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Sun Y, Cheng Y, Hertz DL. Using maximum plasma concentration (C max) to personalize taxane treatment and reduce toxicity. Cancer Chemother Pharmacol 2024; 93:525-539. [PMID: 38734836 DOI: 10.1007/s00280-024-04677-1] [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: 02/01/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
Taxanes are a widely used class of anticancer agents that play a vital role in the treatment of a variety of cancers. However, toxicity remains a major concern of using taxane drugs as some toxicities are highly prevalent, they can not only adversely affect patient prognosis but also compromise the overall treatment plan. Among all kinds of factors that associated with taxane toxicity, taxane exposure has been extensively studied, with different pharmacokinetic (PK) parameters being used as toxicity predictors. Compared to other widely used predictors such as the area under the drug plasma concentration curve versus time (AUC) and time above threshold plasma drug concentration, maximum plasma concentration (Cmax) is easier to collect and shows promise for use in clinical practice. In this article, we review the previous research on using Cmax to predict taxane treatment outcomes. While Cmax and toxicity have been extensively studied, research on the relationship between Cmax and efficacy is lacking. Most of the articles find a positive relationship between Cmax and toxicity but several articles have contradictory findings. Future clinical trials are needed to validate the relationship between Cmax and treatment outcome and determine whether Cmax can serve as a useful surrogate endpoint of taxane treatment efficacy.
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Affiliation(s)
- Yuchen Sun
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Yue Cheng
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA.
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Shen F, Jiang G, Philips S, Cantor E, Gardner L, Xue G, Cunningham G, Kassem N, O'Neill A, Cameron D, Suter TM, Miller KD, Sledge GW, Schneider BP. Germline predictors for bevacizumab induced hypertensive crisis in ECOG-ACRIN 5103 and BEATRICE. Br J Cancer 2024; 130:1348-1355. [PMID: 38347093 PMCID: PMC11014938 DOI: 10.1038/s41416-024-02602-0] [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: 10/08/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Bevacizumab is a beneficial therapy in several advanced cancer types. Predictive biomarkers to better understand which patients are destined to benefit or experience toxicity are needed. Associations between bevacizumab induced hypertension and survival have been reported but with conflicting conclusions. METHODS We performed post-hoc analyses to evaluate the association in 3124 patients from two phase III adjuvant breast cancer trials, E5103 and BEATRICE. Differences in invasive disease-free survival (IDFS) and overall survival (OS) between patients with hypertension and those without were compared. Hypertension was defined as systolic blood pressure (SBP) ≥ 160 mmHg (n = 346) and SBP ≥ 180 mmHg (hypertensive crisis) (n = 69). Genomic analyses were performed to evaluate germline genetic predictors for the hypertensive crisis. RESULTS Hypertensive crisis was significantly associated with superior IDFS (p = 0.015) and OS (p = 0.042), but only IDFS (p = 0.029; HR = 0.28) remained significant after correction for prognostic factors. SBP ≥ 160 mmHg was not associated with either IDFS or OS. A common single-nucleotide polymorphism, rs6486785, was significantly associated with hypertensive crisis (p = 8.4 × 10-9; OR = 5.2). CONCLUSION Bevacizumab-induced hypertensive crisis is associated with superior outcomes and rs6486785 predicted an increased risk of this key toxicity.
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Affiliation(s)
- Fei Shen
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Guanglong Jiang
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Santosh Philips
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Erica Cantor
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Laura Gardner
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gloria Xue
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Nawal Kassem
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anne O'Neill
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - David Cameron
- Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - Thomas M Suter
- Swiss Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Kathy D Miller
- Indiana University School of Medicine, Indianapolis, IN, USA
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McNally GA, Aossey CM, Wiczer T, Sinnott LT, Lustberg M, Baiocchi RA, Lustberg M. A retrospective cohort study describing chemotherapy-induced peripheral neuropathy in Non-Hodgkin lymphoma patients treated with EPOCH ± R: does HIV status matter? Leuk Lymphoma 2024:1-7. [PMID: 38648546 DOI: 10.1080/10428194.2024.2340051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/01/2024] [Indexed: 04/25/2024]
Abstract
The frontline immuno-chemotherapy regimen for HIV-associated non-Hodgkin Lymphoma is dose-adjusted EPOCH ± R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab). Chemotherapy-induced peripheral neuropathy (CIPN), caused by vincristine, is a common adverse effect of EPOCH ± R, negatively impacting long-term patient outcomes. The primary objective of this study was to determine the incidence of CIPN, stratified by HIV status, in patients treated with EPOCH ± R. A retrospective cohort study at a tertiary referral comprehensive cancer center evaluated patients treated with EPOCH ± R from 2011 to 2018. The final sample included 27 patients with HIV compared to 279 without HIV (total n = 306). Overall, the incidence of CIPN was 29.4% (n = 90), including 5 with HIV (18.5%) and 85 without HIV (30.5%). Propensity scores were used to match patients by HIV status. Although no relationship was found between HIV status and neuropathy, CIPN affects too many undergoing treatments for lymphoma, supporting future investigations to minimize toxicities.
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Affiliation(s)
- Gretchen A McNally
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Connor M Aossey
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Tracy Wiczer
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Loraine T Sinnott
- Data Coordination and Analysis Center, College of Optometry, The Ohio State University, Columbus, OH, USA
| | - Mark Lustberg
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robert A Baiocchi
- Department of Internal Medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Trendowski MR, Ruterbusch JJ, Baird T, Kyko JM, Martin JL, Schwartz AG, Markey GE, Badr MS, Beebe-Dimmer JL. Sleep health and quality of life in the Detroit Research on Cancer Survivors cohort. J Cancer Surviv 2024:10.1007/s11764-024-01568-5. [PMID: 38506953 DOI: 10.1007/s11764-024-01568-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Sleep disturbances represent a modifiable target to improve quality of life and longer-term outcomes in cancer survivors. However, the association between sleep health and overall quality of life in African American cancer survivors has been poorly assessed, a population at increased risk for morbidity and mortality. METHODS Seven hundred and eighteen Detroit Research on Cancer Survivors (ROCS) cohort participants completed a supplemental sleep survey at the time of enrollment, which included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI). Linear and logistic regression was used to evaluate the association between sleep and mental health, while block regression models were used to estimate the contribution of clustered factors to Health-Related Quality of Life (HRQOL). RESULTS Nearly 60% of the cohort reported symptoms indicative of poor sleep quality on the PSQI, 15% reported excessive daytime sleepiness on the ESS, and 12% reported moderate to severe insomnia on the ISI. Survivors with elevated ISI scores reported FACT-G scores that were 17 points lower than those without symptoms of insomnia (95% CI: - 13.1, - 21.2). Poor sleep health accounted for the largest proportion of variability in FACT-G scores (R2 = 0.27) and change in R2 value (0.18) when compared to comorbidities, health behaviors, cancer-related factors, and demographics. CONCLUSIONS Overall sleep health was significantly associated with poorer HRQOL and variability in FACT-G scores. Additional studies investigating a causal relationship between sleep and HRQOL are needed to determine whether sleep quality could affect disparities in cancer outcomes. IMPLICATIONS FOR CANCER SURVIVORS Addressing sleep quality in cancer survivors may improve long-term health and HRQOL.
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Affiliation(s)
- Matthew R Trendowski
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Mailcode: MM04EP, Detroit, MI, 48201, USA.
| | - Julie J Ruterbusch
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Mailcode: MM04EP, Detroit, MI, 48201, USA
| | - Tara Baird
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Mailcode: MM04EP, Detroit, MI, 48201, USA
| | - Jaclyn M Kyko
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Mailcode: MM04EP, Detroit, MI, 48201, USA
| | - Jennifer L Martin
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Ann G Schwartz
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Mailcode: MM04EP, Detroit, MI, 48201, USA
| | - Grace E Markey
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Mailcode: MM04EP, Detroit, MI, 48201, USA
| | - M Safwan Badr
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jennifer L Beebe-Dimmer
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Mailcode: MM04EP, Detroit, MI, 48201, USA
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Wileński S, Koper A, Śledzińska P, Bebyn M, Koper K. Innovative strategies for effective paclitaxel delivery: Recent developments and prospects. J Oncol Pharm Pract 2024; 30:367-384. [PMID: 38204196 DOI: 10.1177/10781552231208978] [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] [Indexed: 01/12/2024]
Abstract
PURPOSE Paclitaxel is an effective chemotherapeutic agent against a variety of cancer types. However, the clinical utility of paclitaxel is restricted by its poor solubility in water and high toxicity, resulting in low drug tolerance. These difficulties could be resolved by using suitable pharmacological carriers. Hence, it is essential to determine innovative methods of administering this effective medication to overcome paclitaxel's inherent limitations. METHODS An extensive literature search was conducted using multiple electronic databases to identify relevant studies published. RESULTS In this comprehensive analysis, many different paclitaxel delivery systems are covered and discussed, such as albumin-bound paclitaxel, polymeric micelles, paclitaxel-loaded liposomes, prodrugs, cyclodextrins, and peptide-taxane conjugates. Moreover, the review also covers various delivery routes of conventional paclitaxel or novel paclitaxel formulations, such as oral administration, local applications, and intraperitoneal delivery. CONCLUSION In addition to albumin-bound paclitaxel, polymeric micelles appear to be the most promising formulations for innovative drug delivery systems at present. A variety of variants of polymeric micelles are currently undergoing advanced phases of clinical trials.
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Affiliation(s)
- Sławomir Wileński
- Department of Pharmaceutical Technology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
- Central Cytostatic Drug Department, Hospital Pharmacy, The F. Lukaszczyk Oncology Centre, Bydgoszcz, Poland
| | - Agnieszka Koper
- Department of Oncology and Brachytherapy, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
- Department of Oncology, Franciszek Lukaszczyk Oncology Centre, Bydgoszcz, Poland
| | - Paulina Śledzińska
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, Bydgoszcz, Poland
| | - Marek Bebyn
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, Bydgoszcz, Poland
| | - Krzysztof Koper
- Department of Oncology, Franciszek Lukaszczyk Oncology Centre, Bydgoszcz, Poland
- Department of Clinical Oncology, and Nursing, Department of Oncological Surgery, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
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Head KJ, Hayes LR, Miller NE, Shakil S, Bales CL, Schneider BP. "How is it going to help?": Exploring Black breast cancer patients' questions about biomarker testing to predict chemotherapy-induced peripheral neuropathy. PEC INNOVATION 2023; 2:100118. [PMID: 37214510 PMCID: PMC10194344 DOI: 10.1016/j.pecinn.2022.100118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 05/24/2023]
Abstract
Objective Many Black breast cancer patients experience chemotherapy-induced peripheral neuropathy (CIPN). Our study assessed Black breast cancer patients' questions about a biomarker test that can predict likelihood of CIPN. Methods Nineteen Black women who were previous/current breast cancer patients participated in focus groups. Researchers briefly explained CIPN and the biomarker test, and then participants were asked what questions they would have about the test and its use in treatment decisions. These participant-voiced questions composed the data for this study and were analyzed using thematic analysis. Results Participants' questions centered on six themes: reasons for the test, effect on timeline of breast cancer treatment, testing procedure, limits of test (including accuracy), research done to develop this test (including research participants), and concerns about personal information connected to the test (including DNA). Conclusion This study provides an exploratory look at questions that Black breast cancer patients may have about toxicity biomarker testing use in breast cancer treatment decisions. Innovation These findings provide a starting point for developing patient-centered approaches for integrating this precision medicine tool into clinical care. The methodological choice to generate participants' questions (rather than answers to a question) led to robust, actionable data.
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Affiliation(s)
- Katharine J. Head
- Department of Communication Studies, 425 University Blvd, Indiana University-Purdue University Indianapolis, IN, 46202, United States
| | - Lisa R. Hayes
- Pink-4-Ever Ending Disparities, 8770 Commerce Park Place F, Indianapolis, IN 46286, United States
| | - Nadia E. Miller
- Pink-4-Ever Ending Disparities, 8770 Commerce Park Place F, Indianapolis, IN 46286, United States
| | - Safia Shakil
- Department of Biomedical Engineering, 425 University Blvd, Indiana University-Purdue University Indianapolis, IN 46202, United States
| | - Casey L. Bales
- Department of Medicine-Division of Clinical Pharmacology, 950 West Walnut Street, Rm 402 Research Institute II (R2), Indianapolis, IN 46202, United States
| | - Bryan P. Schneider
- Department of Medicine-Division of Hematology/Oncology, Indiana Cancer Pavilion, 535 Barnhill Drive – 473, Indianapolis, IN 46202, United States
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Anastasio MK, Unnithan S, Scott A, Hayes T, Shah S, Moss HA, Erkanli A, Havrilesky LJ. Cryocompression to Reduce Peripheral Neuropathy in Gynecologic Cancer: A Randomized Controlled Trial. Obstet Gynecol 2023; 142:1459-1467. [PMID: 37883997 DOI: 10.1097/aog.0000000000005419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/24/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE To investigate the efficacy of cryocompression therapy to prevent chemotherapy-induced peripheral neuropathy. METHODS This single-institution, randomized, self-controlled trial of cryocompression enrolled gynecologic cancer patients planned for five to six cycles neurotoxic chemotherapy. Exclusion criteria were prior neurotoxic chemotherapy or baseline peripheral neuropathy. Participants were randomized to cryocompression on dominant versus non-dominant hand and foot (treatment), with no intervention on the opposite side (control). Compression socks and gloves and ice bags were applied 15 minutes before, during, and 15 minutes after infusion. Primary outcome measures included the PNQ (Patient Neurotoxicity Questionnaire) and the Semmes-Weinstein monofilament test; secondary outcomes included the FACT/GOG-NTX (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity) and patient acceptability and tolerability. Sixty patients completing the study were necessary to detect a 70% reduction in the odds of PNQ grade C or higher peripheral sensory neuropathy with 80% power. RESULTS Ninety-one patients were enrolled from January 2021 to October 2022; 69 were eligible for final analysis. Of the 91 patients, 64.8% were White, 30.8% were Black, and 1.1% were Hispanic or Latina. With successive cycles, more patients had sensory PNQ grade C or higher neuropathy on the control side compared with the cryocompression side. Cryocompression decreased the odds of sensory neuropathy (PNQ grade C or higher) by 46% at final visit (odds ratio 0.54, 95% CI 0.31-0.94; P =.03). There was no difference in tactile sensitivity based on the monofilament test between sides at the final visit. At the final visit, average FACT/GOG-NTX-11 (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity 11 Item Version) scores were significantly lower on the cryocompression than the control side (estimate -0.97, 95% CI -1.89 to -0.06; P =.04), as were FACT/GOG-NTX-4 (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity 4 Item Version) scores (estimate -0.35, 95% CI -0.64 to -0.05; P =.02). More than 85% of patients assessed the intervention as acceptable and tolerable. CONCLUSIONS Cryocompression therapy reduces subjective chemotherapy-induced peripheral sensory neuropathy in patients who are receiving paclitaxel or cisplatin for gynecologic cancer. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT04563130.
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Affiliation(s)
- Mary Katherine Anastasio
- Department of Obstetrics and Gynecology, the Department of Biostatistics and Bioinformatics, the Department of Neurology, and the Duke Cancer Institute, Duke University Medical Center, and the Division of Gynecologic Oncology, Duke Cancer Institute, Durham, North Carolina
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Obeng-Gyasi S, Handley D, Elsaid MI, Rahurkar S, Andersen BL, Jonnalagadda P, Chen JC, Owusu-Brackett N, Carson WE, Stover DG. Low Hospital Volume Is Associated with Higher All-Cause Mortality in Black Women with Triple Negative Breast Cancer. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01788-y. [PMID: 38038902 DOI: 10.1007/s40615-023-01788-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/20/2023] [Accepted: 09/01/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION This study examines the association between hospital volume and all-cause mortality in Black women with triple negative breast cancer (TNBC) who received surgery and chemotherapy. METHODS Black women ages 18+ with stage I-III TNBC who received both surgery and chemotherapy were identified in the National Cancer Database (NCDB). Hospital volume was determined using the number of annual breast cancer cases divided by the number of years the hospital participated in the NCDB. Hospital annual volume quartiles ranged from Q1 (lowest) to Q4 (highest). Univariable analysis and multivariable logistic regression modeling with restricted cubic splines examined the effect of hospital volume on all-cause mortality. RESULTS Sixteen thousand five hundred fifty-six patients met the study criteria. All-cause mortality incidence was lower at higher volume compared to lower volume hospitals Q1 24.1% (95% CI: 22.8 to 25.4), Q2 21.8% (95% CI: 20.5 to 23.1), Q3 20.9% (95% CI: 19.6 to 22.1), Q4 19.0% (95% CI: 17.7 to 20.1), p<0.001. On multivariable analysis, treatment at the highest hospital volume quartile was associated with a 21% reduction in the odds of death compared to the lowest quartile [Q4 Vs. Q1, OR=0.79 (95% CI: 0.67 to 0.92)]. For every 100-patient increase in annual volume, all-cause mortality was reduced by 4% [OR=0.96 (95% CI: 0.94 to 0.98)]. There was a significant linear dose-dependent relationship between increasing hospital volume and all-cause mortality. CONCLUSION Black women treated at high-volume hospitals have lower all-cause mortality than those at low-volume hospitals. Future studies should examine the characteristics of high-volume hospitals associated with improved outcomes.
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Affiliation(s)
- Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA.
| | - Demond Handley
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Mohamed I Elsaid
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Saurabh Rahurkar
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Pallavi Jonnalagadda
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - J C Chen
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Nicci Owusu-Brackett
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - William E Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Daniel G Stover
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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McNeish BL, Kolb N. Toxic Neuropathies. Continuum (Minneap Minn) 2023; 29:1444-1468. [PMID: 37851038 DOI: 10.1212/con.0000000000001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE The purpose of this article is to provide an overview and update on the most clinically relevant toxic neuropathies. LATEST DEVELOPMENTS Broadly, toxic neuropathies were previously quite rare with the notable exception of neuropathy from alcohol or older chemotherapeutics. The development of newer therapies, particularly immunotherapy to treat malignancy, has resulted in a substantial increase in the occurrence of toxic neuropathies that require timely recognition and treatment. The understanding of other toxic neuropathies continues to evolve, such as statin-induced neuropathy, which new evidence suggests is much less common than previously suspected. ESSENTIAL POINTS Toxic neuropathies can be caused by medications, supplements, and recreational substances that injure peripheral nerves. Medications have evolved in the past 2 decades, as have the types of neuropathies that can be seen as related toxicities. In some areas of medicine, new classes and generations of drugs are associated with a lower incidence of toxic neuropathy.
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Hertz DL, Lustberg MB, Sonis S. Evolution of predictive risk factor analysis for chemotherapy-related toxicity. Support Care Cancer 2023; 31:601. [PMID: 37773300 DOI: 10.1007/s00520-023-08074-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Abstract
The causes of variation in toxicity to the same treatment regimen among seemingly similar patients remain largely unknown. There was tremendous optimism that the patient's germline genome would be strongly predictive of treatment-related toxicity and could be used to personalize treatment and improve therapeutic outcomes. However, there has been limited success in discovering robust pharmacogenetic predictors of treatment-related toxicity and even less progress in translating the few validated predictors into clinical practice. It is apparent that identification of toxicity predictors that can be used to predict and prevent treatment-related toxicity will require thinking beyond germline genomics. To that end, we propose an integrated biomarker discovery approach that recognizes that a patient's toxicity risk is determined by the cumulative effects of a broad range of "omic" and non-omic factors. This commentary describes the limited success in discovering and translating clinical and pharmacogenetic toxicity predictors into clinical practice. We illustrate the evolution of cancer toxicity biomarker discovery and translation through studies of taxane-induced peripheral neuropathy, which is one of the most common and debilitating side effects of cancer treatment. We then discuss the opportunities for discovering non-genomic (e.g., metabolomic, lipidomic, transcriptomic, proteomic, microbiomic, medical, behavioral, environmental) and integrated biomarkers that may be more strongly predictive of toxicity risk and the potential challenges with translating integrated biomarkers into clinical practice. This integrated biomarker discovery approach may circumvent some of the major limitations in toxicity biomarker science and move precision oncology treatment forward so that patients receive maximum treatment benefit with minimal toxicity.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church St., Room 3054 College of Pharmacy, Ann Arbor, MI, 48109-1065, USA.
| | | | - Stephen Sonis
- Divisions of Oral Medicine, Brigham and Women's Hospital and the Dana-Farber Cancer Institute, Boston, MA, 02115, USA
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Li S, Brimmers A, van Boekel RL, Vissers KC, Coenen MJ. A systematic review of genome-wide association studies for pain, nociception, neuropathy, and pain treatment responses. Pain 2023; 164:1891-1911. [PMID: 37144689 PMCID: PMC10436363 DOI: 10.1097/j.pain.0000000000002910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 05/06/2023]
Abstract
ABSTRACT Pain is the leading cause of disability worldwide, imposing an enormous burden on personal health and society. Pain is a multifactorial and multidimensional problem. Currently, there is (some) evidence that genetic factors could partially explain individual susceptibility to pain and interpersonal differences in pain treatment response. To better understand the underlying genetic mechanisms of pain, we systematically reviewed and summarized genome-wide association studies (GWASes) investigating the associations between genetic variants and pain/pain-related phenotypes in humans. We reviewed 57 full-text articles and identified 30 loci reported in more than 1 study. To check whether genes described in this review are associated with (other) pain phenotypes, we searched 2 pain genetic databases, Human Pain Genetics Database and Mouse Pain Genetics Database. Six GWAS-identified genes/loci were also reported in those databases, mainly involved in neurological functions and inflammation. These findings demonstrate an important contribution of genetic factors to the risk of pain and pain-related phenotypes. However, replication studies with consistent phenotype definitions and sufficient statistical power are required to validate these pain-associated genes further. Our review also highlights the need for bioinformatic tools to elucidate the function of identified genes/loci. We believe that a better understanding of the genetic background of pain will shed light on the underlying biological mechanisms of pain and benefit patients by improving the clinical management of pain.
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Affiliation(s)
- Song Li
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands. Coenen is now with the Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Annika Brimmers
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands. Coenen is now with the Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Regina L.M. van Boekel
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kris C.P. Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marieke J.H. Coenen
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands. Coenen is now with the Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
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Shen F, Jiang G, Philips S, Gardner L, Xue G, Cantor E, Ly RC, Osei W, Wu X, Dang C, Northfelt D, Skaar T, Miller KD, Sledge GW, Schneider BP. Cytochrome P450 Oxidoreductase (POR) Associated with Severe Paclitaxel-Induced Peripheral Neuropathy in Patients of European Ancestry from ECOG-ACRIN E5103. Clin Cancer Res 2023; 29:2494-2500. [PMID: 37126018 PMCID: PMC10411392 DOI: 10.1158/1078-0432.ccr-22-2431] [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: 08/03/2022] [Revised: 09/06/2022] [Accepted: 04/25/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE Paclitaxel is a widely used anticancer therapeutic. Peripheral neuropathy is the dose-limiting toxicity and negatively impacts quality of life. Rare germline gene markers were evaluated for predicting severe taxane-induced peripheral neuropathy (TIPN) in the patients of European ancestry. In addition, the impact of Cytochrome P450 (CYP) 2C8, CYP3A4, and CYP3A5 metabolizer status on likelihood of severe TIPN was also assessed. EXPERIMENTAL DESIGN Whole-exome sequencing analyses were performed in 340 patients of European ancestry who received a standard dose and schedule of paclitaxel in the adjuvant, randomized phase III breast cancer trial, E5103. Patients who experienced grade 3-4 (n = 168) TIPN were compared to controls (n = 172) who did not experience TIPN. For the analyses, rare variants with a minor allele frequency ≤ 3% and predicted to be deleterious by protein prediction programs were retained. A gene-based, case-control analysis using SKAT was performed to identify genes that harbored an imbalance of deleterious variants associated with increased risk of severe TIPN. CYP star alleles for CYP2C8, CYP3A4, and CYP3A5 were called. An additive logistic regression model was performed to test the association of CYP2C8, CYP3A4, and CYP3A5 metabolizer status with severe TIPN. RESULTS Cytochrome P450 oxidoreductase (POR) was significantly associated with severe TIPN (P value = 1.8 ×10-6). Six variants were predicted to be deleterious in POR. There were no associations between CYP2C8, CYP3A4, or CYP3A5 metabolizer status with severe TIPN. CONCLUSIONS Rare variants in POR predict an increased risk of severe TIPN in patients of European ancestry who receive paclitaxel.
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Affiliation(s)
- Fei Shen
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Guanglong Jiang
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Santosh Philips
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Laura Gardner
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Gloria Xue
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Erica Cantor
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Reynold C. Ly
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Xi Wu
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Chau Dang
- Memorial Sloan Kettering Cancer center, New York, New York
| | | | - Todd Skaar
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Kathy D. Miller
- Indiana University School of Medicine, Indianapolis, Indiana
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McEvoy L, Cliff J, Carr DF, Jorgensen A, Lord R, Pirmohamed M. CYP3A genetic variation and taxane-induced peripheral neuropathy: a systematic review, meta-analysis, and candidate gene study. Front Pharmacol 2023; 14:1178421. [PMID: 37469869 PMCID: PMC10352989 DOI: 10.3389/fphar.2023.1178421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/21/2023] [Indexed: 07/21/2023] Open
Abstract
Background: Taxane-induced peripheral neuropathy (TIPN) is an important cause of premature treatment cessation and dose-limitation in cancer therapy. It also reduces quality of life and survivorship in affected patients. Genetic polymorphisms in the CYP3A family have been investigated but the findings have been inconsistent and contradictory. Methods: A systematic review identified 12 pharmacogenetic studies investigating genetic variation in CYP3A4*22 and CYP3A5*3 and TIPN. In our candidate gene study, 288 eligible participants (211 taxane participants receiving docetaxel or paclitaxel, and 77 control participants receiving oxaliplatin) were successfully genotyped for CYP3A4*22 and CYP3A5*3. Genotyping data was transformed into a combined CYP3A metaboliser phenotype: Poor metabolisers, intermediate metabolisers and extensive metabolisers. Individual genotypes and combined CYP3A metaboliser phenotypes were assessed in relation to neurotoxicity, including by meta-analysis where possible. Results: In the systematic review, no significant association was found between CYP3A5*3 and TIPN in seven studies, with one study reporting a protective association. For CYP3A4*22, one study has reported an association with TIPN, while four other studies failed to show an association. Evaluation of our patient cohort showed that paclitaxel was found to be more neurotoxic than docetaxel (p < 0.001). Diabetes was also significantly associated with the development of TIPN. The candidate gene analysis showed no significant association between either SNP (CYP3A5*3 and CYP3A4*22) and the development of TIPN overall, or severe TIPN. Meta-analysis showed no association between these two variants and TIPN. Transformed into combined CYP3A metaboliser phenotypes, 30 taxane recipients were poor metabolisers, 159 were intermediate metabolisers, and 22 were extensive metabolisers. No significant association was observed between metaboliser status and case-control status. Summary: We have shown that the risk of peripheral neuropathy during taxane chemotherapy is greater in patients who have diabetes. CYP3A genotype or phenotype was not identified as a risk factor in either the candidate gene analysis or the systematic review/meta-analysis, although we cannot exclude the possibility of a minor contribution, which would require a larger sample size.
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Affiliation(s)
- Laurence McEvoy
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Joanne Cliff
- Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | - Daniel F Carr
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Andrea Jorgensen
- Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Rosemary Lord
- Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | - Munir Pirmohamed
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
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Zhang J, Luo L, Long E, Chen L. Neurotoxicity induced by taxane-derived drugs: analysis of the FAERS database 2017-2021. Expert Opin Drug Saf 2023; 22:715-724. [PMID: 36939004 DOI: 10.1080/14740338.2023.2193391] [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: 09/11/2022] [Accepted: 02/06/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVES Taxane-related neurotoxicity is a frequent clinical problem but lacks postmarketing data regarding neurological disorders. This study aimed to evaluate the potential association between neurological adverse events and several taxanederived drugs via the Food and Drug Administration Adverse Event Reporting System (FAERS). METHODS Disproportionality analysis was applied to data mining of the suspected cases of neurological disorders after using different taxanes based on the FAERS data from January 2017 and December 2021. We also investigated the times to onset, fatality, and hospitalization proportions of taxanerelated neurotoxicity. RESULTS In total, 3,940 cases were screened out, which were more prevalent in elderly patients and females. Peripheral neuropathy was a common adverse event among all taxanes with relatively strong association. Generally, the median time to neurological adverse effect onset was 27 days (interquartile range, 11.0 ~ 78.0 days) following taxane regimens, and the majority of cases were detected within the first 30 days. Among cases of neurological adverse events treated with taxane, the fatality and hospitalization proportions were 6.13% and 28.63%, respectively. CONCLUSION By analyzing the FAERS data, we provided a detailed profile of neurotoxicity and different taxanes in detail in terms of clinical characteristics, time to onset, and patient outcomes.
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Affiliation(s)
- Jiaying Zhang
- Department of Western Pharmacy, Chengdu Integrated TCM and Western Medicine Hospital/Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Lin Luo
- Department of Western Pharmacy, Chengdu Integrated TCM and Western Medicine Hospital/Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Enwu Long
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Department of Pharmacy, Affiliated Hospital of University of Electronic Science and Technology of China/Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Li Chen
- Department of Pharmacy, Center for Evidence-based Pharmacy, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
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Lustberg M, Wu X, Fernández-Martínez JL, de Andrés-Galiana EJ, Philips S, Leibowitz J, Schneider B, Sonis S. Leveraging GWAS data derived from a large cooperative group trial to assess the risk of taxane-induced peripheral neuropathy (TIPN) in patients being treated for breast cancer: Part 2-functional implications of a SNP cluster associated with TIPN risk in patients being treated for breast cancer. Support Care Cancer 2023; 31:178. [PMID: 36809570 DOI: 10.1007/s00520-023-07617-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/28/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Using GWAS data derived from a large collaborative trial (ECOG-5103), we identified a cluster of 267 SNPs which predicted CIPN in treatment-naive patients as reported in Part 1 of this study. To assess the functional and pathological implications of this set, we identified collective gene signatures were and evaluated the informational value of those signatures in defining CIPN's pathogenesis. METHODS In Part 1, we analyzed GWAS data derived from ECOG-5103, first identifying those SNPs that were most strongly associated with CIPN using Fisher's ratio. After identifying those SNPs which differentiated CIPN-positive from CIPN-negative phenotypes, we ranked them in order of their discriminatory power to produce a cluster of SNPs which provided the highest predictive accuracy using leave-one-out cross validation (LOOCV). An uncertainty analysis was included. Using the best predictive SNP cluster, we performed gene attribution for each SNP using NCBI Phenotype Genotype Integrator and then assessed functionality by applying GeneAnalytics, Gene Set Enrichment Analysis, and PCViz. RESULTS Using aggregate data derived from the GWAS, we identified a 267 SNP cluster which was associated with a CIPN+ phenotype with an accuracy of 96.1%. We could attribute 173 genes to the 267 SNP cluster. Six long intergenic non-protein coding genes were excluded. Ultimately, the functional analysis was based on 138 genes. Of the 17 pathways identified by Gene Analytics (GA) software, the irinotecan pharmacokinetic pathway had the highest score. Highly matching gene ontology attributions included flavone metabolic process, flavonoid glucuronidation, xenobiotic glucuronidation, nervous system development, UDP glycosyltransferase activity, retinoic acid binding, protein kinase C binding, and glucoronosyl transferase activity. Gene Set Enrichment Analysis (GSEA) GO terms identified neuron-associated genes as most significant (p = 5.45e-10). Consistent with the GA's output, flavone, and flavonoid associated terms, glucuronidation were noted as were GO terms associated with neurogenesis. CONCLUSION The application of functional analyses to phenotype-associated SNP clusters provides an independent validation step in assessing the clinical meaningfulness of GWAS-derived data. Functional analyses following gene attribution of a CIPN-predictive SNP cluster identified pathways, gene ontology terms, and a network which were consistent with a neuropathic phenotype.
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Affiliation(s)
| | - Xuan Wu
- Harvard School of Dental Medicine, Boston, MA, USA
| | | | | | - Santosh Philips
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeffrey Leibowitz
- Primary Endpoint Solutions, Waltham, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Bryan Schneider
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stephen Sonis
- Harvard School of Dental Medicine, Boston, MA, USA.,Primary Endpoint Solutions, Waltham, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Dana-Farber Cancer Institute, Boston, MA, USA
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16
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Identification of a SNP cluster associated with taxane-induced peripheral neuropathy risk in patients being treated for breast cancer using GWAS data derived from a large cooperative group trial. Support Care Cancer 2023; 31:139. [PMID: 36707490 DOI: 10.1007/s00520-023-07595-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a common toxicity of taxanes for which there is no effective intervention. Genomic CIPN risk determination has yielded promising, but inconsistent results. The present study assessed the utility of a collective SNP cluster identified using novel analytics to describe taxane-associated CIPN risk. METHODS We analyzed GWAS data derived from ECOG-5103, first identifying SNPs that were most strongly associated with CIPN using Fisher's ratio (FR). We then ranked ordered those SNPs which discriminated CIPN-positive (CIPN +) from CIPN-negative phenotypes based on their discriminatory power and developed the cluster of SNPs which provided the highest predictive accuracy using leave-one-out cross-validation (LOOCV). RESULTS Using aggregated genotype data obtained from the previously reported ECOG-5103 clinical trial (in which two different arrays were used, HumanOmniExpress (727,227 SNPs) and HumanOmni1-Quad1 (1,131,857 SNPs)), we identified a 267 SNP cluster which was associated with a CIPN + phenotype with an accuracy of 96.1%. CONCLUSIONS A cluster of SNPs was identified which prospectively discriminated patients most likely to develop symptomatic CIPN following taxane exposure as part of a breast cancer chemotherapy regimen. Validation using an independent patient cohort should be performed.
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17
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Chubykina SV, Tatarinova MU, Avakyan GG. [Neuropathic pain caused by the toxic effect of chemotherapy in patients with malignant neoplasms]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:7-12. [PMID: 37315236 DOI: 10.17116/jnevro20231230517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This article discusses chemotherapy-induced peripheral neuropathic pain (CIPNP) and its associated neuropathic pain syndrome that occurs in patients with malignant neoplasms (MN) during cytostatic therapy. The overall prevalence of CIPNP in patients with malignant neoplasms associated with chemotherapy with neurotoxic drugs is estimated, according to various sources, to be about 70%. The pathophysiological mechanisms of CIPNP have not been fully studied, but it is known that they are based on: impaired axonal transport, oxidative stress, induction of apoptosis, DNA damage, dysfunction of voltage-gated ion channels, and central mechanisms. It is important to recognize CIPNP in the clinical symptoms of patients with cancer treated with cytostatics, since these disorders can lead to serious restrictions in the motor, sensory and autonomic functions of the upper and lower extremities, as well as reduce the quality of life and daily functioning of such patients, forcing them to adjust the dose of chemotherapy drugs, transfer the next cycles and even interrupt the treatment of cancer carried out according to vital needs. In addition to the clinical examination, scales and questionnaires have been developed to identify symptoms of CIPNP, but it is most important for neurological and oncological specialists to know and be able to recognize such symptoms in patients. The mandatory research methods for identifying the symptoms of polyneuropathy include electroneuromyography (ENMG), which allows you to assess muscle activity, functional characteristics and the state of the function of peripheral nerves. The methods used to reduce symptoms are screening patients for the development of CIPNP and identifying patients at high risk of CIPNP and, if necessary, reducing the dose or changing cytostatics. Methods for correcting this disorder using different classes of drugs require more detailed study and further research.
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Affiliation(s)
- S V Chubykina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M U Tatarinova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - G G Avakyan
- Pirogov Russian National Research Medical University, Moscow, Russia
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18
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Hooshmand K, Goldstein D, Timmins HC, Li T, Harrison M, Friedlander ML, Lewis CR, Lees JG, Moalem-Taylor G, Guennewig B, Park SB, Kwok JB. Polygenic risk of paclitaxel-induced peripheral neuropathy: a genome-wide association study. J Transl Med 2022; 20:564. [PMID: 36474270 PMCID: PMC9724416 DOI: 10.1186/s12967-022-03754-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Genetic risk factors for chemotherapy-induced peripheral neuropathy (CIPN), a major dose-limiting side-effect of paclitaxel, are not well understood. METHODS We performed a genome-wide association study (GWAS) in 183 paclitaxel-treated patients to identify genetic loci associated with CIPN assessed via comprehensive neuropathy phenotyping tools (patient-reported, clinical and neurological grading scales). Bioinformatic analyses including pathway enrichment and polygenic risk score analysis were used to identify mechanistic pathways of interest. RESULTS In total, 77% of the cohort were classified with CIPN (n = 139), with moderate/severe neuropathy in 36%. GWAS was undertaken separately for the three measures of CIPN. GWAS of patient-reported CIPN identified 4 chromosomal regions that exceeded genome-wide significance (rs9846958, chromosome 3; rs117158921, chromosome 18; rs4560447, chromosome 4; rs200091415, chromosome 10). rs4560447 is located within a protein-coding gene, LIMCH1, associated with actin and neural development and expressed in the dorsal root ganglia (DRG). There were additional risk loci that exceeded the statistical threshold for suggestive genome-wide association (P < 1 × 10-5) for all measures. A polygenic risk score calculated from the top 46 ranked SNPs was highly correlated with patient-reported CIPN (r2 = 0.53; P = 1.54 × 10-35). Overlap analysis was performed to identify 3338 genes which were in common between the patient-reported CIPN, neurological grading scale and clinical grading scale GWAS. The common gene set was subsequently analysed for enrichment of gene ontology (GO) and Reactome pathways, identifying a number of pathways, including the axon development pathway (GO:0061564; P = 1.78 × 10-6) and neuronal system (R-HSA-112316; adjusted P = 3.33 × 10-7). CONCLUSIONS Our findings highlight the potential role of axon development and regeneration pathways in paclitaxel-induced CIPN.
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Affiliation(s)
- Kosar Hooshmand
- grid.1013.30000 0004 1936 834XSchool of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | - David Goldstein
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, University of New South Wales, Sydney, NSW Australia
| | - Hannah C. Timmins
- grid.1013.30000 0004 1936 834XSchool of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | - Tiffany Li
- grid.1013.30000 0004 1936 834XSchool of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | | | - Michael L. Friedlander
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, University of New South Wales, Sydney, NSW Australia
| | - Craig R. Lewis
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, University of New South Wales, Sydney, NSW Australia
| | - Justin G. Lees
- grid.1005.40000 0004 4902 0432School of Biomedical Sciences, University of New South Wales, UNSW Sydney, Sydney, NSW Australia
| | - Gila Moalem-Taylor
- grid.1005.40000 0004 4902 0432School of Biomedical Sciences, University of New South Wales, UNSW Sydney, Sydney, NSW Australia
| | - Boris Guennewig
- grid.1013.30000 0004 1936 834XSchool of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | - Susanna B. Park
- grid.1013.30000 0004 1936 834XSchool of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | - John B. Kwok
- grid.1013.30000 0004 1936 834XSchool of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
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Rocque GB, Andrews C, Lawhon VM, Ingram SA, Frazier RM, Smith ML, Wagner LI, Zubkoff L, Wallner LP, Wolff AC. Physician Perspectives on Reducing Curative Cancer Treatment Intensity for Populations Underrepresented in Clinical Trials. Oncologist 2022; 27:1067-1073. [PMID: 36215065 PMCID: PMC9732232 DOI: 10.1093/oncolo/oyac191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Historically, clinical trials involved adding novel agents to standard of care to improve survival. There has been a shift to an individualized approach with testing less intense treatment, particularly in breast cancer where risk of recurrence is low. Little is known about physician perspectives on delivering less intense treatment for patients who are not well represented in clinical trials. METHODS Open-ended, individual qualitative interviews with medical oncologists explored their perspectives on trials that test less intense treatment for patients with cancer, with a focus on breast cancer. Interviews were audio-recorded and transcribed. Four independent coders utilized a content analysis approach to analyze transcripts using NVivo. Major themes and exemplary quotes were extracted. RESULTS Of the 39 participating physicians, 61.5% felt comfortable extrapolating, 30.8% were hesitant, and 7.7% would not feel comfortable extrapolating trial outcomes to underrepresented populations. Facilitators of comfort included the sentiment that "biology is biology" (such that the cancer characteristics were what mattered), the strength of the evidence, inclusion of subset analysis on underrepresented populations, and prior experience making decisions with limited data. Barriers to extrapolation included potential harm over the patient's lifetime, concerns about groups that had minimal participants, application to younger patients, and extending findings to diverse populations. Universally, broader inclusion in trials testing lowering chemotherapy was desired. CONCLUSIONS The majority (92%) of physicians reported that they would de-implement treatment for patients poorly represented in clinical trials testing less treatment, while expressing concerns about applicability to specific subpopulations. Further work is needed to increase clinical trial representation of diverse populations to safely and effectively optimize treatment for patients with cancer. TRIAL REGISTRATION NCT03248258.
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Affiliation(s)
- Gabrielle B Rocque
- Corresponding author: Gabrielle B. Rocque, MD, MSPH, The University of Alabama at Birmingham, WTI 240E, Birmingham, AL 35294, USA. Tel: +1 205 975 2914;
| | - Courtney Andrews
- Institute for Human Rights, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Valerie M Lawhon
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stacey A Ingram
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel M Frazier
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Lisa Zubkoff
- O’Neal Comprehensive Cancer Center, Birmingham, AL, USA,Division of Preventive Medicine, , Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA,Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC), Birmingham VA Healthcare System, Birmingham, AL, USA
| | - Lauren P Wallner
- Rogel Cancer Center, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Antonio C Wolff
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Guijosa A, Freyria A, Espinosa‐Fernandez JR, Estrada‐Mena FJ, Armenta‐Quiroga AS, Ortega‐Treviño MF, Catalán R, Antonio‐Aguirre B, Villarreal‐Garza C, Perez‐Ortiz AC. Pharmacogenetics of taxane-induced neurotoxicity in breast cancer: Systematic review and meta-analysis. Clin Transl Sci 2022; 15:2403-2436. [PMID: 35892315 PMCID: PMC9579387 DOI: 10.1111/cts.13370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/09/2022] [Accepted: 06/20/2022] [Indexed: 01/25/2023] Open
Abstract
Taxane-based chemotherapy regimens are used as first-line treatment for breast cancer. Neurotoxicity, mainly taxane-induced peripheral neuropathy (TIPN), remains the most important dose-limiting adverse event. Multiple genes may be associated with TIPN; however, the strength and direction of the association remain unclear. For this reason, we systematically reviewed observational studies of TIPN pharmacogenetic markers in breast cancer treatment. We conducted a systematic search of terms alluding to breast cancer, genetic markers, taxanes, and neurotoxicity in Ovid, ProQuest, PubMed, Scopus, Virtual Health, and Web of Science. We assessed the quality of evidence and bias profile. We extracted relevant variables and effect measures. Whenever possible, we performed random-effects gene meta-analyses and examined interstudy heterogeneity with meta-regression models and subgroup analyses. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and STrengthening the REporting of Genetic Association Studies (STREGA) reporting guidance. A total of 42 studies with 19,431 participants were included. These evaluated 262 single-nucleotide polymorphisms (SNPs) across 121 genes. We conducted meta-analyses on 23 genes with 60 SNPs (19 studies and 6246 participants). Thirteen individual SNPs (ABCB1-rs2032582, ABCB1-rs3213619, BCL6/-rs1903216, /CAND1-rs17781082, CYP1B1-rs1056836, CYP2C8-rs10509681, CYP2C8-rs11572080, EPHA5-rs7349683, EPHA6-rs301927, FZD3-rs7001034, GSTP1-rs1138272, TUBB2A-rs9501929, and XKR4-rs4737264) and the overall SNPs' effect in four genes (CYP3A4, EphA5, GSTP1, and SLCO1B1) were statistically significantly associated with TIPN through meta-analysis. In conclusion, through systematic review and meta-analysis, we found that polymorphisms, and particularly 13 SNPs, are associated with TIPN, suggesting that genetics does play a role in interindividual predisposition. Further studies could potentially use these findings to develop individual risk profiles and guide decision making.
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Affiliation(s)
| | - Ana Freyria
- School of MedicineUniversidad PanamericanaMexico CityMexico
| | | | | | | | | | - Rodrigo Catalán
- School of MedicineUniversidad PanamericanaMexico CityMexico,Thoracic Oncology UnitInstituto Nacional de CancerologíaMexico CityMexico
| | | | - Cynthia Villarreal‐Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de MonterreySan Pedro Garza GarcíaNuevo LeónMexico
| | - Andric C. Perez‐Ortiz
- School of MedicineUniversidad PanamericanaMexico CityMexico,Transplant CenterMassachusetts General HospitalBostonMassachusettsUSA
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Kim G, Pastoriza JM, Qin J, Lin J, Karagiannis GS, Condeelis JS, Yothers G, Anderson S, Julian T, Entenberg D, Rohan TE, Xue X, Sparano JA, Oktay MH. Racial disparity in distant recurrence-free survival in patients with localized breast cancer: A pooled analysis of National Surgical Adjuvant Breast and Bowel Project trials. Cancer 2022; 128:2728-2735. [PMID: 35578919 DOI: 10.1002/cncr.34241] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Black race is associated with worse outcome in patients with breast cancer. The distant relapse-free survival (DRFS) between Black and White women with localized breast cancer who participated in National Cancer Institute-sponsored clinical trial was evaluated. METHODS Pooled data were analyzed from 8 National Surgical Adjuvant Breast and Bowel Project (NSABP) trials including 9702 women with localized breast cancer treated with adjuvant chemotherapy (AC, n = 7485) or neoadjuvant chemotherapy (NAC, n = 2217), who self-reported as Black (n = 1070) or White (n = 8632) race. The association between race and DRFS was analyzed using log-rank tests and multivariate Cox regression. RESULTS After adjustment for covariates including age, tumor size, nodal status, body mass index and taxane use, and treatment (AC vs NAC), Black race was associated with an inferior DRFS in estrogen receptor-positive (ER+; hazard ratio [HR], 1.24; 95% CI, 1.05-1.46; P = .01), but not in ER- disease (HR, 0.97; 95% CI, 0.83-1.14; P = .73), and significant interaction between race and ER status was observed (P = .03). There was no racial disparity in DRFS among patients with pathologic complete response (pCR) (log-rank P = .8). For patients without pCR, Black race was associated with worse DRFS in ER+ (HR, 1.67; 95% CI, 1.14-2.45; P = .01), but not in ER- disease (HR, 0.91; 95% CI, 0.65-1.28; P = .59). CONCLUSIONS Black race was associated with significantly inferior DRFS in ER+ localized breast cancer treated with AC or NAC, but not in ER- disease. In the NAC group, racial disparity was also observed in patients with residual ER+ breast cancer at surgery, but not in those who had pCR. LAY SUMMARY Black women with breast cancer have worse outcomes compared with White women. We investigated if this held true in the context of clinical trials that provide controlled treatment setting. Black women with cancer expressing estrogen receptors (ERs) had worse outcome than White women. If breast cancers did not express ERs, there was no racial disparity in outcome. We also observed racial disparity in women who received chemotherapy before their cancer was removed, but only if they had cancer expressing ERs and residual disease on completion of treatment. If the cancer disappeared with presurgical chemotherapy, there was no racial disparity.
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Affiliation(s)
- Gina Kim
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Department of Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Jessica M Pastoriza
- Department of Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Jiyue Qin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Juan Lin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - George S Karagiannis
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine/Montefiore Medical center, Bronx, New York
- Integrated Imaging Program, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - John S Condeelis
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine/Montefiore Medical center, Bronx, New York
- Integrated Imaging Program, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Greg Yothers
- Department of Biostatistics, Graduate School of Public, Health at University of Pittsburgh, Pittsburgh, Pennsylvania
- NRG Oncology, Philadelphia, Pennsylvania
| | - Stewart Anderson
- Department of Biostatistics, Graduate School of Public, Health at University of Pittsburgh, Pittsburgh, Pennsylvania
- NRG Oncology, Philadelphia, Pennsylvania
| | - Thomas Julian
- NRG Oncology, Philadelphia, Pennsylvania
- Department of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - David Entenberg
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine/Montefiore Medical center, Bronx, New York
- Integrated Imaging Program, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Joseph A Sparano
- Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York
| | - Maja H Oktay
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine/Montefiore Medical center, Bronx, New York
- Integrated Imaging Program, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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22
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Sugimoto M, Takagi T, Suzuki R, Konno N, Asama H, Sato Y, Irie H, Okubo Y, Nakamura J, Takasumi M, Hashimoto M, Kato T, Kobashi R, Hikichi T, Ohira H. Drug treatment for chemotherapy-induced peripheral neuropathy in patients with pancreatic cancer. Fukushima J Med Sci 2022; 68:1-10. [PMID: 35197393 PMCID: PMC9071352 DOI: 10.5387/fms.2021-32] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/11/2022] [Indexed: 12/24/2022] Open
Abstract
Pancreatic cancer (PC) is a lethal disease where most tumors are too advanced at diagnosis for resection, leaving chemotherapy as the mainstay of treatment. Although the prognosis of unresectable PC is poor, it has been dramatically improved by new chemotherapy treatments, such as the combination of 5-fluorouracil, oxaliplatin, irinotecan, and leucovorin (FOLFIRINOX) or gemcitabine plus nab-paclitaxel. However, as oxaliplatin and paclitaxel are common neurotoxic drugs, chemotherapy-induced peripheral neuropathy (CIPN) is a common and severe adverse effect of both treatments. As there are no agents recommended in the ASCO guidelines, we review the methods used to treat CIPN caused by PC treatment. The efficacy of duloxetine was observed in a large randomized controlled trial (RCT). In addition, pregabalin was more effective than duloxetine for CIPN in two RCTs. Although duloxetine and pregabalin can be effective for CIPN, they have several side effects. Therefore, the choice between the two drugs should be determined according to effect and tolerability. Mirogabalin is also used in patients with PC and there is hope it will yield positive outcomes when treating CIPN in the future.
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Affiliation(s)
- Mitsuru Sugimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Tadayuki Takagi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Rei Suzuki
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Naoki Konno
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Hiroyuki Asama
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Yuki Sato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Hiroki Irie
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Yoshinori Okubo
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
- Department of Endoscopy, Fukushima Medical University Hospital
| | - Jun Nakamura
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
- Department of Endoscopy, Fukushima Medical University Hospital
| | - Mika Takasumi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Minami Hashimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
- Department of Endoscopy, Fukushima Medical University Hospital
| | - Tsunetaka Kato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
- Department of Endoscopy, Fukushima Medical University Hospital
| | - Ryoichiro Kobashi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital
| | - Hiromasa Ohira
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
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23
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Rodwin RL, Siddiq NZ, Ehrlich BE, Lustberg MB. Biomarkers of Chemotherapy-Induced Peripheral Neuropathy: Current Status and Future Directions. FRONTIERS IN PAIN RESEARCH 2022; 3:864910. [PMID: 35360655 PMCID: PMC8963873 DOI: 10.3389/fpain.2022.864910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/16/2022] [Indexed: 01/18/2023] Open
Abstract
Chemotherapy induced peripheral neuropathy (CIPN) is an often severe and debilitating complication of multiple chemotherapeutic agents that can affect patients of all ages, across cancer diagnoses. CIPN can persist post-therapy, and significantly impact the health and quality of life of cancer survivors. Identifying patients at risk for CIPN is challenging due to the lack of standardized objective measures to assess for CIPN. Furthermore, there are no approved preventative treatments for CIPN, and therapeutic options for CIPN remain limited once it develops. Biomarkers of CIPN have been studied but are not widely used in clinical practice. They can serve as an important clinical tool to identify individuals at risk for CIPN and to better understand the pathogenesis and avenues for treatment of CIPN. Here we review promising biomarkers of CIPN in humans and their clinical implications.
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Affiliation(s)
- Rozalyn L. Rodwin
- Section of Pediatric Hematology/Oncology, Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
| | - Namrah Z. Siddiq
- Section of Medical Oncology, Department of Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Barbara E. Ehrlich
- Department of Pharmacology, Yale School of Medicine, New Haven, CT, United States
- Yale Cancer Center, New Haven, CT, United States
| | - Maryam B. Lustberg
- Section of Medical Oncology, Department of Medicine, Yale School of Medicine, New Haven, CT, United States
- Yale Cancer Center, New Haven, CT, United States
- *Correspondence: Maryam B. Lustberg
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24
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Quintanilha JCF, Wang J, Sibley AB, Jiang C, Etheridge AS, Shen F, Jiang G, Mulkey F, Patel JN, Hertz DL, Dees EC, McLeod HL, Bertagnolli M, Rugo H, Kindler HL, Kelly WK, Ratain MJ, Kroetz DL, Owzar K, Schneider BP, Lin D, Innocenti F. Bevacizumab-induced hypertension and proteinuria: a genome-wide study of more than 1000 patients. Br J Cancer 2022; 126:265-274. [PMID: 34616010 PMCID: PMC8770703 DOI: 10.1038/s41416-021-01557-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 08/06/2021] [Accepted: 09/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hypertension and proteinuria are common bevacizumab-induced toxicities. No validated biomarkers are available for identifying patients at risk of these toxicities. METHODS A genome-wide association study (GWAS) meta-analysis was performed in 1039 bevacizumab-treated patients of European ancestry in four clinical trials (CALGB 40502, 40503, 80303, 90401). Grade ≥2 hypertension and proteinuria were recorded (CTCAE v.3.0). Single-nucleotide polymorphism (SNP)-toxicity associations were determined using a cause-specific Cox model adjusting for age and sex. RESULTS The most significant SNP associated with hypertension with concordant effect in three out of the four studies (p-value <0.05 for each study) was rs6770663 (A > G) in KCNAB1, with the G allele increasing the risk of hypertension (p-value = 4.16 × 10-6). The effect of the G allele was replicated in ECOG-ACRIN E5103 in 582 patients (p-value = 0.005). The meta-analysis of all five studies for rs6770663 led to p-value = 7.73 × 10-8, close to genome-wide significance. The most significant SNP associated with proteinuria was rs339947 (C > A, between DNAH5 and TRIO), with the A allele increasing the risk of proteinuria (p-value = 1.58 × 10-7). CONCLUSIONS The results from the largest study of bevacizumab toxicity provide new markers of drug safety for further evaluations. SNP in KCNAB1 validated in an independent dataset provides evidence toward its clinical applicability to predict bevacizumab-induced hypertension. ClinicalTrials.gov Identifier: NCT00785291 (CALGB 40502); NCT00601900 (CALGB 40503); NCT00088894 (CALGB 80303) and NCT00110214 (CALGB 90401).
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Affiliation(s)
- Julia C F Quintanilha
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jin Wang
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Chen Jiang
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Amy S Etheridge
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fei Shen
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Guanglong Jiang
- Department of BioHealth Informatics, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Flora Mulkey
- Alliance Statistics and Data Center, Duke University, Durham, NC, USA
| | | | - Daniel L Hertz
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth Claire Dees
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Howard L McLeod
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Hope Rugo
- Department of Medicine, Hematology/Oncology, University of California at San Francisco, San Francisco, CA, USA
| | - Hedy L Kindler
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | | | - Mark J Ratain
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | - Deanna L Kroetz
- Department of Bioengineering and Therapeutic Sciences, University of California at San Francisco, San Francisco, CA, USA
| | - Kouros Owzar
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Bryan P Schneider
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Danyu Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Federico Innocenti
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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25
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Pozzi E, Alberti P. Management of Side Effects in the Personalized Medicine Era: Chemotherapy-Induced Peripheral Neurotoxicity. Methods Mol Biol 2022; 2547:95-140. [PMID: 36068462 DOI: 10.1007/978-1-0716-2573-6_5] [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] [Indexed: 06/15/2023]
Abstract
Pharmacogenomics is a powerful tool to predict individual response to treatment, in order to personalize therapy, and it has been explored extensively in oncology practice. Not only efficacy on the malignant disease has been investigated but also the possibility to predict adverse effects due to drug administration. Chemotherapy-induced peripheral neurotoxicity (CIPN) is one of those. This potentially severe and long-lasting/permanent side effect of commonly administered anticancer drugs can severely impair quality of life (QoL) in a large cohort of long survival patients. So far, a pharmacogenomics-based approach in CIPN regard has been quite delusive, making a methodological improvement warranted in this field of interest: even the most refined genetic analysis cannot be effective if not applied correctly. Here we try to devise why it is so, suggesting how THE "bench-side" (pharmacogenomics) might benefit from and should cooperate with THE "bed-side" (clinimetrics), in order to make genetic profiling effective if applied to CIPN.
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Affiliation(s)
- Eleonora Pozzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Paola Alberti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
- NeuroMI (Milan Center for Neuroscience), Milan, Italy.
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26
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Chua KC, El-Haj N, Priotti J, Kroetz DL. Mechanistic insights into the pathogenesis of microtubule-targeting agent-induced peripheral neuropathy from pharmacogenetic and functional studies. Basic Clin Pharmacol Toxicol 2022; 130 Suppl 1:60-74. [PMID: 34481421 PMCID: PMC8716520 DOI: 10.1111/bcpt.13654] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/04/2021] [Accepted: 09/01/2021] [Indexed: 01/03/2023]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting toxicity that affects 30%-40% of patients undergoing cancer treatment. Although multiple mechanisms of chemotherapy-induced neurotoxicity have been described in preclinical models, these have not been translated into widely effective strategies for the prevention or treatment of CIPN. Predictive biomarkers to inform therapeutic approaches are also lacking. Recent studies have examined genetic risk factors associated with CIPN susceptibility. This review provides an overview of the clinical and pathologic features of CIPN and summarizes efforts to identify target pathways through genetic and functional studies. Structurally and mechanistically diverse chemotherapeutics are associated with CIPN; however, the current review is focused on microtubule-targeting agents since these are the focus of most pharmacogenetic association and functional studies of CIPN. Genome-wide pharmacogenetic association studies are useful tools to identify not only causative genes and genetic variants but also genetic networks implicated in drug response or toxicity and have been increasingly applied to investigations of CIPN. Induced pluripotent stem cell-derived models of human sensory neurons are especially useful to understand the mechanistic significance of genomic findings. Combined genetic and functional genomic efforts to understand CIPN hold great promise for developing therapeutic approaches for its prevention and treatment.
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Affiliation(s)
- Katherina C. Chua
- Pharmaceutical Sciences and Pharmacogenomics Graduate Program, University of California San Francisco, San Francisco, CA 94143-2911,Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143-2911
| | - Nura El-Haj
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143-2911
| | - Josefina Priotti
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143-2911
| | - Deanna L. Kroetz
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143-2911,Institute for Human Genetics, University of California San Francisco, San Francisco, CA 94143-2911
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27
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Talebi Z, Sparreboom A, Colace SI. Pharmacogenomics in Cytotoxic Chemotherapy of Cancer. Methods Mol Biol 2022; 2547:63-94. [PMID: 36068461 DOI: 10.1007/978-1-0716-2573-6_4] [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] [Indexed: 06/15/2023]
Abstract
Pharmacogenetic testing in patients with cancer requiring cytotoxic chemotherapy offers the potential to predict, prevent, and mitigate chemotherapy-related toxicities. While multiple drug-gene pairs have been identified and studied, few drug-gene pairs are currently used routinely in the clinical status. Here we review what is known, theorized, and unknown regarding the use of pharmacogenetic testing in cancer.
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Affiliation(s)
- Zahra Talebi
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Alex Sparreboom
- Division of Pharmaceutics and Pharmacology, College of Pharmacy & Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Susan I Colace
- Division of Hematology, Oncology, and Blood & Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, USA.
- The Ohio State University, Columbus, OH, USA.
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28
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Sharma A, Johnson KB, Bie B, Rhoades EE, Sen A, Kida Y, Hockings J, Gatta A, Davenport J, Arcangelini C, Ritzu J, DeVecchio J, Hughen R, Wei M, Thomas Budd G, Lynn Henry N, Eng C, Foss J, Rotroff DM. A Multimodal Approach to Discover Biomarkers for Taxane-Induced Peripheral Neuropathy (TIPN): A Study Protocol. Technol Cancer Res Treat 2022; 21:15330338221127169. [PMID: 36172750 PMCID: PMC9523841 DOI: 10.1177/15330338221127169] [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] [Indexed: 11/23/2022] Open
Abstract
Introduction: Taxanes are a class of chemotherapeutics commonly used to treat various solid tumors, including breast and ovarian cancers. Taxane-induced peripheral neuropathy (TIPN) occurs in up to 70% of patients, impacting quality of life both during and after treatment. TIPN typically manifests as tingling and numbness in the hands and feet and can cause irreversible loss of function of peripheral nerves. TIPN can be dose-limiting, potentially impacting clinical outcomes. The mechanisms underlying TIPN are poorly understood. As such, there are limited treatment options and no tools to provide early detection of those who will develop TIPN. Although some patients may have a genetic predisposition, genetic biomarkers have been inconsistent in predicting chemotherapy-induced peripheral neuropathy (CIPN). Moreover, other molecular markers (eg, metabolites, mRNA, miRNA, proteins) may be informative for predicting CIPN, but remain largely unexplored. We anticipate that combinations of multiple biomarkers will be required to consistently predict those who will develop TIPN. Methods: To address this clinical gap of identifying patients at risk of TIPN, we initiated the Genetics and Inflammatory Markers for CIPN (GENIE) study. This longitudinal multicenter observational study uses a novel, multimodal approach to evaluate genomic variation, metabolites, DNA methylation, gene expression, and circulating cytokines/chemokines prior to, during, and after taxane treatment in 400 patients with breast cancer. Molecular and patient reported data will be collected prior to, during, and after taxane therapy. Multi-modal data will be used to develop a set of comprehensive predictive biomarker signatures of TIPN. Conclusion: The goal of this study is to enable early detection of patients at risk of developing TIPN, provide a tool to modify taxane treatment to minimize morbidity from TIPN, and improved patient quality of life. Here we provide a brief review of the current state of research into CIPN and TIPN and introduce the GENIE study design.
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Affiliation(s)
- Anukriti Sharma
- Department of Quantitative Health Sciences, 22516Lerner Research Institute, Cleveland Clinic, OH, USA
| | - Ken B Johnson
- Department of Anesthesiology, 14434University of Utah, UT, USA
| | - Bihua Bie
- Department of Anesthesiology, 2569Cleveland Clinic, OH, USA
| | | | - Alper Sen
- Department of Anesthesiology, 14434University of Utah, UT, USA
| | - Yuri Kida
- Department of Anesthesiology, 14434University of Utah, UT, USA
| | - Jennifer Hockings
- Genomic Medicine Institute, Lerner Research Institute, 196246Cleveland Clinic, OH, USA.,Department of Pharmacy, 2569Cleveland Clinic, OH, USA.,196246Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Alycia Gatta
- 170292Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | | | | | - Jennifer Ritzu
- 170292Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Jennifer DeVecchio
- Genomic Medicine Institute, Lerner Research Institute, 196246Cleveland Clinic, OH, USA
| | - Ron Hughen
- Department of Anesthesiology, 14434University of Utah, UT, USA
| | - Mei Wei
- 20270Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - G Thomas Budd
- 170292Taussig Cancer Institute, Cleveland Clinic, OH, USA.,196246Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - N Lynn Henry
- 67159University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Charis Eng
- 170292Taussig Cancer Institute, Cleveland Clinic, OH, USA.,Genomic Medicine Institute, Lerner Research Institute, 196246Cleveland Clinic, OH, USA.,196246Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joseph Foss
- Department of Anesthesiology, 2569Cleveland Clinic, OH, USA
| | - Daniel M Rotroff
- Department of Quantitative Health Sciences, 22516Lerner Research Institute, Cleveland Clinic, OH, USA.,196246Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA
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29
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Cunningham GM, Shen F, Wu X, Cantor EL, Gardner L, Philips S, Jiang G, Bales CL, Tan Z, Liu Y, Wan J, Fehrenbacher JC, Schneider BP. The impact of SBF2 on taxane-induced peripheral neuropathy. PLoS Genet 2022; 18:e1009968. [PMID: 34986146 PMCID: PMC8765656 DOI: 10.1371/journal.pgen.1009968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/18/2022] [Accepted: 11/26/2021] [Indexed: 12/13/2022] Open
Abstract
Taxane-induced peripheral neuropathy (TIPN) is a devastating survivorship issue for many cancer patients. In addition to its impact on quality of life, this toxicity may lead to dose reductions or treatment discontinuation, adversely impacting survival outcomes and leading to health disparities in African Americans (AA). Our lab has previously identified deleterious mutations in SET-Binding Factor 2 (SBF2) that significantly associated with severe TIPN in AA patients. Here, we demonstrate the impact of SBF2 on taxane-induced neuronal damage using an ex vivo model of SBF2 knockdown of induced pluripotent stem cell-derived sensory neurons. Knockdown of SBF2 exacerbated paclitaxel changes to cell viability and neurite outgrowth while attenuating paclitaxel-induced sodium current inhibition. Our studies identified paclitaxel-induced expression changes specific to mature sensory neurons and revealed candidate genes involved in the exacerbation of paclitaxel-induced phenotypes accompanying SBF2 knockdown. Overall, these findings provide ex vivo support for the impact of SBF2 on the development of TIPN and shed light on the potential pathways involved.
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Affiliation(s)
- Geneva M. Cunningham
- Department of Medical and Molecular Genetics, Indiana University School of Medicine; Indianapolis, Indiana, United States of America
| | - Fei Shen
- Department of Hematology and Oncology, Indiana University School of Medicine; Indianapolis, Indiana, United States of America
| | - Xi Wu
- Department of Hematology and Oncology, Indiana University School of Medicine; Indianapolis, Indiana, United States of America
| | - Erica L. Cantor
- Department of Hematology and Oncology, Indiana University School of Medicine; Indianapolis, Indiana, United States of America
| | - Laura Gardner
- Department of Hematology and Oncology, Indiana University School of Medicine; Indianapolis, Indiana, United States of America
| | - Santosh Philips
- Department of Clinical Pharmacology, Indiana University School of Medicine; Indianapolis, Indiana, United States of America
| | - Guanglong Jiang
- Department of Medical and Molecular Genetics, Indiana University School of Medicine; Indianapolis, Indiana, United States of America
| | - Casey L. Bales
- Department of Clinical Pharmacology, Indiana University School of Medicine; Indianapolis, Indiana, United States of America
| | - Zhiyong Tan
- Department of Pharmacology and Toxicology, Indiana University School of Medicine; Indianapolis, Indiana, United States of America
| | - Yunlong Liu
- Department of Medical and Molecular Genetics, Indiana University School of Medicine; Indianapolis, Indiana, United States of America
| | - Jun Wan
- Department of Medical and Molecular Genetics, Indiana University School of Medicine; Indianapolis, Indiana, United States of America
| | - Jill C. Fehrenbacher
- Department of Pharmacology and Toxicology, Indiana University School of Medicine; Indianapolis, Indiana, United States of America
| | - Bryan P. Schneider
- Department of Medical and Molecular Genetics, Indiana University School of Medicine; Indianapolis, Indiana, United States of America
- Department of Hematology and Oncology, Indiana University School of Medicine; Indianapolis, Indiana, United States of America
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Schneider BP, Jiang G, Ballinger TJ, Shen F, Chitambar C, Nanda R, Falkson C, Lynce FC, Gallagher C, Isaacs C, Blaya M, Paplomata E, Walling R, Daily K, Mahtani R, Thompson MA, Graham R, Cooper ME, Pavlick DC, Albacker LA, Gregg J, Solzak JP, Chen YH, Bales CL, Cantor E, Hancock BA, Kassem N, Helft P, O'Neil B, Storniolo AMV, Badve S, Miller KD, Radovich M. BRE12-158: A Postneoadjuvant, Randomized Phase II Trial of Personalized Therapy Versus Treatment of Physician's Choice for Patients With Residual Triple-Negative Breast Cancer. J Clin Oncol 2021; 40:345-355. [PMID: 34910554 DOI: 10.1200/jco.21.01657] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Patients with triple-negative breast cancer (TNBC) with residual disease after neoadjuvant chemotherapy (NAC) have high risk of recurrence with prior data suggesting improved outcomes with capecitabine. Targeted agents have demonstrated activity across multiple cancer types. BRE12-158 was a phase II, multicenter trial that randomly allocated patients with TNBC with residual disease after NAC to genomically directed therapy versus treatment of physician choice (TPC). PATIENTS AND METHODS From March 2014 to December 2018, 193 patients were enrolled. Residual tumors were sequenced using a next-generation sequencing test. A molecular tumor board adjudicated all results. Patients were randomly allocated to four cycles of genomically directed therapy (arm A) versus TPC (arm B). Patients without a target were assigned to arm B. Primary end point was 2-year disease-free survival (DFS) among randomly assigned patients. Secondary/exploratory end points included distant disease-free survival, overall survival, toxicity assessment, time-based evolution of therapy, and drug-specific outcomes. RESULTS One hundred ninety-three patients were randomly allocated or were assigned to arm B. The estimated 2-year DFS for the randomized population only was 56.6% (95% CI, 0.45 to 0.70) for arm A versus 62.4% (95% CI, 0.52 to 0.75) for arm B. No difference was seen in DFS, distant disease-free survival, or overall survival for the entire or randomized populations. There was increased uptake of capecitabine for TPC over time. Patients randomly allocated later had less distant recurrences. Circulating tumor DNA status remained a significant predictor of outcome with some patients demonstrating clearance with postneoadjuvant therapy. CONCLUSION Genomically directed therapy was not superior to TPC for patients with residual TNBC after NAC. Capecitabine should remain the standard of care; however, the activity of other agents in this setting provides rationale for testing optimal combinations to improve outcomes. Circulating tumor DNA should be considered a standard covariate for trials in this setting.
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Affiliation(s)
- Bryan P Schneider
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Guanglong Jiang
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Tarah J Ballinger
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Fei Shen
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | | | | | | | | | | | | | | | | | | | | | - Reshma Mahtani
- Sylvester Comprehensive Cancer Center, Deerfield Beach, FL
| | | | | | | | | | | | - Jeffrey Gregg
- Foundation Medicine Inc, Cambridge, MA.,University of California at Davis, Sacramento, CA
| | - Jeffrey P Solzak
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Yu-Hsiang Chen
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Casey L Bales
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Erica Cantor
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Bradley A Hancock
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Nawal Kassem
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Paul Helft
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Bert O'Neil
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | | | - Sunil Badve
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Kathy D Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Milan Radovich
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
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31
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Tymon-Rosario J, Adjei NN, Roque DM, Santin AD. Microtubule-Interfering Drugs: Current and Future Roles in Epithelial Ovarian Cancer Treatment. Cancers (Basel) 2021; 13:6239. [PMID: 34944858 PMCID: PMC8699494 DOI: 10.3390/cancers13246239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
Taxanes and epothilones are chemotherapeutic agents that ultimately lead to cell death through inhibition of normal microtubular function. This review summarizes the literature demonstrating their current use and potential promise as therapeutic agents in the treatment of epithelial ovarian cancer (EOC), as well as putative mechanisms of resistance. Historically, taxanes have become the standard of care in the front-line and recurrent treatment of epithelial ovarian cancer. In the past few years, epothilones (i.e., ixabepilone) have become of interest as they may retain activity in taxane-treated patients since they harbor several features that may overcome mechanisms of taxane resistance. Clinical data now support the use of ixabepilone in the treatment of platinum-resistant or refractory ovarian cancer. Clinical data strongly support the use of microtubule-interfering drugs alone or in combination in the treatment of epithelial ovarian cancer. Ongoing clinical trials will shed further light into the potential of making these drugs part of current standard practice.
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Affiliation(s)
- Joan Tymon-Rosario
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA; (J.T.-R.); (N.N.A.)
| | - Naomi N. Adjei
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA; (J.T.-R.); (N.N.A.)
| | - Dana M. Roque
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Alessandro D. Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA; (J.T.-R.); (N.N.A.)
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Trendowski MR, Lusk CM, Ruterbusch JJ, Seaton R, Simon MS, Greenwald MK, Harper FWK, Beebe-Dimmer JL, Schwartz AG. Chemotherapy-induced peripheral neuropathy in African American cancer survivors: Risk factors and quality of life outcomes. Cancer Med 2021; 10:8151-8161. [PMID: 34687150 PMCID: PMC8607253 DOI: 10.1002/cam4.4328] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/10/2021] [Accepted: 09/11/2021] [Indexed: 01/12/2023] Open
Abstract
Background Epidemiological studies of chemotherapy‐induced peripheral neuropathy (CIPN) have predominantly focused on non‐Hispanic White patients, despite the observation that African Americans are more likely to experience CIPN. To address this health disparities gap, we sought to identify non‐genetic risk factors and comorbidities associated with CIPN in African American cancer survivors using the Detroit Research on Cancer Survivors study. Methods Logistic regression was used to evaluate relationships between presence of self‐reported CIPN and relevant clinical characteristics in 1045 chemotherapy‐treated African American cancer survivors. Linear regression was used to evaluate risk factors for CIPN and quality of life outcomes that reflect physical, social, emotional, and functional domains of health. Results Patients with CIPN were more likely to report hypertension (OR = 1.28, 95% CI: 0.98–1.67, p = 0.07), hypercholesterolemia (OR = 1.32, 95% CI: 1.001–1.73, p = 0.05), history of depression (OR = 1.62, 95% CI: 1.18–2.25, p = 0.003), and diabetes (OR = 1.33, 95% CI: 0.98–1.82, p = 0.06) after adjustment for age at diagnosis, sex, and cancer site. BMI (OR = 1.02 kg/m2, 95% CI: 1.006–1.04 kg/m2, p = 0.008) was also positively associated with CIPN. In addition, CIPN status was significantly associated with quality of life (FACT‐G total: β = −8.60, 95% CI: −10.88, −6.32) p < 0.0001) and mood (PROMIS® Anxiety: β = 4.18, 95% CI: 2.92–5.45, p < 0.0001; PROMIS® Depression: β = 2.69, 95% CI: 1.53–3.84, p < 0.0001) after adjustment for age at diagnosis, sex, cancer site, and comorbidities. Neither alcohol consumption (OR = 0.88, 95% CI: 0.68–1.14, p = 0.32) nor tobacco use (ever smoked: OR = 1.04, 95% CI: 0.80–1.35, p = 0.76; currently smoke: OR = 1.28, 95% CI: 0.90–1.82, p = 0.18) was associated with increased CIPN risk. Conclusion Risk factor profiles in African Americans are not entirely consistent with those previously reported for non‐Hispanic White patients. Neglecting to understand the correlates of common chemotherapy‐induced toxicities for this patient population may further contribute to the health disparities these individuals face in receiving adequate healthcare.
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Affiliation(s)
- Matthew R Trendowski
- Wayne State University School of Medicine, Department of Oncology, Detroit, Michigan, USA
| | - Christine M Lusk
- Wayne State University School of Medicine, Department of Oncology, Detroit, Michigan, USA.,Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Julie J Ruterbusch
- Wayne State University School of Medicine, Department of Oncology, Detroit, Michigan, USA.,Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Randell Seaton
- Wayne State University School of Medicine, Department of Oncology, Detroit, Michigan, USA.,Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Michael S Simon
- Wayne State University School of Medicine, Department of Oncology, Detroit, Michigan, USA.,Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Mark K Greenwald
- Wayne State University School of Medicine, Department of Psychiatry and Behavioral Neurosciences, Detroit, Michigan, USA
| | - Felicity W K Harper
- Wayne State University School of Medicine, Department of Oncology, Detroit, Michigan, USA.,Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Jennifer L Beebe-Dimmer
- Wayne State University School of Medicine, Department of Oncology, Detroit, Michigan, USA.,Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Ann G Schwartz
- Wayne State University School of Medicine, Department of Oncology, Detroit, Michigan, USA.,Karmanos Cancer Institute, Detroit, Michigan, USA
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Zhang S. Chemotherapy-induced peripheral neuropathy and rehabilitation: A review. Semin Oncol 2021; 48:193-207. [PMID: 34607709 DOI: 10.1053/j.seminoncol.2021.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/29/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common complication after chemotherapy that can damage the sensory, motor, autonomic, or cranial nerves in approximately 30%-60% of patients with cancer. CIPN can lead to detrimental dose modifications and/or premature chemotherapy discontinuation due to patient intolerance. The long-term impact of CIPN is particularly challenging and can have a profound impact on the quality of life (QoL) and survivorship. However, this condition is often underdiagnosed. No agents have been established to prevent CIPN. Pre-chemotherapy testing is recommended for high-risk patients. Duloxetine is considered a first-line treatment, whereas gabapentin, pregabalin, tricyclic antidepressants, and topical compounding creams may be used for neuropathic pain control. Home-based, low-to-moderate walking, and resistance exercise during chemotherapy can reduce the severity and prevalence of CIPN symptoms, especially in older patients. Pre-habilitation and rehabilitation should be recommended for all patients receiving cytotoxic chemotherapies. The purpose of this article is to review common chemotherapeutic drugs causing CIPN, risk factors, diagnosis and treatment of CIPN, and evidence of the benefits of rehabilitation.
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Affiliation(s)
- Shangming Zhang
- Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey medical Center, Hershey, PA.
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Kanai M, Kawaguchi T, Kotaka M, Manaka D, Hasegawa J, Takagane A, Munemoto Y, Kato T, Eto T, Touyama T, Matsui T, Shinozaki K, Matsumoto S, Mizushima T, Mori M, Sakamoto J, Ohtsu A, Yoshino T, Saji S, Matsuda F. Large-Scale Prospective Genome-Wide Association Study of Oxaliplatin in Stage II/III Colon Cancer and Neuropathy. Ann Oncol 2021; 32:1434-1441. [PMID: 34391895 DOI: 10.1016/j.annonc.2021.08.1745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE The severity of oxaliplatin (L-OHP)-induced peripheral sensory neuropathy (PSN) exhibits substantial interpatient variability, and some patients suffer from long-term, persisting PSN. OBJECTIVE To identify single-nucleotide polymorphisms (SNPs) predicting L-OHP-induced PSN using a genome-wide association study (GWAS) approach. DESIGN, SETTING, PARTICIPANTS A large prospective GWAS including 1,379 patients with stage II/III colon cancer who received L-OHP-based adjuvant chemotherapy (mFOLFOX6/CAPOX) under the phase II (JOIN/JFMC41) or the phase III (ACHIVE/JFMC47) trial. MAIN OUTCOMES AND MEASURES First, GWAS comparison of worst grade PSN (grade 0/1 vs. 2/3) was performed. Next, to minimize the impact of ambiguity in PSN grading, extreme PSN phenotypes were selected and analyzed by GWAS. SNPs that could predict time to recovery from PSN were also evaluated. In addition, SNPs associated with L-OHP-induced allergic reactions (AR) and time to disease recurrence were explored. RESULTS No SNPs exceeded the genome-wide significance (p < 5.0 × 10-8) in either GWAS comparison of worst grade PSN, extreme PSN phenotypes, or time to recovery from PSN. Association study focusing on AR or time to disease recurrence also failed to reveal any significant SNPs. CONCLUSION AND RELEVANCE Our results highlight the challenges of utilizing SNPs for predicting susceptibility to L-OHP-induced PSN in daily clinical practice.
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Affiliation(s)
- M Kanai
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - T Kawaguchi
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - M Kotaka
- Gastrointestinal Cancer Center, Sano Hospital, Kobe, Japan
| | - D Manaka
- Department of Surgery, Gastrointestinal Center, Kyoto-Katsura Hospital, Kyoto, Japan
| | - J Hasegawa
- Department of Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - A Takagane
- Department of Surgery, Hakodate Goryoukaku Hospital, Hokkaido, Japan
| | - Y Munemoto
- Department of Surgery, Fukui Ken Saiseikai Hospital, Fukui, Japan
| | - T Kato
- Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - T Eto
- Department of Gastroenterology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - T Touyama
- Department of Surgery, Nakagami Hospital, Okinawa, Japan
| | - T Matsui
- Department of Gastroenterological Surgery, Aichi Cancer Center Aichi Hospital, Aichi, Japan
| | - K Shinozaki
- Division of Clinical Oncology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - S Matsumoto
- Department of Real World Data Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Mizushima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - M Mori
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - J Sakamoto
- Japanese Foundation for Multidisciplinary Treatment of Cancer, Tokyo, Japan; Tokai Central Hospital, Kakamigahara, Japan
| | - A Ohtsu
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - S Saji
- Japanese Foundation for Multidisciplinary Treatment of Cancer, Tokyo, Japan
| | - F Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Nizam W, Yeo HL, Obeng-Gyasi S, Brock MV, Johnston FM. Disparities in Surgical Oncology: Management of Advanced Cancer. Ann Surg Oncol 2021; 28:8056-8073. [PMID: 34268636 DOI: 10.1245/s10434-021-10275-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023]
Abstract
Significant variations in the patterns of care, incidence, and mortality rates of several common cancers have been noted. These disparities have been attributed to a complex interplay of factors, including genetic, environmental, and healthcare-related components. Within this review, primarily focusing on commonly occurring cancers (breast, lung, colorectal), we initially summarize the burden of these disparities with regard to incidence and screening patterns. We then explore the interaction between several proven genetic, epigenetic, and environmental influences that are known to contribute to these disparities.
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Affiliation(s)
- Wasay Nizam
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Heather L Yeo
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Malcolm V Brock
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Fabian M Johnston
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA. .,Division of Gastrointestinal Surgical Oncology, Peritoneal Surface Malignancy Program, Complex General Surgical Oncology Fellowship, Division of Surgical Oncology, Johns Hopkins University, Baltimore, MD, USA.
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Al-Mahayri ZN, AlAhmad MM, Ali BR. Current opinion on the pharmacogenomics of paclitaxel-induced toxicity. Expert Opin Drug Metab Toxicol 2021; 17:785-801. [PMID: 34128748 DOI: 10.1080/17425255.2021.1943358] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Paclitaxel is a microtubule stabilizer that is currently one of the most utilized chemotherapeutic agents. Its efficacy in breast, uterine, lung and other neoplasms made its safety profile enhancement a subject of great interest. Neurotoxicity is the most common paclitaxel-associated toxicities. In addition, hypersensitivity reactions, hematological, gastrointestinal, and cardiac toxicities are all encountered.Areas covered: The current review explores paclitaxel-induced toxicities mechanisms and risk factors. Studies investigating these toxicities pharmacogenomic biomarkers are reviewed and summarized. There is a limited margin of consistency between the retrieved associations. Variants in genes related to neuro-sensitivity are the most promising candidates for future studies.Expert opinion: Genome-wide association studies highlighted multiple-candidate biomarkers relevant to neuro-sensitivity. Most of the identified paclitaxel-neurotoxicity candidate genes are derived from congenital neuropathy and diabetic-induced neurotoxicity pathways. Future studies should explore these sets of genes while considering the multifactorial nature of paclitaxel-induced neurotoxicity. In the absence of certain paclitaxel-toxicity biomarkers, future research should avoid earlier studies' caveats. Genes in paclitaxel's pharmacokinetic pathways could not provide consistent results in any of its associated toxicities. There is a need to dig deeper into toxicity-development mechanisms and personal vulnerability factors, rather than targeting only the genes suspected to affect drug exposure.
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Affiliation(s)
- Zeina N Al-Mahayri
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Mohammad M AlAhmad
- Department of Clinical Pharmacy, College of Pharmacy, Al-Ain University, Al-Ain, United Arab Emirates
| | - Bassam R Ali
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.,Zayed Center for Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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Catalano M, Aprile G, Ramello M, Conca R, Petrioli R, Roviello G. Association between Low-Grade Chemotherapy-Induced Peripheral Neuropathy (CINP) and Survival in Patients with Metastatic Adenocarcinoma of the Pancreas. J Clin Med 2021; 10:jcm10091846. [PMID: 33922821 PMCID: PMC8122977 DOI: 10.3390/jcm10091846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/02/2021] [Accepted: 04/20/2021] [Indexed: 12/19/2022] Open
Abstract
The combination of nab-paclitaxel and gemcitabine demonstrated greater efficacy than gemcitabine alone but resulted in higher rates of chemotherapy-induced peripheral neuropathy (CINP) in patients with metastatic pancreatic cancer (mPC). We aimed to evaluate the correlation between the development of treatment-related peripheral neuropathy and the efficacy of nab-P/Gem combination in these patients. mPC patients treated with nab-paclitaxel 125 mg/m2 and gemcitabine 1000 mg/m2 as a first-line therapy were included. Treatment-related adverse events, mainly peripheral neuropathy, were categorized using the National Cancer Institute Common Toxicity Criteria scale, version 4.02. Efficacy outcomes, including overall survival (OS), progression-free survival (PSF), and disease control rate (DCR), were estimated by the Kaplan–Meier model. A total of 153 patients were analyzed; of these, 47 patients (30.7%) developed grade 1–2 neuropathy. PFS was 7 months (95% CI (6–7 months)) for patients with grade 1–2 neuropathy and 6 months (95% CI (5–6 months)) for patients without peripheral neuropathy (p = 0.42). Median OS was 13 months (95% CI (10–18 months)) and 10 months (95% CI (8–13 months)) in patients with and without peripheral neuropathy, respectively (p = 0.04). DCR was achieved by 83% of patients with grade 1–2 neuropathy and by 58% of patients without neuropathy (p = 0.03). In the multivariate analysis, grade 1–2 neuropathy was independently associated with OS (HR 0.65; 95% CI, 0.45–0.98; p = 0.03). nab-P/Gem represents an optimal first-line treatment for mPC patients. Among possible treatment-related adverse events, peripheral neuropathy is the most frequent, with different grades and incidence. Our study suggests that patients experiencing CINP may have a more favorable outcome, with a higher disease control rate and prolonged median survival compared to those without neuropathy.
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Affiliation(s)
- Martina Catalano
- School of Human Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy;
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, AULSS8 Berica, 36100 Vicenza, Italy;
| | - Monica Ramello
- Oncology Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, Piazza Ospitale, 34100 Trieste, Italy;
| | - Raffaele Conca
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, 85028 Rionero, Vulture (PZ), Italy;
| | - Roberto Petrioli
- Department of Medicine, Surgery and Neurosciences, Medical Oncology Unit, University of Siena, Viale Bracci-Policlinico “Le Scotte”, 53100 Siena, Italy;
| | - Giandomenico Roviello
- Department of Health Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
- Correspondence: ; Tel.: +39-055-7938313
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Albain KS, Gray RJ, Makower DF, Faghih A, Hayes DF, Geyer CE, Dees EC, Goetz MP, Olson JA, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Wood WC, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge GW, Sparano JA. Race, Ethnicity, and Clinical Outcomes in Hormone Receptor-Positive, HER2-Negative, Node-Negative Breast Cancer in the Randomized TAILORx Trial. J Natl Cancer Inst 2021; 113:390-399. [PMID: 32986828 PMCID: PMC8599918 DOI: 10.1093/jnci/djaa148] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/22/2020] [Accepted: 09/09/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Black race is associated with worse outcomes in early breast cancer. We evaluated clinicopathologic characteristics, the 21-gene recurrence score (RS), treatment delivered, and clinical outcomes by race and ethnicity among women who participated in the Trial Assigning Individualized Options for Treatment. METHODS The association between clinical outcomes and race (White, Black, Asian, other or unknown) and ethnicity (Hispanic vs non-Hispanic) was examined using proportional hazards models. All P values are 2-sided. RESULTS Of 9719 eligible women with hormone receptor-positive, HER2-negative, node-negative breast cancer, there were 8189 (84.3%) Whites, 693 (7.1%) Blacks, 405 (4.2%) Asians, and 432 (4.4%) with other or unknown race. Regarding ethnicity, 889 (9.1%) were Hispanic. There were no substantial differences in RS or ESR1, PGR, or HER2 RNA expression by race or ethnicity. After adjustment for other covariates, compared with White race, Black race was associated with higher distant recurrence rates (hazard ratio [HR] = 1.60, 95% confidence intervals [CI] = 1.07 to 2.41) and worse overall survival in the RS 11-25 cohort (HR = 1.51, 95% CI = 1.06 to 2.15) and entire population (HR = 1.41, 95% CI = 1.05 to 1.90). Hispanic ethnicity and Asian race were associated with better outcomes. There was no evidence of chemotherapy benefit for any racial or ethnic group in those with a RS of 11-25. CONCLUSIONS Black women had worse clinical outcomes despite similar 21-gene assay RS results and comparable systemic therapy in the Trial Assigning Individualized Options for Treatment. Similar to Whites, Black women did not benefit from adjuvant chemotherapy if the 21-gene RS was 11-25. Further research is required to elucidate the basis for this racial disparity in prognosis.
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Affiliation(s)
- Kathy S Albain
- Loyola University Chicago Stritch School of Medicine, Cardinal Bernadin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | | | - Della F Makower
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amir Faghih
- Thunder Bay Regional Health Science Centre, Thunder Bay, Ontario, Canada
| | | | | | | | | | - John A Olson
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tracy Lively
- National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - Sunil S Badve
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Lynne I Wagner
- Wake Forest University Health Service, Winston Salem, NC, USA
| | | | | | | | | | - Henry L Gomez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | | | | | | | | | | | | | - Jeffrey Abrams
- National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | | | - Joseph A Sparano
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Sparano JA, Brawley OW. Deconstructing Racial and Ethnic Disparities in Breast Cancer. JAMA Oncol 2021; 7:355-356. [PMID: 33475709 DOI: 10.1001/jamaoncol.2020.7113] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Joseph A Sparano
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Otis W Brawley
- Johns Hopkins School of Medicine and The Bloomberg School of Public Health, Baltimore, Maryland
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40
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Hertz DL. Exploring pharmacogenetics of paclitaxel- and docetaxel-induced peripheral neuropathy by evaluating the direct pharmacogenetic-pharmacokinetic and pharmacokinetic-neuropathy relationships. Expert Opin Drug Metab Toxicol 2021; 17:227-239. [PMID: 33401943 DOI: 10.1080/17425255.2021.1856367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Peripheral neuropathy (PN) is an adverse effect of several classes of chemotherapy including the taxanes. Predictive PN biomarkers could inform individualized taxane treatment to reduce PN and enhance therapeutic outcomes. Pharmacogenetics studies of taxane-induced PN have focused on genes involved in pharmacokinetics, including enzymes and transporters. Contradictory findings from these studies prevent translation of genetic biomarkers into clinical practice. Areas covered: This review discusses the progress toward identifying pharmacogenetic predictors of PN by assessing the evidence for two independent associations; the effect of pharmacogenetics on taxane pharmacokinetics and the evidence that taxane pharmacokinetics affects PN. Assessing these direct relationships allows the reader to understand the progress toward individualized taxane treatment and future research opportunities. Expert opinion: Paclitaxel pharmacokinetics is a major determinant of PN. Additional clinical trials are needed to confirm the clinical benefit of individualized dosing to achieve target paclitaxel exposure. Genetics does not meaningfully contribute to paclitaxel pharmacokinetics and may not be useful to inform dosing. However, genetics may contribute to PN sensitivity and could be useful for estimating patients' optimal paclitaxel exposure. For docetaxel, genetics has not been demonstrated to have a meaningful effect on pharmacokinetics and there is no evidence that pharmacokinetics determines PN.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy , Ann Arbor, MI, United States
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41
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McCall MK, Ibikunle S, Murphy Y, Hunter K, Rosenzweig MQ. Knowledge and Attitudes About Genetic Testing Among Black and White Women with Breast Cancer. J Racial Ethn Health Disparities 2020; 8:1208-1216. [PMID: 33025420 DOI: 10.1007/s40615-020-00878-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
Prior to embarking on a large descriptive evaluation of genetic/racial variations in symptom phenotype, we sought foundational information to determine racial differences in (1) feasibility (consent) and acceptability of collecting genomic samples, (2) genetic literacy, and (3) concerns of genomic research during breast cancer (BC) chemotherapy. Women with early-stage BC undergoing chemotherapy were recruited from an academic, urban breast care center. Information was collected for consent to participate, genetic literacy, and concerns about genetic testing in Black and White women with BC. Fifty-six women were eligible, and 48 were consented (24 Black, 24 White). All participants consented to blood testing. This highly educated sample's mean age was 52.5 + 12.05 (years). Education (years) and genetic knowledge were positively correlated (p = .038). Genetic scores were high, and only one question significantly differed by race. On interview, most participants thought conducting genetic research helped to better understand hereditary disease and/or identify genes that cause disease and stated that they participated in the research to help other people. The majority of participants responded that friends/family would participate in genetic research without concerns, though three Black participants cited mistrust as a possible concern. Overall, there were high levels of genetic knowledge, slightly different between Black and White women. There were no high levels of personal concern regarding genetic testing. Black women reported more concern than White women that friends/family would have hesitations about participating in genetic research. There was general acceptability of blood collection for genetic testing among women with early-stage BC without racial difference.
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Affiliation(s)
- Maura K McCall
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | | | - Yolanda Murphy
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Kenneth Hunter
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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Steffen McLouth LE, Zhao F, Owonikoko TK, Feliciano JL, Mohindra NA, Dahlberg SE, Wade JL, Srkalovic G, Lash BW, Leach JW, Leal TA, Aggarwal C, Cella D, Ramalingam SS, Wagner LI. Patient-reported tolerability of veliparib combined with cisplatin and etoposide for treatment of extensive stage small cell lung cancer: Neurotoxicity and adherence data from the ECOG ACRIN cancer research group E2511 phase II randomized trial. Cancer Med 2020; 9:7511-7523. [PMID: 32860331 PMCID: PMC7571824 DOI: 10.1002/cam4.3416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The ECOG-ACRIN Cancer Research Group trial E2511 recently demonstrated a potential benefit for the addition of veliparib to cisplatin-etoposide (CE) in patients with extensive stage small cell lung cancer (ES-SCLC) in a phase II randomized controlled trial. Secondary trial endpoints included comparison of the incidence and severity of neurotoxicity, hypothesized to be lower in the veliparib arm, and tolerability of the addition of veliparib to CE. Physician-rated and patient-reported neurotoxicity was also compared. MATERIALS AND METHODS Patients randomized to veliparib plus CE (n = 64) or placebo plus CE (n = 64) completed the 11-item Functional Assessment of Cancer Therapy Gynecologic Oncology Group Neurotoxicity (questionnaire pre-treatment, end of cycle 4 [ie 3 months after randomization] and 3 months post-treatment [ie 6-months]). Adherence analysis was based on treatment forms. RESULTS AND CONCLUSION No significant differences in mean or magnitude of change in neurotoxicity scores were observed between treatment arms at any time point. However, patients in the placebo arm reported worsening neurotoxicity from baseline to 3-months (M difference = -1.5, P = .045), compared to stable neurotoxicity in the veliparib arm (M difference = -0.2, P = .778). Weakness was the most common treatment-emergent (>50%) and moderate to severe (>16%) symptom reported, but did not differ between treatment arms. The proportion of adherence to oral therapy in the overall sample was 75%. Three percent of patients reported clinically significant neurotoxicity that was not captured by physician assessment. Neurotoxicity scores were not different between treatment arms. The addition of veliparib to CE appeared tolerable, though weakness should be monitored. CLINICALTRIALS. GOV IDENTIFIER NCT01642251.
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Affiliation(s)
- Laurie E. Steffen McLouth
- Department of Behavioral ScienceCenter for Health Equity TransformationUniversity of Kentucky College of MedicineLexingtonKYUSA
| | - Fengmin Zhao
- Dana‐Farber Cancer Institute & ECOG‐ACRIN Biostatistics CenterBostonMAUSA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Lynne I. Wagner
- Department of Social Sciences & Health PolicyWake Forest School of MedicineWinston‐SalemNCUSA
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43
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Chua KC, Xiong C, Ho C, Mushiroda T, Jiang C, Mulkey F, Lai D, Schneider BP, Rashkin SR, Witte JS, Friedman PN, Ratain MJ, McLeod HL, Rugo HS, Shulman LN, Kubo M, Owzar K, Kroetz DL. Genomewide Meta-Analysis Validates a Role for S1PR1 in Microtubule Targeting Agent-Induced Sensory Peripheral Neuropathy. Clin Pharmacol Ther 2020; 108:625-634. [PMID: 32562552 DOI: 10.1002/cpt.1958] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/04/2020] [Indexed: 12/19/2022]
Abstract
Microtubule targeting agents (MTAs) are anticancer therapies commonly prescribed for breast cancer and other solid tumors. Sensory peripheral neuropathy (PN) is the major dose-limiting toxicity for MTAs and can limit clinical efficacy. The current pharmacogenomic study aimed to identify genetic variations that explain patient susceptibility and drive mechanisms underlying development of MTA-induced PN. A meta-analysis of genomewide association studies (GWAS) from two clinical cohorts treated with MTAs (Cancer and Leukemia Group B (CALGB) 40502 and CALGB 40101) was conducted using a Cox regression model with cumulative dose to first instance of grade 2 or higher PN. Summary statistics from a GWAS of European subjects (n = 469) in CALGB 40502 that estimated cause-specific risk of PN were meta-analyzed with those from a previously published GWAS of European ancestry (n = 855) from CALGB 40101 that estimated the risk of PN. Novel single nucleotide polymorphisms in an enhancer region downstream of sphingosine-1-phosphate receptor 1 (S1PR1 encoding S1PR1 ; e.g., rs74497159, βCALGB 40101 per allele log hazard ratio (95% confidence interval (CI)) = 0.591 (0.254-0.928), βCALGB 40502 per allele log hazard ratio (95% CI) = 0.693 (0.334-1.053); PMETA = 3.62 × 10-7 ) were the most highly ranked associations based on P values with risk of developing grade 2 and higher PN. In silico functional analysis identified multiple regulatory elements and potential enhancer activity for S1PR1 within this genomic region. Inhibition of S1PR1 function in induced pluripotent stem cell-derived human sensory neurons shows partial protection against paclitaxel-induced neurite damage. These pharmacogenetic findings further support ongoing clinical evaluations to target S1PR1 as a therapeutic strategy for prevention and/or treatment of MTA-induced neuropathy.
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Affiliation(s)
- Katherina C Chua
- Pharmaceutical Sciences and Pharmacogenomics Graduate Program, University of California San Francisco, San Francisco, California, USA.,Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Chenling Xiong
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Carol Ho
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Taisei Mushiroda
- Laboratory of Genotyping Development, Riken Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Chen Jiang
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA.,Alliance Statistics and Data Center, Duke University, Durham, North Carolina, USA
| | - Flora Mulkey
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA.,Alliance Statistics and Data Center, Duke University, Durham, North Carolina, USA
| | - Dongbing Lai
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Sara R Rashkin
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, USA
| | - John S Witte
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, USA
| | - Paula N Friedman
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mark J Ratain
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Howard L McLeod
- DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, Florida, USA
| | - Hope S Rugo
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lawrence N Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michiaki Kubo
- Laboratory of Genotyping Development, Riken Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Kouros Owzar
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA.,Alliance Statistics and Data Center, Duke University, Durham, North Carolina, USA
| | - Deanna L Kroetz
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA.,Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
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Kim G, Pastoriza JM, Condeelis JS, Sparano JA, Filippou PS, Karagiannis GS, Oktay MH. The Contribution of Race to Breast Tumor Microenvironment Composition and Disease Progression. Front Oncol 2020; 10:1022. [PMID: 32714862 PMCID: PMC7344193 DOI: 10.3389/fonc.2020.01022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022] Open
Abstract
Breast cancer is the second most commonly diagnosed cancer in American women following skin cancer. Despite overall decrease in breast cancer mortality due to advances in treatment and earlier screening, black patients continue to have 40% higher risk of breast cancer related death compared to white patients. This disparity in outcome persists even when controlled for access to care and stage at presentation and has been attributed to differences in tumor subtypes or gene expression profiles. There is emerging evidence that the tumor microenvironment (TME) may contribute to the racial disparities in outcome as well. Here, we provide a comprehensive review of current literature available regarding race-dependent differences in the TME. Notably, black patients tend to have a higher density of pro-tumorigenic immune cells (e.g., M2 macrophages, regulatory T cells) and microvasculature. Although immune cells are classically thought to be anti-tumorigenic, increase in M2 macrophages and angiogenesis may lead to a paradoxical increase in metastasis by forming doorways of tumor cell intravasation called tumor microenvironment of metastasis (TMEM). Furthermore, black patients also have higher serum levels of inflammatory cytokines, which provide a positive feedback loop in creating a pro-metastatic TME. Lastly, we propose that the higher density of immune cells and angiogenesis observed in the TME of black patients may be a result of evolutionary selection for a more robust immune response in patients of African geographic ancestry. Better understanding of race-dependent differences in the TME will aid in overcoming the racial disparity in breast cancer mortality.
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Affiliation(s)
- Gina Kim
- Department of Anatomy and Structural Biology, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Integrated Imaging Program, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Department of Surgery, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States
| | - Jessica M Pastoriza
- Department of Surgery, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States
| | - John S Condeelis
- Department of Anatomy and Structural Biology, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Integrated Imaging Program, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Department of Surgery, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Gruss-Lipper Biophotonics Center, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States
| | - Joseph A Sparano
- Integrated Imaging Program, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Department of Medicine (Oncology), Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States
| | - Panagiota S Filippou
- School of Health & Life Sciences, Teesside University, Middlesbrough, United Kingdom.,National Horizons Centre, Teesside University, Darlington, United Kingdom
| | - George S Karagiannis
- Department of Anatomy and Structural Biology, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Integrated Imaging Program, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Gruss-Lipper Biophotonics Center, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States
| | - Maja H Oktay
- Department of Anatomy and Structural Biology, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Integrated Imaging Program, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Gruss-Lipper Biophotonics Center, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Department of Pathology, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States
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45
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McCall MK, Connolly M, Nugent B, Conley YP, Bender CM, Rosenzweig MQ. Symptom Experience, Management, and Outcomes According to Race and Social Determinants Including Genomics, Epigenomics, and Metabolomics (SEMOARS + GEM): an Explanatory Model for Breast Cancer Treatment Disparity. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:428-440. [PMID: 31392599 PMCID: PMC7245588 DOI: 10.1007/s13187-019-01571-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Even after controlling for stage, comorbidity, age, and insurance status, black women with breast cancer (BC) in the USA have the lowest 5-year survival as compared with all other races for stage-matched disease. One potential cause of this survival difference is the disparity in cancer treatment, evident in many population clinical trials. Specifically, during BC chemotherapy, black women receive less relative dose intensity with more dose reductions and early chemotherapy cessation compared with white women. Symptom incidence, cancer-related distress, and ineffective communication, including the disparity in patient-centeredness of care surrounding patient symptom reporting and clinician assessment, are important factors contributing to racial disparity in dose reduction and early therapy termination. We present an evidence-based overview and an explanatory model for racial disparity in the symptom experience during BC chemotherapy that may lead to a reduction in dose intensity and a subsequent disparity in outcomes. This explanatory model, the Symptom Experience, Management, Outcomes and Adherence according to Race and Social determinants + Genomics Epigenomics and Metabolomics (SEMOARS + GEM), considers essential factors such as social determinants of health, clinician communication, symptoms and symptom management, genomics, epigenomics, and pharmacologic metabolism as contributory factors.
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Affiliation(s)
- Maura K. McCall
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Mary Connolly
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Bethany Nugent
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Yvette P. Conley
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Catherine M. Bender
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Margaret Q. Rosenzweig
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
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46
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Ballinger TJ, Cunningham GM, Wu X, Schneider BP. Impact of Genetic Ancestry on Treatment Toxicity and Racial Disparities in Breast Cancer. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00369-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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47
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Tamburin S, Park SB, Alberti P, Demichelis C, Schenone A, Argyriou AA. Taxane and epothilone-induced peripheral neurotoxicity: From pathogenesis to treatment. J Peripher Nerv Syst 2020; 24 Suppl 2:S40-S51. [PMID: 31647157 DOI: 10.1111/jns.12336] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/15/2019] [Indexed: 01/17/2023]
Abstract
Taxane-induced peripheral neurotoxicity (TIPN) is the most common non-hematological side effect of taxane-based chemotherapy, and may result in dose reductions and discontinuations, having as such a detrimental effect on patients' overall survival. Epothilones share similar mechanism of action with taxanes. The typical TIPN clinical presentation is mainly comprised of numbness and paresthesia, in a stocking-and-glove distribution and may progress more proximally over time, with paclitaxel being more neurotoxic than docetaxel. Motor and autonomic involvement is less common, whereas an acute taxane-induced acute pain syndrome is frequent. Patient reported outcomes questionnaires, clinical evaluation, and instrumental tools offer complementary information in TIPN. Its electrodiagnostic features include reduced/abolished sensory action potentials, and less prominent motor involvement, in keeping with a length-dependent, axonal dying back predominately sensory neuropathy. TIPN is dose-dependent and may be reversible within months after the end of chemotherapy. The single and cumulative delivered dose of taxanes is considered the main risk factor of TIPN development. Apart from the cumulative dose, other risk factors for TIPN include demographic, clinical, and pharmacogenetic features with several single-nucleotide polymorphisms potentially linked with increased susceptibility of TIPN. There are currently no neuroprotective strategies to reduce the risk of TIPN, and symptomatic treatments are very limited. This review critically examines the pathogenesis, incidence, risk factors (both clinical and pharmacogenetic), clinical phenotype and management of TIPN.
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Affiliation(s)
- Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Chiara Demichelis
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Policlinico San Martino, Genoa, Italy
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Policlinico San Martino, Genoa, Italy
| | - Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece
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48
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Marcath LA, Kidwell KM, Vangipuram K, Gersch CL, Rae JM, Burness ML, Griggs JJ, Van Poznak C, Hayes DF, Smith EML, Henry NL, Beutler AS, Hertz DL. Genetic variation in EPHA contributes to sensitivity to paclitaxel-induced peripheral neuropathy. Br J Clin Pharmacol 2020; 86:880-890. [PMID: 31823378 DOI: 10.1111/bcp.14192] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 12/23/2022] Open
Abstract
AIMS Chemotherapy-induced peripheral neuropathy (PN) is a treatment limiting toxicity of paclitaxel. We evaluated if EPHA genetic variation (EPHA4, EPHA5, EPHA6, and EPHA8) is associated with PN sensitivity by accounting for variability in systemic paclitaxel exposure (time above threshold). METHODS Germline DNA from 60 patients with breast cancer was sequenced. PN was measured using the 8-item sensory subscale (CIPN8) of the patient-reported CIPN20. Associations for 3 genetic models were tested by incorporating genetics into previously published PN prediction models integrating measured paclitaxel exposure and cumulative treatment. Significant associations were then tested for association with PN-related treatment disruption. RESULTS EPHA5 rs7349683 (minor allele frequency = 0.32) was associated with increased PN sensitivity (β-coefficient = 0.39, 95% confidence interval 0.11-0.67, p = 0.007). Setting a maximum tolerable threshold of CIPN8 = 30, optimal paclitaxel exposure target is shorter for rs7349683 homozygous (11.6 h) than heterozygous (12.6 h) or wild-type (13.6 h) patients. Total number of missense variants (median = 0, range 0-2) was associated with decreased PN sensitivity (β-coefficient: -0.42, 95% confidence interval -0.72 to -0.12, P = .006). No association with treatment disruption was detected for the total number of missense variants or rs7349683. CONCLUSION Isolating toxicity sensitivity by accounting for exposure is a novel approach, and rs7349683 represents a promising marker for PN sensitivity that may be used to individualize paclitaxel treatment.
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Affiliation(s)
- Lauren A Marcath
- Department of Pharmacotherapy, Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
| | - Kelley M Kidwell
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.,Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Kiran Vangipuram
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | | | - James M Rae
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Monika L Burness
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer J Griggs
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Catherine Van Poznak
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ellen M Lavoie Smith
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - N Lynn Henry
- Department of Internal Medicine, Division of Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andreas S Beutler
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.,Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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Staff NP, Fehrenbacher JC, Caillaud M, Damaj MI, Segal RA, Rieger S. Pathogenesis of paclitaxel-induced peripheral neuropathy: A current review of in vitro and in vivo findings using rodent and human model systems. Exp Neurol 2020; 324:113121. [PMID: 31758983 PMCID: PMC6993945 DOI: 10.1016/j.expneurol.2019.113121] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/29/2019] [Accepted: 11/19/2019] [Indexed: 12/22/2022]
Abstract
Paclitaxel (Brand name Taxol) is widely used in the treatment of common cancers like breast, ovarian and lung cancer. Although highly effective in blocking tumor progression, paclitaxel also causes peripheral neuropathy as a side effect in 60-70% of chemotherapy patients. Recent efforts by numerous labs have aimed at defining the underlying mechanisms of paclitaxel-induced peripheral neuropathy (PIPN). In vitro models using rodent dorsal root ganglion neurons, human induced pluripotent stem cells, and rodent in vivo models have revealed a number of molecular pathways affected by paclitaxel within axons of sensory neurons and within other cell types, such as the immune system and peripheral glia, as well skin. These studies revealed that paclitaxel induces altered calcium signaling, neuropeptide and growth factor release, mitochondrial damage and reactive oxygen species formation, and can activate ion channels that mediate responses to extracellular cues. Recent studies also suggest a role for the matrix-metalloproteinase 13 (MMP-13) in mediating neuropathy. These diverse changes may be secondary to paclitaxel-induced microtubule transport impairment. Human genetic studies, although still limited, also highlight the involvement of cytoskeletal changes in PIPN. Newly identified molecular targets resulting from these studies could provide the basis for the development of therapies with which to either prevent or reverse paclitaxel-induced peripheral neuropathy in chemotherapy patients.
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Affiliation(s)
- Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Jill C Fehrenbacher
- Department of Pharmacology and Toxicology, University School of Medicine, Indianapolis, IN 46202, USA
| | - Martial Caillaud
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, USA
| | - M Imad Damaj
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, USA
| | - Rosalind A Segal
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Sandra Rieger
- Department of Biology, University of Miami, Coral Gables, FL 33146, USA.
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50
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Anderson JT, Huang KM, Lustberg MB, Sparreboom A, Hu S. Solute Carrier Transportome in Chemotherapy-Induced Adverse Drug Reactions. Rev Physiol Biochem Pharmacol 2020; 183:177-215. [PMID: 32761456 DOI: 10.1007/112_2020_30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Members of the solute carrier (SLC) family of transporters are responsible for the cellular influx of a broad range of endogenous compounds and xenobiotics. These proteins are highly expressed in the gastrointestinal tract and eliminating organs such as the liver and kidney, and are considered to be of particular importance in governing drug absorption and elimination. Many of the same transporters are also expressed in a wide variety of organs targeted by clinically important anticancer drugs, directly affect cellular sensitivity to these agents, and indirectly influence treatment-related side effects. Furthermore, targeted intervention strategies involving the use of transport inhibitors have been recently developed, and have provided promising lead candidates for combinatorial therapies associated with decreased toxicity. Gaining a better understanding of the complex interplay between transporter-mediated on-target and off-target drug disposition will help guide the further development of these novel treatment strategies to prevent drug accumulation in toxicity-associated organs, and improve the safety of currently available treatment modalities. In this report, we provide an update on this rapidly emerging field with particular emphasis on anticancer drugs belonging to the classes of taxanes, platinum derivatives, nucleoside analogs, and anthracyclines.
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Affiliation(s)
- Jason T Anderson
- Division of Pharmaceutics and Pharmacology, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Kevin M Huang
- Division of Pharmaceutics and Pharmacology, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Maryam B Lustberg
- Department of Medical Oncology, The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Alex Sparreboom
- Division of Pharmaceutics and Pharmacology, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Shuiying Hu
- Division of Pharmaceutics and Pharmacology, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
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