Platinum Accumulation and Cancer-Related Fatigue, Correlation With IL-8, TNF-α and Hemocytes

Risk assessment of heavy metal toxicity induced by platinum accumulation in tumor patients

Background

Many studies have focused on adverse reactions caused by platinum drugs but neglected subsequent toxicities and the mechanisms during patient recovery after chemotherapy with different platinum drugs, which need attention because of the heavy metal platinum.

Objectives

We aimed to explore the correlations between platinum accumulation, hematological indices, and clinical toxicity in patients after a metabolism period following platinum drug chemotherapy, to better understand real-world clinical toxicity caused by platinum accumulation.

Methods

We enrolled patients receiving platinum chemotherapy, specifically cisplatin, oxaliplatin, or carboplatin. On the 25th day post-chemotherapy, we measured serum platinum concentrations and hematological indices, documented clinical toxicities, and subsequently performed correlation analyses.

Results

The serum platinum concentrations in oxaliplatin-, cisplatin-, and carboplatin-treated patients were 208.60, 349.15 and 211.30 µg/L (χ 2 = 51.755, p < 0.001), respectively. Mediation effect analysis showed that decreased erythrocyte, hemoglobin and glutamic-pyruvic transaminase individually mediated 21.39, 12.0 and 10.94%, respectively, of the platinum positive effect on fatigue. Decreased erythrocyte counts mediated 5.89%, while increased creatinine mediated 5.2% of the platinum positive effect on adverse reactions. The cutoff values of hematological indices, the risk of adverse reactions and fatigue were also obtained in this research which will be applied in clinical practice.

Discussion and Conclusions

Platinum accumulation, by disrupting the red blood cell system and liver and kidney function, influences fatigue severity and common adverse reactions in patients during the post-chemotherapy recovery period.

Identification of diagnostic biomarkers in prostate cancer-related fatigue by construction of predictive models and experimental validation

BACKGROUND

Cancer-related fatigue (CRF) is a prominent cancer-related complication occurring in Prostate cancer (PCa) patients, profoundly affecting prognosis. The lack of diagnostic criteria and biomarkers hampers the management of CRF.

METHODS

The CRF-related data and PCa single-cell data were retrieved from the GEO database and clinical data was downloaded from the TCGA database. The univariate logistic/Cox regression analysis were used to construct the prediction models. The predictive value of models was analyzed using the ROC curve and Kaplan-Meier survival. The hub genes were screened by an intersection analysis of DEGs. The mice model of PCa and PCa-related fatigue were established, and fatigue-like behaviors of mice were detected. The expression of selected hub genes was validated by RT-PCR and IHC analysis.

RESULTS

The diagnosis and risk models showed great predictive value both in the training and validation dataset. Five genes (Baiap2l2, Cacng4, Sytl2, Sec31b and Ms4a1) that enriched the CXCL signaling were identified as hub genes. Among all hub genes, the MS4A1 expression is the most significant in PCa-related fatigue mice.

CONCLUSIONS

We identified MS4A1 as a promising biomarker for the diagnosis of PCa-related fatigue. Our findings would lay a foundation for revealing the pathogenesis and developing therapies for PCa-related fatigue.

Research focus and emerging trends of cancer-related fatigue in nursing arena: A bibliometric analysis from 2012 to 2021

BACKGROUND

To explore distributed characteristics and identify research focus and emerging trends related to cancer-related fatigue (CRF) in the nursing field.

METHODS

Data were collected from the Web of Science Core Collection database between January 2012 and December 2021 using an advanced search strategy. Data were extracted and analyzed using CiteSpace and Microsoft Excel.

RESULTS

A total of 967 articles were included in this study. The number of published nursing studies on CRF has increased with slight fluctuations. Keyword co-occurrence analysis and timeline view indicated that CRF is closely related to quality of life, and there is a correlation between CRF and other symptoms. Moreover, increasing attention has been paid to CRF nursing interventions. The assessment tools and their different language versions, risk factors and reviews of CRF were the research frontiers in recent years with citation bursts.

CONCLUSIONS

In the field of nursing, the focus of CRF research is still on risk factors, adverse outcomes and nursing management. Assessment tools will continue to be developed and additional risk factors will be studied in the future.

Genes of cancer-related fatigue: a scoping review

Background

Cancer-related fatigue (CRF) is a prevalent adverse effect experienced by cancer patients while receiving and after treatment, impacting as many as 90% of individuals. Although CRF is common, the genetic processes responsible for it and their influence on individual vulnerability are not well understood and are still being investigated.

Objective

The primary objective of this scoping review is to identify and assess genes linked to the vulnerability and severity of CRF. This will help us better understand the genetic factors involved and assist in developing targeted nursing treatments in clinical settings.

Methods

This review followed the PRISMA guidelines. A comprehensive search was performed in databases, such as PubMed, EMBASE, Web of Science, Cochrane Library, SinoMed, CNKI, and VIP, encompassing genetic association studies on CRF published up to February 25, 2024. The JBI Critical Appraisal Tools were used to assess the quality of observational studies.

Results

This evaluation encompassed a comprehensive analysis of 14 studies that involved 3,254 patients. The results indicate strong connections between CRF and various inflammatory cytokines (IL-4, IL-6, IL-8, IL-10, IL-1β), tumor necrosis factor-alpha (TNF-α), catechol-O-methyltransferase (COMT), and circadian rhythm genes (CLOCK, PER).

Conclusion

This scoping review emphasizes the significant genetic factor in CRF, with multiple genes showing distinct effects on cancer fatigue symptoms. Identifying these genes enhances our comprehension of CRF and unveils novel avenues for cancer treatment approaches. Future research should prioritize conducting cohort studies to monitor alterations in gene expression pre- and post-treatment, hence improving individualized medicinal strategies in oncology.

The combination of quercetin and leucine synergistically improves grip strength by attenuating muscle atrophy by multiple mechanisms in mice exposed to cisplatin

Both quercetin and leucine have been shown to exert moderately beneficial effects in preventing muscle atrophy induced by cancers or chemotherapy. However, the combined effects of quercetin and leucine, as well as the possible underlying mechanisms against cisplatin (CDDP)-induced muscle atrophy and cancer-related fatigue (CRF) remain unclear. To investigate the issues, male BALB/c mice were randomly assigned to the following groups for 9 weeks: Control, CDDP (3 mg/kg/week), CDDP+Q (quercetin 200 mg/kg/day administrated by gavage), CDDP+LL (a diet containing 0.8% leucine), CDDP+Q+LL, CDDP+HL (a diet containing 1.6% leucine), and CDDP+Q+HL. The results showed that quercetin in combination with LL or HL synergistically or additively attenuated CDDP-induced decreases in maximum grip strength, fat and muscle mass, muscle fiber size and MyHC level in muscle tissues. However, the combined effects on locomotor activity were less than additive. The combined treatments decreased the activation of the Akt/FoxO1/atrogin-1/MuRF1 signaling pathway (associated with muscle protein degradation), increased the activation of the mTOR and E2F-1 signaling pathways (associated with muscle protein synthesis and cell cycle/growth, respectively). The combined effects on signaling molecules present in muscle tissues were only additive or less. In addition, only Q+HL significantly increased glycogen levels compared to the CDDP group, while the combined treatments considerably decreased CDDP-induced proinflammatory cytokine and MCP-1 levels in the triceps muscle. Using tumor-bearing mice, we demonstrated that the combined treatments did not decrease the anticancer effect of CDDP. In conclusion, this study suggests that the combination of quercetin and leucine enhanced the suppressed effects on CDDP-induced muscle weakness and CRF through downregulating muscle atrophy and upregulating the glycogen level in muscle tissues without compromising the anticancer effect of CDDP. Multiple mechanisms, including regulation of several signaling pathways and decrease in proinflammatory mediator levels in muscles may contributed to the enhanced protective effect of the combined treatments on muscle atrophy.

Factors for the development of anemia in patients with newly introduced olaparib: A retrospective case-control study

Anemia is the most common dose-limiting toxicity of olaparib. However, few studies have analyzed the clinical features of olaparib-induced anemia. This study investigated the clinical features of olaparib-induced anemia. Additionally, the role of folate or vitamin B12 in olaparib-induced anemia was examined. This retrospective case-control study included patients who received olaparib at Mie University Hospital between January 2018 and December 2020. Data were collected between initiation of olaparib and discontinuation of olaparib or till December 2021. We investigated the development of grade ≥ 3 anemia during olaparib administration for at least 1 year. We examined patients with grade ≥ 3 anemia considering the mean corpuscular volume (MCV), its association with gastrointestinal events and cumulative dose of carboplatin. For the sub-study analysis, data on patients treated with olaparib for ovarian or endometrial cancer were collected to evaluate the Common Terminology Criteria for Adverse Events (CTCAE) or monthly changes in folate or vitamin B12 levels from baseline to 3 months after olaparib initiation. These data were collected between initiation of olaparib and discontinuation of olaparib or till November 2022. Patients with no data on folic acid or vitamin B12 levels were excluded from the sub-study. In the main study, 40 patients were included. Eighteen patients (45%) developed grade ≥ 3 anemia, and all patients discontinued treatment (94%) or reduced olaparib dose (67%) after developing anemia. Among the patients with grade ≥ 3 anemia, 9 (50%) exhibited macrocytic anemia and 15 (83%) had previously received carboplatin. The incidence of grade ≥ 2 dysgeusia was significantly higher in patients with grade ≥ 3 anemia (P = .034). Moreover, the cumulative dose of previously administered carboplatin was higher in patients who had 3 episodes of anemia (P = .102). In sub-study, 12 had data on folic acid and vitamin B12 levels. Sub-study analysis showed that none fulfilled the criteria for deficiency of folate or vitamin B12, while 3 developed grade 3 anemia. This study revealed that olaparib-induced anemia frequently occurs as macrocytic and normocytic erythroblastic anemia without folate or vitamin B12 deficiencies. A high cumulative dose of previously administered carboplatin and dysgeusia may be associated with olaparib-induced anemia.

Fatigue in patients with cancer receiving outpatient chemotherapy: a prospective two-center study

BACKGROUND

Cancer-related fatigue (CRF) is one of the most common symptoms in patients with cancer. However, CRF has not been sufficiently evaluated as it involves various factors. In this study, we evaluated fatigue in patients with cancer receiving chemotherapy in an outpatient setting.

METHODS

Patients with cancer receiving chemotherapy at the outpatient treatment center of Fukui University Hospital and Saitama Medical University Medical Center Outpatient Chemotherapy Center were included. The survey period was from March 2020 to June 2020. The frequency of occurrence, time, degree, and related factors were examined. All patients were asked to fill out the Edmonton Symptom Assessment System Revised Japanese version (ESAS-r-J) questionnaire, which is a self-administered rating scale, and patients with ESAS-r-J "Tiredness" scores of ≥ 3 were evaluated for factors related to tiredness, such as age, sex, weight, and laboratory parameters.

RESULTS

A total of 608 patients were enrolled in this study. Fatigue after chemotherapy occurred in 71.0% of patients. ESAS-r-J "Tiredness" scores of ≥ 3 were observed in 20.4% of patients. The factors related to CRF were low hemoglobin level and high C-reactive protein level.

CONCLUSIONS

Twenty percent of patients receiving cancer chemotherapy on an outpatient basis had moderate or severe CRF. Patients with anemia and inflammation are at increased risk of developing fatigue after cancer chemotherapy.

Zhengyuan capsules for the treatment of chemotherapy-induced cancer-related fatigue in stage IIIB-IV unresectable NSCLC: study protocol for a randomized, multi-center, double-blind, placebo-controlled clinical trial

BACKGROUND

Patients with advanced non-small cell lung cancer (NSCLC) frequently experience cancer-related fatigue (CRF) during or after chemotherapy. Traditional Chinese medicine (TCM) can effectively relieve CRF, although the clinical evidence is insufficient due to the absence of extensive and rigorous clinical studies. Zhengyuan capsules have both tonifying and dispersing effects, and its ability to alleviate CRF has been verified in mice. This study aimed to provide evidence for the role of proprietary Chinese medicines in alleviating CRF in advanced NSCLC patients.

METHODS

A multi-center, randomized, double-blind, placebo-controlled clinical trial has been designed to evaluate the efficacy and safety of Zhengyuan capsules for CRF in stage IIIB-IV unresectable NSCLC patients undergoing chemotherapy. Thirty eligible participants will be randomized into two groups at a 1:1 ratio during chemotherapy using the centralized interactive web response system. All patients will receive conventional platinum-based dual-drug chemotherapy and Zhengyuan capsules or simulant for 42 consecutive days starting on the first day of the first week of chemotherapy. The primary outcome is the difference between baseline and post-treatment CRF in the two groups, which will be assessed using the Brief Fatigue Inventory (BFI) score. Secondary outcome measurements include the Revised Piper's Fatigue Scale (RPFS)-Chinese Version, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Module C30 (EORTC QLQ-C30) v3.0 combined with EORTC QLQ-LC13 (Lung Cancer 13), clinical symptom score, hematology exploratory index, and progression-free survival. And safety indicators such as blood, urine, fecal routine, liver and kidney function, coagulation, and electrocardiogram will be performed before chemotherapy. Data will be analyzed according to intention-to-treat (ITT) and per-protocol (PP) principles; Empowerstats and R will be applied for statistical analysis.

DISCUSSION

This trial will provide data on the efficacy and safety of Zhengyuan capsules for treating CRF in stage IIIB-IV unresectable NSCLC patients undergoing chemotherapy. It will also provide a basis for the feasibility of a large-scale clinical trial.

TRIAL REGISTRATION

The clinical trial was registered on 19 November 2020 through https://www.chictr.org.cn (registration number: ChiCTR2000040061).

Associations between pro-inflammatory cytokines and fatigue in pregnant women

Background

Fatigue is one of the most prevalent symptoms among pregnant women. In patients with various diseases, pro-inflammatory cytokines are associated with fatigue; however, such associations are unknown in pregnant women.

Objectives

The objective of this study was to examine the associations between pro-inflammatory cytokines and prenatal fatigue.

Methods

A cross-sectional study was conducted on 271 pregnant Chinese women in their third trimester of pregnancy. Patient-reported Outcome Measurement Information System (PROMIS) was used to evaluate women's prenatal fatigue. Using enzyme-linked immunosorbent assay (ELISA), the serum concentrations of four pro-inflammatory cytokines, including tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β), interleukin 6 (IL-6) and interleukin 8 (IL-8), were measured. The data was analyzed by correlation analysis and general linear regression analysis.

Results

In this sample, the mean (standard deviation) of fatigue scores was 51.94 (10.79). TNF-α (r = 0.21, p < 0.001), IL-6 (r = 0.134, p = 0.027) and IL-8 (r = 0.209, p = 0.001) were positively correlated to prenatal fatigue, although IL-1β was not. TNF-α (β = 0.263, p < 0.001), along with sleep quality (β = 0.27, p < 0.001) and depression (β = 0.376, p < 0.001) independently predicted prenatal fatigue.

Conclusions

TNF-α was identified as an independent biomarker for prenatal fatigue in our study. Reducing pro-inflammatory cytokines may be a unique method for lowering prenatal fatigue and, consequently, enhancing mother and child health.

Efficacy and safety of oral Chinese medicine on cancer-related fatigue for lung cancer patients after chemotherapy: Protocol for systematic review and meta-analysis

Introduction

Lung cancer has the highest mortality rate of about 18.0% among malignant tumors worldwide, and chemotherapy is the main treatment. 80% of patients receiving chemotherapy suffers from cancer-related fatigue, which is the most severe symptom, with a large effect on quality of life as well as prognosis. Oral Chinese medicine, a kind of complementary and alternative medicine, has been proved to benefit lung cancer patients. However, no studies have reviewed whether it can reduce fatigue in lung cancer patients after chemotherapy, which is the purpose of our study.

Methods

Two reviewers will systematically and independently retrieve papers, select studies for inclusion, extract data, and assess risk of bias. The following nine databases will be searched: China National Knowledge Infrastructure, Wan Fang database, Chinese Scientific Journals Database, Chinese biomedical literature service system, PubMed, Web of Science, OVID, Scopus, and EMBASE from inception to February, 2022. Included studies will only be randomized controlled trials. Primary outcome is cancer-related fatigue. Secondary outcomes are quality of life, immunologic function, and the incidence of adverse events. We will use RoB 2 tool to assess the risk of bias and RevMan to analyze data. Risk ratios will be calculated for dichotomous data and mean differences for continuous data. Random-effect model will be used to integrate statistical effects. Meta-regression, subgroup and sensitivity analyses will be carried out. We will evaluate the strength and overall quality of evidence with four levels: very low, low, moderate, and high.

Results

The review of current evidence of oral Chinese medicine on cancer-related fatigue for lung cancer patients after chemotherapy will be narratively summarized and quantitatively analyzed.

Conclusion

The definitive conclusion will help physicians to determine whether oral Chinese medicine is an effective treatment for reducing fatigue in lung cancer patients after chemotherapy in clinical settings.

Systematic review registration

PROSPERO CRD42021292576.