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Zhao S, Liu Z, Ma L, Yin M, Zhou Y. Potential biomarkers in hypoglycemic brain injury. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00681-8. [PMID: 37466819 DOI: 10.1007/s12024-023-00681-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/20/2023]
Abstract
Oxidative stress is a major underlying mechanism in hypoglycemic brain injury. Several oxidative stress-related proteins were identified through previous proteomics and literature review. The aim of the present study was to evaluate the potential of these proteins as biomarkers in hypoglycemic brain injury. Forty male Sprague Dawley rats were randomly and equally divided into four groups: control, acute hypoglycemia, hypoglycemia resuscitation 24 h, and hypoglycemia resuscitation 7 days. The hypoglycemic brain injury rat model was successfully constructed according to the Auer model. Real-time fluorescent quantitative polymerase chain reaction, western blot analysis, and immunohistochemical staining were used to quantify the expression of oxidative stress-related proteins. We also verified the expression level of selected protein in the brain samples of fatal insulin overdose cases. The expression of oxidative stress-related proteins PEX1/5/12 was down-regulated in hypoglycemic brain injury (P < 0.05), while the expressions of DJ-1 and NDRG1 were up-regulated (P < 0.05). Compared with the control group, the serum oxidative stress indexes SOD and MDA in the acute hypoglycemia group were significantly different (P < 0.01). The expressions of DJ-1 and NDRG1 in the hippocampus, cortex, and hypothalamus of rats were increased (P < 0.05). The expressions of DJ-1 and NDRG1 proteins in the cortex of the autopsy samples of insulin overdose were increased (P < 0.05). Oxidative stress-related proteins showed potential value as specific molecular markers in hypoglycemic brain injury, but further confirmatory studies are needed.
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Affiliation(s)
- Shuquan Zhao
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen university, Guang zhou, China
| | - Zihao Liu
- Evidence Identification Center, Chongqing Public Security Bureau, Chongqing, China
| | - Longda Ma
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Yin
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiwu Zhou
- Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen university, Guang zhou, China.
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2
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Trecarichi A, Duggett NA, Granat L, Lo S, Malik AN, Zuliani-Álvarez L, Flatters SJL. Preclinical evidence for mitochondrial DNA as a potential blood biomarker for chemotherapy-induced peripheral neuropathy. PLoS One 2022; 17:e0262544. [PMID: 35015774 PMCID: PMC8752024 DOI: 10.1371/journal.pone.0262544] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/28/2021] [Indexed: 01/14/2023] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a serious dose-limiting side effect of several first-line chemotherapeutic agents including paclitaxel, oxaliplatin and bortezomib, for which no predictive marker is currently available. We have previously shown that mitochondrial dysfunction is associated with the development and maintenance of CIPN. The aim of this study was to evaluate the potential use of mitochondrial DNA (mtDNA) levels and complex I enzyme activity as blood biomarkers for CIPN. Real-time qPCR was used to measure mtDNA levels in whole blood collected from chemotherapy- and vehicle-treated rats at three key time-points of pain-like behaviour: prior to pain development, at the peak of mechanical hypersensitivity and at resolution of pain-like behaviour. Systemic oxaliplatin significantly increased mtDNA levels in whole blood prior to pain development. Furthermore, paclitaxel- and bortezomib-treated animals displayed significantly higher levels of mtDNA at the peak of mechanical hypersensitivity. Mitochondrial complex I activity in whole blood was assessed with an ELISA-based Complex I Enzyme Activity Dipstick Assay. Complex I activity was not altered by any of the three chemotherapeutic agents, either prior to or during pain-like behaviour. These data demonstrate that blood levels of mtDNA are altered after systemic administration of chemotherapy. Oxaliplatin, in particular, is associated with higher mtDNA levels before animals show any pain-like behaviour, thus suggesting a potential role for circulating mtDNA levels as non-invasive predictive biomarker for CIPN.
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Affiliation(s)
- Annalisa Trecarichi
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Natalie A. Duggett
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Lucy Granat
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Samantha Lo
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Afshan N. Malik
- Department of Diabetes, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Lorena Zuliani-Álvarez
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Sarah J. L. Flatters
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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3
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La Verde N, Damia G, Garrone O, Santini D, Fabi A, Ciccarese M, Generali DG, Nunzi M, Poletto E, Ferraris E, Cretella E, Scandurra G, Meattini I, Bertolini AS, Cavanna L, Collovà E, Romagnoli E, Rulli E, Legramandi L, Guffanti F, Bramati A, Moretti A, Cassano A, Vici P, Torri V, Farina G. Tolerability of Eribulin and correlation between polymorphisms and neuropathy in an unselected population of female patients with metastatic breast cancer: results of the multicenter, single arm, phase IV PAINTER study. Breast Cancer Res 2022; 24:71. [PMID: 36307826 PMCID: PMC9615373 DOI: 10.1186/s13058-022-01560-w] [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: 02/02/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metastatic breast cancer (MBC) is an incurable disease and its treatment focuses on prolonging patients' (pts) overall survival (OS) and improving their quality of life. Eribulin is a microtubule inhibitor that increases OS in pre-treated MBC pts. The most common adverse events (AEs) are asthenia, neutropenia and peripheral neuropathy (PN). METHODS PAINTER is a single arm, phase IV study, aimed at evaluating the tolerability of eribulin in MBC pts. Secondary objectives were the description of treatment efficacy and safety, the assessment of the incidence and severity of PN and its association with genetic polymorphisms. Genomic DNA was isolated from blood samples and 15 Single Nucleotide Polymorphisms (SNPs) were genotyped by Taqman specific assays. The association between PN and SNPs were evaluated by Fisher exact test. RESULTS Starting from May 2014 until June 2018 180 pts were enrolled in this study by 20 Italian centers. 170 of these pts could be evaluated for efficacy and toxicity and 159 for polymorphisms analysis. The median age of pts was 60 years old and the biological subtypes were luminal type (64.7%), Her2 positive (18.3%) and triple negative (17%). Pts were pretreated with a median of 5 lines for MBC. The median follow up of this study was 15.4 months with a median number of 4.5 cycles administered (minimum-maximum 1-23). The median overall survival was 12 months. 48.8% of pts experienced a dose reduction, mainly for neutropenia (23.9%) and liver toxicity (12%). 65 pts (38.2%) reported at least one severe toxicity. Neutropenia and neurotoxicity were the most frequent severe AEs (15.3% and 14.7%, respectively); other reported toxicities were osteo-muscular, abdominal or tumor site pain (19.4%), liver toxicity (6.6%), pulmonary toxicity (6.5%) and dermatological toxicity (3.6%). Among the 15 evaluated SNPs, an association with PN was found for rs2233335 and rs7214723. CONCLUSIONS Eribulin is a well-tolerated treatment option in MBC. Schedule and dosage modifications were common, but toxicity rarely led to treatment discontinuation. SNPs rs2233335 (G/T and T/T) in the NDRG1 gene and rs7214723 (CC and CT) in the CAMKK1 gene were associated with PN. These findings, if validated, could allow a tailored treatment with eribulin in cancer patients. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02864030.
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Affiliation(s)
- Nicla La Verde
- grid.144767.70000 0004 4682 2907Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giovanna Damia
- grid.4527.40000000106678902Laboratory of Molecular Pharmacology, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ornella Garrone
- grid.414818.00000 0004 1757 8749Medical Oncology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Santini
- grid.9657.d0000 0004 1757 5329Oncologia Medica Università Campus Biomedico, Rome, Italy ,grid.7841.aUOC Oncologia Universitaria, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Alessandra Fabi
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Mariangela Ciccarese
- grid.417011.20000 0004 1769 6825Dept of Oncology Vito Fazzi Hospital, Lecce, Italy
| | - Daniele Giulio Generali
- U.O. Multidisciplinare Di Patologia Mammaria E Ricerca, Traslazionale Azienda Socio-Sanitaria Territoriale Di Cremona, Cremona, Italy
| | - Martina Nunzi
- grid.416377.00000 0004 1760 672XDept. of Oncology Medical and Translational Oncology Unit, Azienda Ospedaliera S.Maria, Terni, Italy
| | - Elena Poletto
- ASUFC Presidio Ospedaliero Universitario S.M. Misericordia, Udine, Italy
| | - Elisa Ferraris
- grid.419425.f0000 0004 1760 3027Division of Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - Elisabetta Cretella
- grid.415844.80000 0004 1759 7181Oncologia Medica Ospedale Di Bolzano, AS Alto Adige, Bolzano, Italy
| | - Giuseppa Scandurra
- grid.413340.10000 0004 1759 8037Medical Oncology Unit, Cannizzaro Hospital, Catania, Italy
| | - Icro Meattini
- grid.24704.350000 0004 1759 9494Radiation Oncology Unit, Oncology Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | | | - Luigi Cavanna
- Oncology Haematology Department, ASL Piacenza, Piacenza, Italy
| | - Elena Collovà
- ASST Ovest Milanese, Ospedale Di Legnano, Legnano, MI Italy
| | | | - Eliana Rulli
- grid.4527.40000000106678902Laboratory of Methodology for Clinical Research, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Lorenzo Legramandi
- grid.4527.40000000106678902Laboratory of Methodology for Clinical Research, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Federica Guffanti
- grid.4527.40000000106678902Laboratory of Molecular Pharmacology, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Annalisa Bramati
- grid.414759.a0000 0004 1760 170XDepartment of Oncology, Fatebenefratelli Hospital, ASST Fatebenefratelli-Sacco, Piazza Principessa Clotilde 3, 20121 Milan, Italy
| | - Anna Moretti
- grid.414759.a0000 0004 1760 170XDepartment of Oncology, Fatebenefratelli Hospital, ASST Fatebenefratelli-Sacco, Piazza Principessa Clotilde 3, 20121 Milan, Italy
| | - Alessandra Cassano
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Patrizia Vici
- grid.417520.50000 0004 1760 5276Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valter Torri
- Department of Oncology, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Gabriella Farina
- grid.414759.a0000 0004 1760 170XDepartment of Oncology, Fatebenefratelli Hospital, ASST Fatebenefratelli-Sacco, Piazza Principessa Clotilde 3, 20121 Milan, Italy
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Sharma A, Johnson KB, Bie B, Rhoades EE, Sen A, Kida Y, Hockings J, Gatta A, Davenport J, Arcangelini C, Ritzu J, DeVecchio J, Hughen R, Wei M, Thomas Budd G, Lynn Henry N, Eng C, Foss J, Rotroff DM. A Multimodal Approach to Discover Biomarkers for Taxane-Induced Peripheral Neuropathy (TIPN): A Study Protocol. Technol Cancer Res Treat 2022; 21:15330338221127169. [PMID: 36172750 PMCID: PMC9523841 DOI: 10.1177/15330338221127169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Taxanes are a class of chemotherapeutics commonly used to treat various solid tumors, including breast and ovarian cancers. Taxane-induced peripheral neuropathy (TIPN) occurs in up to 70% of patients, impacting quality of life both during and after treatment. TIPN typically manifests as tingling and numbness in the hands and feet and can cause irreversible loss of function of peripheral nerves. TIPN can be dose-limiting, potentially impacting clinical outcomes. The mechanisms underlying TIPN are poorly understood. As such, there are limited treatment options and no tools to provide early detection of those who will develop TIPN. Although some patients may have a genetic predisposition, genetic biomarkers have been inconsistent in predicting chemotherapy-induced peripheral neuropathy (CIPN). Moreover, other molecular markers (eg, metabolites, mRNA, miRNA, proteins) may be informative for predicting CIPN, but remain largely unexplored. We anticipate that combinations of multiple biomarkers will be required to consistently predict those who will develop TIPN. Methods: To address this clinical gap of identifying patients at risk of TIPN, we initiated the Genetics and Inflammatory Markers for CIPN (GENIE) study. This longitudinal multicenter observational study uses a novel, multimodal approach to evaluate genomic variation, metabolites, DNA methylation, gene expression, and circulating cytokines/chemokines prior to, during, and after taxane treatment in 400 patients with breast cancer. Molecular and patient reported data will be collected prior to, during, and after taxane therapy. Multi-modal data will be used to develop a set of comprehensive predictive biomarker signatures of TIPN. Conclusion: The goal of this study is to enable early detection of patients at risk of developing TIPN, provide a tool to modify taxane treatment to minimize morbidity from TIPN, and improved patient quality of life. Here we provide a brief review of the current state of research into CIPN and TIPN and introduce the GENIE study design.
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Affiliation(s)
- Anukriti Sharma
- Department of Quantitative Health Sciences, 22516Lerner Research Institute, Cleveland Clinic, OH, USA
| | - Ken B Johnson
- Department of Anesthesiology, 14434University of Utah, UT, USA
| | - Bihua Bie
- Department of Anesthesiology, 2569Cleveland Clinic, OH, USA
| | | | - Alper Sen
- Department of Anesthesiology, 14434University of Utah, UT, USA
| | - Yuri Kida
- Department of Anesthesiology, 14434University of Utah, UT, USA
| | - Jennifer Hockings
- Genomic Medicine Institute, Lerner Research Institute, 196246Cleveland Clinic, OH, USA.,Department of Pharmacy, 2569Cleveland Clinic, OH, USA.,196246Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Alycia Gatta
- 170292Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | | | | | - Jennifer Ritzu
- 170292Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Jennifer DeVecchio
- Genomic Medicine Institute, Lerner Research Institute, 196246Cleveland Clinic, OH, USA
| | - Ron Hughen
- Department of Anesthesiology, 14434University of Utah, UT, USA
| | - Mei Wei
- 20270Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - G Thomas Budd
- 170292Taussig Cancer Institute, Cleveland Clinic, OH, USA.,196246Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - N Lynn Henry
- 67159University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Charis Eng
- 170292Taussig Cancer Institute, Cleveland Clinic, OH, USA.,Genomic Medicine Institute, Lerner Research Institute, 196246Cleveland Clinic, OH, USA.,196246Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joseph Foss
- Department of Anesthesiology, 2569Cleveland Clinic, OH, USA
| | - Daniel M Rotroff
- Department of Quantitative Health Sciences, 22516Lerner Research Institute, Cleveland Clinic, OH, USA.,196246Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA
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5
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Diaz PL, Furfari A, Wan BA, Lam H, Charames G, Drost L, Fefekos A, Ohearn S, Blake A, Asthana R, Chow E, DeAngelis C. Predictive biomarkers of chemotherapy-induced peripheral neuropathy: a review. Biomark Med 2018; 12:907-916. [DOI: 10.2217/bmm-2017-0427] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of taxane treatment during chemotherapy. Identifying predictive biomarkers of CIPN would allow physicians to alter treatment given to patients according to a personal risk of developing this condition. The current literature on CIPN biomarkers is reviewed, identifying biomarkers which have been found to be significantly related to CIPN. Three genetic biomarkers are identified (ARHGEF10 rs9657362, CYP2C8 rs11572080/rs10509681 and FGD4 rs10771973) which have been found to act as predictive CIPN biomarkers in multiple studies. Possible mechanisms underlying the relationship between these single nucleotide polymorphisms and CIPN development are explored. The biomarkers identified in this study should be investigated further to generate predictive biomarkers that may be used in a clinical setting.
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Affiliation(s)
- Patrick L Diaz
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, M4N 3M5, Canada
| | - Anthony Furfari
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, M4N 3M5, Canada
| | - Bo Angela Wan
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, M4N 3M5, Canada
| | - Henry Lam
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, M4N 3M5, Canada
| | - George Charames
- Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, M5S 1A8, Canada
- Mount Sinai Services Inc., Toronto, Ontario, M5G 1X5, Canada
- Lunenfeld–Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, M5G 1X5, Canada
| | - Leah Drost
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, M4N 3M5, Canada
| | | | | | - Alexia Blake
- MedReleaf Inc., Markham, Ontario, L3R 6G4, Canada
| | - Rashi Asthana
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, M4N 3M5, Canada
| | - Edward Chow
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, M4N 3M5, Canada
| | - Carlo DeAngelis
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, M4N 3M5, Canada
- Department of Pharmacy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, M4N 3M5, Canada
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6
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Chan CWH, Law BMH, So WKW, Chow KM, Waye MMY. Novel Strategies on Personalized Medicine for Breast Cancer Treatment: An Update. Int J Mol Sci 2017; 18:ijms18112423. [PMID: 29140300 PMCID: PMC5713391 DOI: 10.3390/ijms18112423] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/10/2017] [Accepted: 11/13/2017] [Indexed: 12/22/2022] Open
Abstract
Breast cancer is the most common cancer type among women worldwide. With breast cancer patients and survivors being reported to experience a repertoire of symptoms that are detrimental to their quality of life, the development of breast cancer treatment strategies that are effective with minimal side effects is therefore required. Personalized medicine, the treatment process that is tailored to the individual needs of each patient, is recently gaining increasing attention for its prospect in the development of effective cancer treatment regimens. Indeed, recent studies have identified a number of genes and molecules that may be used as biomarkers for predicting drug response and severity of common cancer-associated symptoms. These would provide useful clues not only for the determination of the optimal drug choice/dosage to be used in personalized treatment, but also for the identification of gene or molecular targets for the development of novel symptom management strategies, which ultimately would lead to the development of more personalized therapies for effective cancer treatment. In this article, recent studies that would provide potential new options for personalized therapies for breast cancer patients and survivors are reviewed. We suggest novel strategies, including the optimization of drug choice/dosage and the identification of genetic changes that are associated with cancer symptom occurrence and severity, which may help in enhancing the effectiveness and acceptability of the currently available cancer therapies.
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Affiliation(s)
- Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, The New Territories, Hong Kong, China.
| | - Bernard M H Law
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, The New Territories, Hong Kong, China.
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, The New Territories, Hong Kong, China.
| | - Ka Ming Chow
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, The New Territories, Hong Kong, China.
| | - Mary M Y Waye
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, The New Territories, Hong Kong, China.
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7
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Sundar R, Bandla A, Tan SSH, Liao LD, Kumarakulasinghe NB, Jeyasekharan AD, Ow SGW, Ho J, Tan DSP, Lim JSJ, Vijayan J, Therimadasamy AK, Hairom Z, Ang E, Ang S, Thakor NV, Lee SC, Wilder-Smith EPV. Limb Hypothermia for Preventing Paclitaxel-Induced Peripheral Neuropathy in Breast Cancer Patients: A Pilot Study. Front Oncol 2017; 6:274. [PMID: 28119855 PMCID: PMC5222823 DOI: 10.3389/fonc.2016.00274] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 12/23/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Peripheral neuropathy (PN) due to paclitaxel is a common dose-limiting toxicity with no effective prevention or treatment. We hypothesize that continuous-flow limb hypothermia can reduce paclitaxel-induced PN. PATIENTS AND METHODS An internally controlled pilot trial was conducted to investigate the neuroprotective effect of continuous-flow limb hypothermia in breast cancer patients receiving weekly paclitaxel. Patients underwent limb hypothermia of one limb for a duration of 3 h with every paclitaxel infusion, with the contralateral limb used as control. PN was primarily assessed using nerve conduction studies (NCSs) before the start of chemotherapy, and after 1, 3, and 6 months. Skin temperature and tolerability to hypothermia were monitored using validated scores. RESULTS Twenty patients underwent a total of 218 cycles of continuous-flow limb hypothermia at a coolant temperature of 22°C. Continuous-flow limb hypothermia achieved mean skin temperature reduction of 1.5 ± 0.7°C and was well tolerated, with no premature termination of cooling due to intolerance. Grade 3 PN occurred in 2 patients (10%), grade 2 in 2 (10%), and grade 1 in 12 (60%). Significant correlation was observed between amount of skin cooling and motor nerve amplitude preservation at 6 months (p < 0.0005). Sensory velocity and amplitude in the cooled limbs were less preserved than in the control limbs, but the difference did not attain statistical significance. One patient with a history of diabetes mellitus had significant preservation of compound muscle action potential in the cooled limb on NCS analysis. CONCLUSION This study suggests that continuous limb hypothermia accompanying paclitaxel infusion may reduce paclitaxel-induced PN and have therapeutic potential in select patients and warrants further investigation. The method is safe and well tolerated.
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Affiliation(s)
- Raghav Sundar
- Department of Haematology-Oncology, National University Health System , Singapore , Singapore
| | - Aishwarya Bandla
- Singapore Institute for Neurotechnology, National University of Singapore, Singapore, Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Stacey Sze Hui Tan
- Singapore Institute for Neurotechnology, National University of Singapore , Singapore , Singapore
| | - Lun-De Liao
- Singapore Institute for Neurotechnology, National University of Singapore, Singapore, Singapore; Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan Township, Taiwan
| | | | - Anand D Jeyasekharan
- Department of Haematology-Oncology, National University Health System , Singapore , Singapore
| | - Samuel Guan Wei Ow
- Department of Haematology-Oncology, National University Health System , Singapore , Singapore
| | - Jingshan Ho
- Department of Haematology-Oncology, National University Health System , Singapore , Singapore
| | - David Shao Peng Tan
- Department of Haematology-Oncology, National University Health System , Singapore , Singapore
| | - Joline Si Jing Lim
- Department of Haematology-Oncology, National University Health System , Singapore , Singapore
| | - Joy Vijayan
- Department of Medicine, National University Health System , Singapore , Singapore
| | | | - Zarinah Hairom
- National University Cancer Institute, National University Health System , Singapore , Singapore
| | - Emily Ang
- National University Cancer Institute, National University Health System , Singapore , Singapore
| | - Sally Ang
- Department of Haematology-Oncology, National University Health System , Singapore , Singapore
| | - Nitish V Thakor
- Singapore Institute for Neurotechnology, National University of Singapore, Singapore, Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Soo-Chin Lee
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Einar P V Wilder-Smith
- Singapore Institute for Neurotechnology, National University of Singapore, Singapore, Singapore; Department of Medicine, National University Health System, Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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