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Allergy in Cancer Care: Antineoplastic Therapy-Induced Hypersensitivity Reactions. Int J Mol Sci 2023; 24:ijms24043886. [PMID: 36835299 PMCID: PMC9961679 DOI: 10.3390/ijms24043886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/24/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
As the backbone of oncological treatments, systemic chemotherapy is still one of the main pawns in cancer care, alone or in combination with newer targeted agents. All chemotherapy agents can be associated with a type of adverse event called an infusion reaction, which can be characterized as unpredictable, non-dose related, and unexplained by the cytotoxic profile of the drug. For some of these events, a certain immunological mechanism can be identified by blood or skin testing. In this case, we can speak of true hypersensitivity reactions that occur as a response to an antigen/allergen. The current work summarizes the main antineoplastic therapy agents and their susceptibility to induce hypersensitivity reactions and also includes a review of clinical presentation, diagnostic methods in hypersensitivity reactions, and perspectives to overcome these negative events in the treatment of patients suffering from various types of cancer.
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Sigworth EA, Rubinstein SM, Chaugai S, Rivera DR, Walker PD, Chen Q, Warner JL. Development of a Bayesian toxo-equivalence model between docetaxel and paclitaxel. iScience 2022; 25:104045. [PMID: 35359803 PMCID: PMC8961223 DOI: 10.1016/j.isci.2022.104045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/20/2022] [Accepted: 03/08/2022] [Indexed: 11/19/2022] Open
Abstract
Members of the taxane class of chemotherapies, staples of cancer treatment since the 1990s, can induce chemotherapy-induced peripheral neuropathy (CIPN), a potentially irreversible outcome related to cumulative exposure. Switching between taxanes is often clinically necessary; however, different taxanes have different efficacies, toxicities, and dosing strategies, necessitating an evidence-based schema focused on toxicity. We performed a systematic review and meta-analysis of the literature on docetaxel and paclitaxel, extracting cumulative dose, rates of CIPN, and subject demographics, thereby establishing their dose-toxo-equivalence relationship through a Bayesian meta-analysis model, calculating doses of the two drugs that are expected to have comparable rates of CIPN, along with credible intervals. Our final model, based on 169 studies, produces credible interval widths that provide guidance within one treatment cycle. In practice, this model provides a framework under which oncologists can make treatment switching and dosing decisions, hopefully reducing patient risk of CIPN. We created a dosing framework for oncologists using published clinical trials Our approach leverages existing publicly available data via Bayesian meta-analysis This framework uses a toxicity outcome rather than more common efficacy outcomes The output range of equivalent doses provides guidance within one treatment cycle
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Affiliation(s)
| | - Samuel M. Rubinstein
- Division of Hematology, University of North Carolina School of Medicine, Chapel Hill, NC 27514, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Sandip Chaugai
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN 37203, USA
- Department of Internal Medicine, Meharry Medical College, Nashville, TN 37208, USA
| | - Donna R. Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20892, USA
| | - Philip D. Walker
- Eskind Biomedical Library, Vanderbilt University, Nashville, TN 37232, USA
| | - Qingxia Chen
- Department of Biostatistics, Vanderbilt University, Nashville, TN 37203, USA
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN 37203, USA
| | - Jeremy L. Warner
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN 37203, USA
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN 37232, USA
- Corresponding author
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Jose WM. Taxanes – The Backbone of Medical Oncology. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_1_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractDrug development in oncology has witnessed a revolutionary growth from its humble beginning with nitrogen mustard in 1940 to immunotherapy in 1986 (Interferon alpha). The arsenal of cytotoxics is ever increasing, contributing to better survival outcomes and improved quality of life. Over the years, many cytotoxics have fallen out of favor too, due to its side effects and availability of drugs with better efficacy and toxicity profile. Taxane, a microtubule stabilizing agent extracted from the poisonous Yew tree, was discovered in 1964 and came into clinical use in 1992 with its approval for ovarian cancer. This group has grown into a cornerstone of many treatment protocols, spanning multiple tumor types. This review discusses in brief the salient features of cytotoxic agents in this drug group, its history, physico-chemical properties, mechanism of action, pharmacodynamics, and pharmacokinetics. Though the benefits of taxanes are well understood, there are unique problems associated with the use of taxanes and there is an expanding literature on taxane resistance. We briefly look at the resistance mechanisms. There have been significant efforts to circumvent the problems related to conventional taxanes, with an attempt at creating newer carrier molecules and adjunct drugs with taxanes, which is slowly gaining traction in clinical practice.
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Affiliation(s)
- Wesley M Jose
- Department of Medical Oncology and Hematology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham, Health Science Campus, Kochi, Kerala, India
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