71-based labeling. Mutant phenotype reticulocytes were significantly elevated at doses ≥0.1 mg/kg/day, and mutant phenotype erythrocytes were elevated at doses ≥0.05 mg/kg/day. In the 0.4 mg/kg/day group, these effects persisted for the 6 month observation period. Cisplatin also induced a modest but statistically significant increase in micronucleus frequency at the highest dose tested. The prolonged persistence in the production of mutant erythrocytes following cisplatin exposure suggests that this drug mutates hematopoietic stem cells and that this damage may ultimately contribute to the increased incidence of secondary leukemias seen in patients cured of primary malignancies with platinum-based regimens.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - James Palis
- Department of Pediatrics and Center for Pediatric Biomedical Research, University of Rochester Medical Center, Rochester, New York
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21
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Lymphohematopoietic cancers induced by chemicals and other agents and their implications for risk evaluation: An overview. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2014; 761:40-64. [PMID: 24731989 DOI: 10.1016/j.mrrev.2014.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 12/13/2022]
Abstract
Lymphohematopoietic neoplasia are one of the most common types of cancer induced by therapeutic and environmental agents. Of the more than 100 human carcinogens identified by the International Agency for Research on Cancer, approximately 25% induce leukemias or lymphomas. The objective of this review is to provide an introduction into the origins and mechanisms underlying lymphohematopoietic cancers induced by xenobiotics in humans with an emphasis on acute myeloid leukemia, and discuss the implications of this information for risk assessment. Among the agents causing lymphohematopoietic cancers, a number of patterns were observed. Most physical and chemical leukemia-inducing agents such as the therapeutic alkylating agents, topoisomerase II inhibitors, and ionizing radiation induce mainly acute myeloid leukemia through DNA-damaging mechanisms that result in either gene or chromosomal mutations. In contrast, biological agents and a few immunosuppressive chemicals induce primarily lymphoid neoplasms through mechanisms that involve alterations in immune response. Among the environmental agents examined, benzene was clearly associated with acute myeloid leukemia in humans, with increasing but still limited evidence for an association with lymphoid neoplasms. Ethylene oxide and 1,3-butadiene were linked primarily to lymphoid cancers. Although the association between formaldehyde and leukemia remains controversial, several recent evaluations have indicated a potential link between formaldehyde and acute myeloid leukemia. The four environmental agents examined in detail were all genotoxic, inducing gene mutations, chromosomal alterations, and/or micronuclei in vivo. Although it is clear that rapid progress has been made in recent years in our understanding of leukemogenesis, many questions remain for future research regarding chemically induced leukemias and lymphomas, including the mechanisms by which the environmental agents reviewed here induce these diseases and the risks associated with exposures to such agents.
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22
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Secondary Leukemia After Chemotherapy and/or Radiotherapy for Gynecologic Neoplasia. Int J Gynecol Cancer 2014; 24:178-83. [DOI: 10.1097/igc.0000000000000045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveSecondary leukemia is a known complication of chemotherapy and radiotherapy. It was generally recognized that leukemia secondary to chemotherapy was due to the use of alkylating agents in the treatment of ovarian cancer. Recently, many types of chemotherapeutic agents have been used in the treatment of gynecologic malignancies in addition to ovarian cancer. We analyzed the clinical characteristics and outcome of patients with recent onset of secondary leukemia after the treatment of gynecologic cancer to consider the diagnosis and management of secondary leukemia.Materials and MethodsWe reviewed the clinical charts and follow-up data of patients with gynecologic malignancies treated in the past 20 years. During this period, 2482 newly diagnosed invasive gynecologic cancers were treated in our institution. All patients with secondary leukemia were analyzed for clinical background, latency period (interval between the diagnosis of primary carcinoma and the development of leukemia), treatment, and outcome. We also reviewed the literature for secondary leukemia under gynecology using the PubMed.ResultsFour patients were found to have developed secondary leukemia after the treatment of gynecologic malignancies during this period. The cumulative risk of secondary leukemia was approximately 0.38%. All patients received platinum-based chemotherapy. Two patients received combination chemotherapy and/or bone marrow transplantation, and 1 of these 2 patients lived more than 6 years but died of recurrent ovarian cancer.ConclusionsLong survival time might be expected in patients who show complete response to bone marrow transplantation and/or combination chemotherapy for secondary leukemia. In recent years, we have aggressively used various types of anticancer drugs for the treatment of not only ovarian cancer but also uterine cervical cancer and endometrial cancer. Physicians need to keep in mind the risk of secondary leukemia in the follow-up of long-term survivors after several courses of chemotherapy and radiotherapy.
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23
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Leukemia from Dermal Exposure to Cyclophosphamide among Nurses in the Netherlands: Quantitative Assessment of the Risk. ACTA ACUST UNITED AC 2014; 58:271-82. [DOI: 10.1093/annhyg/met077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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24
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Villarini M, Dominici L, Fatigoni C, Muzi G, Monarca S, Moretti M. Biological Effect Monitoring in Peripheral Blood Lymphocytes from Subjects Occupationally Exposed to Antineoplastic Drugs: Assessment of Micronuclei Frequency. J Occup Health 2013; 54:405-15. [DOI: 10.1539/joh.12-0038-oa] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Milena Villarini
- Department of Medical‐Surgical Specialties and Public Health (Section of Public Health)University of PerugiaItaly
| | - Luca Dominici
- Department of Medical‐Surgical Specialties and Public Health (Section of Public Health)University of PerugiaItaly
| | - Cristina Fatigoni
- Department of Medical‐Surgical Specialties and Public Health (Section of Public Health)University of PerugiaItaly
| | - Giacomo Muzi
- Department of Clinical and Experimental Medicine (Section of Occupational MedicineRespiratory Diseases and Toxicology), University of PerugiaItaly
| | - Silvano Monarca
- Department of Medical‐Surgical Specialties and Public Health (Section of Public Health)University of PerugiaItaly
| | - Massimo Moretti
- Department of Medical‐Surgical Specialties and Public Health (Section of Public Health)University of PerugiaItaly
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25
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Xu Y, Wang H, Zhou S, Yu M, Wang X, Fu K, Qian Z, Zhang H, Qiu L, Liu X, Wang P. Risk of second malignant neoplasms after cyclophosphamide-based chemotherapy with or without radiotherapy for non-Hodgkin lymphoma. Leuk Lymphoma 2012; 54:1396-404. [PMID: 23101661 DOI: 10.3109/10428194.2012.743657] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yuanlin Xu
- Department of Lymphoma, Tianjin Medical University Cancer Hospital, Sino-US Center for Lymphoma and Leukemia, Tianjin Key Laboratory of Cancer Prevention and Therapy,
Tianjin, China
| | - Huaqing Wang
- Department of Lymphoma, Tianjin Medical University Cancer Hospital, Sino-US Center for Lymphoma and Leukemia, Tianjin Key Laboratory of Cancer Prevention and Therapy,
Tianjin, China
| | - Shiyong Zhou
- Department of Lymphoma, Tianjin Medical University Cancer Hospital, Sino-US Center for Lymphoma and Leukemia, Tianjin Key Laboratory of Cancer Prevention and Therapy,
Tianjin, China
| | - Man Yu
- Ontario Cancer Institute/Princess Margaret Hospital, University of Toronto,
Toronto, Canada
| | - Xianhuo Wang
- Department of Lymphoma, Tianjin Medical University Cancer Hospital, Sino-US Center for Lymphoma and Leukemia, Tianjin Key Laboratory of Cancer Prevention and Therapy,
Tianjin, China
| | - Kai Fu
- Department of Pathology and Microbiology, University of Nebraska Medical Center,
Omaha, NE, USA
| | - Zhengzi Qian
- Department of Lymphoma, Tianjin Medical University Cancer Hospital, Sino-US Center for Lymphoma and Leukemia, Tianjin Key Laboratory of Cancer Prevention and Therapy,
Tianjin, China
| | - Huilai Zhang
- Department of Lymphoma, Tianjin Medical University Cancer Hospital, Sino-US Center for Lymphoma and Leukemia, Tianjin Key Laboratory of Cancer Prevention and Therapy,
Tianjin, China
| | - Lihua Qiu
- Department of Lymphoma, Tianjin Medical University Cancer Hospital, Sino-US Center for Lymphoma and Leukemia, Tianjin Key Laboratory of Cancer Prevention and Therapy,
Tianjin, China
| | - Xianming Liu
- Department of Lymphoma, Tianjin Medical University Cancer Hospital, Sino-US Center for Lymphoma and Leukemia, Tianjin Key Laboratory of Cancer Prevention and Therapy,
Tianjin, China
| | - Ping Wang
- Department of Lymphoma, Tianjin Medical University Cancer Hospital, Sino-US Center for Lymphoma and Leukemia, Tianjin Key Laboratory of Cancer Prevention and Therapy,
Tianjin, China
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26
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Kater L, Gmelig-Meyling FHJ, Derksen RHWM, Faille HB. Immunopathogenesis and Therapy of Systemic Lupus Erythematosus. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/bf03259309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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27
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Ardiani A, Johnson AJ, Ruan H, Sanchez-Bonilla M, Serve K, Black ME. Enzymes to die for: exploiting nucleotide metabolizing enzymes for cancer gene therapy. Curr Gene Ther 2012; 12:77-91. [PMID: 22384805 DOI: 10.2174/156652312800099571] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 01/26/2012] [Accepted: 01/27/2012] [Indexed: 11/22/2022]
Abstract
Suicide gene therapy is an attractive strategy to selectively destroy cancer cells while minimizing unnecessary toxicity to normal cells. Since this idea was first introduced more than two decades ago, numerous studies have been conducted and significant developments have been made to further its application for mainstream cancer therapy. Major limitations of the suicide gene therapy strategy that have hindered its clinical application include inefficient directed delivery to cancer cells and the poor prodrug activation capacity of suicide enzymes. This review is focused on efforts that have been and are currently being pursued to improve the activity of individual suicide enzymes towards their respective prodrugs with particular attention to the application of nucleotide metabolizing enzymes in suicide cancer gene therapy. A number of protein engineering strategies have been employed and our discussion here will center on the use of mutagenesis approaches to create and evaluate nucleotide metabolizing enzymes with enhanced prodrug activation capacity and increased thermostability. Several of these studies have yielded clinically important enzyme variants that are relevant for cancer gene therapy applications because their utilization can serve to maximize cancer cell killing while minimizing the prodrug dose, thereby limiting undesirable side effects.
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Affiliation(s)
- Andressa Ardiani
- School of Molecular Biosciences, Washington State University, Pullman, 99164-7520, USA
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28
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Rodeghiero F, Ruggeri M. Short- and long-term risks of splenectomy for benign haematological disorders: should we revisit the indications? Br J Haematol 2012; 158:16-29. [PMID: 22571181 DOI: 10.1111/j.1365-2141.2012.09146.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 03/19/2012] [Indexed: 12/22/2022]
Abstract
Splenectomy has represented a key treatment option in the treatment of many benign haematological diseases, including immune thrombocytopenia (ITP) and disorders associated with ongoing haemolysis (thalassaemia major and intermedia, sickle cell disease, and hereditary or acquired haemolytic anaemias). Improvements in surgical techniques have reduced perioperative complications and mortality. Preventive measures (new protein conjugate vaccines, antibiotic prophylaxis, and increased vigilance) are thought to greatly reduce the risk of overwhelming post-splenectomy infection (OPSI), although their implementation is inconsistent. Nevertheless, there is increasing documentation of the short- and long-term risks of splenectomy, which vary according to the underlying indication. Splenectomized patients are at increased risk of venous thromboembolism, particularly within the splenoportal system. The long-term thromboembolic risk is higher in haematological disorders associated with ongoing haemolysis, particularly in thalassaemia intermedia, which has led to a more conservative approach. In comparison, patients with ITP appear to be at lower risk of adverse effects of splenectomy, which maintains its place as the potentially most curative and safe second-line treatment. However, a splenectomy-sparing approach is also emerging for ITP, and recent guidelines recommend that this procedure is deferred until ≥ 12 months from ITP diagnosis, to allow sufficient time for possible remission.
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Affiliation(s)
- Francesco Rodeghiero
- Department of Cell Therapy and Haematology, San Bortolo Hospital, Vicenza, Italy.
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Bindra RS, Yahalom J. The important role of radiation therapy in early-stage diffuse large B-cell lymphoma: time to review the evidence once again. Expert Rev Anticancer Ther 2012; 11:1367-78. [PMID: 21929311 DOI: 10.1586/era.11.88] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin's lymphoma in the USA, and approximately one-third of patients present with early stage, localized disease. While significant controversy still exists regarding the appropriate management of these patients, the overwhelming evidence from a wide range of studies over the last 40 years points to the superior efficacy of combined-modality therapy for this disease. The current standard of care for the vast majority of early-stage DLBCL cases now involves a combination of chemotherapy, immunotherapy and consolidation radiotherapy. Using this multimodality approach, very high rates of local control can be achieved, which will translate into significant survival benefits for patients with localized disease. The use of intensive immunochemotherapy without radiation therapy requires formal testing and validation in a randomized clinical trial before it can be used as an alternative treatment regimen for early-stage DLBCL. In this article, we discuss the results of the key randomized trials, critical retrospective studies and recent clinical trials, which collectively address the important role of radiotherapy in the treatment of early-stage DLBCL.
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Affiliation(s)
- Ranjit S Bindra
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA
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VanderWalde AM, Hurria A. Second malignancies among elderly survivors of cancer. Oncologist 2011; 16:1572-81. [PMID: 22042787 PMCID: PMC3233292 DOI: 10.1634/theoncologist.2011-0214] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 08/29/2011] [Indexed: 12/18/2022] Open
Abstract
The U.S. population is aging, life expectancy is increasing, and cancer is a disease associated with aging. Advances in screening and therapeutics have led to a growing number of cancer survivors who are at risk for the development of secondary malignancies. Although the risks for the development of second malignancies following a first diagnosis of cancer are well described for survivors of childhood malignancies, there are fewer data for malignancies common in older adults. With the aging of the U.S. population, and with improving survival statistics in many adult malignancies, there is an increasing need to identify those second malignancies that might develop in the older adult survivor of cancer. In this paper, we describe the types and rates of second malignancies following cancers commonly seen in older adults and review the literature on these malignancies. Comparisons are made between older and younger adults with regard to the risks for developing treatment-related cancers with different modalities. Recommendations for early detection of second malignancies are summarized, though there remains an unmet need for evidence-based guidelines for screening for second malignancies in the older adult in particular.
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Affiliation(s)
- Ari M VanderWalde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California 91010, USA.
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Doyen J, Courdi A, Gérard JP. Deuxième cancer primitif survenant après radiothérapie. Cancer Radiother 2010; 14:255-62. [DOI: 10.1016/j.canrad.2010.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 03/21/2010] [Indexed: 12/26/2022]
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Abstract
The treatment and survival outcome of acute leukemia in women is generally similar to that of men. However, acute leukemia in women poses additional challenges in clinical practice. In addition to important precautions during therapy, such as prevention of abnormal uterine bleeding in premenopausal women and therapy during pregnancy, women who are survivors of acute leukemia face unique and potentially long-term health-related problems. In this review, we address the aforementioned issues, as well as the various health and psychosocial challenges faced by women who survive childhood leukemia during their path to adulthood. Finally, we address the issue of therapy-related acute leukemia in the category of women who are survivors of breast and ovarian cancer.
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Abstract
The treatment of acute leukemia is usually similar in women and men. The outcome is also generally the same. However, diagnosis in women poses additional challenges in clinical practice such as leukemia following breast or ovarian cancers, prevention of abnormal uterine bleeding in premenopausal females, treatment during pregnancy related-problems in long-term survivors. All these special issues are addressed in this review of the literature.
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Ardiani A, Sanchez-Bonilla M, Black ME. Fusion enzymes containing HSV-1 thymidine kinase mutants and guanylate kinase enhance prodrug sensitivity in vitro and in vivo. Cancer Gene Ther 2010; 17:86-96. [PMID: 19763147 PMCID: PMC2808426 DOI: 10.1038/cgt.2009.60] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 05/16/2009] [Accepted: 07/08/2009] [Indexed: 11/15/2022]
Abstract
Herpes simplex virus thymidine kinase (HSVTK) with ganciclovir (GCV) is currently the most widely used suicide gene/prodrug system in cancer gene therapy. A major limitation in this therapy is the inefficient activation of GCV by HSVTK to its active antimetabolites. We described earlier two strategies to overcome this limitation: (1) generation of HSVTK mutants with improved GCV activation potential and (2) construction of a fusion protein encoding HSVTK and mouse guanylate kinase (MGMK), the second enzyme in the GCV activation pathway. As a means to further enhance GCV activation, two MGMK/HSVTK constructs containing the HSVTK mutants, mutant 30 and SR39, were generated and evaluated for their tumor and bystander killing effects in vitro and in vivo. One fusion mutant, MGMK/30, shows significant reduction in IC(50) values of approximately 12 500-fold, 100-fold, and 125-fold compared with HSVTK, mutant 30 or MGMK/HSVTK, respectively. In vitro bystander analyses show that 5% of MGMK/30-expressing cells are sufficient to induce 75% of tumor cell killing. In an xenograft tumor model, MGMK/30 displays the greatest inhibition of tumor growth at a GCV concentration (1 mg kg(-1)) that has no effect on wild-type HSVTK-, MGMK/HSVTK-, or mutant 30-transfected cells. Another fusion construct, MGMK/SR39, sensitizes rat C6 glioma cells to GCV by 2500-fold or 25-fold compared with HSVTK or MGMK/HSVTK, respectively. In vitro analyses show similar IC(50) values between cells harboring SR39 and MGMK/SR39, although MGMK/SR39 seems to elicit stronger bystander killing effects in which 1% of MGMK/SR39-transfected cells result in 60% cell death. In a xenograft tumor model, despite observable tumor growth inhibition, no statistical significance in tumor volume was detected between mice harboring SR39- and MGMK/SR39-transfected cells when dosed with 1 mg kg(-1) GCV. However, at a lower dose of GCV (0.1 mg kg(-1)), MGMK/SR39 seems to have slightly greater tumor growth inhibition properties compared with SR39 (P< or =0.05). In vivo studies indicate that both mutant fusion proteins display substantial improvements in bystander killing in the presence of 1 mg kg(-1) GCV, even when only 5% of the tumor cells are transfected. Such fusion mutants with exceptional prodrug converting properties will allow administration of lower and non-myelosuppressive doses of GCV concomitant with improved tumor killing and as such are promising candidates for translational gene therapy studies.
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Affiliation(s)
- Andressa Ardiani
- School of Molecular Biosciences, P.O. Box 646534, Washington State University, Pullman, WA 99164-6534
| | - Marilyn Sanchez-Bonilla
- Department of Pharmaceutical Sciences, P.O. Box 646534, Washington State University, Pullman, WA 99164-6534
| | - Margaret E. Black
- School of Molecular Biosciences, P.O. Box 646534, Washington State University, Pullman, WA 99164-6534
- Department of Pharmaceutical Sciences, P.O. Box 646534, Washington State University, Pullman, WA 99164-6534
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Engelen MJA, Snel BJ, Schaapveld M, Pras E, de Vries EGE, Gietema JA, van der Zee AGJ, Willemse PHB. Long-term morbidity of adjuvant whole abdominal radiotherapy (WART) or chemotherapy for early stage ovarian cancer. Eur J Cancer 2009; 45:1193-1200. [PMID: 19201598 DOI: 10.1016/j.ejca.2009.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 12/18/2008] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
Abstract
UNLABELLED The aim of the study was to evaluate long-term toxicity of adjuvant treatment in early stage ovarian cancer survivors. Data from all patients treated in one hospital for early stage ovarian cancer diagnosed between 1980 and 1990 were collected using a structured data form. In 93 FIGO stages I and II patients, cytoreductive and staging surgery was performed; 15 received no adjuvant treatment (controls), 39 whole abdominal radiotherapy (WART) and 39 platin-based chemotherapy. Median age at diagnosis was 54 years (range 21-83 years). During follow-up, 49/93 (53%) patients have died with a median overall survival of 18.4 years (95% CI 12.8-23.9). In both the radiotherapy and the chemotherapy group, 50% of patients reported long-term side-effects (all grades) versus 13% of controls. Two patients in the WART group died from bowel complications. Secondary malignancies were observed in 16 patients. Of all patients alive at the last follow-up, 12/17 (71%) patients treated with radiotherapy and 11/18 (61%) treated with chemotherapy experienced long-term morbidity versus 2/9 (22%) controls (P=0.03). IN CONCLUSION Long-term follow-up of early stage ovarian cancer patients showed lasting GI morbidity in the survivors treated with adjuvant radiotherapy, which has therefore become obsolete. Cisplatin-based chemotherapy caused peripheral neuropathy versus virtual absence of problems in the survivors of just surgery, emphasising the need for strict criteria before instigating adjuvant treatment.
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Affiliation(s)
- M J A Engelen
- Department of Gynaecologic Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - B J Snel
- Department of Gynaecologic Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - M Schaapveld
- Department of Epidemiology and Statistics, Comprehensive Cancer Centre North Netherlands, P.O. Box 330, 9700 AH Groningen, The Netherlands
| | - E Pras
- Department of Radiotherapy, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - E G E de Vries
- Department of Medical Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - J A Gietema
- Department of Medical Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - A G J van der Zee
- Department of Gynaecologic Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - P H B Willemse
- Department of Medical Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
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Chakraborty S, Sun CL, Francisco L, Sabado M, Li L, Chang KL, Forman S, Bhatia S, Bhatia R. Accelerated telomere shortening precedes development of therapy-related myelodysplasia or acute myelogenous leukemia after autologous transplantation for lymphoma. J Clin Oncol 2009; 27:791-8. [PMID: 19124806 DOI: 10.1200/jco.2008.17.1033] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Therapy-related myelodysplasia or acute myelogenous leukemia (t-MDS/AML) is a lethal complication of autologous hematopoietic stem-cell transplantation (aHCT) for Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). Here, we investigated the hypothesis that accelerated telomere shortening after aHCT could contribute to the development of t-MDS/AML. PATIENTS AND METHODS A prospective longitudinal cohort was constructed to investigate the sequence of cellular and molecular abnormalities leading to development of t-MDS/AML after aHCT for HL/NHL. This cohort formed the sampling frame for a nested case-control study to compare changes in telomere length in serial blood samples from patients who developed t-MDS/AML with matched controls who did not develop t-MDS/AML. RESULTS An initial increase in telomere length at day 100 after aHCT was followed by an accelerated telomere shortening in t-MDS/AML patients when compared with controls. These telomere alterations preceded the onset of t-MDS and were independent of other known risk factors associated with development of t-MDS/AML on multivariate analysis. Additionally, we observed reduced generation of committed progenitors in patients who developed t-MDS/AML, indicating that these telomere alterations were associated with reduced regenerative capacity of hematopoietic stem cells. CONCLUSION The development of t-MDS/AML after aHCT is associated with and preceded by markedly altered telomere dynamics in hematopoietic cells. Accelerated telomere loss in patients developing t-MDS/AML may reflect increased clonal proliferation and/or altered telomere regulation in premalignant cells. Genetic instability associated with shortened telomeres may contribute to leukemic transformation in t-MDS/AML.
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Affiliation(s)
- Sujata Chakraborty
- Department of Stem Cell and Leukemia Research, Division of Population Sciences, City of Hope National Medical Center, Duarte, CA 91010, USA
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Abstract
Cancer patients have a 20% higher risk of new primary cancer compared with the general population. Approximately one third of cancer survivors aged >60 years were diagnosed more than once with another cancer. As the number of cancer survivors and of older people increases, occurrence of multiple primary cancers is also likely to increase. An increasing interest from epidemiologic and clinical perspectives seems logical. This chapter begins with the risk pattern of multiple cancers in the population of a developed country with high survival rates. Multiple cancers comprise two or more primary cancers occurring in an individual that originate in a primary site or tissue and that are neither an extension, nor a recurrence or metastasis. Studies of multiple cancers have been mainly conducted in population-based settings, and more recently in clinical trials and case control studies leading to further understanding of risk factors for the development of multiple primary cancers. These factors include an inherited predisposition to cancer; the usual carcinogenic or cancer-promoting aspects of lifestyle, hormonal, and environmental factors; treatment of the previous primary cancer; and increased surveillance of cancer survivors. Finally, implication on research strategies and clinical practice are discussed, covering the whole range of epidemiologic approach.
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Rachet B, Mitry E, Shah A, Cooper N, Coleman MP. Survival from adult leukaemia in England and Wales up to 2001. Br J Cancer 2008; 99 Suppl 1:S116-8. [PMID: 18813243 PMCID: PMC2557539 DOI: 10.1038/sj.bjc.6604609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Rachet
- Cancer Research UK Cancer Survival Group, Non-Communicable Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - E Mitry
- Département d’Hepatogastroentérologie et Oncologie Digestive, Centre Hospitalo-Universitaire Ambroise-Paré, 9 avenue Charles de Gaulle, Boulogne F-92100, France
| | - A Shah
- Cancer Research UK Cancer Survival Group, Non-Communicable Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - N Cooper
- Social and Health Analysis and Reporting Division, Office for National Statistics (Room FG/114), 1 Myddelton Street, London EC1R 1UW, UK
| | - M P Coleman
- Cancer Research UK Cancer Survival Group, Non-Communicable Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Zablotska LB, Matasar MJ, Neugut AI. Second Malignancies After Radiation Treatment and Chemotherapy for Primary Cancers. Oncology 2007. [DOI: 10.1007/0-387-31056-8_111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Karagiannis S, Papadimitriou CA, Sotiropoulou M, Dimopoulos F, Chrysanthopoulou H, Dimopoulos MA, Michopoulos S. Squamous cell esophageal carcinoma as a second primary malignancy in a woman with epithelial ovarian cancer. Dig Dis Sci 2007; 52:3099-101. [PMID: 17393316 DOI: 10.1007/s10620-007-9800-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2006] [Accepted: 01/29/2007] [Indexed: 12/09/2022]
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Westhoff TH, van der Giet M. Tacrolimus in the treatment of idiopathic nephrotic syndrome. Expert Opin Investig Drugs 2007; 16:1099-110. [PMID: 17594193 DOI: 10.1517/13543784.16.7.1099] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The immunosuppressant tacrolimus (FK-506) is a calcineurin inhibitor with a widespread use for the prevention of graft rejection in transplantation medicine. Tacrolimus inhibits the activation of an essential transcription factor for the transcription of cytokine genes in T cells leading to a decreased production of cytokines such as IL-2 and IFN-gamma. As T-cell activation plays a crucial role in the pathogenesis of inflammatory glomerular diseases, there is an increasing number of reports on the use of tacrolimus in nephrotic syndrome. In idiopathic nephrotic syndrome, corticosteroid treatment constitutes the first-line therapy to achieve remission. In the case of steroid resistance or steroid dependence, alternative immunosuppressive strategies are needed. Cyclophosphamide and ciclosporin are well-established drugs in this condition. The present article reviews the pharmacodynamics, pharmacokinetics, safety and clinical efficacy of tacrolimus in steroid-resistant and steroid-dependent nephrotic syndrome.
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Affiliation(s)
- Timm H Westhoff
- Charité--Campus Benjamin Franklin, Centrum 10--Nephrology, Hindenburgdamm 30, Berlin, Germany.
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Harrison BR, Peters BG, Bing MR. Comparison of surface contamination with cyclophosphamide and fluorouracil using a closed-system drug transfer device versus standard preparation techniques. Am J Health Syst Pharm 2007; 63:1736-44. [PMID: 16960258 DOI: 10.2146/ajhp050258] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A comparison was conducted of the levels of surface contamination with two commonly used antineoplastic drugs, cyclophosphamide and fluorouracil, on countertops, floors, and hood surfaces in three oncology pharmacies following preparation with standard hazardous drug (HD) preparation techniques, or a closed-system drug transfer device (CSTD) in conjunction with standard HD preparation techniques, or a CSTD in conjunction with standard HD preparation techniques but prepared on a countertop outside the biological safety cabinet (BSC). METHODS Wipe samples of the various surfaces in each pharmacy were obtained biweekly for 12 weeks (six samples) to establish a baseline. Following implementation of the CSTD, an additional six biweekly samples were collected. The CSTD was then removed, and a final six samples were collected again using standard preparation techniques. During the CSTD Phase, fluorouracil was prepared on the countertop outside the BSC. RESULTS During the 36-week study, 342 samples were collected. A total of 8% positive fluorouracil wipe samples were found in the three pharmacies. The proportion of positive fluorouracil samples was significantly less in the CSTD Phase than in the control phases (p = 0.0002). There were 324 (95%) positive cyclophosphamide wipe samples. The median surface contamination was significantly different across the three phases (p < 0.00001). This was consistent at all sites, for both the BSC work surfaces and countertops. Contamination on floors adjacent to the BSCs was not consistently reduced. CONCLUSION The use of a CSTD in the BSC in conjunction with standard HD preparation techniques significantly reduced cyclophosphamide surface contamination as compared to standard techniques alone. Preparation of fluorouracil outside the BSC using the CSTD did not result in significant analytically detectable contamination on the countertops.
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Affiliation(s)
- Bruce R Harrison
- Department of Veterans Affairs Medical Center, St. Louis, MO, USA.
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Kim KB, Faderl S, Hwang CS, Khuri FR. Chronic myelomonocytic leukaemia after platinum-based therapy for non-small cell lung cancer: case report and review of the literature. J Clin Pharm Ther 2006; 31:401-6. [PMID: 16882113 DOI: 10.1111/j.1365-2710.2006.00748.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic myelomonocytic leukaemia (CMML) is a preleukaemic condition with myeloproliferative features, and classified as a part of myelodysplastic syndrome (MDS). Other than alkylating agents and topoisomerase II inhibitors, there is less evidence that chemotherapeutic drugs are associated with therapy-related CMML, acute leukaemia or MDS. We present a patient who developed CMML within 2 years of platinum-based chemotherapy for a metastatic non-small cell lung cancer. He received a cumulative dose of 240 mg/m(2) of cisplatin, and 1123 mg/m(2) of carboplatin before developing CMML. The cytogenetic study revealed trisomy 8. This is the first reported case that links platinum-based therapy with development of CMML with trisomy 8. Although the relationship between platinum therapy and the development of CMML is difficult to assess due to combinational nature of therapy in most cases, physicians should consider the possibility of CMML in patients with symptoms or signs suggestive of haematologic malignancy after platinum therapy.
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Affiliation(s)
- K B Kim
- Department of Melanoma Medical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Markman M. Chemotherapy-induced peripheral neuropathy: underreported and underappreciated. Curr Pain Headache Rep 2006; 10:275-8. [PMID: 16834942 DOI: 10.1007/s11916-006-0032-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chemotherapy-induced neuropathy is one of the most serious non-life-threatening side effects experienced by patients receiving this group of pharmaceutical agents. Although frequently reversible, some patients may remain with symptoms for the remainder of their lives. Early recognition that "numbness and tingling" in the hands and feet of a patient receiving chemotherapy is due to the antineoplastic drug, with subsequent dose reduction or discontinuation of the offending agent, may prevent the development of serious neurologic dysfunction.
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Affiliation(s)
- Maurie Markman
- University of Texas M.D. Anderson Cancer Center (Mail Box #121), 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Stovall M, Weathers R, Kasper C, Smith SA, Travis L, Ron E, Kleinerman R. Dose reconstruction for therapeutic and diagnostic radiation exposures: use in epidemiological studies. Radiat Res 2006; 166:141-57. [PMID: 16808603 DOI: 10.1667/rr3525.1] [Citation(s) in RCA: 196] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This paper describes methods developed specifically for reconstructing individual organ- and tissue-absorbed dose of radiation from past exposures from medical treatments and procedures for use in epidemiological studies. These methods have evolved over the past three decades and have been applied to a variety of medical exposures including external-beam radiation therapy and brachytherapy for malignant and benign diseases as well as diagnostic examinations. The methods used for estimating absorbed dose to organs in and outside the defined treatment volume generally require archival data collection, abstraction and review, and phantom measurements to simulate past exposure conditions. Three techniques are used to estimate doses from radiation therapy: (1) calculation in three-dimensional mathematical computer models using an extensive database of out-of-beam doses measured in tissue-equivalent materials, (2) measurement in anthropomorphic phantoms constructed of tissue-equivalent material, and (3) calculation using a three-dimensional treatment-planning computer. For diagnostic exposures, doses are estimated from published data and software based on Monte Carlo techniques. We describe and compare these methods of dose estimation and discuss uncertainties in estimated organ doses and potential for future improvement. Seven epidemiological studies are discussed to illustrate the methods.
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Affiliation(s)
- Marilyn Stovall
- Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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Mudie NY, Swerdlow AJ, Higgins CD, Smith P, Qiao Z, Hancock BW, Hoskin PJ, Linch DC. Risk of Second Malignancy After Non-Hodgkin's Lymphoma: A British Cohort Study. J Clin Oncol 2006; 24:1568-74. [PMID: 16520465 DOI: 10.1200/jco.2005.04.2200] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess long-term site-specific risks of second malignancy following non-Hodgkin's lymphoma (NHL) in relation to treatment and demographic factors. Patients and Methods A cohort of 2,456 patients with NHL who were first treated from 1973 to 2000 and were younger than 60 years from centers in the British National Lymphoma Investigation were observed, and occurrences of second malignancy was compared with expectations based on general population cancer rates in England and Wales. Results In total, 123 second malignancies occurred. Relative risks (RRs) were significantly elevated for all malignancies combined (RR = 1.3; 95% CI, 1.1 to 1.6) and for leukemia (RR = 8.8; 95% CI, 5.1 to 14.1) and lung cancer (RR = 1.6; 95% CI, 1.1 to 2.3). RRs of malignancy overall diminished significantly with increasing age at first treatment. Leukemia risk was significantly increased after chemotherapy (RR = 10.5; 95% CI, 5.0 to 19.3) and mixed-modality treatment (RR = 13.0; 95% CI, 5.2 to 26.7). Relative risks of lung (RR = 1.9; 95% CI, 1.1 to 3.1) and colorectal (RR = 2.1; 95% CI, 1.1 to 3.6) cancers were significantly raised following chemotherapy. Conclusion NHL patients are at elevated risk of developing second malignancy, particularly leukemia and lung cancer. The relative risk is greater with patients who are younger at first treatment. Chemotherapy predisposes patients toan increased risk of leukemia, and possibly lung and colorectal cancers. The role of specific drug treatments in the etiology of solid cancers after NHL deserves further investigation.
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Affiliation(s)
- Nadejda Y Mudie
- Section of Epidemiology, Institute of Cancer Research, Sutton, Surrey, United Kingdom.
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Markman M. Cancer survivorship: The concept and the increasingly recognized reality. Curr Oncol Rep 2006; 8:79-80. [PMID: 16507215 DOI: 10.1007/s11912-006-0039-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Flandin I, Hartmann O, Michon J, Pinkerton R, Coze C, Stephan JL, Fourquet B, Valteau-Couanet D, Bergeron C, Philip T, Carrie C. Impact of TBI on late effects in children treated by megatherapy for Stage IV neuroblastoma. A study of the French Society of Pediatric oncology. Int J Radiat Oncol Biol Phys 2006; 64:1424-31. [PMID: 16427213 DOI: 10.1016/j.ijrobp.2005.10.020] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Revised: 10/16/2005] [Accepted: 10/30/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the contribution of total body irradiation (TBI) to late sequelae in children treated with high-dose chemotherapy and autologous bone marrow transplantation for Stage IV neuroblastoma. PATIENTS AND METHODS We compared two populations that were similar with regard to age, stage, pre-autologous bone marrow transplantation chemotherapy (CT) regimen, period of treatment, and follow-up (12 years). The TBI group (n = 32) received TBI as part of the megatherapy procedure (1982-1993), whereas the CT group (n = 30) received conditioning without TBI (1985-1992). Analysis 12 years later focused on growth, weight and corpulence (body mass index) delay; hormonal deficiencies; liver, kidney, heart, ear, eye, and dental sequelae; school performance; and the incidence of secondary tumors. RESULTS Impact of TBI was most marked in relation to growth and weight delay, although the mean delay was not severe, probably because of treatment with growth hormones. Other consequences of TBI were thyroid insufficiency, cataracts, and a high incidence of secondary tumors. Hearing loss and dental agenesis were more prominent in the group treated with CT alone. No differences were observed in school performance. CONCLUSION The most frequent side effects of TBI were cataracts, thyroid insufficiency, and growth delay, but more worrying is the risk of secondary tumors. Because of the young mean age of patients and the toxicity of TBI regimens without any survival advantage, regimens without TBI are preferable in the management of Stage IV neuroblastoma.
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Affiliation(s)
- Isabelle Flandin
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
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49
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Abstract
Therapy-related cancers, defined as second primary cancers that arise as a consequence of chemotherapy and/or radiotherapy, are unusual in that they have a well-defined aetiology. Knowledge of the specific nature of the initiating exposure and exactly when it occurred has made it easier to identify crucial genetic events and to model these in vitro and in vivo. As such, the study of therapy-related cancers has led to the elucidation of discrete mechanisms of carcinogenesis, including DNA double-strand-break-induced gene translocation and genomic instability conferred by loss of DNA repair. Unsurprisingly, some of these mechanisms seem to operate in the development of sporadic cancers.
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Affiliation(s)
- James M Allan
- Epidemiology and Genetics Unit, Department of Biology, University of York, Heslington, York, YO10 5YW, UK.
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50
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Abstract
The platinum agents (cisplatin, carboplatin and oxaliplatin) are among the most useful anticancer agents available to oncologists. The drugs have the potential to produce both mild and more serious side effects. However, in general, the platinum agents can be delivered with acceptable toxicity, even when used in combination chemotherapy regimens. Furthermore, with appropriate dose modifications, the large majority of patients who may benefit from this class of cytotoxic pharmaceutical drugs will be able to complete a planned therapeutic programme.
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Affiliation(s)
- Maurie Markman
- Department of Hematology/Medical Oncology (R 35), The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio, USA.
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