Mucocutaneous Adverse Reactions of Cancer Chemotherapy and Chemoradiation

Exposome Impact on Nail Health

Background

The nail unit is a complex system with various components, each serving distinct functions. The exposome, encompassing external and internal factors such as UV radiation, air pollution, dietary habits, and cosmetic product usage, substantially influences nail health and can lead to premature nail aging.

Summary

Internal and external exposomal factors can impact differently on nail health, inducing a variety of different clinical conditions. Effective therapeutic strategies exist, but a comprehensive understanding of how the exposome affects nails is lacking. This article aims to bridge this knowledge gap by exploring the relationship between the exposome and nail health, emphasizing it as a central focus of our analysis.

Key Messages

(1) The exposome, comprising various external and internal factors, may significantly influence nail health negatively, leading to premature nail aging. (2) Different nail conditions may arise due to the exposomal influence on nails. (3) Understanding the exposome's impact on nail health is crucial for developing solutions to mitigate negative effects and improve overall nail well-being.

Mucocutaneous Findings in Hematolymphoid Neoplasms: An Observational Study

Background

Cutaneous manifestations of hematological neoplasms can be divided into three broad categories - direct infiltration, paraneoplastic conditions, and those due to the treatment of hematological cancers.

Objectives

To study the frequency and patterns of mucocutaneous manifestations in patients with hematolymphoid neoplasms and those due to chemotherapy.

Materials and Methods

This was an observational study done with 172 patients. Categorization of mucocutaneous manifestations was done into malignancy-associated and chemotherapeutic drugs-associated and data was analyzed.

Results

Out of a total of 172 patients, 15.6% (27/172) had malignancy-related mucocutaneous manifestations. Among these, 4.6% (8/172) had direct infiltration of malignant cells into the skin and 11% (19/172) had paraneoplastic manifestations. The most common chemotherapy-related mucocutaneous manifestations were nail changes - 47.1% (81/172), of which transverse melanonychia was the most common (20.9%). About 44.2% (76/172) had a cutaneous infection, the commonest of which was a fungal infection (15.1%). Chemotherapy-induced alopecia was noted in 46.5% (80/172) and found to be significantly associated with cytarabine, daunorubicin, doxorubicin, methotrexate, and vincristine. Cutaneous hyperpigmentation was found to be significantly associated with cytarabine, doxorubicin, and vincristine.

Conclusion

Mucocutaneous manifestations cause additional discomfort to a patient undergoing chemotherapy. Early recognition and timely and appropriate management facilitate symptom control and prevent treatment-related morbidity. A multidisciplinary approach involving hemato-oncologists and dermatologists can help achieve this target.

An Observational Study of Cutaneous Manifestations in Patients on Chemo and Radiation Therapy for Internal Malignancies at Tertiary Care Center

CONTEXT

Chemotherapy and radiation therapy given to treat internal malignancies may cause cutaneous, hair, nail, and oral mucosal changes. The present study is an effort to know the pattern of cutaneous drug reactions with chemo and radiotherapy.

MATERIALS AND METHODS

Patients of internal malignancies with skin lesions attending the dermatology and oncology OPD/ward were recruited after taking their written consent in vernacular language. A detailed history of skin lesions, malignancies, and treatment was taken. Clinical examination was carried out. Relevant investigations and biopsy were carried out as and when required. Being a descriptive study, age group and gender-wise frequency and percentage were calculated for the treatment of malignancies and dermatosis.

RESULTS

The study included 150 patients with 28 different types of internal malignancies, of which 127 (84.66%) patients were treated, 45 (35.43%) treated exclusively with chemotherapy, 16 (12.59%) with exclusive radiation therapy, and 66 (51.96%) with combined chemo and radiation therapy. Total 111 (87.41%) patients received chemotherapy and 82 (64.56%) patients received radiation therapy. Most common internal malignancy was breast carcinoma in 43 (28.67%) cases. Most common chemotherapeutic agent given was paclitaxel to 33 (29.73%) patients. Most common dermatosis associated with exclusive chemotherapy was hand-foot syndrome in 7 (15.55%) cases and with exclusive radiation therapy was radiation dermatitis in 8 (50%) cases.

CONCLUSIONS

The study was useful in understanding various chemo and radiation therapy-associated dermatosis so that early interventions can be done to prevent further treatment-related adverse effects.

LIMITATION

Small sample size and inability of pinpointing a single drug as the side effect.

The prevalence of skin lesions and associated factors in hospitalised adult patients with cancer

OBJECTIVE

To assess the prevalence of skin lesions and evaluate the clinical and sociodemographic factors associated with their presence in hospitalised patients.

METHOD

This descriptive, cross-sectional, correlational study was performed in inpatient units and intensive care units of a cancer hospital in São Paulo, Brazil, after approval by the Institutional Research Ethics Committee. Data from hospitalised adult patients with cancer were collected during physical examinations and from medical records. A Chi-squared test, univariate analysis, a logistic regression model with results expressed as odds ratio (OR) and 95% confidence intervals (CI), and Classification and Regression Tree (CART) analysis were used to evaluate the data.

RESULTS

Of 341 patients, 80 had skin lesions, equating to an overall prevalence of 23.5%. The skin lesions included pressure injuries (10%), incontinence-associated dermatitis (6.7%), skin tears (6.5%), malignant wounds (3.8%) and complicated surgical wounds (3.2%). The factors associated with skin lesions in cancer patients were the use of disposable nappies (OR: 4.436) and age (59.1±15.1 years), according to the CART analysis, and the wearing of nappies (OR: 4.466, p<0.001), presence of ecchymosis (OR: 2.532, p<0.001) and infection (OR: 6.449, p=0.040), according to multiple regression analysis.

CONCLUSION

This study contributed to knowledge about prevalence and associated factors of skin lesions in hospitalised patients with cancer, allowing the implementation of preventive measures.

Evaluation of chemotherapy-induced cutaneous side effects in cancer patients

BACKGROUND

Cutaneous side effects are commonly seen in cancer chemotherapy. As new chemotherapy drugs are developed, the frequency and the diversity of these cutaneous side effects increase. For this reason, identification and management of these side effects are an important part of the treatment of cancer patients. This study aimed to investigate mucocutaneous side effects of conventional chemotherapy and targeted therapy agents that are used in cancer patients.

METHODS

In this cross-sectional study, 231 cancer patients, who received single or combination chemotherapy at the oncology department of our hospital between 2013 and 2020, were retrospectively reviewed, and mucocutaneous side effects we evaluated.

RESULTS

The ages of the patients varied between 27 and 90 years with a median age of 60 years. Of the patients, 136 (58.9%) were women, and 95 (41.1%) were men. Combination chemotherapy was applied to 174 patients (71.9%). Mucocutaneous side effects were present in 558 patients. The most common side effect was alopecia, which was observed in 158 patients (65.6%). This was followed by mucositis (39.4%), hand-foot syndrome (35.3%), papulopustular rash (22%), dermatitis (18.3%), xerosis (14.1%), nail disorders (12%), and others.

CONCLUSIONS

Although chemotherapy-induced cutaneous side effects are not usually life-threatening, they may lead to the development of morbidity and discontinuance or termination of the treatment. Therefore, these side effects should be well managed to improve the quality of life of cancer patients.

Chemotherapy-associated oral complications in a south Indian population: a cross-sectional study

Over the years, chemotherapy (CT) has evolved as an essential therapeutic modality for cancer, with oral manifestations frequently encountered as complications of cancer CT. Our study aimed to assess the prevalence of oral complications during CT and evaluate the significance of independent risk factors (age, gender, socio-economic status, oral hygiene practices etc). A cross-sectional study was carried out in a tertiary cancer hospital in Bhubaneswar, Odisha, India, in which a total of 138 hospitalized patients undergoing CT and fulfilling the inclusion and exclusion criteria were included. Comprehensive history and rigorous clinical examination eliciting the oral manifestations were carried out. Around 60% of patients exhibited oral manifestations. Xerostomia and lichenoid reactions were the highest and lowest recorded manifestations. Higher frequencies of oral lesions occurred in patients with breast cancer, TNM stage III, and with the administration of the docetaxel. Also, patients in the older age group, poor socio-economic status, poor quality of life, poor oral hygiene practices, and longer CT duration demonstrated more oral lesions. Individuals subjected to a dental evaluation either before or during CT exhibited a reduction in the number of oral features. Several oral complications were reported in the present study. All patients undergoing chemotherapy must receive reinforcement of oral hygiene instructions and dental evaluation before, during, and after chemotherapy treatment. The study also emphasizes the importance of oral health physician inclusion in the multidisciplinary cancer treatment team.

Evaluation of cutaneous side-effects associated with chemotherapeutic use in oncological patients

INTRODUCTION

Side-effects are frequently encountered in classic chemotherapy. However, the recent development of targeted treatments has resulted in a diminution of these. The most common side-effects are dermatological.

AIM

To investigate cutaneous changes occurring in patients using classic and targeted chemotherapeutic agents, and the prevalence of these changes in the two groups.

MATERIAL AND METHODS

One hundred twenty-eight volunteer oncological patients using chemotherapeutic agents were included in this prospective study. Two subgroups were established, patients using classic and those using targeted chemotherapeutic agents.

RESULTS

Xerosis was the most common side-effect, being seen in 93 (72.7%) of the 128 patients. Other common side-effects included alopecia, pruritus, mucositis, skin pigmentation, and palmar-plantar erythema. The most common side-effects in the classic chemotherapeutic group were xerosis seen in 71 (75.5%) patients, pruritus in 50 (53.2%), alopecia in 49 (52.1%), and nail changes in 43 (45.7%). The most common side-effects in the targeted chemotherapeutic group were xerosis seen in 22 (64.7%) patients, nail changes in 17 (50%), alopecia in 15 (44.1%), and pruritus in 13 (38.2%).

CONCLUSIONS

The most common cutaneous side-effects were less prevalent in the patient group using targeted chemotherapeutic agents than in the classic group. Various side-effects associated with chemotherapeutic use which had not been previously reported were also identified in this study. Classic chemotherapeutic agents caused more serious side-effects requiring discontinuation of treatment than targeted chemotherapeutic agents.

A Scientometric Visualization Analysis for Natural Products on Cancer Research from 2008 to 2020

Background: An increasing number of studies have shown that natural products have anti-tumor effects, and it has become a hotspot in cancer research. However, few bibliometric analyses have been examined in this field systematically. The current study aimed to explore the status and provide the developing trends in the natural products on cancer research.

Methods: Publications on natural products in cancer research were extracted from the Web of Science core collection database. CiteSpace (5.6.R3) software and GraphPad prism 6 were used to analyze and plot the references.

Results: On February 1, 2021, 34,611 records of natural products in cancer research published from 2008 to 2020 were collected. The United States was the driving force, with a strong academic reputation in this area. The top-contributing institution was the Chinese Academy of Sciences. Most publications were published in Molecules. Efferth Thomas was the most prolific author, while Newman DJ was the most cited and frequently co-cited author. Flavonoid, curcumin, and polyphenol were the most widely studied natural products. Oleanolic acid and rosmarinic acid have gradually become research hotspots recently. Breast cancer, prostate cancer, and colorectal cancer were the most common types of cancer in this field. “Natural killer cell” was the leading research hotspot. The keywords of “leaf extract,” “molecular docking” and “gold nanoparticle” appeared most recently as research frontiers.

Conclusion: Our results provided a general overview of the major research directions of natural products research in cancer. The mechanisms of natural products, especially those related to molecular docking, gold nanoparticle, gut microbiota, and immune checkpoints may soon become hotspots and should be closely monitored.

Sonophoresis Enhanced Transdermal Delivery of Cisplatin in the Xenografted Tumor Model of Cervical Cancer

Background

Transdermal drug delivery system has been researched for a long time because of its advantage in decreasing side effects such as nausea, vomiting, and gastrointestinal disturbance. Sonophoresis has been shown to be very effective in promoting the transdermal delivery of drugs. This study is on purpose to research the feasibility of sonophoresis promoting cisplatin in the treatment of cervical cancer and the optimum drug delivery mode.

Methods

Thirty-two female nude-mice model of cervical cancer were randomly divided into 4 groups (n=8 in each group): control group without any intervention, low, medium and high concentration groups were treated with the corresponding cisplatin concentrations of 0.2mg/mL, 0.4mg/mL and 0.8mg/mL, respectively, with concurrent sonophoresis applied on the skin of local tumor, 1 mL at a time, once a day for a total of 5 days. Therapeutic pulsed ultrasound (TPU) was 1.0 MHz, 2.0 W/cm² and 60-min duration. Weight of mice and tumor diameters were measured every day during the intervention. The concentration of cisplatin in tumors was detected by HPLC. Meanwhile, tumor, skin, liver and kidney gross structures and ultrastructure were observed in order to evaluate the effectiveness and safety of experimental conditions. In addition, apoptosis and proliferation-related factors (MPO, Caspase-3, PCNA) were detected by immunohistochemistry, immunofluorescence and TUNEL assay.

Results

The weight of nude mice in each group showed an increasing trend, except for a decrease of weight in the 0.8 mg/mL group. No obvious tumor inhibition effect was observed. Cisplatin was detected in the 0.4 mg/mL group and 0.8 mg/mL group, with relative concentrations of 0.081±0.033 mg/mL and 0.111±0.021 mg/mL, respectively. Both skin and kidney inflammation were observed in the 0.8 mg/mL group. The expression of MPO, caspase-3 and TUNEL was concentration dependent, with the highest expression in the 0.8 mg/mL group, followed by the 0.4 mg/mL group, with no significant differences between the control and the 0.2 mg/mL group. PCNA was highly expressed in both the control and 0.2 mg/mL groups but decreased in the 0.4 mg/mL and 0.8 mg/mL groups.

Conclusion

Sonophoresis enhanced transdermal delivery of cisplatin in a xenograft tumor model of cervical cancer. Considering the occurrence of skin inflammation and renal injury caused by cisplatin, the recommended concentration to be administered is 0.4mg/mL.