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Yang D, Chen W, Lai F, Qiu M, Li J. Feasibility of apalutamide combined with androgen deprivation therapy and short-course low-dose prednisone in treating metastatic hormone-sensitive prostate cancer: a pilot randomized controlled trial. Front Oncol 2023; 13:1110807. [PMID: 38023146 PMCID: PMC10657800 DOI: 10.3389/fonc.2023.1110807] [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: 11/29/2022] [Accepted: 01/30/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The role of prednisone in the prevention of androgen receptor antagonist-related rash and treatment for metastatic hormone-sensitive prostate cancer (mHSPC) is unclear. This pilot trial (ChiCTR2200060388) aimed to investigate the feasibility of apalutamide combined with androgen deprivation therapy (ADT) and short-course low-dose prednisone in the treatment of mHSPC. Methods All patients received apalutamide and ADT and were randomly divided into two groups based on the administration of oral prednisone or not (control group). The primary endpoint was the incidence of rash. The secondary endpoint included the proportions of patients with a decline in PSA ≥50% from baseline, PSA ≥90% from baseline, and decreased to PSA ≤0.2 ng/mL. Results Between June 2021 and March 2022, a total of 83 patients were enrolled (41 in the prednisone group and 42 in the control group). During the 6-month follow-up, the incidence of rash was significantly lower in the prednisone group compared with the control group (17.1% vs. 38.1%, P=0.049). There were no significant differences in the incidence of other adverse events, the number of patients who required dose adjustment (reduction, interruption, or discontinuation) of apalutamide due to rash, the number of patients with prostate-specific antigen (PSA) decreased by ≥50%, the number of patients with PSA decrease ≥90%, and the number of patients with PSA ≤0.2 ng/mL between the two groups. All patients with diabetes had stable glycemic control with no glucose-related adverse events. Discussion In patients with mHSPC, the addition of short-course low-dose prednisolone to apalutamide plus ADT can reduce the incidence of rash without risk of other adverse events.
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Affiliation(s)
- Dingyuan Yang
- Urinary Surgery, Chengdu Second People’s Hospital, Chengdu, China
| | - Wenqiang Chen
- Urinary Surgery, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, Chengdu, China
| | - Fei Lai
- Urinary Surgery, Chengdu Second People’s Hospital, Chengdu, China
| | - Mingxing Qiu
- Urinary Surgery, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, Chengdu, China
| | - Jun Li
- Urinary Surgery, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, Chengdu, China
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Huang DDR, Liao BC, Hsu WH, Yang CY, Lin YT, Wu SG, Tsai TH, Chen KY, Ho CC, Liao WY, Shih JY, Yu CJ, Yang JCH, Cheng AL, Shen YC. Effects of Early Short-Course Corticosteroids on Immune-Related Adverse Events in Non-Small Cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors. Oncology 2023; 102:318-326. [PMID: 37778345 DOI: 10.1159/000534350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION In real-world practice, most non-small cell lung cancer (NSCLC) patients receiving combined immunochemotherapy are exposed to short-course corticosteroids following immune checkpoint inhibitor (ICI) infusion to prevent chemotherapy-related adverse events. However, whether this early short-course corticosteroid use prevents immune-related adverse events (irAEs) remains unknown. METHODS Between January 1st, 2015, and December 31st, 2020, NSCLC patients who received at least one cycle of ICI with or without chemotherapy were enrolled. Early short-course corticosteroids were defined as corticosteroids administered following ICI injection and before chemotherapy on the same day and no longer than 3 days afterward. The patients were categorized as either "corticosteroid group" or "non-corticosteroid group" depending on their exposure to early short-course corticosteroid. The frequencies of irAEs requiring systemic corticosteroid use and irAEs leading to ICI discontinuation were compared between the two groups, and exploratory survival analyses were performed. RESULTS Among 252 eligible patients, 137 patients were categorized as "corticosteroid group" and 115 patients as "non-corticosteroid group." The corticosteroid group enriched patients in the first-line setting (n = 75, 54.7%), compared to the non-corticosteroid group (n = 28, 24.3%). Thirty patients (21.9%) in the corticosteroid group and 35 patients (30.4%) in the non-corticosteroid group developed irAEs requiring systemic corticosteroid use (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.35-1.18; p = 0.15). Eight patients (5.8%) in the corticosteroid group, as compared with 18 patients (15.7%) in the non-corticosteroid group, permanently discontinued ICI due to irAEs (OR, 0.34; 95% CI, 0.12-0.85; p = 0.013). CONCLUSION Early short-course corticosteroids following each ICI injection may reduce the rate of irAEs that lead to ICIs discontinuation, warranting further investigation of its prophylactic use to mitigate clinically significant irAEs.
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Affiliation(s)
- Derek De-Rui Huang
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Bin-Chi Liao
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Hsun Hsu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Yao Yang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Ting Lin
- Department of Internal Medicine, National Taiwan University Hospital Cancer Center, Taipei, Taiwan
| | - Shang-Gin Wu
- Department of Internal Medicine, National Taiwan University Hospital Cancer Center, Taipei, Taiwan
| | - Tzu-Hsiu Tsai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Chi Ho
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Yu Liao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Yuan Shih
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - James Chih-Hsin Yang
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ann-Lii Cheng
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Chun Shen
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Willems M, Scherpereel A, Wasielewski E, Raskin J, Brossel H, Fontaine A, Grégoire M, Halkin L, Jamakhani M, Heinen V, Louis R, Duysinx B, Hamaidia M, Willems L. Excess of blood eosinophils prior to therapy correlates with worse prognosis in mesothelioma. Front Immunol 2023; 14:1148798. [PMID: 37026006 PMCID: PMC10070849 DOI: 10.3389/fimmu.2023.1148798] [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: 01/20/2023] [Accepted: 02/20/2023] [Indexed: 04/08/2023] Open
Abstract
Background Only a fraction of patients with malignant pleural mesothelioma (MPM) will respond to chemo- or immunotherapy. For the majority, the condition will irremediably relapse after 13 to 18 months. In this study, we hypothesized that patients' outcome could be correlated to their immune cell profile. Focus was given to peripheral blood eosinophils that, paradoxically, can both promote or inhibit tumor growth depending on the cancer type. Methods The characteristics of 242 patients with histologically proven MPM were retrospectively collected in three centers. Characteristics included overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR). The mean absolute eosinophil counts (AEC) were determined by averaging AEC data sets of the last month preceding the administration of chemo- or immunotherapy. Results An optimal cutoff of 220 eosinophils/µL of blood segregated the cohort into two groups with significantly different median OS after chemotherapy (14 and 29 months above and below the threshold, p = 0.0001). The corresponding two-year OS rates were 28% and 55% in the AEC ≥ 220/µL and AEC < 220/µL groups, respectively. Based on shorter median PFS (8 vs 17 months, p < 0.0001) and reduced DCR (55.9% vs 35.2% at 6 months), the response to standard chemotherapy was significantly affected in the AEC ≥ 220/µL subset. Similar conclusions were also drawn from data sets of patients receiving immune checkpoint-based immunotherapy. Conclusion In conclusion, baseline AEC ≥ 220/µL preceding therapy is associated with worse outcome and quicker relapse in MPM.
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Affiliation(s)
- Mégane Willems
- Laboratory of Molecular and Cellular Epigenetics (GIGA at University of Liege), Sart-Tilman, Molecular Biology, Teaching and Research Centre (TERRA), Gembloux, Belgium
| | - Arnaud Scherpereel
- Department of Pneumology and Thoracic Oncology, (CHU Lille) and INSERM (ONCOTHAI), Lille, France
| | - Eric Wasielewski
- Department of Pneumology and Thoracic Oncology, (CHU Lille) and INSERM (ONCOTHAI), Lille, France
| | - Jo Raskin
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Hélène Brossel
- Laboratory of Molecular and Cellular Epigenetics (GIGA at University of Liege), Sart-Tilman, Molecular Biology, Teaching and Research Centre (TERRA), Gembloux, Belgium
| | - Alexis Fontaine
- Laboratory of Molecular and Cellular Epigenetics (GIGA at University of Liege), Sart-Tilman, Molecular Biology, Teaching and Research Centre (TERRA), Gembloux, Belgium
| | - Mélanie Grégoire
- Laboratory of Molecular and Cellular Epigenetics (GIGA at University of Liege), Sart-Tilman, Molecular Biology, Teaching and Research Centre (TERRA), Gembloux, Belgium
| | - Louise Halkin
- Laboratory of Molecular and Cellular Epigenetics (GIGA at University of Liege), Sart-Tilman, Molecular Biology, Teaching and Research Centre (TERRA), Gembloux, Belgium
| | - Majeed Jamakhani
- Laboratory of Molecular and Cellular Epigenetics (GIGA at University of Liege), Sart-Tilman, Molecular Biology, Teaching and Research Centre (TERRA), Gembloux, Belgium
| | - Vincent Heinen
- Department of Pneumology, University Hospital of Liege, Liege, Belgium
| | - Renaud Louis
- Department of Pneumology, University Hospital of Liege, Liege, Belgium
| | - Bernard Duysinx
- Department of Pneumology, University Hospital of Liege, Liege, Belgium
| | - Malik Hamaidia
- Laboratory of Molecular and Cellular Epigenetics (GIGA at University of Liege), Sart-Tilman, Molecular Biology, Teaching and Research Centre (TERRA), Gembloux, Belgium
| | - Luc Willems
- Laboratory of Molecular and Cellular Epigenetics (GIGA at University of Liege), Sart-Tilman, Molecular Biology, Teaching and Research Centre (TERRA), Gembloux, Belgium
- *Correspondence: Luc Willems,
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He Y, Wang J, Xie S, Xue Q. Efficacy of Bevacizumab Combined with Pemetrexed in the Treatment of Recurrent and Metastatic Cervical Cancer. Front Surg 2022; 9:908101. [PMID: 35651677 PMCID: PMC9149275 DOI: 10.3389/fsurg.2022.908101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background To investigate the efficacy and safety of bevacizumab combined with pemetrexed in the treatment of recurrent and metastatic cervical cancer. Methods Clinical data of 65 patients with recurrent and metastatic cervical cancer who were admitted to our hospital were collected for retrospective analysis. All patients were administered with bevacizumab combined with pemetrexed for 4–6 cycles (21 days as 1 cycle). The short-term clinical efficacy and adverse reactions were compared between the two groups. In addition, the survival status of patients was followed up and recorded. Results At least 4 cycles of chemotherapy were given to the 65 patients. There were 0 cases of complete response (CR), 14 cases of partial response (PR), 36 cases of stable disease (SD) and 15 cases of progressive disease (PD). The objective response rate (ORR) and the disease control rate (DCR) were 21.5% (14/65) and 76.9% (50/65), respectively. DCR was superior in patients with squamous cell carcinoma to that in those with adenocarcinoma (p = 0.039), but no statistically significant difference was found in ORR. Patients with extra-pelvic metastatic lesions had a better efficacy than those with intra-pelvic metastatic lesions, but the difference was not statistically significant (p > 0.05). The post-treatment adverse reactions mainly involved fatigue, nausea and vomiting, bleeding, leukopenia, anemia, thrombocytopenia, transaminase elevation, hypertension, proteinuria and neurotoxicity, most of which were grade I–II that ameliorated after symptomatic therapy. Grade III adverse reactions mainly included pain in 5 cases (7.7%), leukopenia in 17 cases (26.2%), anemia in 22 cases (33.8%), thrombocytopenia in 6 cases (9.2%), hypertension in 5 cases (7.7%) and neurotoxicity in 7 cases (10.8%). The follow-up results manifested that median overall survival (OS) and median progression-free survival (PFS) were 10.6 months and 6.6 months, respectively. Conclusion Bevacizumab combined with pemetrexed exhibits certain efficacy in the treatment of recurrent and metastatic cervical cancer, with tolerable adverse reactions. Therefore, this therapeutic option deserves clinical popularization and application.
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Affiliation(s)
- Ying He
- Department of Gynecology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Jing Wang
- Department of Gynecology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Shuangshuang Xie
- Department of Gynecology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Qianlong Xue
- Department of Emergency, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
- Correspondence: Qianlong Xue
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Sakurada T, Nokihara H, Koga T, Zamami Y, Goda M, Yagi K, Hamano H, Aizawa F, Ogino H, Sato S, Kirino Y, Goto H, Nishioka Y, Ishizawa K. OUP accepted manuscript. Oncologist 2022; 27:e554-e560. [PMID: 35325241 PMCID: PMC9255977 DOI: 10.1093/oncolo/oyab077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022] Open
Abstract
Background Rash eruptions are a common side-effect of pemetrexed, for which the administration of 8 mg/day of dexamethasone for 3 days from the day preceding pemetrexed administration is recommended. This study aimed to prospectively assess the effectiveness of prophylactic administration of low-dose dexamethasone for pemetrexed-induced rashes. Methods This single-arm, phase II study recruited patients with non-squamous non–small cell lung cancer and malignant pleural mesothelioma scheduled to receive chemotherapy including pemetrexed. Patients received 2 mg of dexamethasone daily from days 2 to 6 after chemotherapy with pemetrexed. The primary endpoint was the 3-week incidence of rash eruptions. Results Twenty-five patients were enrolled between September 2017 and May 2019. The incidence of rash after 3 weeks was 16.7%. Rashes erupted mainly on the upper half of the body, such as the chest and neck, and were of grades 1 and 2 in 2 patients each. No rashes of grade 3 or higher were observed, and there were no adverse events associated with additional corticosteroids. Conclusion Prophylactic administration of low-dose dexamethasone for 5 days from the day after pemetrexed administration resulted in a milder incidence and severity of rash. These findings may provide a standard preventative strategy for pemetrexed-induced rashes. (Trial identifier: UMIN000025666).
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Affiliation(s)
- Takumi Sakurada
- Corresponding author: Takumi Sakurada, PhD, Department of Pharmacy, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, Japan 770-8503. Tel: +81 88 631 3111;
| | - Hiroshi Nokihara
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tadashi Koga
- Clinical Research Professionals, Clinical Study Support, Inc., Nagoya, Japan
| | - Yoshito Zamami
- Department of Pharmacy, Okayama University Hospital, Okayama, Japan
| | - Mitsuhiro Goda
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan
- Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kenta Yagi
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima, Japan
| | - Hirofumi Hamano
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima, Japan
| | - Fuka Aizawa
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan
| | - Hirokazu Ogino
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Seidai Sato
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasushi Kirino
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan
| | - Hisatsugu Goto
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Keisuke Ishizawa
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan
- Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Mechanisms, Management and Prevention of Pemetrexed-Related Toxicity. Drug Saf 2021; 44:1271-1281. [PMID: 34741752 DOI: 10.1007/s40264-021-01135-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 12/17/2022]
Abstract
Pemetrexed is a cytostatic antifolate drug and a cornerstone in the treatment of lung cancer. Although generally well tolerated, a substantial part of the patient population experiences dose-limiting or even treatment-limiting toxicities. These include mucositis, skin problems, fatigue, renal toxicity, and neutropenia. Several studies confirmed that pemetrexed pharmacokinetics can serve as a prognostic factor for the development of toxicity, especially for neutropenia. Preventing and managing toxicity of pemetrexed can help to ensure durable treatment. Several evidence-based strategies are already implemented in clinical care. With the introduction of standard vitamin supplementation and dexamethasone, the incidence of hematological toxicity and skin reactions substantially decreased. In the case of high risk for toxicity, granulocyte colony-stimulating factor can be used to prevent severe hematological toxicity. Moreover, high-dose folinic acid can resolve severe pemetrexed-induced toxicity. There are several experimental options to prevent or manage pemetrexed-related toxicity, such as the use of standard folinic acid, hemodialysis, antidotes such as thymidine, hypoxanthine, and glucarpidase, and the use of therapeutic drug monitoring. These strategies still need clinical evaluation before implementation, but could enable treatment with pemetrexed for patients who are at risk for toxicity, such as in renal impairment.
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Lenci E, Cantini L, Pecci F, Cognigni V, Agostinelli V, Mentrasti G, Lupi A, Ranallo N, Paoloni F, Rinaldi S, Nicolardi L, Caglio A, Aerts S, Cortellini A, Ficorella C, Chiari R, Di Maio M, Dingemans AMC, Aerts JGJV, Berardi R. The Gustave Roussy Immune (GRIm)-Score Variation Is an Early-on-Treatment Biomarker of Outcome in Advanced Non-Small Cell Lung Cancer (NSCLC) Patients Treated with First-Line Pembrolizumab. J Clin Med 2021; 10:jcm10051005. [PMID: 33801320 PMCID: PMC7958321 DOI: 10.3390/jcm10051005] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The Gustave Roussy Immune (GRIm)-Score takes into account neutrophil-to-lymphocyte ratio (NLR), serum albumin concentration and lactate dehydrogenase (LDH) and its prognostic value has been investigated in patients treated with immune check-point inhibitors (ICIs). To further assess the prognostic and predictive value of baseline GRIm-Score (GRImT0) in advanced non-small cell lung cancer (aNSCLC) patients, we separately investigated two cohorts of patients treated with first-line pembrolizumab or chemotherapy. We also investigated whether GRIm-Score at 45 days since treatment initiation (GRImT1) and GRIm-Score difference between the two timepoints may better predict clinical outcomes (GRImΔ = GRImT0 − GRImT1). Methods: We retrospectively evaluated 222 aNSCLC patients: 135 treated with pembrolizumab and 87 treated with chemotherapy as the first-line regimen. NLR, serum albumin and LDH concentrations were assessed at T0 and at T1. According to the GRIm-Score, patients were assigned 1 point if they had NLR > 6, LDH > upper limit normal or albumin < 3.5 g/dL. Patients with a GRIm-Score < 2 were considered as having a low Score. Results: In both cohorts, no difference in terms of overall survival (OS) between patients with low and high GRImT0 was found. Otherwise, median OS and progression free survival (PFS) of the low GRImT1 group were significantly longer than those of the high GRImT1 group in pembrolizumab-treated patients, but not in the CHT cohort (pembrolizumab cohort: low vs. high; median OS not reached vs. 9.2 months, p = 0.004; median PFS 10.8 vs. 2.3 months, p = 0.002). Patients receiving pembrolizumab with stable/positive GRImΔ had better OS (median OS not reached vs. 12.0 months, p < 0.001), PFS (median PFS 20.6 vs. 2.6 months, p < 0.001) and objective response rate (58.2% vs. 7.6%, p = 0.003) compared to patients with negative GRImΔ. Conclusion: Our data shown that GRImT1 and GRImΔ are more reliable peripheral blood biomarkers of outcome compared to GRImT0 in aNSCLC patients treated with pembrolizumab and might represent useful biomarkers to drive clinical decisions in this setting.
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Affiliation(s)
- Edoardo Lenci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Luca Cantini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
- Department of Pulmonary Medicine, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.A.); (A.-M.C.D.); (J.G.J.V.A.)
- Erasmus MC Cancer Institute, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Federica Pecci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Valeria Cognigni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Veronica Agostinelli
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Giulia Mentrasti
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Alessio Lupi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Nicoletta Ranallo
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Francesco Paoloni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Silvia Rinaldi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Linda Nicolardi
- Medical Oncology, Ospedali Riuniti Padova Sud, 35043 Monselice, Italy; (L.N.); (R.C.)
| | - Andrea Caglio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, 10128 Torino, Italy; (A.C.); (M.D.M.)
| | - Sophie Aerts
- Department of Pulmonary Medicine, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.A.); (A.-M.C.D.); (J.G.J.V.A.)
- Erasmus MC Cancer Institute, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Alessio Cortellini
- Medical Oncology, St Salvatore Hospital, 67100 L’Aquila, Italy; (A.C.); (C.F.)
- Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Corrado Ficorella
- Medical Oncology, St Salvatore Hospital, 67100 L’Aquila, Italy; (A.C.); (C.F.)
- Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud, 35043 Monselice, Italy; (L.N.); (R.C.)
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, 10128 Torino, Italy; (A.C.); (M.D.M.)
| | - Anne-Marie C. Dingemans
- Department of Pulmonary Medicine, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.A.); (A.-M.C.D.); (J.G.J.V.A.)
- Erasmus MC Cancer Institute, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Joachim G. J. V. Aerts
- Department of Pulmonary Medicine, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.A.); (A.-M.C.D.); (J.G.J.V.A.)
- Erasmus MC Cancer Institute, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
- Correspondence: ; Tel.: +39-071-596-4169
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8
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Sakurada T, Bando S, Zamami Y, Takechi K, Chuma M, Goda M, Kirino Y, Nakamura T, Teraoka K, Morimoto M, Tangoku A, Ishizawa K. Prophylactic administration of granulocyte colony-stimulating factor in epirubicin and cyclophosphamide chemotherapy for Japanese breast cancer patients: a retrospective study. Cancer Chemother Pharmacol 2019; 84:1107-1114. [PMID: 31502114 DOI: 10.1007/s00280-019-03948-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/28/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Epirubicin and cyclophosphamide (EC) therapy, a major chemotherapy for patients with early-stage breast cancer, has a low risk (< 10%) of febrile neutropenia (FN). However, data used in reports on the incidence rate of FN were derived primarily from non-Asian populations. In this study, we investigated the FN incidence rate using EC therapy among Japanese patients with breast cancer and evaluated the significance of prophylactic administration of granulocyte colony-stimulating factor (G-CSF). METHODS We evaluated medical records of patients with early-stage breast cancer who had been treated with EC therapy as neoadjuvant or adjuvant therapy between November 2014 and July 2018. RESULTS The incidence rate of FN was 23.9%. In patients who received G-CSF as primary prophylaxis, FN expression was completely suppressed. The incidence rate of severe leucopenia/neutropenia, emergency hospitalization, and the use of antimicrobial agents were low in patients receiving primary prophylaxis with G-CSF compared with those not receiving G-CSF (27.3% vs. 64.8%, 9.1% vs. 27.3%, and 27.3% vs. 71.6%, respectively). Furthermore, in all patients who received primary prophylaxis with G-CSF, a relative dose intensity > 85% using EC therapy was maintained. CONCLUSION The incidence of FN in EC therapy among Japanese patients was higher than expected, EC therapy appears to be a high-risk chemotherapy for FN, and prophylactic administration of G-CSF is recommended. Maintaining high therapeutic intensity is associated with a positive prognosis for patients with early breast cancer, and prophylactic administration of G-CSF is likely to be beneficial in treatment involving EC therapy.
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Affiliation(s)
- Takumi Sakurada
- Department of Pharmacy, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima, 770-8503, Japan.
| | - Sanako Bando
- Department of Pharmacy, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yoshito Zamami
- Department of Pharmacy, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima, 770-8503, Japan.,Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Kenshi Takechi
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Masayuki Chuma
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Mitsuhiro Goda
- Department of Pharmacy, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yasushi Kirino
- Department of Pharmacy, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Toshimi Nakamura
- Department of Pharmacy, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Kazuhiko Teraoka
- Department of Pharmacy, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Masami Morimoto
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Akira Tangoku
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Keisuke Ishizawa
- Department of Pharmacy, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima, 770-8503, Japan.,Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan
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9
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Sakurada T. Analysis of Risk Factors for Side Effects and the Establishment of Supportive Therapy during Cancer Chemotherapy. YAKUGAKU ZASSHI 2018; 138:1363-1370. [DOI: 10.1248/yakushi.18-00141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Clark SK, Anselmo LM. Incidence of cutaneous reactions with pemetrexed: Comparison of patients who received three days of oral dexamethasone twice daily to patients who did not. J Oncol Pharm Pract 2018; 25:1645-1650. [PMID: 30319062 DOI: 10.1177/1078155218804869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pemetrexed is a multitargeted antifolate indicated for locally advanced or metastatic non-squamous non-small-cell lung cancer and malignant pleural mesothelioma. Cutaneous reactions are associated with pemetrexed use. Pemetrexed prescribing information recommends oral dexamethasone 4 mg twice daily for three days starting the day before pemetrexed infusion to prevent cutaneous reactions. Patients receive intravenous dexamethasone before pemetrexed infusion at the University of New Mexico Comprehensive Cancer Center, but the oral dexamethasone recommendation is not always followed. The objective of this study was to determine if there is a difference between patients who received three days of oral dexamethasone starting the day before pemetrexed infusion and patients who did not by determining incidence of cutaneous reactions, delay in therapy, and therapy change due to adverse reactions. Eighty-five patients received at least one dose of pemetrexed between August 1, 2012 and August 31, 2017. Twenty-nine patients did not receive three days of oral dexamethasone 4 mg twice daily and 56 patients did (34.1% vs. 65.9%). There was no statistically significant difference in the incidence of cutaneous reactions between the intervention group and the control group (13.8% vs. 25.0%; p = 0.384), delay in pemetrexed therapy between groups (44.8% vs. 32.1%; p = 0.2), or therapy change due to adverse events (34.5% vs. 23.2%; p = 0.654). Results suggest three days of oral dexamethasone 4 mg twice daily did not significantly affect incidence rates of cutaneous reactions, delay in therapy, or therapy change in patients who received intravenous dexamethasone before pemetrexed infusion at University of New Mexico Comprehensive Cancer Center.
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Affiliation(s)
- Stefanie K Clark
- Department of Pharmacy, University of New Mexico Hospitals, Albuquerque, NM, USA
| | - Lisa M Anselmo
- Department of Pharmacy, University of New Mexico Hospitals, Albuquerque, NM, USA
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11
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Miyahara T, Sueoka-Aragane N, Iwanaga K, Ureshino N, Komiya K, Nakamura T, Nakashima C, Abe T, Matsunaga H, Kimura S. Severity and predictive factors of adverse events in pemetrexed-containing chemotherapy for non-small cell lung cancer. Med Oncol 2017; 34:195. [PMID: 29124473 DOI: 10.1007/s12032-017-1053-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 10/30/2017] [Indexed: 12/21/2022]
Abstract
Pemetrexed is a key anticancer agent for treatment of advanced non-small cell lung cancer (NSCLC). Pemetrexed is generally well tolerated, but individual-patient differences exist in severity of adverse events. Our study aimed to characterize the adverse events of pemetrexed that result in discontinuation of chemotherapy and to identify risk factors associated with those adverse events. We retrospectively studied the incidence of adverse events in 257 patients with NSCLC who received pemetrexed (P) with or without bevacizumab (B) and/or carboplatin (C): P, PB, CP, or CPB. Patients whose chemotherapy was discontinued were divided into two groups according to adverse events and disease progression. Grade 2/3 nausea, fatigue with P and PB, and rash with CP and CPB occurred more frequent in the adverse events group than in the disease progression group. Multivariate analysis indicated that grade 2/3 nausea [odds ratio (OR) 9.94; 95% confidence interval (CI) 1.46-67.37; p = 0.01] and fatigue (OR 10.62; CI 1.60-70.20; p = 0.01) with P or PB, and rash (OR 6.12; CI 1.34-27.88; p = 0.01) with CP or CPB, were independent risk factors for discontinuation of chemotherapy. Administration of dexamethasone at doses less than 4 mg after the day of pemetrexed administration was associated with nausea following P or PB (OR 11.08; 95% CI 1.02-119.95; p = 0.04). Grade 2/3 nausea and fatigue with P or PB, and rash with CP or CPB, were associated with discontinuation of chemotherapy.
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Affiliation(s)
- Tsuyoshi Miyahara
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan.,Department of Pharmacy, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan.
| | - Kentaro Iwanaga
- Division of Respiratory Medicine, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Norio Ureshino
- Division of Medical Oncology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Kazutoshi Komiya
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Tomomi Nakamura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Chiho Nakashima
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Tomonori Abe
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Hisashi Matsunaga
- Department of Pharmacy, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
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