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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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2
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Affiliation(s)
- Gabriel N. Hortobagyi
- The University of Texas MD Anderson Cancer Center, Houston, TX,Gabriel N. Hortobagyi, MD, FACP, FASCO, The University of Texas MD Anderson Cancer Center, Breast Medical Oncology, 1515 Holcombe Blvd, Houston, Texas 77030; e-mail:
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3
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Wongsaengsak S, Quirch M, Ball S, Sultan A, Jahan N, Elmassry M, Rehman S. Docetaxel-induced acute myositis: a case report with review of literature. J Chemother 2020; 33:116-121. [PMID: 32619151 DOI: 10.1080/1120009x.2020.1785740] [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: 10/23/2022]
Abstract
Docetaxel is an anti-microtubule agent and a highly effective treatment of locally advanced and metastatic breast cancer. There are several adverse effects associated with docetaxel, such as myelosuppression, peripheral neuropathy, fluid retention, and asthenia. One of the most well-known side-effects of this medication is mild to moderate myalgia. Here, we report a case of a 49-year-old female with stage 3 breast cancers who developed severe acute myositis following docetaxel use. The mechanism of docetaxel-induced myositis remains unclear; however, physicians still need to be aware of the possibility of this complication in patients with cancer and a history of exposure to this medication.
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Affiliation(s)
- Sariya Wongsaengsak
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Miguel Quirch
- Division of Hematology and Medical Oncology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Somedeb Ball
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Anita Sultan
- Division of Hematology and Medical Oncology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Nusrat Jahan
- Division of Hematology and Medical Oncology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Mohamed Elmassry
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Shabnam Rehman
- Division of Hematology and Medical Oncology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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4
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Parida GK, Upadhyay A, Mitra S, Suman A, Muthu GS. Rare Case of Docetaxel-Induced Myositis Detected on Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in a Patient with Carcinoma Breast. Indian J Nucl Med 2020; 35:248-250. [PMID: 33082686 PMCID: PMC7537934 DOI: 10.4103/ijnm.ijnm_25_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022] Open
Abstract
We report an extremely rare case of acute inflammatory myopathy during combination chemotherapy with docetaxel and transtuzumab for metastatic breast carcinoma in a 44-year-old female patient. Despite the significant response in the follow-up fluorodeoxyglucose (FDG) positron emission tomography/computed tomography, of the underlying malignancy to the chemotherapeutic regimen, there was diffusely increased FDG uptake in the upper and lower limb muscles with associated painful, proximal muscle weakness. These symptoms regressed after the discontinuation of docetaxel and the administration of corticosteroids, suggesting it to be the drug-induced myositis.
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Affiliation(s)
- Girish Kumar Parida
- Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Amitabh Upadhyay
- Department of Medical Oncology, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Sujata Mitra
- Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Akchata Suman
- Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Gopal Sonai Muthu
- Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur, Jharkhand, India
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5
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Saraswat N, Sood A, Verma R, Kumar D, Kumar S. Nail Changes Induced by Chemotherapeutic Agents. Indian J Dermatol 2020; 65:193-198. [PMID: 32565559 PMCID: PMC7292457 DOI: 10.4103/ijd.ijd_37_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Nail toxicity is a relatively uncommon cutaneous adverse effect of chemotherapeutic agents. Rapidly dividing cells of the nail matrix are perturbed by the antimitotic activity of these agents. Although most of these changes are cosmetic and regress once the therapy is completed, a few of these adverse effects are challenging to manage and require temporary or permanent suspension of chemotherapeutic agents. Materials and Methods: A total of 205 patients with various malignancies and under chemotherapy in oncology ward of the hospital over a period of 3 months were screened for nail involvement postchemotherapy. Relevant details, protocol of chemotherapeutic agents were assessed. Nail examination was carried out in daylight and the changes were analyzed. Results: A total of 124 (60.4%) patients had nail changes due to chemotherapeutic agents. The most common change was diffuse hyperpigmentation in 101 (81.4%) patients commonly due to a combination of cyclophosphamide and adriamycin in 43 (42.5%) patients. Longitudinal melanonychia was seen in 36 (29%), Beau's lines in 31 (25%), onychomadesis in 17 (13.7%), Mees' lines in 15 (12%), paronychia in 12 (9.6%), subungual hyperkeratosis in 10 (8%), and Muehrcke's lines in 4 (3.2%) patients. All the patients who developed Muehrcke's lines were on a combination of cyclophosphamide/doxorubicin/5 FU. Exudative onycholysis was observed in 2 (1.6%) patients; both these patients were on paclitaxel therapy. A total 2 (1.6%) patients who developed exudative onycholysis were advised discontinuation and another substitute chemotherapy was advised. Therapy for 2 (1.6%) patients who developed acute paronychia due to gefitinib was temporarily suspended. Unfortunately, most of the patients were on multiple chemotherapeutic agents hence, we could not pinpoint one drug as a cause. Therefore, a combination of agents was implicated in most cases. Conclusion: Nail toxicities are common with chemotherapeutic agents, however less importance is given to nail involvement. Apart from being cosmetically significant, a few adverse effects may warrant modification of the chemotherapy.
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Affiliation(s)
- Neerja Saraswat
- Department of Dermatology, Base Hospital, Delhi Cantt, Delhi, India
| | - Aradhana Sood
- Department of Dermatology, Base Hospital, Lucknow Cantt, Lucknow, Uttar Pradesh, India
| | | | - Dhramesh Kumar
- Commandant, Military Hospital, Jodhapur, Rajasthan, India
| | - Sushil Kumar
- Department of Dermatology, MLN Medical College, Allahabad, Uttar Pradesh, India
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6
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Sanz Del Olmo N, Bajo AM, Ionov M, García-Gallego S, Bryszewska M, Gómez R, Ortega P, de la Mata FJ. Cyclopentadienyl ruthenium(II) carbosilane metallodendrimers as a promising treatment against advanced prostate cancer. Eur J Med Chem 2020; 199:112414. [PMID: 32438200 DOI: 10.1016/j.ejmech.2020.112414] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/16/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
In searching for efficient and selective antitumour drugs, a new family of carbosilane metallodendrimers functionalized with [Ru(η5-C5H5)(PTA)Cl] (PTA = 1,3,5-triaza-7-phosphatricyclo-[3.3.1.1] decane) is reported. Experiments of the biophysical characterization showed an ability to interact with biological membranes, as well as with proteins (e.g. human serum albumin) without affecting their usual biological activity. These metallodendrimers possessed potent and selective anticancer activity in vitro in a panel of tumour cell lines. Importantly, the first generation metallodendrimer, bearing 4 Ru(II) complexes, was remarkably active towards resistant prostate cancer cells, inhibiting both cell proliferation and metastasis to bone tissues. Such promising antitumour activity can be further improved when given with docetaxel, with in vitro cytotoxicity being in the nanomolar range. Furthermore, its intravenous administration to an advanced prostate cancer mice model inhibited tumour growth up to 25% and 45% when given 10 mg/kg/week and 7.5 mg/kg/4-5 days, respectively.
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Affiliation(s)
- Natalia Sanz Del Olmo
- Department of Organic and Inorganic Chemistry, Research Institute in Chemistry "Andrés M. del Río" (IQAR), University of Alcalá, Madrid, Spain
| | - Ana M Bajo
- Department of Biology of Systems, Biochemistry and Molecular Biology Unit, University of Alcalá, Madrid, Spain
| | - Maksim Ionov
- Department of General Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236, Lodz, Poland
| | - Sandra García-Gallego
- Department of Organic and Inorganic Chemistry, Research Institute in Chemistry "Andrés M. del Río" (IQAR), University of Alcalá, Madrid, Spain
| | - Maria Bryszewska
- Department of General Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236, Lodz, Poland
| | - Rafael Gómez
- Department of Organic and Inorganic Chemistry, Research Institute in Chemistry "Andrés M. del Río" (IQAR), University of Alcalá, Madrid, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain and Institute "Ramón y Cajal" for Health Research (IRYCIS), Spain
| | - Paula Ortega
- Department of Organic and Inorganic Chemistry, Research Institute in Chemistry "Andrés M. del Río" (IQAR), University of Alcalá, Madrid, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain and Institute "Ramón y Cajal" for Health Research (IRYCIS), Spain.
| | - F Javier de la Mata
- Department of Organic and Inorganic Chemistry, Research Institute in Chemistry "Andrés M. del Río" (IQAR), University of Alcalá, Madrid, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain and Institute "Ramón y Cajal" for Health Research (IRYCIS), Spain.
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7
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Perez-Garcia JM, Cortes J. The safety of eribulin for the treatment of metastatic breast cancer. Expert Opin Drug Saf 2019; 18:347-355. [PMID: 31107111 DOI: 10.1080/14740338.2019.1608946] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Eribulin mesylate is a highly potent anticancer agent approved for use in pretreated metastatic breast cancer (MBC). Clinical trials of eribulin in MBC have demonstrated activity against this tumor type, and a phase 3 study in patients with MBC previously treated with an anthracycline and a taxane showed a significant increase in overall survival (OS) with eribulin versus control regimens. Areas covered: This review presents overviews of the development of eribulin, its pharmacology, and its efficacy in MBC. A detailed review of its safety profile is presented, and the safety of eribulin is compared with other agents commonly used to treat MBC. Expert opinion: As eribulin is the only drug shown to improve OS in patients with pretreated MBC, it is an important treatment option for many patients. Eribulin is currently considered a second-line (Europe) or third-line (United States) therapy, and studies have been examining use in the first-line setting. The use of eribulin in combination with other therapies is beginning to be explored because its manageable safety profile makes it an ideal combination-treatment partner. Emerging eribulin combination-treatment data suggest a manageable toxicity profile, and eribulin is set to be a key drug for the treatment of MBC in the future.
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Affiliation(s)
- Jose Manuel Perez-Garcia
- a Medica Scientia Innovation Research (MedSIR) , Barcelona , Spain.,b IOB Institute of Oncology, Quirónsalud Group , Madrid and Barcelona , Spain
| | - Javier Cortes
- a Medica Scientia Innovation Research (MedSIR) , Barcelona , Spain.,b IOB Institute of Oncology, Quirónsalud Group , Madrid and Barcelona , Spain.,c Vall d'Hebron Institute of Oncology , Barcelona , Spain
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8
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Kalofonos HP, Onyenadum A, Kosmas C, Koutras A, Petsas T, Efthimiou V, Koukouras D, Tzoracolefterakis E, Andrikopoulos P, Androulakis J. Mitomycin C and Vinblastine in Anthracycline-resistant Metastatic Breast Cancer: A Phase Ii Study. TUMORI JOURNAL 2018; 87:394-7. [PMID: 11989593 DOI: 10.1177/030089160108700608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this phase II study was to evaluate the clinical efficacy of mitomycin C and vinblastine in patients with anthracycline-resistant metastatic breast cancer. This single-center, non-randomized trial enrolled 39 patients. Eligible patients must have received at least three chemotherapy regimens with epirubicin or CAF and had treatment failure while on chemotherapy or within 6 months of completing therapy. Treatment consisted of mitomycin C at a starting dose of 8 mg/m2 on day 1 and vinblastine (8 mg/m2, days 1 and 28). The regimen was repeated every 6 weeks with a 20% dose escalation of both drugs after the first cycle in the absence of grade III hematologic or other toxicity. On an intent-to-treat basis, 38 patients were eligible for assessment; 9 (23.7%, 95% confidence interval 1.92-2.45%) achieved a partial response and 13 (34.2%) had stable disease. The median time to disease progression was 6.21 ±4.26 months (range, 1-15; 95% confidence interval, 4.81-7.61), and the median survival was 10.76±7.6 (range, 1-29; 95% confidence interval 8.0-13.1%). Responsive patients had a significantly better survival than those with stable and progressive disease. Treatment was well tolerated. Anemia and neutropenia (grade I-III) developed in 28.9% and 26.3% of the patients, respectively. One patient with grade III granulocytopenia developed fever and infection that required hospitalization. Moderate neurotoxicity, myalgia, constipation, diarrhea and alopecia were observed. No toxic death occurred. Mitomycin C plus vinblastine is an effective and well-tolerated regimen for anthracycline resistant cancer.
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Affiliation(s)
- H P Kalofonos
- Department of Medicine/Oncology, University Hospital of Patras, Greece.
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9
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Xie Z, Zhang Y, Jin C, Fu D. Gemcitabine-based chemotherapy as a viable option for treatment of advanced breast cancer patients: a meta-analysis and literature review. Oncotarget 2018; 9:7148-7161. [PMID: 29467957 PMCID: PMC5805543 DOI: 10.18632/oncotarget.23426] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 11/29/2017] [Indexed: 01/27/2023] Open
Abstract
This meta-analysis was designed to compare the efficacy and safety of gemcitabine-based regimens for the treatment advanced breast cancer (ABC). Altogether 15 studies involving 8195 ABC patients were retrieved for analysis. Compared with non-gemcitabine-based chemotherapies, patients receiving gemcitabine-based therapy exhibited better overall survival (OS), progression free survival (PFS), and objective response rate (ORR) (HR = 1.12, 95% CI 1.05 to 1.19; HR = 1.16, 95% CI 1.03 to 1.30; HR = 1.14, 95% CI 1.04 to 1.24). Grade 3/4 hematologic toxicity was significantly high but manageable in gemcitabine-based groups. Subgroup analysis revealed that patients with first-line gemcitabine-based chemotherapy had better OS (HR = 1.19, 95% CI 1.07 to 1.32), PFS (HR = 1.17, 95% CI 1.08 to 1.27), and ORR (RR = 1.16, 95% CI 1.02 to 1.32). In addition, additional gemcitabine chemotherapy also showed better OS (HR = 1.17, 95% CI 1.06 to 1.30), PFS (HR = 1.20, 95% CI 1.11 to 1.30) and ORR (RR = 1.23, 95% CI 1.06 to 1.42) than gemcitabine replacement therapy. Furthermore, patients receiving gemcitabine-taxanes-based regimens had better OS (HR = 1.17, 95% CI 1.06 to 1.28), PFS (HR = 1.12, 95% CI 1.04 to 1.20) and ORR (RR = 1.17, 95% CI 1.01 to 1.35) than patients with non-gemcitabine-taxanes-based chemotherapy. These findings indicate that gemcitabine combination regimens could serve as a promising regimen for ABC patients, though increased hematologic toxicity should be considered with caution.
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Affiliation(s)
- Zhibo Xie
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Yifan Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Chen Jin
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Deliang Fu
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
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10
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Sumera, Anwar A, Ovais M, Khan A, Raza A. Docetaxel‐loaded solid lipid nanoparticles: a novel drug delivery system. IET Nanobiotechnol 2017; 11:621-629. [PMCID: PMC8676273 DOI: 10.1049/iet-nbt.2017.0001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/18/2017] [Accepted: 03/30/2017] [Indexed: 07/29/2023] Open
Abstract
Over the past few years, taxanes have emerged as a new class of anticancer drugs. Docetaxel (DTX) the prototype of this class has been approved for the treatment of broad range of cancers. However, to date the commercial preparation of DTX (Taxotere®) is accompanying adverse side effects, intolerance, and poor solubility, which can be overcome by encapsulating them using solid lipid nanoparticles (SLNs). SLNs represent versatile delivery system of drugs with newer forms such as polymer–solid lipid hybrid, surface modified and long circulating nanoparticles bringing forth improved prospects for cancer chemotherapy. In this review, the authors have discussed the current uses of various SLNs formulations of DTX with key emphasis on controlled and site‐specific drug delivery along with enhanced antitumour activity elucidated via in vitro and in vivo studies. Furthermore, the review article highlights few approaches that can be used in combination with existing DTX‐loaded SLNs to supplement DTX drug delivery.
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Affiliation(s)
- Sumera
- Department of PharmacyUniversity of SwabiSwabi23430Pakistan
| | - Amania Anwar
- Atta‐ur‐Rehman School of Applied BiosciencesNational University of Science and TechnologyIslamabad44000Pakistan
| | - Muhammad Ovais
- Department of BiotechnologyFaculty of Biological SciencesQuaid‐i‐Azam UniversityIslamabad45320Pakistan
| | - Abad Khan
- Department of PharmacyUniversity of SwabiSwabi23430Pakistan
| | - Abida Raza
- Nanotheragnostics LabNational Institute of Lasers and OptronicsPakistan Atomic Energy CommissionIslamabad44000Pakistan
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11
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Hypoxia-induced mobilization of NHE6 to the plasma membrane triggers endosome hyperacidification and chemoresistance. Nat Commun 2017. [PMID: 28635961 PMCID: PMC5482059 DOI: 10.1038/ncomms15884] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The pH-dependent partitioning of chemotherapeutic drugs is a fundamental yet understudied drug distribution mechanism that may underlie the low success rates of current approaches to counter multidrug resistance (MDR). This mechanism is influenced by the hypoxic tumour microenvironment and results in selective trapping of weakly basic drugs into acidified compartments such as the extracellular environment. Here we report that hypoxia not only leads to acidification of the tumour microenvironment but also induces endosome hyperacidification. The acidity of the vesicular lumen, together with the alkaline pH of the cytoplasm, gives rise to a strong intracellular pH gradient that drives intravesicular drug trapping and chemoresistance. Endosome hyperacidification is due to the relocalization of the Na+/H+ exchanger isoform 6 (NHE6) from endosomes to the plasma membrane, an event that involves binding of NHE6 to the activated protein kinase C-receptor for activated C kinase 1 complex. These findings reveal a novel mechanism of hypoxia-induced MDR that involves the aberrant intracellular distribution of NHE6.
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12
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Naik R, Khan MA. Doceaqualip in a patient with prostate cancer who had an allergic reaction to conventional docetaxel: A case report. Mol Clin Oncol 2017; 6:341-343. [PMID: 28451410 PMCID: PMC5403271 DOI: 10.3892/mco.2017.1147] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/29/2016] [Indexed: 12/25/2022] Open
Abstract
Docetaxel has been widely used in the treatment of several cancers, including adenocarcinoma of the prostate gland. As docetaxel is insoluble in water, it must be administered with polysorbate 80 and ethanol, which are known to cause hypersensitivity reactions. Premedication with corticosteroids and antihistamines is advocated prior to docetaxel administration; however, toxicities, occasionally fatal, have been reported, even with corticosteroid premedication. We herein report the case of a patient with adenocarcinoma of the prostate, with bone metastasis and an Eastern Cooperative Oncology Group performance status of <2, who developed an allergic reaction to conventional docetaxel (Taxotere), despite being premedicated with corticosteroids and antihistamines. The patient was managed with corticosteroids and antihistamines, and was later started on Doceaqualip, a nanosomal docetaxel lipid suspension. Doceaqualip was well-tolerated by the patient and 5 cycles were subsequently administered, without any adverse reactions. Adenocarcinoma also regressed, as evidenced by positron emission tomography/computed tomography.
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Affiliation(s)
- Radheshyam Naik
- Department of Medical Oncology, HCG Hospital, Bangalore, Karnataka 560027, India
| | - Mujtaba A Khan
- Department of Medical Affairs, Intas Pharmaceuticals Ltd., Ahmedabad, Gujarat 382210, India
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13
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Zhang L, Shen Y, Qiu L. Loading docetaxel in β-cyclodextrin-based micelles for enhanced oral chemotherapy through inhibition of P-glycoprotein mediated efflux transport. RSC Adv 2017. [DOI: 10.1039/c7ra03180g] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
β-Cyclodextrin-based polymeric micelle (PELC) effectively delivered docetaxel by oral administration through inhibition of P-glycoprotein mediated efflux.
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Affiliation(s)
- Lu Zhang
- Medicine Clinical Trial Organization
- The First Affiliated Hospital of Wenzhou Medical University
- Wenzhou 325000
- China
| | - Yurun Shen
- Ministry of Education (MOE) Key Laboratory of Macromolecular Synthesis and Functionalization
- Department of Polymer Science and Engineering
- Zhejiang University
- Hangzhou 310027
- China
| | - Liyan Qiu
- Ministry of Education (MOE) Key Laboratory of Macromolecular Synthesis and Functionalization
- Department of Polymer Science and Engineering
- Zhejiang University
- Hangzhou 310027
- China
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14
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Crown J, Palmby W. Docetaxel: use in non—small cell lung cancer and metastatic breast cancer and formulation update. J Oncol Pharm Pract 2016. [DOI: 10.1177/107815520000600i302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To summarize the systematic development of docetaxel as a new and effective treatment option for advanced non-small cell lung cancer (NSCLC) and breast cancer patients, and to discuss the physical and chemical stability, compatibility with drugs commonly used in cancer patients, and administration issues with the new docetaxel formulation. Data Sources. A MEDLINE search was conducted using carboplatin, cisplatin, compatibility, docetaxel, doxorubicin, metastatic breast cancer (MBC), NSCLC, and stability as search terms. Reference lists, bibliographies of pertinent articles, and abstracts from the American Society of Clinical Oncology and the European Society for Medical Oncology annual meetings were also identified and reviewed. Information related to the new docetaxel formulation was obtained from the manufacturer. The clinical literature was reviewed and analyzed. Data Synthesis. Docetaxel has recently emerged as an active agent in the treatment of advanced NSCLC and MBC. Results of phase II and III studies of single-agent docetaxel and docetaxel combinations, both as first- and second-line therapy, have produced impressive response rates and improved survival times compared with current standards of care. Docetaxel has a unique toxicity profile that includes hypersensitivity reactions, skin toxicities, and fluid retention. Because docetaxel's toxicity profile differs from that of the platinum analogs and the anthracyclines, combinations with these agents for NSCLC and MBC are well tolerated. Docetaxel was recently reformulated, allowing for improved stability, shelf-life, and storage requirements. Compatibility studies of docetaxel with 81 commonly used drugs in cancer patients were recently reported, showing that docetaxel is compatible with all but three drugs studied—amphotericin B, nalbuphine hydrochloride, and methylprednisolone sodium succinate—when administered as Y-site injections into existing intravenous lines. With the increasing use of this agent, the new docetaxel formulation and compatibility data should facilitate ease of administration.
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Affiliation(s)
- John Crown
- St. Vincent's Hospital, 3rd Floor, Medical Oncology Unit, Elm Park, Merrio Road, Dublin 4, Ireland
| | - Wendy Palmby
- Scientific Communications, Aventis Pharmaceuticals, Inc, Collegeville, Pennsylvania
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Abstract
Purpose. The primary objective of this paper is to provide a brief overview of docetaxel pharmacokinetics, pharmacodynamics, indications, and drug interactions, concentrating on their relationship with docetaxel use in patients with hepatic impairment. Data Sources. The literature was reviewed through a MEDLINE search from 1986 to 2000. Relevant articles cited in literature obtained by MEDLINE searching were also considered. The following terms were searched: hepatic impairment, liver failure, Taxotere, and docetaxel. The search was restricted to the English language. Data Extraction. The current literature is reviewed in regard to docetaxel pharmacokinetics, pharmacodynamics, dosing, efficacy, adverse effects, and drug interactions and with a special emphasis on docetaxel use in patients with hepatic impairment. Data Synthesis. Docetaxel has a wide spectrum of clinical activity and is used frequently in the treatment of metastatic breast cancer, NSCLC, ovarian cancer and cancer of the head and neck. The dose-limiting toxicity of docetaxel is neutropenia. Docetaxel is metabolized in the liver and elevations in hepatic enzymes can predict a reduced clearance of docetaxel, which is associated with an increased incidence of neutropenia. Based on population pharmacokinetic modeling, docetaxel can be safely administered in patients with elevated hepatic enzymes if the dose is reduced on the first cycle.
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Affiliation(s)
- Jill M Kolesar
- School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin
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Lu XF, Bi K, Chen X. Physiologically based pharmacokinetic model of docetaxel and interspecies scaling: comparison of simple injection with folate receptor-targeting amphiphilic copolymer-modified liposomes. Xenobiotica 2016; 46:1093-1104. [DOI: 10.3109/00498254.2016.1155128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Xue-Feng Lu
- Department of Pharmaceutical Analysis, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Kaishun Bi
- Department of Pharmaceutical Analysis, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Xiaohui Chen
- Department of Pharmaceutical Analysis, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
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A Case of Docetaxel Induced Myositis and Review of the Literature. Case Rep Rheumatol 2015; 2015:795242. [PMID: 26257973 PMCID: PMC4519533 DOI: 10.1155/2015/795242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/12/2015] [Accepted: 06/22/2015] [Indexed: 12/13/2022] Open
Abstract
In phase I and II trials taxane chemotherapeutic agents reported side effects, including myelosuppression, peripheral edema, and fluid retention. With further use of these agents, studies in the late 1980s and early 1990s began to report peripheral neuropathy and proximal muscle weakness as common complaints, the later with unexplained pathophysiology. We report a 65-year-old Hispanic woman with estrogen receptor (ER) and progesterone receptor (PR) positive invasive ductal breast carcinoma who presented with right thigh pain and swelling eight days after her third infusion of docetaxel (a taxane chemotherapeutic) and cyclophosphamide. Laboratory findings were notable for elevation in creatine phosphokinase (CPK), aldolase, and erythrocyte sedimentation rate (ESR); a magnetic resonance imaging (MRI) of her lower extremities showed evidence of bilateral muscle edema involving the anterior compartment muscles of the thighs. A workup to rule out other causes of myositis was negative. Docetaxel was not reintroduced and the patient improved with corticosteroids. Since 2005 this is, to our knowledge, the fifth reported case of docetaxel related inflammatory myositis. Taxanes have been noted to cause disabling but transient arthralgias and myalgias; it is important to consider the possibility of inflammatory myopathy as a possible complication in patients undergoing treatment with these agents.
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Truong SN, Van Pham P. Stem cell technology and engineering for cancer treatment. BIOMEDICAL RESEARCH AND THERAPY 2015. [DOI: 10.7603/s40730-015-0013-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kim DJ, Lee WY, Park NW, Kim GS, Lee KM, Kim J, Choi MK, Lee GH, Han W, Lee SK. Drug response of captured BT20 cells and evaluation of circulating tumor cells on a silicon nanowire platform. Biosens Bioelectron 2015; 67:370-8. [DOI: 10.1016/j.bios.2014.08.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/16/2014] [Accepted: 08/22/2014] [Indexed: 12/16/2022]
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Perrone F, Nuzzo F, Di Rella F, Gravina A, Iodice G, Labonia V, Landi G, Pacilio C, Rossi E, De Laurentiis M, D'Aiuto M, Botti G, Forestieri V, Lauria R, De Placido S, Tinessa V, Daniele B, Gori S, Colantuoni G, Barni S, Riccardi F, De Maio E, Montanino A, Morabito A, Daniele G, Di Maio M, Piccirillo M, Signoriello S, Gallo C, de Matteis A. Weekly docetaxel versus CMF as adjuvant chemotherapy for older women with early breast cancer: final results of the randomized phase III ELDA trial. Ann Oncol 2015; 26:675-682. [DOI: 10.1093/annonc/mdu564] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Park SO, Yoo YB, Kim YH, Baek KJ, Yang JH, Choi PC, Lee JH, Lee KR, Park KS. Effects of combination therapy of docetaxel with selenium on the human breast cancer cell lines MDA-MB-231 and MCF-7. Ann Surg Treat Res 2015; 88:55-62. [PMID: 25692115 PMCID: PMC4325646 DOI: 10.4174/astr.2015.88.2.55] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/06/2014] [Accepted: 09/25/2014] [Indexed: 12/20/2022] Open
Abstract
Purpose The anticancer property and cytoprotective role of selenium in chemotherapy have been reported. However, the combination effects of selenium on chemotherapy for advanced breast cancer have not yet been clearly defined. The purpose of this study was to investigate the combined effects of selenium on chemotherapy using docetaxel on breast cancer cell lines. Methods Under adherent culture conditions, two breast cancer cell lines, MDA-MB-231 and MCF-7, were treated with docetaxel at 500pM and selenium at 100nM, 1µM, or 10µM. Changes in cell growth, cell cycle duration, and degree of apoptosis after 72 hours in each treated group were evaluated. Results In the MDA-MB-231 cells, the combination therapy group (docetaxel at 500pM plus selenium at 10µM) showed a significantly decreased percentage of cell growth (15% vs. 28%; P = 0.004), a significantly increased percentage of late apoptosis (63% vs. 26%; P = 0.001), and an increased cell cycle arrest in the G2/M phase (P = 0.001) compared with the solitary docetaxel therapy group. Isobologram analysis demonstrated the synergistic effect of the combination therapy in the MDA-MB-231 cells. However, in the MCF-7 cells, no significant differences in the percentage of cell growth apoptosis, the percentage of apoptosis, and the pattern of cell cycle arrest were noted between the combination therapy groups and the solitary docetaxel therapy group. Conclusion Our in vitro study indicated that the combination of selenium with docetaxel inhibits cell proliferation through apoptosis and cell arrest in the G2/M phase in MDA-MB-231 breast cancer cells.
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Affiliation(s)
- Sang O Park
- Department of Emergency Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Young Bum Yoo
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Yong Hun Kim
- Department of Surgery, Konkuk University Chungju Hospital, Chungju, Korea
| | - Kwang Je Baek
- Department of Emergency Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jung-Hyun Yang
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Pil Cho Choi
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hun Lee
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Kyeong Ryong Lee
- Department of Emergency Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyoung Sik Park
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Análisis de la efectividad del tratamiento neoadyuvante al añadir docetaxel secuencial a fluorouracilo, epirrubicina y ciclofosfamida en pacientes con cáncer de mama avanzado: resultados preliminares de respuesta tumoral. GACETA MEXICANA DE ONCOLOGÍA 2015. [DOI: 10.1016/j.gamo.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Ojima I, Kamath A, Seitz JD. Taxol, Taxoids, and Related Taxanes. METHODS AND PRINCIPLES IN MEDICINAL CHEMISTRY 2014. [DOI: 10.1002/9783527676545.ch04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Metastatic breast cancer develops in approximately 50% of women diagnosed with breast cancer. The optimal treatment for patients with metastatic breast cancer has yet to be defined, owing to the heterogeneity of this group and the available agents. Patients with metastatic breast cancer often receive single-agent treatment in sequence as it is unclear whether combination therapy with cytotoxic drugs offers an overall disease-free survival benefit and single agents may offer less toxicity. The advantages of combination cytotoxic therapies have included higher response rates. However, such trials have not stratified on rapidity of disease progression or on tumor bulk. In previous studies, docetaxel is one of the few cytotoxic agents to demonstrate a survival benefit in anthracycline-resistant patients and thus it has become a vital component of cytotoxic therapy. Capecitabine is also an important oral drug and has demonstrated activity in patients pretreated with anthracyclines and taxanes. Recent preclinical and clinical trials of this combination have demonstrated an increased time to tumor progression and overall survival benefit. Paclitaxel combined with gemcitabine has been compared with docetaxel plus capecitabine, with similar response rates and survival benefits. As patients on these trials have not received uniform crossover to the other active agent, whether or not the combination therapy offers an advantage for the entire cohort of metastatic patients or may be indicated for specific subgroups remains uncertain. Combination treatments may be preferable to sequential therapy for patients requiring urgent reduction in their tumor burden. Combinations of cytotoxic agents in combination with biological agents are currently being defined.
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Affiliation(s)
- Julia Mandelblat
- New York University, Don Monti Division of Oncology, North Shore University Hospital, Manhasset, New York, USA
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A phase II study of docetaxel and vinorelbine plus filgrastim for HER-2 negative, stage IV breast cancer: SWOG S0102. Breast Cancer Res Treat 2013; 143:351-8. [PMID: 24352574 PMCID: PMC3889983 DOI: 10.1007/s10549-013-2797-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 11/26/2013] [Indexed: 11/24/2022]
Abstract
Docetaxel and vinorelbine have demonstrated Single-agent activity in breast cancer. Preclinical studies suggest potential synergy between these antitubulin chemotherapy agents. This study evaluates these drugs in combination in metastatic breast cancer. Taxane-naive patients with HER-2 negative, stage IV breast cancer without prior chemotherapy for metastatic disease, were eligible. Docetaxel (60 mg/m2) was given intravenously on Day 1, vinorelbine (27.5 mg/m2) intravenously on Days 8 and 15, and filgrastim on Days 2–21 of a 21-day cycle. The primary study outcome was one-year overall survival (OS), with secondary outcomes of progression-free survival (PFS), response rate (RR), and toxicity. Of 95 patients registered, 92 were eligible and received treatment. One-year OS was 74 % (95 % CI 64–82 %) with a median OS of 22.3 months (95 % CI 18.8–31.4 months). One-year PFS was 34 % (95 % CI 24–43 %) with median of 7.2 months (95 % CI 6.4–10.3). OS at 2 and 3 years were 49 % (95 % CI 38–59 %) and 30 % (95 % CI 21–40 %), respectively. OS was poorer for women with estrogen-receptor negative disease (n = 32) compared to estrogen-receptor positive (n = 60) (log-rank p = 0.031), but PFS was not significantly different (p = 0.11). RR was 59 % among the 74 patients with measurable disease. Grade 3 and 4 adverse events were 48 and 16 %, respectively. Grade 4 neutropenia was 12 % and grade 3/4 febrile neutropenia was 3 %. Common grade 3/4 nonhematologic toxicities were fatigue (14 %), pneumonitis (10 %), and dyspnea (9 %). The combination of docetaxel and vinorelbine is an active first-line chemotherapy in HER-2 nonoverexpressing, metastatic breast cancer. This combination is associated with significant hematologic and nonhematologic toxicity. The safety profile and expense of the filgrastim limit recommendations for routine use.
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Cho EK, Park JY, Lee KH, Song HS, Min YJ, Kim YH, Kang JH. Open-label, randomized, single-dose, crossover study to evaluate the pharmacokinetics and safety differences between two docetaxel products, CKD-810 and Taxotere injection, in patients with advanced solid cancer. Cancer Chemother Pharmacol 2013; 73:9-16. [PMID: 24337589 DOI: 10.1007/s00280-013-2264-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 08/07/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to compare CKD-810 (test docetaxel) with Taxotere(®) (reference docetaxel) in terms of pharmacokinetics and safety for patients with advanced or metastatic carcinoma. METHODS A randomized, open-label, two-way crossover study was conducted in eligible patients. Patients received with reference or test drugs of 75 mg/m(2) docetaxel by intravenous infusion for 60 min in the first period and the alternative drug in the second period with a washout of 3 weeks. Plasma concentrations of docetaxel were determined by validated high-performance liquid chromatography coupled to tandem mass spectrometry detection. Pharmacokinetic parameters, including the maximum plasma concentration (C(max)) and the area under the concentration-time curve (AUC), were determined by non-compartmental analysis. RESULTS A total of 44 patients were included in the study, 21 patients received test drug and 23 received reference drug for the first cycle. The C(max) of docetaxel was 2,658.77 ng/mL for test drug and 2,827.60 ng/mL for reference drug, and two drugs showed no difference with a statistical significance. Time to reach C(max) (T(max)) of CKD-810 (0.94 h) versus reference docetaxel (0.97 h) was also not significantly different. Other pharmacokinetic parameters including the plasma AUC, elimination half-life, and total body clearance exhibited similar values without a significant difference. The most common grade 3 or 4 toxicity was neutropenia (CKD-810 19.5 or 29.3 %; reference docetaxel 14.6 or 41.5 %). Febrile neutropenia was experienced by only one patient in each group. Two patients died of progression of disease during the study. CONCLUSION Docetaxel anhydrous CKD-810 use with patients suffering advanced or metastatic solid malignancies was equivalent to reference docetaxel in terms of pharmacokinetic parameters and safety profile. Additionally, the test and reference drug met the regulatory criteria for pharmacokinetic equivalence.
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Affiliation(s)
- Eun Kyung Cho
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
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Alken S, Kelly CM. Benefit risk assessment and update on the use of docetaxel in the management of breast cancer. Cancer Manag Res 2013; 5:357-65. [PMID: 24143122 PMCID: PMC3798099 DOI: 10.2147/cmar.s49321] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The objective of this paper is to review the data supporting the use of docetaxel in the treatment of breast cancer, focusing on pharmacokinetics, efficacy in adjuvant and metastatic trials alone and in combination with chemotherapeutic and targeted agents, and the toxicity of docetaxel in comparison to paclitaxel. Docetaxel is a semisynthetic product derived from the European yew tree Taxus baccata L. It promotes the assembly of microtubules, stabilizes them, and thereby prevents their depolymerization. Docetaxel has been incorporated into neo-adjuvant chemotherapy regimens, both with and without anthracyclines. The inclusion of taxanes such as docetaxel in polychemotherapy regimens in early breast cancer is associated with a statistically significant reduction in mortality. As a single agent, docetaxel is highly active in the treatment of metastatic breast cancer. In first-line treatment of metastatic breast cancer, the combination of docetaxel and capecitabine was associated with an improvement in overall survival; however, toxicity was higher. The toxicity profile of docetaxel has been well documented and is predictable; the most frequent adverse effects are neutropenia and febrile neutropenia. Taxane-specific adverse effects, such as peripheral neuropathy, are also expected but are manageable with appropriate dosing and scheduling.
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Affiliation(s)
- Scheryll Alken
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
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Ahmad A, Sheikh S, Taran R, Srivastav SP, Prasad K, Rajappa SJ, Kumar V, Gopichand M, Paithankar M, Sharma M, Rane RC, Ahmad I. Therapeutic efficacy of a novel nanosomal docetaxel lipid suspension compared with taxotere in locally advanced or metastatic breast cancer patients. Clin Breast Cancer 2013; 14:177-81. [PMID: 24287370 DOI: 10.1016/j.clbc.2013.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 09/17/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Nanosomal docetaxel lipid suspension formulation was developed to eliminate ethanol and polysorbate 80 from the currently used docetaxel (Taxotere) drug for treatment of cancer patients. NDLS clinical safety and efficacy was evaluated and compared with Taxotere at 75 mg/m(2) in metastatic breast cancer patients. PATIENTS AND METHODS A total of 72 patients were randomized in a ratio of 2:1 (NDLS:Taxotere). Patients treated with NDLS were not premedicated with corticosteroids as required with solvent-based Taxotere. Disease status and tumor response was assessed after every 2 cycles of treatment using Response Evaluation Criteria in Solid Tumors 1.1 guidelines through cycle 6. RESULTS Overall therapeutic response (complete + partial) rate in metastatic breast cancer patients treated with NDLS and Taxotere were 35.5% and 26.3%, respectively, indicating better response in patients treated with NDLS. Patients in the NDLS group were not premedicated but the safety results of NDLS were found to be comparable with Taxotere. CONCLUSION NDLS formulation with no premedication provides an alternative treatment option for breast cancer patients.
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Affiliation(s)
| | | | | | | | | | - Senthil J Rajappa
- Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Vijay Kumar
- M.V. Hospital and Research Center, Lucknow, India
| | | | | | | | | | - Imran Ahmad
- Jina Pharmaceuticals, Inc, Libertyville, IL.
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Taj A. Docetaxel-induced hypersensitivity pneumonitis mimicking lymphangitic carcinomatosis in a patient with metastatic adenocarcinoma of the lung. Hematol Oncol Stem Cell Ther 2013; 6:117-9. [DOI: 10.1016/j.hemonc.2013.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 08/14/2013] [Accepted: 08/27/2013] [Indexed: 11/26/2022] Open
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Abstract
Docetaxel has been recognized as one of the most efficient anticancer drugs over the past decade; however, its poor water solubility and systemic toxicity have greatly limited its clinical application. In recent decades, the emergence of nanotechnology has provided new drug delivery systems for docetaxel, which can improve its water solubility, minimize the side effects and increase the tumor-targeting distribution by passive or active targeting. This review focuses on the research progress in nanoformulations related to docetaxel delivery – such as polymer-based, lipid-based, and lipid-polymer hybrid nanocarriers, as well as inorganic nanoparticles – addressing their structures, characteristics, preparation, physicochemical properties, methods by which drugs are loaded into them, and their in vitro and in vivo efficacies. Further, the targeted ligands used in the docetaxel nanoformulations, such as monoclonal antibodies, peptides, folic acid, transferrin, aptamers and hyaluronic acid, are described. The issues to overcome before docetaxel nanoformulations can be used in clinical and commercial applications are also discussed.
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Affiliation(s)
- Li Zhang
- School of Pharmaceutical Science, Shandong University, Shandong Province, People's Republic of China
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Chalvatzis N, Manthou ME, Tzamalis A, Hytiroglou P, Dimitrakos S. Erosive conjunctival and corneal inflammatory changes in a patient receiving weekly docetaxel for breast cancer. Ocul Immunol Inflamm 2013; 22:164-6. [PMID: 23876214 DOI: 10.3109/09273948.2013.812221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nikolaos Chalvatzis
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki , Greece
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Kosmas C, Tsavaris N, Mylonakis N, Tsakonas G, Gassiamis A, Skopelitis H, Polyzos A, Malamos N, Karabelis A. Docetaxel-Ifosfamide Combination in Patients with Advanced Breast Cancer Failing Prior Anthracycline- Based Regimens: Results of a Phase I-II Study. J Chemother 2013; 19:322-31. [PMID: 17594929 DOI: 10.1179/joc.2007.19.3.322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The established clinical activity of docetaxel and ifosfamide as single agents in anthracycline pre-treated breast cancer, led us to conduct a phase I-II study to define the maximum tolerated dose (MTD), dose-limiting toxicities (DLTs), and clinical activity of the docetaxel+ifosfamide combination in this setting. Patients with histologically confirmed metastatic breast cancer, after failure on prior anthracycline-based chemotherapy, were treated at successive dose levels (DLs) in cohorts of 3-6 with escalated doses of docetaxel 70-100 mg/m(2) over 1 h on day 1 followed by ifosfamide 5-6 g/m(2) divided over days 1+2 (2.5-3.0 g/m(2)/day over 1 h), every 21 days. G-CSF was added once dose-limiting neutropenia was encountered at a certain DL and planned to be incorporated prophylactically in subsequent higher DLs. Between March 1997 and December 2002, 65 patients with a median age of 57 years (range, 32-72) and performance status (WHO) of 1 (range, 0-2) were treated at 5 DLs as follows; 21 in phase I DLs (DL1: 3, DL2: 6, DL3: 3, DL4: 6, and DL5: 3) and the remaining 44 were treated at DL4 (total of 50 patients at DL4), which was defined as the level for phase II testing. All patients were assessable for toxicity and 62 for response. DLT (with the addition of G-CSF after DL2) was reached at DL5 with 2/3 initial patients developing febrile neutropenia. Clinical response rates (RRs), on an intention-to-treat basis, in phase II were: 56%; (95% CI, 42.2-69.7%); 4 CRs, 24 PRs, 10 SD and 12 PD. The median response duration was 7 mo (3-24 mo), median TTP 6.5 mo (0.1-26 mo), and median OS 13 mo (0.1-33 mo). Grade 3/4 toxicities included: neutropenia in 72% of patients, with 60% developing grade 4 neutropenia (<or=7 days) and in 10% of these febrile neutropenia, while no grade 3/4 thrombocytopenia was observed. Other toxicities included peripheral neuropathy grade 2 only in 10%, grade 1/2 reversible CNS toxicity in 16%, no renal toxicity, grade 2 myalgias in 8%, grade 3 diarrhea in 8%, skin/nail toxicity in 14%, and grade 2 fluid retention in 2% of patients. One patient in the study treated at phase II died as a result of acute liver failure after the first cycle. The present phase I-II study has determined the feasibility, defined the MTD and demonstrated the encouraging activity of the docetaxel-ifosfamide combination in the phase II part of the study. Therefore, future randomized phase III studies versus single-agent docetaxel or combinations of the latter with other active agents are warranted.
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Affiliation(s)
- C Kosmas
- Department of Medicine, 2nd Division of Medical Oncology, Metaxa Cancer Hospital, Piraeus, Greece
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Eckmann K, Michaud LB, Rivera E, Madden TL, Esparza-Guerra L, Kawedia J, Booser DJ, Green MC, Hortobagyi GN, Valero V. Pilot study to assess toxicity and pharmacokinetics of docetaxel in patients with metastatic breast cancer and impaired liver function secondary to hepatic metastases. J Oncol Pharm Pract 2013; 20:120-9. [PMID: 23676510 DOI: 10.1177/1078155213480536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited clinical data are available regarding the safety of docetaxel in metastatic breast cancer patients with liver dysfunction. METHODS Eligible patients had breast cancer with impaired liver function secondary to hepatic metastases and were candidates for docetaxel therapy. They were assigned to one of five groups on the basis of total bilirubin, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase levels. All other causes of liver dysfunction were excluded, and bile duct obstruction was corrected, if possible, prior to study entry. Patients received docetaxel every three weeks. The chemotherapy dose was chosen on the basis of the patient's level of hepatic dysfunction and escalated as tolerated. The primary outcome of this study was safety. The secondary outcomes were pharmacokinetic data and efficacy in terms of time to disease progression. RESULTS Twenty-three patients were enrolled. No unexpected toxicities occurred. Grade 3/4 fatigue (65%), neutropenia (30%), myalgias (26%), neutropenic fever (26%), vomiting (9%), and rash (9%) were the most common serious adverse events. The median time to progression was three months (range 1-18 months). Pharmacokinetic results indicated that patients with more severe hepatic dysfunction may have been underdosed based on our conservative dosing strategy. CONCLUSIONS Docetaxel can be administered to patients with metastatic breast cancer and liver dysfunction after dose attenuation. However, because of a narrow therapeutic index in this clinical setting, therapy should be closely monitored with subsequent dose escalation when possible.
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Affiliation(s)
- Karen Eckmann
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Sequential docetaxel as adjuvant chemotherapy for node-positive or/and T3 or T4 breast cancer: clinical outcome (Mansoura University). Med Oncol 2013; 30:457. [PMID: 23322524 DOI: 10.1007/s12032-013-0457-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 01/05/2013] [Indexed: 10/27/2022]
Abstract
This trial compared 6 cycles of fluorouracil, epirubicin, and cyclophosphamide (FEC) with a sequential regimen of 3 cycles of FEC followed by 3 cycles of docetaxel (FEC-D) as adjuvant treatment for women with node-positive or/and T3 or T4 breast cancer. Between January 2006 and January 2010, 657 patients with operable breast cancer were randomly assigned to either FEC every 21 days for 6 cycles, or 3 cycles of FEC followed by 3 cycles of docetaxel, both given every 21 days. Radiotherapy was mandatory for all patients who had undergone breast conserving surgery. Radiation to the chest wall, supraclavicular area, was recommended following mastectomy. Hormone-receptor-positive patients received tamoxifen for 5 years after chemotherapy. The primary end point was 5-year disease-free survival (DFS). Median follow-up was 61 months. Five-year DFS rates were 74 % with FEC and 78 % with FEC-D (P = 0.013). Multivariate analysis adjusted for prognostic factors showed a 17 % reduction in the relative risk of relapse with FEC-D. Five-year overall survival rates were 85 % with FEC and 89.4 % with FEC-D, demonstrating a 27 % reduction in the relative risk of death (P = 0.014). The incidence of grade 3-4 neutropenia, the need for hematopoietic growth factor, and incidence of nausea/vomiting were higher with FEC. Docetaxel was associated with more febrile neutropenia, stomatitis, edema, and nail disorders. Though rare overall, there were fewer cardiac events after FEC-D, attributable mainly to the lower anthracycline cumulative dose. Sequential adjuvant chemotherapy with FEC followed by docetaxel significantly improves disease-free and overall survival in node-positive or/and T3 or T4 breast cancer patients. Although the magnitude of the benefit observed with FEC-D, differences in the toxicity profiles of FEC and FEC-D may influence the choice of treatment for patients.
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Vahdat LT, Thomas ES, Roché HH, Hortobagyi GN, Sparano JA, Yelle L, Fornier MN, Martín M, Bunnell CA, Mukhopadhyay P, Peck RA, Perez EA. Ixabepilone-associated peripheral neuropathy: data from across the phase II and III clinical trials. Support Care Cancer 2012; 20:2661-8. [PMID: 22382588 PMCID: PMC3461204 DOI: 10.1007/s00520-012-1384-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 01/08/2012] [Indexed: 12/22/2022]
Abstract
PURPOSE Dose-limiting neuropathy is a major adverse event associated with most of the microtubule-stabilizing agent-based chemotherapy regimens. Ixabepilone, a semisynthetic analogue of the natural epothilone B, has activity against a wide range of tumor types. Peripheral neuropathy (PN), associated with ixabepilone treatment, is usually mild to moderate, predominantly sensory and cumulative. Preclinical studies demonstrate that ixabepilone and taxanes produce a similar neurotoxicity profile. METHODS We searched databases of phase II/III clinical trials involving patients receiving ixabepilone as a monotherapy or in combination with capecitabine for incidences of neuropathy. Potential risk factors for grade 3/4 PN were identified by a Cox regression analysis on a dataset of 1,540 patients with different tumor types across multiple studies. RESULTS Rates for incidence of ixabepilone-induced severe PN (Common Terminology Criteria for Adverse Events grade 3/4) ranged from 1% in early untreated breast cancer up to 24% in heavily pretreated metastatic breast cancer; grade 4 PN was rare (≤ 1%). Common symptoms included numbness, paresthesias, and sometimes dysesthesias. Cox regression analysis identified only preexisting neuropathy as a risk factor for increased ixabepilone-associated PN. The management of PN has been primarily through dose adjustments (dose delays and/or dose reduction). Patients had resolution of their neuropathy within a median time of 5 to 6 weeks. CONCLUSIONS PN is a dose-limiting toxicity associated with ixabepilone treatment, is reversible in most patients, and can be managed with dose reduction and delays.
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Affiliation(s)
- Linda T Vahdat
- Weill Cornell Breast Center, Weill Cornell Medical College, New York, NY, USA.
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Palmieri C, Alifrangis C, Shipway D, Tat T, Watson V, Mackie D, Emson M, Coombes RC. A randomized feasibility study of docetaxel versus vinorelbine in advanced breast cancer. Oncologist 2012; 17:1429-e47. [PMID: 23002126 DOI: 10.1634/theoncologist.2012-0161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Docetaxel and vinorelbine have demonstrated efficacy in the treatment of metastatic breast cancer (MBC). This prospective feasibility study compared the efficacy of these two treatments in MBC. METHODS Patients with MBC progressing following anthracycline treatment were randomly assigned to either docetaxel (100 mg/m(2)day 1 q3W) or vinorelbine (25mg/m(2) day 1 q2W). Patients were eligible to cross over at progression. Objective response rates (ORR), time to progression (TTP) and overall survival (OS) were measured. RESULTS 37 patients were randomised. 2 patients were excluded due to protocol violations. Of 35 remaining patients 17 received docetaxel and 18 received vinorelbine per protocol. ORR was 12.5% and 6.0% respectively for docetaxel and vinorelbine. The median time to progression was 10.4 weeks (range 6-14 weeks) in docetaxel arm and 7.6 weeks (range 4-11 weeks) in vinorelbine arm (p = .82). The clinical benefit rate (defined as complete response, partial response plus stable disease) was 44% in the docetaxel arm and 12% in the vinorelbine arm. Based on intent to treat the median OS in the docetaxel arm was 34 weeks (95% CI, 20.7-48) and 21.2 weeks (95% CI, 17-25.4) in vinorelbine arm (p = .388). 16 patients crossed over, 5 from docetaxel to vinorelbine and 11 from vinorelbine to docetaxel. At cross over the ORR was 0% and 18% on cross over to vinorelbine and docetaxel respectively with a median TTP of 17.3 weeks (95% CI, 16.3-18.1) and 18.7 weeks (95% CI, 13.9-23.4) for those receiving vinorebine and docetaxel at cross over respectively. Vinorelbine however was much better tolerated with fewer grade 3-4 toxicity events (n = 4) than docetaxel (n = 27). DISCUSSION While docetaxel resulted in a longer TTP and OS in this study it did not reach statistical significance. TTP duration for those patients who crossed over was similar, but overwhelmingly vinorelbine had fewer significant grade 3-4 toxicities than docetaxel. Only two previous randomized studies have compared the efficacy of single agent docetaxel and vinorelbine following prior anthracycline exposure, one in an unselected population [16], and the other, HERNATA, in HER2 positive disease with trastuzumab used in both arms [17]. The patients randomized in this study were relatively heavily pretreated with the majority having received 2-3 lines of prior treatment for their metastatic disease. The lower response rates with vinorelbine as compared to docetaxel in this study concur with results reported in other studies [16]. However, the numbers in both this study and the other unselected study [16] are small and need to be interpreted with caution. With regard to toxicity, in the present study, grade 3-4 hematological adverse events and infection were tenfold greater with docetaxel as compared with vinorelbine, consistent with results in HERNATA [17]. While others have reported a significantly higher number of overall grade 3-4 toxicities with vinorelbine [16], the fact that, as in HERNATA, discontinuations due to toxicities in that study [16] were significantly greater with docetaxel as compared to vinorelbine suggests either the toxicity data collected did not reflect the true toxicities on treatment or that docetaxel toxicities were in some way more severe or protracted leading to more numerous discontinuations [16]. Larger randomized studies are needed to determine (1) the efficacy of docetaxel versus vinorelbine in anthracycline pretreated disease and (2) the efficacy of vinorelbine after prior taxane exposure, and particularly how it may compares both with regard to efficacy and tolerability with other possible regimens that may utilized such as carboplatin-gemcitabine [20] or eribulin [21]. The longer as well as comparable TTP at cross over for both agents compared to that upfront suggests there may be enrichment at cross over of a group of patients who are not only fit for further treatment but are more likely to a derive continued benefit from additional treatment.
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Rogatko A, Ghosh P, Vidakovic B, Tighiouart M. Patient-Specific Dose Adjustment in the Cancer Clinical Trial Setting. Pharmaceut Med 2012. [DOI: 10.1007/bf03256730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Recchia F, Candeloro G, Desideri G, Necozione S, Recchia COC, Cirulli V, Rea S. Triple-negative breast cancer: multipronged approach, single-arm pilot phase II study. Cancer Med 2012; 1:89-95. [PMID: 23342258 PMCID: PMC3544434 DOI: 10.1002/cam4.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 03/26/2012] [Accepted: 03/28/2012] [Indexed: 12/21/2022] Open
Abstract
Anthracyclines (A) and taxanes (T) are standard first-line chemotherapy agents for patients with advanced breast cancer. Platinum analogues have also shown activity in the triple-negative breast cancer (TNBC) histology, but clinical data are limited. Here we report the long-term follow-up of a phase II study on TNBC treated with a combined modality therapy, including induction with AT, cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) with concurrent radiation therapy, and a dose-dense consolidation chemotherapy (HDCT) with carboplatin (CBDCA), ifosfamide (IFX), etoposide (VP-16). Patients' median age was 44 years, with 73% premenopausal. Epirubicin 75 mg/m(2) and docetaxel 75 mg/m(2) were administered to 70 patients with TNBC: as neoadjuvant and adjuvant therapy to 12 and 58 patients, respectively. Postoperative radiation therapy, 5000 cGy, was delivered, synchronous with triweekly CMF. After radiation therapy, two courses of HDCT with CBDCA, IFX, VP-16, were given, with hematological growth factors. After a median follow-up of 81 months, all patients were evaluable for toxicity and response. Most important toxicity were grade 3 skin reaction and grade 4 hematological in 3% and 31% of patients, respectively. Pathological complete response was observed in 25% of patients receiving preoperative chemotherapy. Treatment failures were as follows: eight visceral, four contralateral breast cancer, four locoregional, and one leukemia. Five-year progression-free survival and overall survival rate were 78% and 91%, respectively. Induction chemotherapy, followed by chemoradiation therapy and HDCT, provides a prolonged disease-free period and a significant increase in overall survival in TNBC, with an acceptable toxicity profile.
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Affiliation(s)
- Francesco Recchia
- Oncology Unit, Civilian Hospital Avezzano, Italy; Carlo Ferri Foundation Monterotondo, Rome, Italy.
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Yano R, Konno A, Watanabe K, Tsukamoto H, Kayano Y, Ohnaka H, Goto N, Nakamura T, Masada M. Pharmacoethnicity of docetaxel-induced severe neutropenia: integrated analysis of published phase II and III trials. Int J Clin Oncol 2011; 18:96-104. [PMID: 22095245 DOI: 10.1007/s10147-011-0349-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 10/31/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ethnic differences in drug susceptibility and toxicity are a major concern, not only in drug development but also in the clinical setting. We review the toxicity profiles of docetaxel according to dose and ethnicity. METHODS We analyzed phase II and III clinical trials that included a once-every-3-weeks single-agent docetaxel arm. Logistic regression analysis was applied to identify the significant variables affecting the reported incidence of docetaxel-induced severe neutropenia. RESULTS Multivariate logistic regression analysis identified studies conducted in Asia [odds ratio (OR) 19.0; 95% confidence interval (95% CI) 3.64-99.0] and docetaxel dose (OR 1.08; 95% CI 1.03-1.13) as independent variables for the incidence of grade 3/4 neutropenia. CONCLUSIONS There is a significant difference in the incidence of docetaxel-induced severe neutropenia between Asian and non-Asian clinical studies. Physicians and pharmacists should consider ethnic diversity in docetaxel toxicity when interpreting the results of clinical trials.
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Affiliation(s)
- Ryoichi Yano
- Department of Pharmacy, University of Fukui Hospital, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
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Gwak G, Park K, Shin E, Han S, Kim JY, Kim H, Kim YD, Kim HJ, Kim KW, Bae BN, Yang KH, Cho H, Park SJ. Comparison of CVF (Cyclophosphamide+Vinorelbine+5-Fluorouracil) and CMF (Cyclophosphamide+Methotrexate+5-Fluorouracil) Adjuvant Chemotherapy in Early Breast Cancer. J Breast Cancer 2011; 14:223-8. [PMID: 22031805 PMCID: PMC3200519 DOI: 10.4048/jbc.2011.14.3.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 06/09/2011] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Our study aimed to evaluate the feasibility of adjuvant cyclophosphamide/vinorelbine/5-fluorourail (CVF) chemotherapy as an alternative to cyclophosphamide/methotrexate/5-fluorouracil (CMF) chemotherapy for treating early breast cancer. METHODS One hundred and forty-nine patients were randomly assigned to CMF or CVF adjuvant chemotherapy for treating their early stage breast cancer between September 2000 and December 2007. The disease-free survival (DFS), the overall survival (OS), and the toxicity profiles of both groups were compared. RESULTS Sixty-seven patients underwent CMF chemotherapy whereas 82 patients underwent CVF chemotherapy. The DFS and OS were 88 months (95% confidence interval [CI], 76-101 months) and 94 months (95% CI, 83-104 months), respectively for the CMF group, and 97 months (95% CI, 93-101 months), and 101 months (95% CI, 98-104 months), respectively for the CVF group. However, those survival gains of the CVF group were not statistically significant (p-value=0.069 for the DFS and 0.99 for the OS). The CVF group showed a favorable toxicity profile in terms of the grade 3/4 hematologic toxicities as compared to that of the CMF group. CONCLUSION Clinical outcome of CVF chemotherapy was comparable to CMF with a favorable toxicity profiles. However, it is difficult to conclude the feasibility of CVF regimen because of small number of studied patients.
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Affiliation(s)
- Geumhee Gwak
- Department of Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Kyeongmee Park
- Department of Pathology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Eunah Shin
- Department of Pathology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sehwan Han
- Department of Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Ji-Young Kim
- Department of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hongyong Kim
- Department of Surgery, Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Young Duk Kim
- Department of Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hong Ju Kim
- Department of Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Ki Whan Kim
- Department of Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byung Noe Bae
- Department of Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Keun Ho Yang
- Department of Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hyunjin Cho
- Department of Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sung-Jin Park
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Coombes RC, Bliss JM, Espie M, Erdkamp F, Wals J, Tres A, Marty M, Coleman RE, Tubiana-Mathieu N, den Boer MO, Wardley A, Kilburn LS, Cooper D, Thomas MW, Reise JA, Wilkinson K, Hupperets P. Randomized, Phase III Trial of Sequential Epirubicin and Docetaxel Versus Epirubicin Alone in Postmenopausal Patients With Node-Positive Breast Cancer. J Clin Oncol 2011; 29:3247-54. [DOI: 10.1200/jco.2010.32.7254] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The Docetaxel Epirubicin Adjuvant (DEVA) trial evaluated the efficacy and toxicity of incorporating docetaxel after epirubicin to create a sequential anthracycline-taxane regimen in early breast cancer. Patients and Methods After complete tumor excision, postmenopausal women with node-positive early breast cancer were randomly assigned to either epirubicin 50 mg/m2 on days 1 and 8 every 4 weeks for six cycles (EPI × 6) or three cycles of epirubicin 50 mg/m2 on days 1 and 8 every 4 weeks followed by three cycles of docetaxel 100 mg/m2 on day 1 every 3 weeks (EPI-DOC). A subset of patients also participated in a quality of life (QOL) study. The primary end point was disease-free survival (DFS). Results From 1997 to 2005, 803 patients entered DEVA (EPI × 6, n = 397; EPI-DOC, n = 406). At a median follow-up of 64.7 months (interquartile range, 45.2 to 84.4 months), 198 DFS events had been reported (EPI × 6, n = 114; EPI-DOC, n = 84). The 5-year DFS rates were 72.7% (95% CI, 68.0% to 77.3%) for epirubicin alone and 79.5% (95% CI, 75.2% to 83.8%) for epirubicin followed by docetaxel; evidence of improvement in DFS was observed with EPI-DOC (hazard ratio [HR], 0.68; 95% CI, 0.52 to 0.91; P = .008). One hundred twenty-seven patients have died (EPI × 6, n = 75; EPI-DOC, n = 52); a reduction in deaths was observed with EPI-DOC (HR, 0.66; 95% CI, 0.46 to 0.94; P = .02). The 5-year overall survival rates were 81.8% (95% CI, 77.7% to 85.9%) for epirubicin and 88.9% (95% CI, 85.5% to 92.2%) for epirubicin followed by docetaxel. Assessment of toxicity and QOL showed that EPI-DOC was associated with greater toxicity but with no difference in QOL between arms during follow-up. Conclusion These results suggest, within a relatively small trial, that substitution of docetaxel for epirubicin for the last three cycles of chemotherapy results in improved outcome in postmenopausal women with node-positive, early breast cancer compared with six cycles of epirubicin monotherapy.
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Affiliation(s)
- R. Charles Coombes
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Judith M. Bliss
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Marc Espie
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Frans Erdkamp
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Jacob Wals
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Alejandro Tres
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Michel Marty
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Robert E. Coleman
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Nicole Tubiana-Mathieu
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Marinus O. den Boer
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Andrew Wardley
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Lucy S. Kilburn
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Derek Cooper
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Marina W.K. Thomas
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Justine A. Reise
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Katie Wilkinson
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Pierre Hupperets
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
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Palmeri L, Vaglica M, Palmeri S. Weekly docetaxel in the treatment of metastatic breast cancer. Ther Clin Risk Manag 2011; 4:1047-59. [PMID: 19209285 PMCID: PMC2621419 DOI: 10.2147/tcrm.s3397] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Breast cancer is the most frequent tumor among women worldwide and is the second cause of cancer-related mortality in the US. Metastatic breast cancer (MBC) accounts for less than 10% of newly diagnosed breast cancer patients and about 30% of early breast cancer patients will develop recurrent, advanced, or metastatic disease. It remains an incurable illness and the primary goal of its management is palliative. Several agents are active for the first-line treatment of MBC. The taxanes, paclitaxel and docetaxel, represent the standard of care for the treatment of these patients. Among the various schedules, docetaxel can be administered weekly, achieving similar efficacy results with lower toxicity compared with conventional schedules. Weekly docetaxel (25–40 mg/m2) has been widely tested in several phase I and II studies both as a single agent and in multichemotherapy regimens, reaching overall response rates ranging from 26% and 86% or 20% and 73% with docetaxel alone or in combination, respectively, depending on doses, associations, and line of treatment. Overall, published data support the administration of weekly docetaxel for the treatment of MBC patients even if data from phase III randomized trials are still lacking.
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Affiliation(s)
- Laura Palmeri
- Department of Oncology, University of Palermo, Palermo, Italy
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Dorsey JF, Dowling ML, Kim M, Voong R, Solin LJ, Kao GD. Modulation of the anti-cancer efficacy of microtubule-targeting agents by cellular growth conditions. Cancer Biol Ther 2011; 9:809-18. [PMID: 20234172 DOI: 10.4161/cbt.9.10.11453] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Mitotic spindle-disrupting agents target and disrupt microtubule dynamics. These agents include clinically important chemotherapies, including taxanes (paclitaxel (Taxol), docetaxel (Taxotere)) and vinca alkaloids (vincristine (Oncovin), vinblastine). Taxanes are a standard component of treatment for many malignancies, often in conjunction with other cytotoxic agents. However, the optimal sequencing of these treatments and whether efficacy may be influenced by in vitro cellular growth conditions remain incompletely investigated. Yet such preclinical investigations may guide clinical decision making. We therefore studied the effect of cell density on rapid killing by paclitaxel and vincristine. Breast, ovarian and prostate cancer cells were sensitive to rapid killing by either agent when grown at low density, but were markedly resistant when grown at high density, i.e. nearly confluent. The resistance of densely growing cells to rapid killing by these drugs translated to increased clonogenic survival. Pretreatment of densely growing cancer cells with cisplatin followed by paclitaxel, partially reversed the treatment resistance. Gene ontology associations from microarray analyses of cells grown at low and high density, suggested roles for membrane signal transduction and adhesion, but potentially also DNA damage repair and metabolism. Taken together, the treatment resistance at higher cell density may be associated with a lower proportion of active cycling in cells growing at high density as well as transduction of survival signals induced by increased cell-cell adhesion. Collectively these findings suggest mechanisms by which growth conditions may contribute to resistance to rapid killing by microtubule-disrupting drugs.
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Affiliation(s)
- Jay F Dorsey
- Department of Radiation Oncology and Radiation Biology and Imaging Program, Abramson Comprehensive Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Huang XX, Zhou CL, Wang H, Chen C, Yu SQ, Xu Q, Zhu YY, Ren Y. Pharmacokinetics, efficacy, and safety evaluation of docetaxel/hydroxypropyl-sulfobutyl-β-cyclodextrin inclusion complex. AAPS PharmSciTech 2011; 12:665-72. [PMID: 21584856 DOI: 10.1208/s12249-011-9631-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 05/05/2011] [Indexed: 11/30/2022] Open
Abstract
Hydroxypropyl-sulfobutyl-β-cyclodextrin (HP-SBE-β-CD) inclusion complex was developed and used as a drug delivery system for DTX (DTX/HP-SBE-β-CD). The objective of the present study was to evaluate and compare the biological properties of DTX/HP-SBE-Β-CD with Taxotere®. The pharmacokinetics, biodistribution, antitumor efficacy in vivo and in vitro, and safety evaluation of DTX/HP-SBE-β-CD were studied. The most significant finding was that it was possible to prepare a Polysorbate-80-free inclusion complex for DTX. Studies based on pharmacokinetics, biodistribution, and antitumor efficacy indicated that DTX/HP-SBE-β-CD had similar pharmacokinetic properties and antitumor efficacy both in vitro and in vivo as Taxotere®. Fortunately, this new drug delivery system attenuated the side effects when used in vivo. As a consequence, DTX/HP-SBE-β-CD may be a promising alternative to Taxotere® for cancer chemotherapy treatment with reduced side effects. The therapeutic potential against a variety of human tumors and low toxicity demonstrated in a stringent study clearly warrant clinical investigation of DTX/HP-SBE-β-CD for possible use against human tumors.
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Abstract
To assess the efficacy and the tolerability of TAC (docetaxel, doxorubicin, and cyclophosphamide) protocol in early breast cancer patients with node positive in the adjuvant treatment 64 patients (median age 46 years) with early node positive breast cancer were studied from October 2003 to May 2009 according to certain inclusion criteria. They received TAC protocol chemotherapy; Disease free survival (DFS), Overall Survival (OS) and toxicity profile were assessed. All except one received six cycles of chemotherapy according to TAC protocol. Median follows-up was 60 months. Disease free (DFS) and Overall Survival (OS) were 77% and 87% respectively. The chemotherapy was well tolerated and the toxicity profile was better in comparison to previously published studies. It is concluded that TAC protocol in the adjuvant treatment of early breast cancer is effective and well-tolerated as evident by the toxicity profile provided the G-CSF is started as primary prophylaxis from the first cycle.
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Affiliation(s)
- K.I. Rasul
- Hematology/Oncology Department, Al Amal Hospital, Hamad Medical Corporation Doha, Qatar
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Liu Z, Liu D, Wang L, Zhang J, Zhang N. Docetaxel-loaded pluronic p123 polymeric micelles: in vitro and in vivo evaluation. Int J Mol Sci 2011; 12:1684-96. [PMID: 21673916 PMCID: PMC3111627 DOI: 10.3390/ijms12031684] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/26/2011] [Accepted: 02/28/2011] [Indexed: 11/17/2022] Open
Abstract
In this work, novel docetaxel (DTX) -loaded Tween 80-free Pluronic P123 (P123) micelles with improved therapeutic effect were developed. The freeze-dried DTX-loaded P123 micelles (DTX-micelles) were analyzed by HPLC, TEM and DLS to determine the DTX loading, micelle morphology, size, respectively. The in vitro cytotoxic activity of DTX-micelles in HepG2, A549 and malignant melanoma B16 cells were evaluated by MTT assay. The corresponding in vivo antitumor efficacy was assessed in Kunming mice bearing B16 tumor after intravenous administration. The DTX-loading and efficiency into the micelles were 2.12 ± 0.09% and 86.34 ± 3.32%, respectively. The DTX-micelles were spherical with a mean particle size of 50.7 nm and size distribution from 22 to 84 nm, which suggested that they should be able to selectively accumulate in solid tumors by means of EPR effect, with a zeta potential of -12.45 ± 3.24 mV. The in vitro release behavior of DTX from DTX-micelles followed the Weibull equation. Compared with Duopafei(®), DTX-micelles showed higher cytotoxicity against HepG2 (P < 0.01), A549 (P < 0.05) and B16 (P < 0.01) cells. In addition, DTX-micelles exhibited remarkable antitumor activity and reduced toxicity on B16 tumor in vivo. The tumor inhibition rates (TIR) of DTX-micelles was 91.6% versus 76.3% of Duopafei(®) (P < 0.01). These results suggested that P123 micelles might be considered as an effective DTX delivery system.
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Affiliation(s)
- Zhihong Liu
- School of Pharmaceutical Science, Shandong University, 44 Wenhua Xi Road, Ji’nan 250012, Shandong, China
| | - Donghua Liu
- School of Pharmaceutical Science, Shandong University, 44 Wenhua Xi Road, Ji’nan 250012, Shandong, China
| | - Lili Wang
- School of Pharmaceutical Science, Shandong University, 44 Wenhua Xi Road, Ji’nan 250012, Shandong, China
| | - Juan Zhang
- School of Pharmaceutical Science, Shandong University, 44 Wenhua Xi Road, Ji’nan 250012, Shandong, China
| | - Na Zhang
- School of Pharmaceutical Science, Shandong University, 44 Wenhua Xi Road, Ji’nan 250012, Shandong, China
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Treatment of metastatic breast cancer: state-of-the-art, subtypes and perspectives. Crit Rev Oncol Hematol 2011; 80:433-49. [PMID: 21330148 DOI: 10.1016/j.critrevonc.2011.01.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 12/16/2010] [Accepted: 01/18/2011] [Indexed: 01/01/2023] Open
Abstract
Current treatment of metastatic breast cancer (MBC) aims at achieving meaningful clinical responses, improved quality of life, long-term remissions, prolonged survival, and dares to hope for a cure in a small percentage of cases. This article will discuss both consensus and controversies in the management of MBC in the context of the new evolving breast cancer molecular classification. Hormonal therapy remains the mainstay of management of MBC Luminal A and B. Data is emerging on management of ErbB2-positive HR-positive MBC by combining hormonal manipulation and targeted anti-ErbB2 therapy and has recently received regulatory approval in Europe and USA. The optimal use and duration of single agent or combination chemotherapy is discussed. Data and controversies surrounding the use of newer agents such as nab-paclitaxel, ixabepilone, eribulin, and PARP inhibitors as well as trastuzumab is reviewed. Better understanding of pathophysiology has paved the way for the introduction of newer anti-ErbB2 agents such as lapatinib, pertuzumab, T-DM1 and neratinib. Controversies regarding bevacizumab and anti-angiogenesis are discussed. Bisphosphonates have significantly reduced skeletal related events and made significant improvements in the quality of life of patients with MBC. Newer anti-RANK Ligand antibodies show promising results. Significant advances in the understanding of molecular biology of breast cancer have been made and should lead to an improvement in the outcome of MBC. More possibilities of cure can become an attainable goal in the near future.
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Nuzzo F, Morabito A, Gravina A, Di Rella F, Landi G, Pacilio C, Labonia V, Rossi E, De Maio E, Piccirillo MC, D'Aiuto G, Thomas R, Rinaldo M, Botti G, Di Bonito M, Di Maio M, Gallo C, Perrone F, de Matteis A. Effects on quality of life of weekly docetaxel-based chemotherapy in patients with locally advanced or metastatic breast cancer: results of a single-centre randomized phase 3 trial. BMC Cancer 2011; 11:75. [PMID: 21324184 PMCID: PMC3050853 DOI: 10.1186/1471-2407-11-75] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 02/16/2011] [Indexed: 11/12/2022] Open
Abstract
Background To evaluate whether weekly schedules of docetaxel-based chemotherapy were superior to 3-weekly ones in terms of quality of life in locally advanced or metastatic breast cancer. Methods Patients with locally advanced or metastatic breast cancer, aged ≤ 70 years, performance status 0-2, chemotherapy-naive for metastatic disease, were eligible. They were randomized to weekly or 3-weekly combination of docetaxel and epirubicin, if they were not treated with adjuvant anthracyclines, or docetaxel and capecitabine, if treated with adjuvant anthracyclines. Primary end-point was global quality of life change at 6-weeks, measured by EORTC QLQ-C30. With two-sided alpha 0.05 and 80% power for 35% effect size, 130 patients per arm were needed. Results From February 2004 to March 2008, 139 patients were randomized, 70 to weekly and 69 to 3-weekly arm; 129 and 89 patients filled baseline and 6-week questionnaires, respectively. Global quality of life was better in the 3-weekly arm (p = 0.03); patients treated with weekly schedules presented a significantly worsening in role functioning and financial scores (p = 0.02 and p < 0.001). Neutropenia and stomatitis were worse in the 3-weekly arm, where two toxic deaths were observed. Overall response rate was 39.1% and 33.3% in 3-weekly and weekly arms; hazard ratio of progression was 1.29 (95% CI: 0.84-1.97) and hazard ratio of death was 1.38 (95% CI: 0.82-2.30) in the weekly arm. Conclusions In this trial, the weekly schedules of docetaxel-based chemotherapy appear to be inferior to the 3-weekly one in terms of quality of life in patients with locally advanced or metastatic breast cancer. Trial registration ClinicalTrials.gov NCT00540800.
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Affiliation(s)
- Francesco Nuzzo
- National Cancer Institute, via M, Semmola, 80131 Napoli, Italy
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Egashira N, Kawashiri T, Oishi R. [The current state of the drugs for the treatment of peripheral neuropathy induced by anticancer drugs]. Nihon Yakurigaku Zasshi 2010; 136:275-9. [PMID: 21079366 DOI: 10.1254/fpj.136.275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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