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Tang L, Ding C, Li H, Yin G, Zhang H, Liu WS, Ji Y, Li H. A pharmacovigilance study of adverse event profiles and haemorrhagic safety of bevacizumab based on the FAERS database. Expert Opin Drug Saf 2024; 23:213-220. [PMID: 37581403 DOI: 10.1080/14740338.2023.2248876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Bevacizumab is used for the treatment of advanced malignant tumors; it acts by inhibiting angiogenesis. This study aimed to examine adverse events (AEs) of bevacizumab, especially hemorrhage, using the Food and Drug Administration Adverse Event Reporting System (FAERS) database. RESEARCH DESIGN AND METHODS The reporting odds ratio (ROR) and proportional reporting ratio (PRR) were used to analyze the AEs of bevacizumab using FAERS registration data from January 2004 to September 2022. Clinical information regarding hemorrhagic signals was further analyzed. RESULTS The number of bevacizumab-associated AE reports was 96,477. Our study found that 892 significant preferred terms (PTs) were spread throughout 25 organ systems. The system organ classes (SOCs) focus on general disorders, administration site conditions, blood and lymphatic system disorders, injury, poisoning, and procedural complications. A total of 2,847 bevacizumab-related hemorrhage cases were reported, and 37 hemorrhagic signals were identified. Hemorrhagic signals were focused on SOC levels in vascular, gastrointestinal, and nervous system disorders. Colorectal, lung, and breast cancers are the three most common malignancies associated with BV-induced hemorrhage. CONCLUSION The AE report from the present study confirms the majority of label information for bevacizumab, while also identifying new AEs. In addition, this was a large descriptive study of bevacizumab-induced hemorrhage.
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Affiliation(s)
- Linlin Tang
- Department of Pharmacy, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, China
| | - Chuanhua Ding
- Department of Pharmacy, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, China
| | - Hongying Li
- Department of Pharmacy, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, China
| | - Guoqiang Yin
- Department of Pharmacy, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, China
| | - Haixia Zhang
- Department of Pharmacy, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, China
| | - Wen Shan Liu
- Department of Pharmacy, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, China
| | - Yinghui Ji
- Department of Pharmacy, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, China
| | - Hui Li
- Department of Pharmacy, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, China
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Chitkara A, Kaur N, Desai A, Mehta D, Anamika F, Sarkar S, Gowda N, Sethi P, Thawani R, Chen EY. Risks of hypertension and thromboembolism in patients receiving bevacizumab with chemotherapy for colorectal cancer: A systematic review and meta-analysis. Cancer Med 2023; 12:21579-21591. [PMID: 38069531 PMCID: PMC10757147 DOI: 10.1002/cam4.6662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Guidelines show that for metastatic colorectal cancer (mCRC), a combination of three-drug regimens, fluorouracil, leucovorin, and oxaliplatin and bevacizumab (BVZ), is one of the first-line standard therapies. BVZ is generally well tolerated; however, it is associated with infrequent, life-threatening side effects such as severe hypertension (HTN) (5%-18%), Grade ≥3 arterial thromboembolism (ATE) (2.6%), Grade ≥3 hemorrhagic events (1.2%-4.6%), and gastrointestinal perforation (0.3%-2.4%). This meta-analysis aims to evaluate the additive risk of BVZ-induced severe HTN and thromboembolism when BVZ is combined with a standard chemotherapy regime in patients with mCRC. METHODS Our search was conducted from January 29, 2022, to February 22, 2022, through databases of PubMed, clinicaltrial.gov, EMBASE, Web of Science, and Cochrane Library. Data analysis from randomized controlled trials (RCTs) and clinical trials was conducted using Review Manager V.5.4, comparing BVZ-chemotherapy to chemotherapy only, focusing on cardiovascular AE such as HTN and arterial and venous thromboembolism. RESULTS The analysis from 26 clinical trials and RCTs showed that the odds of HTN were about four times higher, and ATE subgroup analysis of 11 studies showed over two times higher odds of ATE in patients being treated with BVZ compared to the chemotherapy-only group. CONCLUSION BVZ, when added to the standard chemotherapy regimen for mCRC, was associated with higher odds of developing HTN and thromboembolism, specifically ATE, than the chemotherapy-only group. Our findings are significant as they provide vital information in analyzing the risk-benefit ratio of adding BVZ to the standard chemotherapy regime in patients with mCRC, especially in patients with vascular comorbidities.
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Affiliation(s)
- Akshit Chitkara
- Internal MedicineUniversity of California RiversideRiversideCaliforniaUSA
| | - Nirmaljot Kaur
- Internal MedicineUniversity of California RiversideRiversideCaliforniaUSA
| | - Aditya Desai
- Internal MedicineUniversity of California RiversideRiversideCaliforniaUSA
| | - Devanshi Mehta
- Loma Linda UniversityCalifornia in Internal MedicineCaliforniaUSA
| | - Fnu Anamika
- Internal MedicineHackensack Meridian Ocean UniversityBrickNew JerseyUSA
| | - Srawani Sarkar
- Research LabAlbert Einstein College of MedicineNew YorkNew YorkUSA
| | - Nandini Gowda
- Internal MedicineUniversity of California RiversideRiversideCaliforniaUSA
| | - Prabhdeep Sethi
- Internal MedicineUniversity of California RiversideRiversideCaliforniaUSA
| | - Rajat Thawani
- Division of Hematology and Medical Oncology, Knight Cancer InstituteOregon Health & Sciences UniversityPortlandOregonUSA
| | - Emerson Y. Chen
- Division of Hematology and Medical Oncology, Knight Cancer InstituteOregon Health & Sciences UniversityPortlandOregonUSA
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Badescu MC, Badulescu OV, Scripcariu DV, Butnariu LI, Bararu-Bojan I, Popescu D, Ciocoiu M, Gorduza EV, Costache II, Rezus E, Rezus C. Myocardial Ischemia Related to Common Cancer Therapy-Prevention Insights. LIFE (BASEL, SWITZERLAND) 2022; 12:life12071034. [PMID: 35888122 PMCID: PMC9325217 DOI: 10.3390/life12071034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 12/18/2022]
Abstract
Modern antineoplastic therapy improves survival and quality of life in cancer patients, but its indisputable benefits are accompanied by multiple and major side effects, such as cardiovascular ones. Endothelial dysfunction, arterial spasm, intravascular thrombosis, and accelerated atherosclerosis affect the coronary arteries, leading to acute and chronic coronary syndromes that negatively interfere with the oncologic treatment. The cardiac toxicity of antineoplastic agents may be mitigated by using adequate prophylactic measures. In the absence of dedicated guidelines, our work provides the most comprehensive, systematized, structured, and up-to-date analyses of the available literature focusing on measures aiming to protect the coronary arteries from the toxicity of cancer therapy. Our work facilitates the implementation of these measures in daily practice. The ultimate goal is to offer clinicians the necessary data for a personalized therapeutic approach for cancer patients receiving evidence-based oncology treatments with potential cardiovascular toxicity.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (I.I.C.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Oana Viola Badulescu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (I.B.-B.); (M.C.)
- Hematology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
- Correspondence: (O.V.B.); (D.V.S.); (L.I.B.)
| | - Dragos Viorel Scripcariu
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- 1st Surgical Oncology Unit, Regional Institute of Oncology, 2-4 General Henri Mathias Berthelot Street, 700483 Iasi, Romania
- Correspondence: (O.V.B.); (D.V.S.); (L.I.B.)
| | - Lăcrămioara Ionela Butnariu
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Correspondence: (O.V.B.); (D.V.S.); (L.I.B.)
| | - Iris Bararu-Bojan
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (I.B.-B.); (M.C.)
| | - Diana Popescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (I.I.C.); (C.R.)
| | - Manuela Ciocoiu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (I.B.-B.); (M.C.)
| | - Eusebiu Vlad Gorduza
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Irina Iuliana Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (I.I.C.); (C.R.)
- Cardiology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Elena Rezus
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- I Rheumatology Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (I.I.C.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
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Kong Y, Xu XC, Hong L. Arteriovenous thrombotic events in a patient with advanced lung cancer following bevacizumab plus chemotherapy: A case report. World J Clin Cases 2022; 10:6507-6513. [PMID: 35979297 PMCID: PMC9294919 DOI: 10.12998/wjcc.v10.i19.6507] [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: 08/08/2021] [Revised: 11/15/2021] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In driver gene-negative non-small cell lung cancer patients who relapse following radical resection, combination chemotherapy using bevacizumab and platinum-based dual drugs is known to increase both progression-free and overall survival. Treatment initially includes bevacizumab, and if patients are able to tolerate it, bevacizumab can continue to be utilized until disease progression. Bevacizumab is a recombinant humanized monoclonal neutralizing antibody that acts against vascular endothelial growth factor (VEGF). Various anti-VEGF monoclonal antibodies, such as bevacizumab, can increase the risk of arterial thromboembolism. Current data indicate that VEGF-targeted treatment does not significantly increase the risk of venous thromboembolism events, except for bevacizumab.
CASE SUMMARY A 55-year-old man underwent radical resection for cancer of the right lung. Six months following surgery, multiple metastases were observed in his left lung. Subsequently, six cycles of bevacizumab combined with pemetrexed/carboplatin chemotherapy was given. Efficacy evaluation continued to be partial relief according to RECIST 1.1 standards, and no noticeable adverse reactions were noted. After three cycles of maintenance therapy using a combination of bevacizumab and pemetrexed, the patient developed dizziness and dyspnea. The patient was diagnosed with acute cerebral infarction and pulmonary embolism following head magnetic resonance imaging, computed tomography (CT) angiography, and chest enhanced CT. Although the patient received low-molecular-weight heparin anticoagulation and other treatment, the patient eventually died of respiratory failure 1 mo later. This case report may offer some insight into fatal arteriovenous embolism, which has not been previously reported.
CONCLUSION Bevacizumab combined with chemotherapy may also increase the risk of arteriovenous thromboembolism. Accordingly, patients who receive angiogenesis inhibitor therapy should be carefully selected. Furthermore, close monitoring and timely intervention are necessary in order to reduce the risk of such toxicities.
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Affiliation(s)
- Ying Kong
- Department of Oncology, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou 311200, Zhejiang Province, China
| | - Xiao-Cheng Xu
- Department of Oncology, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou 311200, Zhejiang Province, China
| | - Liang Hong
- Department of Oncology, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou 311200, Zhejiang Province, China
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Kumar N, Rai A, Dutta P, Gupta P, Singh P, Mukherjee KK, Dhandapani S. Noncontiguous Radiation-Induced Brain Necrosis (RIBN) in a Patient with Aggressive Pituitary Adenoma and the Utility of Bevacizumab. Neurol India 2021; 69:1055-1057. [PMID: 34507446 DOI: 10.4103/0028-3886.325385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Narendra Kumar
- Department of Radiotherapy, Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Rai
- Department of Endocrinology, Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prakamya Gupta
- Department of Indian Council of Medical Research, Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Paramjeet Singh
- Department of Radiology, Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanchan K Mukherjee
- Department of Neurosurgery, Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Purpose Growing evidence suggests different systemic exposure of anti-vascular endothelial growth factor (anti-VEGF) agents with repeated intravitreal application. Since the penetration of anti-VEGF agents through vascular barrier was reported, the interaction of anti-VEGF with nonresident platelets has become a topic of interest. The purpose of this study was to evaluate, with the help of visualization techniques, whether platelets take up the anti-VEGF agents ranibizumab, aflibercept, and bevacizumab. Methods The uptake of anti-VEGF agents with or without VEGF treatment was investigated using immunofluorescence and immunogold staining in human platelets. The role of actin filaments and clathrin-coated vesicles in the transport of ranibizumab, aflibercept, and bevacizumab was evaluated by two pharmacologic inhibitors: staurosporine (protein kinase C inhibitor) and cytochalasin D. Results All three anti-VEGF agents were taken up by platelets and colocalized with VEGF. Ranibizumab and aflibercept were mainly detected in alpha-granules; however, bevacizumab was equally localized in alpha-granules and in platelet vesicles. Both staurosporine and cytochalasin D completely inhibited the uptake of aflibercept into platelets. Both pharmacological inhibitors also decreased the transport of ranibizumab and bevacizumab into platelets. Bevacizumab was significantly more frequently colocalized within clathrin-coated vesicles than ranibizumab and aflibercept. Conclusion All three anti-VEGF agents are taken up by platelets and internalized in alpha-granules, which may result in a higher local exposure of anti-VEGF after the activation of platelets, potentially contributing to arterial thromboembolic events. Clathrin-coated vesicles seem to be more prominent in the transport of bevacizumab than ranibizumab and aflibercept. Nevertheless, whether the different localization and transport of bevacizumab are truly related to specific differences of receptor-mediated endocytosis has to be revealed by further research.
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Aronson D, Brenner B. Arterial thrombosis and cancer. Thromb Res 2018; 164 Suppl 1:S23-S28. [PMID: 29703480 DOI: 10.1016/j.thromres.2018.01.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 12/17/2017] [Accepted: 01/02/2018] [Indexed: 12/21/2022]
Abstract
Cancer-associated arterial thrombotic events (ATEs) are increasingly recognized in specific malignancies and in association with the expanding armamentarium of novel chemotherapeutic agents. The improved cancer survival led to cardiovascular complications becoming clinically relevant many years after cancer diagnosis. The pathobiology of ATEs in cancer is complex and the individual patient risk for an ATE entails a multifactorial interaction between the traditional cardiovascular risk factors and comorbidities, the specific malignancy and selected therapy. Treatment with several specific chemotherapeutic agents, immunomodulatory drugs, vascular endothelial growth factor pathway inhibitors, tyrosine kinase inhibitors, and radiotherapy, impart increased risk for ATEs that result from specific therapy-related mechanisms, often involving endothelial injury. Cancer cell-specific prothrombotic properties are important players in the pathogenesis of cancer-associated hypercoagulability. There are distinct biological and molecular processes preferentially activated in specific cancer cells which can trigger ATEs, including platelet activation, increased expression of procoagulants and suppression of fibrinolytic activity. ATEs portend adverse prognosis in cancer patients. Prevention and treatment of cancer-associated ATEs may be improved by greater awareness and careful monitoring for vascular toxicity, aggressive effort to optimize conventional cardiovascular risk factors, and use of antiplatelet and antithrombotic agents in selected patients. These issues are targets for future studies aimed to reduce ATEs in patients with cancer.
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Affiliation(s)
- Doron Aronson
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel; The Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; The Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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Abstract
A 65-year-old man was diagnosed with advanced non-small, non-squamous lung cancer. He was treated with chemotherapy containing bevacizumab as well as cisplatin and pemetrexed. After 2 courses of treatment, computed tomography revealed that his abdominal aortic artery was almost occluded by a thrombus; however, he had no ischemic symptoms. Heparin infusion and warfarin reduced the size of the arterial thrombus and the patient was subsequently treated with chemotherapy without bevacizumab. No thrombotic events occurred during the subsequent treatment. We later noticed a small organized abdominal arterial clot and calcification on a computed tomography scan taken before bevacizumab treatment. Atherosclerotic changes should be evaluated before the administration of bevacizumab.
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Affiliation(s)
- Kazuo Suzuki
- Department of Internal Medicine, Niigata Prefectural Matsudai Hospital, Japan
- Department of Respiratory and Infectious Medicine, Uonuma Kikan Hospital, Niigata University Medical and Dental Hospital, Japan
| | - Takahiro Yanagimura
- Department of Respiratory and Infectious Medicine, Uonuma Kikan Hospital, Niigata University Medical and Dental Hospital, Japan
| | - Kazumasa Ohashi
- Department of Respiratory and Infectious Medicine, Uonuma Kikan Hospital, Niigata University Medical and Dental Hospital, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Japan
| | - Toshinori Takada
- Department of Respiratory and Infectious Medicine, Uonuma Kikan Hospital, Niigata University Medical and Dental Hospital, Japan
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Wu D, Zhao Y, Fu S, Zhang J, Wang W, Yan Z, Guo H, Liu A. Seleno-short-chain chitosan induces apoptosis in human breast cancer cells through mitochondrial apoptosis pathway in vitro. Cell Cycle 2018; 17:1579-1590. [PMID: 29895197 DOI: 10.1080/15384101.2018.1464845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Seleno-short-chain chitosan (SSCC) was a synthesized chitosan derivative with the molecular weight of 4826.986 Da. The study is aimed to investigate cytotoxicity of SSCC on human breast cancer MCF-7 and BT-20 cells and explore apoptosis-related mechanism in vitro. The MTT (3- [4,5-Dimethylthiazol-2-yl]-2, 5-diphenylterazolium bromide) assay showed that SSCC exhibited significantly cytotoxic effects on MCF-7 and BT-20 cells in a dose- and time-dependent manner, and the effective inhibitory concentration was 100 μg/ml and 200 μg/ml, respectively. Apoptosis assay of these two kinds of cells was determined by Hoechst 33,342/PI and Annexin V-FITC/PI double staining. The cell cycle assay showed that SSCC triggered S and G2/M phase cell cycle arrest in MCF-7 cells and S phase cell cycle arrest in BT-20 cells in a time-dependent manner. Further studies demonstrated that SSCC led to the generation of reactive oxygen species (ROS) and the disruption of mitochondrial membrane potential (MMP) in these two kinds of cells. N- acetyl-L cysteine (NAC), as a radical scavenger, significantly inhibited the generation of ROS and decreased the apoptosis of MCF-7 and BT-20 cells. Moreover, the expression of mitochondrial apoptosis-related proteins was detected by western blot assay. SSCC up-regulated the expression of Bax, down-regulated the expression of Bcl-2, subsequently increased the release of cytochrome c from mitochondria to cytoplasm, and activated the cleavage of caspase-9 and -3, which finally induced apoptosis in MCF-7 and BT-20 cells in vitro. Consequently, these data indicated that SSCC could induce apoptosis of MCF-7and BT-20 cells in vitro by mitochondrial pathway.
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Affiliation(s)
- Di Wu
- a Key Laboratory of Food Nutrition and Safety, Ministry of Education, College of Food Engineering and Biotechnology , Tianjin University of Science and Technology , Tianjin , PR , China
| | - Yana Zhao
- a Key Laboratory of Food Nutrition and Safety, Ministry of Education, College of Food Engineering and Biotechnology , Tianjin University of Science and Technology , Tianjin , PR , China
| | - Shengnan Fu
- a Key Laboratory of Food Nutrition and Safety, Ministry of Education, College of Food Engineering and Biotechnology , Tianjin University of Science and Technology , Tianjin , PR , China
| | - Jianbo Zhang
- a Key Laboratory of Food Nutrition and Safety, Ministry of Education, College of Food Engineering and Biotechnology , Tianjin University of Science and Technology , Tianjin , PR , China
| | - Wenhang Wang
- a Key Laboratory of Food Nutrition and Safety, Ministry of Education, College of Food Engineering and Biotechnology , Tianjin University of Science and Technology , Tianjin , PR , China
| | - Zhexian Yan
- a Key Laboratory of Food Nutrition and Safety, Ministry of Education, College of Food Engineering and Biotechnology , Tianjin University of Science and Technology , Tianjin , PR , China
| | - Heng Guo
- a Key Laboratory of Food Nutrition and Safety, Ministry of Education, College of Food Engineering and Biotechnology , Tianjin University of Science and Technology , Tianjin , PR , China
| | - Anjun Liu
- a Key Laboratory of Food Nutrition and Safety, Ministry of Education, College of Food Engineering and Biotechnology , Tianjin University of Science and Technology , Tianjin , PR , China
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Influence of aflibercept on platelet activation profile. Exp Eye Res 2018; 175:166-172. [PMID: 29908884 DOI: 10.1016/j.exer.2018.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 12/21/2022]
Abstract
Aflibercept appears to accumulate in systemic circulation following intravitreal injections in therapy of neovascular age-related macular degeneration. This gives raise to the question of whether aflibercept affects platelets and their function such as activation and aggregation, which are substantial in the pathogenesis of an arterial thromboembolic event (ATE). In order to determine the effect of aflibercept in platelet activation, platelets from healthy volunteers were treated with aflibercept and its solvents at equal concentrations (0.04 μg/mL - 4 μg/mL - 40 μg/mL - 400 μg/mL - 4 mg/mL) for 10 and 30 min before addition of agonists. IgG1 antibody was used as a control. The surface expression of GPIIb/IIIa, P-selectin, and platelet-bound stromal-cell-derived factor-1, which are potential blood biomarkers for ATEs, was determined on resting and activated platelets by the multispectral imaging flow cytometry, combining the features of flow cytometry with fluorescence microscopy. Platelet aggregation was assessed with light transmission aggregometry. To determine whether aflibercept directly interacts with platelets, aflibercept was labeled with the fluorescence FITC. Co-treatment of platelets with thrombin or PAR-4-AP and aflibercept resulted in increased activation of the fibrinogen receptor GPIIb/IIIa in comparison to controls (P < 0.05). Interestingly, the expression of platelet-derived P-selectin and SDF-1 was not affected by aflibercept, except thrombin-activated CD62P with 0.04 μg/mL aflibercept (aflibercept vs. its solvent: MSI = 1.54, IC = 1.201-1.879 vs. MSI = 1.37, IC = 1.136-1.604 [P = 0.031]) and SDF-1 with 4 mg/mL aflibercept (aflibercept vs. its solvent: MSI = 1.971, IC = 1.206-2.737 vs. MSI = 1.200, IC = 0.738-1.662 [P = 0.041]). Although the levels of platelet-bound aflibercept-FITC were significantly increased in all activated platelets, no effect was observed in platelet aggregation. Albeit no impact of aflibercept was found on platelet aggregation under the studied experimental conditions, the increased activation of the fibrinogen receptor GPIIb/IIIa and the presence of a direct interaction between aflibercept and platelets may partially explain the risk of ATE in patients under aflibercept treatment due to FcγRIIa mediated αIIbβ3 outside-in integrin signaling and transport of aflibercept into platelets. Therefore, the Fc domain seems to be involved in interactions between aflibercept and platelets. Further research is needed to explain the role of Fc containing aflibercept in the pathogenesis of drug-associated vascular events involving platelets, coagulation cascade, extracellular matrix proteins and other cells.
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Papaxoinis G, Kamposioras K, Germetaki T, Weaver JMJ, Stamatopoulou S, Nasralla M, Kordatou Z, Owen-Holt V, Anthoney A, Mansoor W. Predictive factors of thromboembolic complications in patients with esophagogatric adenocarcinoma undergoing preoperative chemotherapy. Acta Oncol 2018; 57:790-798. [PMID: 29308947 DOI: 10.1080/0284186x.2017.1423375] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Thromboembolic events (TEEs) represent a significant treatment and disease complication for cancer patients. In the present study we assessed the incidence of TEEs in patients receiving preoperative chemotherapy for esophagogastric adenocarcinoma. The risk factors for TEE development and their impact on prognosis were further analyzed. MATERIAL AND METHODS Data from 590 patients with esophagogastric adenocarcinoma, who received preoperative epirubicin-cisplatin with capecitabine (ECX) or 5-fluorouracil (ECF) between 2009 and 2016 in three UK hospitals were retrospectively collected. RESULTS Twenty-one percent had stomach primary and 98% received ECX chemotherapy. In total, 52 patients (9%) had a venous and 22 (4%) an arterial event. Of those patients with venous TEEs (vTTEs), 39 had pulmonary embolism and 13 deep vein thrombosis, whereas in patients with arterial TEEs (arTTEs), 7 developed a myocardial infarct, 8 developed limb ischemia, 4 developed cerebrovascular accidents and 3 developed superior mesenteric artery thrombosis. ArTEEs were associated with a much higher inoperability rate compared to cases without TEE or with vTEE (77% vs. 20% vs. 31%, respectively, p < .001). Independent risk factors of vTEEs were primary site being the stomach (Odds ratio [OR] 3.24, 95%CI 1.72-6.12, p < .001), being overweight (OR 3.11, 95%CI 1.33-7.26, p = .009) or obese (OR 4.52, 95%CI 1.85-11.09, p = .001) and the presence of central venous access device (OR 3.40, 95%CI 1.00-11.55, p = .050). In contrast, anticoagulant treatment was independently associated with a lower risk of vTEE (OR 0.22, 95%CI 0.06-0.83, p = .026). Khorana score of 4-5 was an independent risk factor of arTEE (OR 6.38, 95%CI 1.85-22.04, p = .003). Finally, arTEEs were an independent poor prognostic factor for OS, when adjusted for baseline patient, tumor and treatment characteristics (Hazard ratio 3.02, 95%CI 1.85-4.95, p < .001). CONCLUSION Preoperative ECX/ECF chemotherapy for patients with resectable esophagogastric adenocarcinoma was associated with relatively high incidence of TEEs. However, only arTEEs affected patient survival outcomes.
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Affiliation(s)
- George Papaxoinis
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Theodora Germetaki
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Jamie M. J. Weaver
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Sofia Stamatopoulou
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Magdy Nasralla
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Zoe Kordatou
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Vikki Owen-Holt
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Alan Anthoney
- Department of Medical Oncology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Wasat Mansoor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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13
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Tuzovic M, Herrmann J, Iliescu C, Marmagkiolis K, Ziaeian B, Yang EH. Arterial Thrombosis in Patients with Cancer. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:40. [PMID: 29627870 PMCID: PMC7658957 DOI: 10.1007/s11936-018-0635-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Cancer is a common cause of morbidity and mortality in the USA. While the association between venous thrombosis and malignancy is well established, arterial thrombosis has more recently been recognized as a serious complication of cancer and certain chemotherapeutic agents. This review aims to summarize the most recent literature regarding the incidence and risk factors for cancer-related arterial thrombosis, understand the pathophysiologic mechanisms of thrombosis, and highlight the specific diagnostic and treatment considerations relevant to cancer patients. RECENT FINDINGS Based on a recent study looking at the Surveillance, Epidemiology, and End Results (SEER) database, the incidence of arterial thromboembolic events (ATEs) in patients with cancer at 6 months is 4.7%; the presence of an ATE is predictive of worse outcomes. Certain drugs such as platinum-based agents, vascular endothelial growth factor inhibitors, tyrosine kinase inhibitors, and taxanes have been associated with high rates of ATEs. Increased platelet reactivity appears crucial to development of arterial thrombosis in cancer patients. Cancer patients have an increased risk of arterial thrombosis that is likely due to both a cancer-associated procoagulant state as well as the adverse effects of certain chemotherapeutic agents. Treatment of arterial thromboembolism in cancer patients typically requires a multidisciplinary approach in part due to high rates of thrombocytopenia and stent thrombosis in the setting of percutaneous interventions. More studies are needed to investigate optimal prophylaxis, surveillance strategies, and treatments of cancer-related arterial thromboembolic disease.
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Affiliation(s)
- Mirela Tuzovic
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, 100 Medical Plaza, Suite 630, Los Angeles, CA, 90095, USA
| | - Joerg Herrmann
- Division of Cardiovascular Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Cezar Iliescu
- Division of Cardiology, Department of Medicine, MD Anderson Cancer Center, University of Texas at Houston, Houston, TX, USA
| | | | - Boback Ziaeian
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, 100 Medical Plaza, Suite 630, Los Angeles, CA, 90095, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, 100 Medical Plaza, Suite 630, Los Angeles, CA, 90095, USA.
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14
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Bevacizumab for Radiation Induced Optic Neuritis Among Aggressive Residual/Recurrent Suprasellar Tumors: More Than a Mere Antineoplastic Effect. World Neurosurg 2017; 107:1044.e5-1044.e10. [DOI: 10.1016/j.wneu.2017.07.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 12/21/2022]
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15
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GHERMAN ALEXANDRA, CĂINAP CĂLIN, CONSTANTIN ANNEMARIE, CETEAN SÎNZIANA, CĂINAP SIMONASORANA. Molecular targeted treatment of metastatic colorectal cancer: the cardiovascular adverse effects of Bevacizumab and Cetuximab. CLUJUL MEDICAL (1957) 2017; 90:377-384. [PMID: 29151784 PMCID: PMC5683825 DOI: 10.15386/cjmed-745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/06/2016] [Indexed: 12/21/2022]
Abstract
Novel emerging therapies have changed paradigms in metastatic colorectal cancer. The advantages of molecular targeted treatments, either the anti-angiogenic or the anti-epidermal growth factor receptor drugs, reside in the fact that while their specificity for the cancer cell is higher, their toxicity on normal tissues is significantly lower when compared to chemotherapy. But when it comes to their safety, especially from a cardiovascular point of view, they still need to pass the test of time and further prospective studies are needed. Clinical trial patients are very well selected with regards to comorbidities and therefore, they often differ from real-life patients. In order to maximize the benefits from these drugs, we need to better identify the population at risk, understand and early diagnose their on- and off-target adverse effects and to adequately choose the diagnostic tools; with a better prevention and early treatment, the quality and quantity of our patients' lives can be significantly improved.
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Affiliation(s)
- ALEXANDRA GHERMAN
- 11th Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - CĂLIN CĂINAP
- 11th Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Prof. Dr. Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
| | - ANNE-MARIE CONSTANTIN
- 1st Department of Morphological Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - SÎNZIANA CETEAN
- 2nd Department of General and Inorganic Chemistry, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - SIMONA SORANA CĂINAP
- 2nd Pediatric Clinic, Cluj-Napoca, Romania
- 9th Department of Infant Care, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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16
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Totzeck M, Mincu RI, Rassaf T. Cardiovascular Adverse Events in Patients With Cancer Treated With Bevacizumab: A Meta-Analysis of More Than 20 000 Patients. J Am Heart Assoc 2017; 6:JAHA.117.006278. [PMID: 28862931 PMCID: PMC5586462 DOI: 10.1161/jaha.117.006278] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background The monoclonal antibody bevacizumab effectively inhibits angiogenesis in several types of cancers by blocking vascular endothelial growth factor. However, life‐threatening cardiovascular adverse effects could limit its use and may warrant specific follow‐up strategies. Methods and Results We systematically searched MEDLINE, Cochrane, EMBASE, and Web of Science for randomized controlled trials published until November 2016 that assessed patients with cancer treated with or without bevacizumab in addition to standard chemotherapy. A total of 20 050 patients with a broad range of cancer types from 22 studies were included in this analysis (10 394 in the bevacizumab group and 9656 in the control group). The risks of arterial and venous adverse events were higher in the bevacizumab groups (relative risk [RR], 1.37; 95% CI, 1.10–1.70 [P=0.004] and RR, 1.29; 95% CI, 1.12–1.47 [P<0.001], respectively), and more arterial adverse events occurred in patients taking high‐dose bevacizumab regimens. Bevacizumab treatment was associated with the highest risk of cardiac and cerebral ischemia in the high‐dose bevacizumab groups (RR, 4.4; 95% CI, 1.59–12.70 [P=0.004] and RR, 6.67; 95% CI, 2.17–20.66 [P=0.001], respectively). In addition, the risk of bleeding and arterial hypertension were higher in the bevacizumab groups (RR, 2.74; 95% CI, 2.38–3.15 [P<0.001] and RR, 4.73; 95% CI, 4.15–5.39 [P<0.00001], respectively), with higher values for patiens taking high‐dose regimens. Conclusions Treatment with bevacizumab increases the risk of arterial adverse events, particularly cardiac and cerebral ischemia, venous adverse events, bleeding, and arterial hypertension. This risk is additionally increased with high doses of bevacizumab. Further studies should determine the appropriate options for cardio‐oncology management. Clinical Trial Registration URL: https://www.crd.york.ac.uk. Unique identifier: PROSPERO(CRD42016054305).
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Affiliation(s)
- Matthias Totzeck
- Department of Cardiology and Vascular Medicine, Medical Faculty, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Raluca Ileana Mincu
- Department of Cardiology and Vascular Medicine, Medical Faculty, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, Medical Faculty, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
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17
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Maurea N, Spallarossa P, Cadeddu C, Madonna R, Mele D, Monte I, Novo G, Pagliaro P, Pepe A, Tocchetti CG, Zito C, Mercuro G. A recommended practical approach to the management of target therapy and angiogenesis inhibitors cardiotoxicity: an opinion paper of the working group on drug cardiotoxicity and cardioprotection, Italian Society of Cardiology. J Cardiovasc Med (Hagerstown) 2016; 17 Suppl 1:S93-S104. [PMID: 27183530 PMCID: PMC4927319 DOI: 10.2459/jcm.0000000000000383] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Indexed: 12/21/2022]
Abstract
The US National Cancer Institute estimates that cardiotoxicity (CTX) from target therapy refers mostly to four groups of drugs: epidermal growth factor receptor 2 inhibitors, angiogenic inhibitors, directed Abelson murine leukemia viral oncogene homolog inhibitors, and proteasome inhibitors. The main cardiotoxic side-effects related to antiepidermal growth factor receptor 2 therapy are left ventricular systolic dysfunction and heart failure. Angiogenesis inhibitors are associated with hypertension, left ventricular dysfunction/heart failure, myocardial ischemia, QT prolongation, and thrombosis. Moreover, other agents may be related to CTX induced by treatment. In this study, we review the guidelines for a practical approach for the management of CTX in patients under anticancer target therapy.
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Affiliation(s)
- Nicola Maurea
- Division of Cardiology, Istituto Nazionale per lo Studio e la Cura dei Tumori ‘Fondazione Giovanni Pascale’ – IRCCS, Naples
| | | | - Christian Cadeddu
- Department of Medical Sciences ‘Mario Aresu’, University of Cagliari, Cagliari
| | - Rosalinda Madonna
- Institute of Cardiology, Center of Excellence on Aging, ‘G. d’Annunzio’ University, Chieti
| | - Donato Mele
- Cardiology Unit, University Hospital of Ferrara, Ferrara
| | - Ines Monte
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, Catania
| | - Giuseppina Novo
- Chair and Division of Cardiology, University of Palermo, Palermo
| | - Pasquale Pagliaro
- Department of Clinical and Biological Sciences, University of Turin, Turin
| | - Alessia Pepe
- U.O.C. Magnetic Resonance Imaging, Fondazione G. Monasterio C.N.R., Pisa
| | - Carlo G. Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples
| | - Concetta Zito
- U.O.C. Cardiology Intensive Unit, A.O.U. Policlinico ‘G. Martino’, University of Messina, Messina, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences ‘Mario Aresu’, University of Cagliari, Cagliari
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18
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Sundararajan S, Kumar A, Poongkunran M, Kannan A, Vogelzang NJ. Cardiovascular adverse effects of targeted antiangiogenic drugs: mechanisms and management. Future Oncol 2016; 12:1067-80. [DOI: 10.2217/fon.16.4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Anticancer treatment has evolved enormously over the last decade. Drugs targeting receptor tyrosine kinases, VEGFR and EGFR have changed the treatment landscape of certain cancers and have shifted the theme of anticancer therapy toward personalized care. However, these newer agents also come with unique side-effect profiles not seen with conventional chemotherapy including serious cardiovascular adverse effects. Hence, meticulous understanding of the adverse effects is crucial in maximizing clinical benefits and minimizing detrimental effects of these newer drugs. We have reviewed the cardiovascular adverse effects of anti-VEGF therapy in this article.
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Affiliation(s)
- Srinath Sundararajan
- Division of Hematology & Oncology, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Abhijeet Kumar
- Division of Hematology & Oncology, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Mugilan Poongkunran
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Arun Kannan
- Division of Cardiology, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Nicholas J Vogelzang
- University of Nevada School of Medicine & US Oncology/Comprehensive Cancer Centers of Nevada, Las Vegas, NV, USA
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19
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Harkins KA, Haschke M, Do DV. Aflibercept for the treatment of diabetic macular edema. Immunotherapy 2016; 8:503-10. [PMID: 26907516 DOI: 10.2217/imt.16.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Diabetic macular edema (DME) is an accumulation of fluid in the central retina, secondary to vascular-leakage from diabetic vascular damage. DME and other ophthalmic sequela of diabetes are the leading cause of blindness in 20 to 74-year-olds. The development of VEGF-inhibitors (anti-VEGF) has revolutionized DME treatment improving the clinician's ability to remove excess fluid from the macula, improving visual-acuity. Aflibercept is an anti-VEGF agent made of a recombinant fusion protein (consisting of VEGF receptors 1 and 2 extracellular domains) fused with the Fc-portion of human-IgG1, which binds both VEGF isoforms A and B, and placental growth factor. Phase III clinical trials and published scientific studies have demonstrated the efficacy of intravitreal aflibercept injection in the treatment of DME.
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Affiliation(s)
- Keegan A Harkins
- Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth St, Omaha, NE 68105, USA
| | - Mary Haschke
- Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth St, Omaha, NE 68105, USA
| | - Diana V Do
- Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth St, Omaha, NE 68105, USA
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20
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Al-Shamsi HO, Al Farsi A, Anjum M, Shen H, Zbuk K, Cook RJ, Linkins LA, Major P. Thrombotic events in metastatic colorectal cancer patients treated with leucovorin, fluorouracil and irinotican (FOLFIRI) plus bevacizumab. J Gastrointest Oncol 2015; 6:274-9. [PMID: 26029454 DOI: 10.3978/j.issn.2078-6891.2015.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/13/2015] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To determine the incidence and risk factors for thrombotic events (TEs) in patients with metastatic colorectal cancer (mCRC) who received bevacizumab (BV) and FOLFIRI (leucovorin, fluorouracil and irinotican) compared to FOLFIRI alone. METHODS Single institution retrospective study of 450 mCRC patients who received either BV plus FOLFIRI or FOLFIRI alone between April 2004 and August 2012. Demographics, TE risk factors, and treatment data were abstracted from patients' records. Multivariate analysis was used to identify factors that contributed to thromboembolism. RESULTS Two-hundred-sixty-one mCRC patients received BV plus FOLFIRI [64.8% males, mean body mass index (BMI) of 27.6] compared to 189 control patients who received FOLFIRI alone (61.9% males, BMI 27.2). The incidence of TEs was 14.9% in the BV plus FOLFIRI group, compared to 15.9% in the control group. Multivariate analysis controlling for age, BMI, gender, malignancy, metastatic sites, line of treatment, and risk factors did not suggest a significant increase in the risk of TE with the addition of BV (OR =0.83 95% CI: 0.40-1.70; P=0.602). No difference in the site of TEs was observed between the treatment groups. The only statistically significant risk factor for thrombosis in the FOLFIRI plus BV group was increased BMI (OR =1.05; 95% CI: 1.01-1.10; P=0.01). CONCLUSIONS This study does not support a significant increase in the risk of TE in patients with mCRC who received BV in addition to FOLFIRI. Increased BMI may be a risk factor for thrombosis in patients treated with BV.
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Affiliation(s)
- Humaid O Al-Shamsi
- 1 Department of Oncology, McMaster University, Hamilton, Ontario, Canada ; 2 Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada ; 3 Department of Medicine, Sheikh Zayed Military Hospital, Abu Dhabi, United Arab Emirates ; 4 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Abdulaziz Al Farsi
- 1 Department of Oncology, McMaster University, Hamilton, Ontario, Canada ; 2 Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada ; 3 Department of Medicine, Sheikh Zayed Military Hospital, Abu Dhabi, United Arab Emirates ; 4 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mahraz Anjum
- 1 Department of Oncology, McMaster University, Hamilton, Ontario, Canada ; 2 Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada ; 3 Department of Medicine, Sheikh Zayed Military Hospital, Abu Dhabi, United Arab Emirates ; 4 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hua Shen
- 1 Department of Oncology, McMaster University, Hamilton, Ontario, Canada ; 2 Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada ; 3 Department of Medicine, Sheikh Zayed Military Hospital, Abu Dhabi, United Arab Emirates ; 4 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Zbuk
- 1 Department of Oncology, McMaster University, Hamilton, Ontario, Canada ; 2 Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada ; 3 Department of Medicine, Sheikh Zayed Military Hospital, Abu Dhabi, United Arab Emirates ; 4 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard J Cook
- 1 Department of Oncology, McMaster University, Hamilton, Ontario, Canada ; 2 Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada ; 3 Department of Medicine, Sheikh Zayed Military Hospital, Abu Dhabi, United Arab Emirates ; 4 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lori-Ann Linkins
- 1 Department of Oncology, McMaster University, Hamilton, Ontario, Canada ; 2 Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada ; 3 Department of Medicine, Sheikh Zayed Military Hospital, Abu Dhabi, United Arab Emirates ; 4 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pierre Major
- 1 Department of Oncology, McMaster University, Hamilton, Ontario, Canada ; 2 Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada ; 3 Department of Medicine, Sheikh Zayed Military Hospital, Abu Dhabi, United Arab Emirates ; 4 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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21
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Di Bartolomeo M, Maggi C, Ricchini F, Pietrantonio F, Iacovelli R, de Braud F, Inno A. Bevacizumab treatment in the elderly patient with metastatic colorectal cancer. Clin Interv Aging 2015; 10:127-33. [PMID: 25584021 PMCID: PMC4289484 DOI: 10.2147/cia.s54675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Metastatic colorectal cancer (mCRC), like many cancers, is primarily a disease of elderly people. Despite this prevalence, such patients are often excluded from randomized trials or represent a minority of enrolled patients. Moreover, the criteria for establishing benefit or side effects of treatment strategies in this population are uncertain and not well recognized. Bevacizumab improves the outcome of mCRC when used in combination with standard first-line and second-line chemotherapy and beyond the first disease progression when given with a chemotherapy backbone different from that used in the precedent line. The particular toxicity profile of this antiangiogenesis agent (in particular hypertension, thromboembolic events, hemorrhage, and renal failure) may discourage its use in elderly patients with comorbidities. Data from subgroup analyses of randomized trials and the results of recent cohort studies suggest a significant benefit from the addition of bevacizumab to standard chemotherapy for elderly patients comparable with that observed in younger patients, except for the increased risk for thromboembolic events. Age alone should not be a barrier to use of bevacizumab, and further research with a more complete geriatric assessment should investigate the role of bevacizumab in elderly patients with mCRC to avoid undertreatment of this patient population due to a historical conservative approach.
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Affiliation(s)
- Maria Di Bartolomeo
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Maggi
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Ricchini
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Roberto Iacovelli
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Inno
- Department of Medical Oncology, Sacro Cuore-Don Calabria Hospital, Negrar, Italy
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22
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Gunduz S, Mutlu H, Uysal M, Coskun HS, Bozcuk H. Elucidating the correlation between treatment with tyrosine kinase inhibitors and mean platelet volume in patients with metastatic renal cell cancer. Oncol Lett 2014; 8:2249-2252. [PMID: 25289104 PMCID: PMC4186555 DOI: 10.3892/ol.2014.2495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 08/07/2014] [Indexed: 12/21/2022] Open
Abstract
Patients with cancer are at increased risk of thrombosis. Additionally, an increased mean platelet volume (MPV) has been demonstrated to be associated with thromboembolism. Tyrosine kinase inhibitors (TKIs) may modulate the activation of systemic coagulation in cancer patients, rendering them more susceptible to thromboembolism. The aim of the current study was to investigate the association between antiangiogenic TKIs and MPV. A total of 45 patients with metastatic renal cell carcinoma (RCC), who were treated with TKIs and were patients at the Akdeniz University Hospital and Afyon Kocatepe University Ahmet Necdet Sezer Research and Practice Hospital, were retrospectively reviewed. The results prior to treatment and after three months for the MPV values and platelet levels were evaluated. The MPV values increased following the treatment with TKIs; however, no statistically significant difference was observed between the baseline and three month values (P=0.286). Conversely, a significant decrease was observed in the platelet levels following treatment (P=0.005). Treatment with TKIs in patients with metastatic RCC caused a modest increase in MPV, which is an indicator of thrombocytic reactivity; however, further studies are required to validate these results.
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Affiliation(s)
- Seyda Gunduz
- Department of Medical Oncology, Akdeniz University Hospital, Antalya 07070, Turkey
| | - Hasan Mutlu
- Department of Medical Oncology, Akdeniz University Hospital, Antalya 07070, Turkey
| | - Mukremin Uysal
- Department of Medical Oncology, Afyon Kocatepe University Ahmet Necdet Sezer Research and Practice Hospital, Afyon 3000, Turkey
| | - Hasan Senol Coskun
- Department of Medical Oncology, Akdeniz University Hospital, Antalya 07070, Turkey
| | - Hakan Bozcuk
- Department of Medical Oncology, Akdeniz University Hospital, Antalya 07070, Turkey
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23
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Huillard O, Defaucheux C, Chapron J, Dusser D, Boudou-Rouquette P, Alexandre J, Goldwasser F. How should we manage bevacizumab toxicity in lung cancer patients? Lung Cancer Manag 2014. [DOI: 10.2217/lmt.14.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Bevacizumab is an antiangiogenic targeted therapy approved for the treatment of patients with advanced non-small-cell lung cancer other than predominantly squamous cell histology in addition to platinum-based chemotherapy. The safety of bevacizumab has been assessed in studies across most cancer types and bevacizumab is generally well tolerated. Some specific issues associated with the use of bevacizumab in lung cancer are discussed in this report (pulmonary hemorrhage, brain metastases or concurrent thoracic radiotherapy) as well as frequent and clinically relevant adverse events and their management. Oncologists and pulmonologists should be aware of such events and their management since the prescription of bevacizumab concerns many patients and the future use in maintenance therapy will be associated with prolonged treatment.
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Affiliation(s)
- Olivier Huillard
- Angiogenesis inhibitors multidisciplinary study group (CERIA), Department of Medical Oncology, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France
| | - Cécile Defaucheux
- Angiogenesis inhibitors multidisciplinary study group (CERIA), Department of Medical Oncology, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France
| | - Jeanne Chapron
- Department of Respiratory Medicine, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France
| | - Daniel Dusser
- Department of Respiratory Medicine, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France
| | - Pascaline Boudou-Rouquette
- Angiogenesis inhibitors multidisciplinary study group (CERIA), Department of Medical Oncology, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France
| | - Jérôme Alexandre
- Angiogenesis inhibitors multidisciplinary study group (CERIA), Department of Medical Oncology, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France
| | - François Goldwasser
- Angiogenesis inhibitors multidisciplinary study group (CERIA), Department of Medical Oncology, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France
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Kelly CM, Power DG, Lichtman SM. Targeted therapy in older patients with solid tumors. J Clin Oncol 2014; 32:2635-46. [PMID: 25071113 DOI: 10.1200/jco.2014.55.4246] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The introduction of targeted therapy has ushered in the era of personalized medicine in cancer therapy. The increased understanding of tumor heterogeneity has led to the determination of specific targets that can be exploited in treatment. This review highlights approved drugs in different therapeutic classes, including tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, drugs targeted to the human epidermal growth factor receptor 2, BRAF-mutation targeted drugs, anti-epidermal growth factor receptor inhibitors, and anti-vascular endothelial growth factor therapy. There have not been elderly patient-specific trials of these therapies. Most of the data are extrapolated from larger trials in which older patients generally were a fraction of the participants. Therapeutic recommendations are made on the basis of this analysis with the recognition that the older clinical trial participants may not be representative of patients seen in daily practice. Patient selection and geriatric evaluation are critical for appropriate drug selection, dosing, and monitoring. With care, these therapies are a major step forward in the safe and effective treatment of older patients with cancer.
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Affiliation(s)
- Ciara M Kelly
- Ciara M. Kelly and Derek G. Power, Mercy University Hospital, Cork, Ireland; and Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY
| | - Derek G Power
- Ciara M. Kelly and Derek G. Power, Mercy University Hospital, Cork, Ireland; and Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY
| | - Stuart M Lichtman
- Ciara M. Kelly and Derek G. Power, Mercy University Hospital, Cork, Ireland; and Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY.
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Dai F, Shu L, Bian Y, Wang Z, Yang Z, Chu W, Gao S. Safety of bevacizumab in treating metastatic colorectal cancer: a systematic review and meta-analysis of all randomized clinical trials. Clin Drug Investig 2014; 33:779-88. [PMID: 23979925 DOI: 10.1007/s40261-013-0125-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE The incidence rates of colorectal cancer (CRC) are increasing in a number of different regions, and recent studies have indicated that addition of bevacizumab to CRC therapy is beneficial. To better understand the relative risk (RR) of adverse events associated with use of bevacizumab, we systematically reviewed published clinical trials that studied use of bevacizumab in treatment of patients affected by metastatic CRC (mCRC). METHODS The National Library of Medicine PubMed, MEDLINE, Ovid, Cochrane Library and Chinese Biomedicine databases were searched. The RR and number needed to harm (NNH) values for major side effects with 95% confidence intervals (CIs) were calculated in a fixed-effects model and a random-effects model, where appropriate. RESULTS Fifteen controlled trials totalling 6,937 patients were eligible for this analysis. Compared with the control group, the bevacizumab treatment group had a slightly higher risk of any severe adverse event (pooled RR 1.07 [95% CI 1.02-1.12]). The pooled risk difference was 5% [95% CI 2-9%], with an NNH of 20 treated patients. Analyses showed a statistically significantly higher risk of secondary endpoints, including the discovery that bevacizumab was associated with a threefold higher risk of hypertension (pooled RR 3.06 [95% CI 2.45-3.83]), a twofold higher risk of gastrointestinal haemorrhage/perforation and a lower risk of neutropenia (pooled RR 0.75 [95% CI 0.26-2.19]). CONCLUSION Bevacizumab has efficacy in all treatment regimens for advanced CRC. However, our meta-analysis raises safety concerns regarding an increased risk of serious adverse events associated with use of bevacizumab among patients with mCRC. Our findings warrant cautious use of bevacizumab in clinical oncology.
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Affiliation(s)
- Fei Dai
- Pharmacy Department of Changhai Hospital, The First Affiliated Hospital of Second Military Medical University, Shanghai, China
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26
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A clinical study of metastasized rectal cancer treatment: assessing a multimodal approach. Med Oncol 2014; 31:839. [PMID: 24477647 PMCID: PMC3933738 DOI: 10.1007/s12032-014-0839-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/09/2014] [Indexed: 12/21/2022]
Abstract
Metastasized rectal cancer has long been considered incurable. During recent years, the treatment of rectal cancer patients has been improved, and nowadays, a subgroup of patients might even be cured. The aim of this study was to investigate the optimal timing of treatment in a multimodal therapy schedule in order to see whether the addition of bevacizumab (Avastin) to conventional chemotherapy was effective. The study included 39 patients with metastatic rectal cancer between 2009 and 2011, and three were excluded due to the lack of metastases or lack of follow-up information. The remaining 36 patients were divided into groups by treatment intention. The group with curative intention received mainly oxaliplatin (Eloxatin) in combination with capecitabine (Xeloda) with or without bevacizumab (Avastin) for 2 months followed by preoperative radiotherapy (RT) and surgery. Palliative patients had very different treatments depending on their needs of palliation. The median survival time for patients with curative intention was 31 months and for the palliative patients 12 months. Four of the patients (11 %) with curative intention were considered cured at the end of follow-up. The response to chemotherapy after 2-month treatment is a good prognostic sign for which patients can be cured. Long-lasting palliation can be obtained with this treatment schedule. The main side effects were gastrointestinal events, including bowel perforation, neuropathy, thrombo-embolic disease and reduced general condition. All side effects are known, and the treatment is considered tolerable. We conclude that a good treatment schedule would be oxaliplatin (Eloxatin) in combination with capecitabine (Xeloda) with or without bevacizumab (Avastin) for 2 months, followed by preoperative RT and surgery.
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Conti E, Romiti A, Musumeci MB, Passerini J, Zezza L, Mastromarino V, D'Antonio C, Marchetti P, Paneni F, Autore C, Volpe M. Arterial thrombotic events and acute coronary syndromes with cancer drugs: Are growth factors the missed link? Int J Cardiol 2013; 167:2421-9. [DOI: 10.1016/j.ijcard.2013.01.052] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/18/2013] [Indexed: 12/21/2022]
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Iannuzzi JC, Rickles AS, Kelly KN, Monson JRT, Fleming FJ. Prediction of venous thromboembolism after surgery for colorectal cancer: a prevention paradigm. COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
SUMMARY Colorectal cancer patients are at elevated risk for venous thromboembolism, especially in the postsurgical setting. Many risk factors particular to colorectal patients have been identified including malignancy-associated hypercoagulability, colorectal cancer in its own right, chemotherapy, obesity and operative approach. While initiatives aimed at improving inpatient prophylaxis have been effective, the period of risk extends far beyond the inpatient episode suggesting that this approach is inadequate. The prolonged hypercoaguable state combined with the efficacy of extended-duration thromboprophylaxis has led to international consensus guidelines suggesting its implementation. International compliance is low, highlighting the need for greater educational efforts. Risk stratification using identified predictors of venous thromboembolism may improve guideline delivery through a more targeted approach.
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Affiliation(s)
- James C Iannuzzi
- Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, NY, USA.
| | - Aaron S Rickles
- Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, NY, USA
| | - Kristin N Kelly
- Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, NY, USA
| | - John RT Monson
- Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, NY, USA
| | - Fergal J Fleming
- Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, NY, USA
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Aprile G, Fontanella C, Lutrino ES, Ferrari L, Casagrande M, Cardellino GG, Rosati G, Fasola G. Angiogenic inhibitors for older patients with advanced colorectal cancer: Does the age hold the stage? World J Gastroenterol 2013; 19:2131-40. [PMID: 23847406 PMCID: PMC3706712 DOI: 10.3748/wjg.v19.i14.2131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 04/12/2013] [Accepted: 04/13/2013] [Indexed: 02/06/2023] Open
Abstract
Although major progress has been achieved in the treatment of advanced colorectal cancer (CRC) with the employment of antiangiogenic agents, several questions remain on the use of these drugs in older patients. Since cardiovascular, renal and other comorbidities are common in the elderly, an accurate assessment of the patients’ conditions should be performed before a treatment decision is made. Since most CRC patients enrolled in clinical trials testing antiangiogenic drugs were aged < 65 years, the efficacy and tolerability of these agents in elderly patients has not been adequately explored. Data suggest that patients with advanced CRC derive similar benefit from bevacizumab treatment regardless of age, but the advantage of other antiangiogenic drugs in the same class of patients appears more blurred. Literature data suggest that specific antiangiogenic-related toxicities such as hypertension or arterial thromboembolic events may be higher in the elderly than in the younger patients. In addition, it should be emphasized that the patients included in the clinical studies discussed herein were selected and therefore may not be representative of the usual elderly population. Advanced age alone should not discourage the use of bevacizumab. However, a careful patients’ selection and watchful monitoring of toxicities are required to optimize the use of antiangiogenics in this population.
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Tsai HT, Marshall JL, Weiss SR, Huang CY, Warren JL, Freedman AN, Fu AZ, Sansbury LB, Potosky AL. Bevacizumab use and risk of cardiovascular adverse events among elderly patients with colorectal cancer receiving chemotherapy: a population-based study. Ann Oncol 2013; 24:1574-9. [PMID: 23429865 DOI: 10.1093/annonc/mdt019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiovascular risk attributable to bevacizumab (Avastin(®), BEV) for treatment of metastatic colorectal cancer (CRC) remains unclear. We conducted a population-based cohort study to assess the safety of BEV use among patients aged ≥ 65. PATIENTS AND METHODS We identified CRC patients diagnosed from 2005 to 2007 who received chemotherapy and were followed until 31 December 2009. Outcomes were 3-year risk of arterial thromboembolic events (ATEs), cardiomyopathy or congestive heart failure (CM/CHF), and cardiac death (CD) after chemotherapy initiation. We fitted Cox-proportional hazards (PHs) models with inverse-probability-of-treatment-weights and calculated hazard ratios (HRs) for the risk of adverse events. RESULTS We identified 6803 CRC patients (median age: 73 years). Those with cardiac comorbidity were less likely to receive BEV (P < 0.0001). BEV is associated with an elevated risk of ATEs (HR = 1.82, 95% CI = 1.20-2.76, P < 0.001; rate difference: 3.5 additional cases/1000 person-years). We observed no association between BEV and CD or CM/CHF. CONCLUSIONS In general practice, the cardiovascular risk of BEV in elderly CRC is modest. The observed ATEs risk is lower than reported in clinical trials, which may be due to careful patient selection. Our findings may facilitate clinical decision-making of BEV use in elderly patients.
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Affiliation(s)
- H-T Tsai
- Department of Oncology, Georgetown University Medical Center, Washington, DC 20007-2401, USA.
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Bair SM, Choueiri TK, Moslehi J. Cardiovascular complications associated with novel angiogenesis inhibitors: emerging evidence and evolving perspectives. Trends Cardiovasc Med 2013; 23:104-13. [PMID: 23290365 DOI: 10.1016/j.tcm.2012.09.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 12/21/2022]
Abstract
Novel cancer therapies targeting tumor angiogenesis have revolutionized treatment options in a variety of tumors. Specifically, VEGF signaling pathway (VSP) inhibitors have been introduced into clinical practice at a rapid pace over the last decade. It is becoming increasingly clear that VSP inhibitors can cause cardiovascular toxicities including hypertension, thrombosis, and heart failure. This review highlights these toxicities and proposes several strategies in their prevention and treatment. However, we recognize the dearth of data in this area and advocate a multi-disciplinary approach involving cardiologists and oncologists, as well as clinical and translational studies, in understanding and treating VSP-inhibitor associated toxicities.
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Affiliation(s)
- Steven M Bair
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, MA 02115, USA
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32
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Shankaran V, Mummy D, Koepl L, Blough D, Yim YM, Yu E, Ramsey S. Adverse events associated with bevacizumab and chemotherapy in older patients with metastatic colorectal cancer. Clin Colorectal Cancer 2012; 12:204-213.e1. [PMID: 23276520 DOI: 10.1016/j.clcc.2012.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 10/19/2012] [Accepted: 11/08/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND The safety of bevacizumab in older mCRC patients is poorly understood. The purpose of this analysis was to determine the prevalence, incidence, and risk factors for treatment-related AEs in older bevacizumab recipients. PATIENTS AND METHODS Patients age ≥65 were identified from SEER-Medicare and categorized by mCRC diagnosis pre and post bevacizumab approval (2001-2003 vs. 2005-2007). Preexisting conditions known to increase bevacizumab-related AE risk were identified in the year before diagnosis. Factors associated with bevacizumab receipt were identified using logistic regression. Incidence rates for all AEs and specific serious AEs were determined. Risk factors for first AE were determined by competing risks regression. RESULTS Of 6821 patients, 3282 (48%) were diagnosed in 2005-2007 of whom 19% received first-line bevacizumab. Likelihood of bevacizumab receipt was lower in patients age ≥ 75 (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.36-0.47), nonwhite patients (OR, 0.67; 95% CI, 0.55-0.81), patients with higher comorbidity index (OR, 0.52; 95% CI, 0.43-0.62), and patients with preexisting cerebrovascular disease (OR, 0.49; 95% CI, 0.33-0.73). AE incidence rate was not increased among first-line bevacizumab recipients relative to first-line chemotherapy recipients. In a competing risk regression adjusting for potential confounders, bevacizumab receipt (2005-2007) was not associated with an increased risk of first AE compared with chemotherapy alone (2001-2007) (hazard ratio, 0.97; 95% CI, 0.87-1.08). CONCLUSION In an older mCRC population, bevacizumab receipt was less likely in older (age ≥ 75) nonwhite patients with preexisting cerebrovascular comorbidities. First-line bevacizumab was not associated with increased AE incidence or risk of first AE compared with chemotherapy alone.
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Affiliation(s)
- Veena Shankaran
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
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Ortiz LD, Syro LV, Scheithauer BW, Ersen A, Uribe H, Fadul CE, Rotondo F, Horvath E, Kovacs K. Anti-VEGF therapy in pituitary carcinoma. Pituitary 2012; 15:445-9. [PMID: 21918831 DOI: 10.1007/s11102-011-0346-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We report the case of a 44-year-old male patient with an aggressive silent corticotroph cell pituitary adenoma, subtype 2. In that it progressed to carcinoma despite temozolomide administration, anti-VEGF therapy was begun. MRI, PET scan and pathologic analysis were undertaken. After 10 months of anti-VEGF (bevacizumab) treatment no progression of the lesion was noted. The tumor was biopsied and morphological analysis showed severe cell injury, vascular abnormalities and fibrosis. Bevacizumab treatment has continued for additional 16 months to present with stabilization of disease as documented on serial MRI and PET scans. This is the first case of a bevacizumab-treated pituitary carcinoma with long-term, now 26 months, control of disease. The present findings are promising in that anti-angiogenic therapy appears to represent a new option in the treatment of aggressive pituitary tumors.
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Affiliation(s)
- Leon D Ortiz
- Division of Neuro-Oncology, Instituto de Cancerologia, Clinica Las Americas, Medellin, Colombia
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Ma C, Wang Q, Man Y, Kemmner W. Cardiovascular medications in angiogenesis-How to avoid the sting in the tail. Int J Cancer 2012; 131:1249-59. [DOI: 10.1002/ijc.27576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 03/19/2012] [Indexed: 12/21/2022]
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Strickler JH, Hurwitz HI. Bevacizumab-based therapies in the first-line treatment of metastatic colorectal cancer. Oncologist 2012; 17:513-24. [PMID: 22477726 PMCID: PMC3336830 DOI: 10.1634/theoncologist.2012-0003] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 02/13/2012] [Indexed: 12/21/2022] Open
Abstract
Since its approval for the first-line treatment of metastatic colorectal cancer (mCRC), bevacizumab has become a standard treatment option in combination with chemotherapy for patients with mCRC. Bevacizumab has demonstrated efficacy in combination with a number of different backbone chemotherapy regimens, and its widespread use has introduced several important questions regarding the selection and optimization of bevacizumab-based treatment regimens, its use in various patient populations, and the identification of associated adverse events. This review discusses the results of several phase II and phase III clinical trials, as well as large observational studies, to address the use of bevacizumab in the treatment of patients with mCRC in the first-line setting.
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Affiliation(s)
- John H Strickler
- Duke University Medical Center, DUMC 2823, Durham, North Carolina 27710, USA.
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Price TJ, Zannino D, Wilson K, Simes RJ, Cassidy J, Van Hazel GA, Robinson BA, Broad A, Ganju V, Ackland SP, Tebbutt NC. Bevacizumab is equally effective and no more toxic in elderly patients with advanced colorectal cancer: a subgroup analysis from the AGITG MAX trial: an international randomised controlled trial of Capecitabine, Bevacizumab and Mitomycin C. Ann Oncol 2011; 23:1531-6. [PMID: 22039086 DOI: 10.1093/annonc/mdr488] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In an ageing population, a greater proportion of geriatric patients will be considered for systemic chemotherapy. Colorectal cancer (CRC) is a common malignancy and will be a major health issue in geriatrics. We used the MAX population to investigate whether age affected the improved outcome found in CRC when bevacizumab is added to capecitabine chemotherapy. PATIENTS AND METHODS MAX, a three arm study of Capecitabine (C) versus CBevacizumab (CB) versus CBMitomycin C (CBM), found an improvement in progression-free survival (PFS), with addition of B [+/- mitomycin C (MMC)] to C. This analysis assesses the effect of adding B (+/- MMC) to C on PFS, overall survival (OS), response rate (RR), toxicity and dose intensity in geriatric patients (age ≥ 75 years). RESULTS Ninety-nine patients (21%) were aged 75-86 years. Baseline characteristics were well balanced. Eighty-eight per cent commenced C at the lower optional dose of 2000 mg/m(2)/day; days 1-14, q21 (61% for <75 years) and 88% were Eastern Cooperative Oncology Group 0-1. Co-morbidities were as expected in this population. The addition of B significantly improved PFS in geriatric patients(C 5.8 months versus CB 8.8 months, Hazard ratio (HR) 0.65 and C versus CBM 10.4 months HR 0.38). The interaction test for OS, RR and PFS revealed no impact of age. Dose intensity was maintained >90% in all patients. There were no major differences in toxicity patterns between age cohorts. CONCLUSIONS Addition of B to C significantly improved PFS in this geriatric population, with similar benefits to those aged <75 years. Treatment was well tolerated with no signal of increased toxicity (including thromboembolism) when compared with those aged <75 years.
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Affiliation(s)
- T J Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide, Australia.
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