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Marini I, Uzun G, Jamal K, Bakchoul T. Treatment of drug-induced immune thrombocytopenias. Haematologica 2022; 107:1264-1277. [PMID: 35642486 PMCID: PMC9152960 DOI: 10.3324/haematol.2021.279484] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Indexed: 01/19/2023] Open
Abstract
Several therapeutic agents can cause thrombocytopenia by either immune-mediated or non-immune-mediated mechanisms. Non-immune-mediated thrombocytopenia is due to direct toxicity of drug molecules to platelets or megakaryocytes. Immune-mediated thrombocytopenia, on the other hand, involves the formation of antibodies that react to platelet-specific glycoprotein complexes, as in classic drug-induced immune thrombocytopenia (DITP), or to platelet factor 4, as in heparin-induced thrombocytopenia (HIT) and vaccine-induced immune thrombotic thrombocytopenia (VITT). Clinical signs include a rapid drop in platelet count, bleeding or thrombosis. Since the patient's condition can deteriorate rapidly, prompt diagnosis and management are critical. However, the necessary diagnostic tests are only available in specialized laboratories. Therefore, the most demanding step in treatment is to identify the agent responsible for thrombocytopenia, which often proves difficult because many patients are taking multiple medications and have comorbidities that can themselves also cause thrombocytopenia. While DITP is commonly associated with an increased risk of bleeding, HIT and VITT have a high mortality rate due to the high incidence of thromboembolic complications. A structured approach to drug-associated thrombocytopenia/thrombosis can lead to successful treatment and a lower mortality rate. In addition to describing the treatment of DITP, HIT, VITT, and vaccine-associated immune thrombocytopenia, this review also provides the pathophysiological and clinical information necessary for correct patient management.
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Affiliation(s)
- Irene Marini
- Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen
| | - Gunalp Uzun
- Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen
| | - Kinan Jamal
- Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen
| | - Tamam Bakchoul
- Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen.
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Kuter DJ. Treatment of chemotherapy-induced thrombocytopenia in patients with non-hematologic malignancies. Haematologica 2022; 107:1243-1263. [PMID: 35642485 PMCID: PMC9152964 DOI: 10.3324/haematol.2021.279512] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Indexed: 01/19/2023] Open
Abstract
Chemotherapy-induced thrombocytopenia (CIT) is a common complication of the treatment of non-hematologic malignancies. Many patient-related variables (e.g., age, tumor type, number of prior chemotherapy cycles, amount of bone marrow tumor involvement) determine the extent of CIT. CIT is related to the type and dose of chemotherapy, with regimens containing gemcitabine, platinum, or temozolomide producing it most commonly. Bleeding and the need for platelet transfusions in CIT are rather uncommon except in patients with platelet counts below 25x109/L in whom bleeding rates increase significantly and platelet transfusions are the only treatment. Nonetheless, platelet counts below 70x109/L present a challenge. In patients with such counts, it is important to exclude other causes of thrombocytopenia (medications, infection, thrombotic microangiopathy, post-transfusion purpura, coagulopathy and immune thrombocytopenia). If these are not present, the common approach is to reduce chemotherapy dose intensity or switch to other agents. Unfortunately decreasing relative dose intensity is associated with reduced tumor response and remission rates. Thrombopoietic growth factors (recombinant human thrombopoietin, pegylated human megakaryocyte growth and development factor, romiplostim, eltrombopag, avatrombopag and hetrombopag) improve pretreatment and nadir platelet counts, reduce the need for platelet transfusions, and enable chemotherapy dose intensity to be maintained. National Comprehensive Cancer Network guidelines permit their use but their widespread adoption awaits adequate phase III randomized, placebo-controlled studies demonstrating maintenance of relative dose intensity, reduction of platelet transfusions and bleeding, and possibly improved survival. Their potential appropriate use also depends on consensus by the oncology community as to what constitutes an appropriate pretreatment platelet count as well as identification of patient-related and treatment variables that might predict bleeding.
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Affiliation(s)
- David J Kuter
- Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Fu HT, Xu YY, Tian JJ, Fu JX, Nie SL, Tang YY, Chen P, Zong L. Long-term efficacy of capecitabine plus oxaliplatin chemotherapy on stage III colon cancer: A meta-analysis. World J Meta-Anal 2020; 8:27-40. [DOI: 10.13105/wjma.v8.i1.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/26/2019] [Accepted: 10/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many clinical studies for the long-term survival or efficacy of capecitabine plus oxaliplatin (XELOX) in colon cancer have already been studied, but its clinical benefit is controversial.
AIM To evaluate the long-term efficacy of XELOX regimen in comparison with other adjuvant chemotherapy protocols in colon cancer.
METHODS By searching the PubMed, EMBASE and Cochrane databases, a total of 12 randomized controlled trials involving 6698 stage III colon cancer cases (XELOX protocol: n = 3298 cases; other adjuvant chemotherapy protocol: n = 3268 cases) were included. The parameter outcomes included the overall survival and the disease-free survival. The quality control of selected literature was based on the Jadad scale and the GRADE system.
RESULTS In comparison to other adjuvant chemotherapy regimen, XELOX regimen showed a better overall survival (odds ratio = 1.29, 95% confidence interval: 1.15-1.44, P < 0.0001) and a better disease-free survival (odds ratio = 1.32, 95% confidence interval: 1.18-1.46, P < 0.0001) for colon cancer patients, suggesting the XELOX regimen can be a good option for postoperative treatment of stage III colon cancer.
CONCLUSION The XELOX regimen can be a preferred option for adjuvant treatment of stage III colon cancer after surgery.
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Affiliation(s)
- Hong-Tao Fu
- Department of Clinical Medicine, University of South China, Hengyang 421000, Hunan Province, China
| | - Ying-Ying Xu
- Department of General Surgery, Yizheng People’s Hospital, Yangzhou University, Yangzhou 225000, Jiangsu Province, China
| | - Jing-Jing Tian
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China
| | - Jia-Xin Fu
- Department of General Surgery, Northern Jiangsu People’s Hospital, Yangzhou University, Yangzhou 225000, Jiangsu Province, China
| | - Shao-Ling Nie
- Department of Colorectal Surgery, Hunan Cancer Hospital, Central South University, Changsha 410000, Hunan Province, China
| | - Yan-Yan Tang
- Department of Colorectal Surgery, Hunan Cancer Hospital, Central South University, Changsha 410000, Hunan Province, China
| | - Ping Chen
- Department of General Surgery, Northern Jiangsu People’s Hospital, Yangzhou University, Yangzhou 225000, Jiangsu Province, China
| | - Liang Zong
- Department of General Surgery, Northern Jiangsu People’s Hospital, Yangzhou University, Yangzhou 225000, Jiangsu Province, China
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Dou H, Shen R, Tao J, Huang L, Shi H, Chen H, Wang Y, Wang T. Curcumin Suppresses the Colon Cancer Proliferation by Inhibiting Wnt/β-Catenin Pathways via miR-130a. Front Pharmacol 2017; 8:877. [PMID: 29225578 PMCID: PMC5705620 DOI: 10.3389/fphar.2017.00877] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/13/2017] [Indexed: 12/15/2022] Open
Abstract
Curcumin exhibits anti-tumor effects in several cancers, including colorectal carcinoma (CRC), but the detailed mechanisms are still unclear. Here we studied the mechanisms underlying the anti-tumor effect of curcumin in colon cancer cells. SW480 cells were injected into mice to establish the xenograft tumor model, followed by evaluation of survival rate with the treatment of curcumin. The expression levels of β-catenin, Axin and TCF4 were measured in the SW480 cells in the absence or presence of curcumin. Moreover, miRNAs related to the curcumin treatment were also detected in vitro. Curcumin could suppress the growth of colon cancer cells in the mouse model. This anti-tumor activity of curcumin was exerted by inhibiting cell proliferation rather than promoting cell apoptosis. Further study suggested that curcumin inhibited cell proliferation by suppressing the Wnt/β-catenin pathway. MiR-130a was down-regulated by curcumin treatment, and overexpressing miR-130a could abolish the anti-tumor activity of curcumin. Our study confirms that curcumin is able to inhibit colon cancer by suppressing the Wnt/β-catenin pathways via miR-130a. MiR-130a may serve as a new target of curcumin for CRC treatment.
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Affiliation(s)
- Huiqiang Dou
- Department of Endoscopy Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Renhui Shen
- Department of Endoscopy Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Jianxin Tao
- Department of Endoscopy Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Longchang Huang
- Department of Endoscopy Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Haoze Shi
- Department of Endoscopy Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Hang Chen
- Department of Endoscopy Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Yixin Wang
- Department of Endoscopy Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Tong Wang
- Department of Endoscopy Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
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Danno K, Hata T, Tamai K, Fujie Y, Ide Y, Kim HM, Ohnishi T, Morita S, Yoshioka S, Kudo T, Nishimura J, Matsuda C, Akamatsu H, Mizushima T, Nezu R, Doki Y, Mori M. Interim analysis of a phase II trial evaluating the safety and efficacy of capecitabine plus oxaliplatin (XELOX) as adjuvant therapy in Japanese patients with operated stage III colon cancer. Cancer Chemother Pharmacol 2017; 80:777-785. [DOI: 10.1007/s00280-017-3419-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/07/2017] [Indexed: 01/09/2023]
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Kumar S, Burney IA, Zahid KF, D Souza PC, Belushi MAL, Mufti TD, Meki WAL, Furrukh M, Moundhri MSAL. Colorectal Cancer Patient Characteristics, Treatment and Survival in Oman--a Single Center Study. Asian Pac J Cancer Prev 2016; 16:4853-8. [PMID: 26163603 DOI: 10.7314/apjcp.2015.16.12.4853] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colorectal cancer is the most common gastrointestinal cancer in Oman with an increasing incidence. We here report the presenting features, treatment outcomes and survival in a University hospital in Oman and compare our data with regional and international studies. MATERIALS AND METHODS Medical records of patients with colorectal cancer were reviewed retrospectively between June 2000 and December 2013 and were followed until June 2014. RESULTS A total of 162 patients were diagnosed with colorectal cancer. The majority were males (58.6%), with a median age of 56 years. Rectum was involved in 29.6% of patients, followed by ascending and sigmoid colon. The majority of patients had stage III (42.6%) and stage IV (32.7%) disease at presentation. K-Ras status was checked for 79 patients, and 41 (51.9%) featured the wild type. Median relapse free survival was 22 months. Median overall survival for all patients was 43 months. Observed 5 year overall survival (OS) for stages I, II and III was 100%, 60% and 60% respectively. On Log rank univariate analysis, age, BMI, diabetes, hypertension, metformin use, stage, clinical nodal status for rectal cancer, pathological T and nodal status, site of metastasis, surgical intervention, chemotherapy, radiotherapy, chemotherapy regimen, no of cycles of chemotherapy, response, RFS, site of recurrence and administration of 2nd line chemotherapy were significant factors affecting OS. On Cox regression multivariate analysis none of the factors independently affected the OS. CONCLUSIONS The majority of patients present with advanced disease and at young age. The survival rates are comparable to the published regional and international literature.
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Affiliation(s)
- Shiyam Kumar
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman E-mail :
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Bano N, Najam R, Qazi F, Mateen A. Gastrointestinal adverse effects in advanced colorectal carcinoma patients treated with different schedules of FOLFOX. Asian Pac J Cancer Prev 2015; 15:8089-93. [PMID: 25338989 DOI: 10.7314/apjcp.2014.15.19.8089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To assess the frequency and severity of gastrointestinal adverse effects in advanced colorectal carcinoma patients treated with four different schedules of FOLFOX. MATERIALS AND METHODS Patients (median age 61 years) who underwent surgery were included in the study. All had measureable disease at CT scan, ultrasonography or clinical examination. Toxicity was graded on a scale of 1-5 according to the general grade definition of CTC v2.0. The severity of adverse effects (Grade 3 and 4) assessed in each treatment arm was compared. RESULTS Differences between the incidence rates of 3 and 4 toxicity and all grades of toxicity for all parameters in GI toxicity were very highly significant (p<0.001). Severe gastrointestinal symptoms of toxicity were noted with FOLFOX7 (oxaliplatin 130 mg/m2). Grade 3 diarrhea was reported in 25% patients and grade 4 diarrhea in 4% in the FOLFOX7 treatment arm. Grade 2 vomiting was very frequently reported in the FOLFOX4 treatment arm (oxaliplatin 85mg/m2). Grade 2 stomatitis was reported in 42% patients treated with mFOLFOX6 (oxaliplatin 100mg/m2). Differences in the incidence rate of nausea, diarrhea and stomatitis among all treatment arms of FOLFOX were significant (p<0.05) . CONCLUSIONS Severe diarrhea is associated with FOLFOX7 treatment. No grade 3 or 4 GI toxicity was reported in patients of the mFOLFOX6 arm.
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Affiliation(s)
- Nusrat Bano
- Pharmacology Department, Ziauddin University, Karachi, Pakistan E-mail :
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Tariq A, Majeed I, Khurshid A. Types of Cancers Prevailing in Pakistan and their Management Evaluation. Asian Pac J Cancer Prev 2015; 16:3605-16. [DOI: 10.7314/apjcp.2015.16.9.3605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Li BL, Hu XL, Zhao XH, Sun HG, Zhou CY, Zhang Y. Endostar combined with irinotecan/calcium folinate/5-fluorouracil (FOLFIRI) for treating advanced colorectal cancer: A clinical study. J Chemother 2015; 27:301-6. [PMID: 25873343 DOI: 10.1179/1973947815y.0000000022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
PURPOSE The current study aimed to evaluate the short-term efficacy and safety of endostar plus irinotecan/calcium folinate/5-fluorouracil (FOLFIRI) in treatment of advanced colorectal cancer (CRC). METHODS Forty patients with advanced CRC were enrolled in this study and randomly assigned to two groups. The control group (n = 18) and tested group (n = 22) were received FOLFIRI alone and FOLFIRI plus endostar, respectively. The end points were overall response rate, progression-free survival (PFS) and toxicity. RESULTS A total of 38 patients (17 in control group and 21 in tested group) completed two cycles of treatment and were deemed assessable for response. Patients treated with FOLFIRI plus endostar experienced a obviously higher overall response rate (42.9%) compared with patients who received FOLFIRI alone (29.4%) and a statistically significant improvement in median PFS (14.5 vs. 11.0 months). The toxicity of FOLFIRI/endostar was comparative to that of FOLFIRI with regard to gastrointestinal reactions, haematologic toxicity, peripheral neuropathy and cholinergic syndrome. Cardiovascular adverse reactions including electrocardiogram abnormality and hypertension, which might be ascribed to endostar treatment, were reversible and manageable. CONCLUSION The addition of endostar to FOLFIRI resulted in a higher overall response rate and longer PFS and did not increase unacceptable adverse responses in patients with advanced CRC. Future randomised controlled clinical trials with a larger group of patients are warranted to further investigate the value of FOLFIRI plus endostar in CRC treatment.
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Li L, Ma BB. Colorectal cancer in Chinese patients: current and emerging treatment options. Onco Targets Ther 2014. [PMID: 25336973 DOI: 10.2147/ott.s48409ott-7-1817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Colorectal cancer is the second most common cancer in Hong Kong and its incidence is rising in economically developed Chinese cities, including Hong Kong and Shanghai. Several studies conducted in the People's Republic of China have characterized the unique molecular epidemiology of familial colorectal cancer syndromes and molecular biomarkers such as microsatellite instability and genetic mutations (eg, KRAS, NRAS, BRAF, PIK3CA, ERCC1) in Chinese populations. Interethnic differences in anticancer drug response and toxicity have been well described in many cancers, and this review examined the literature with regard to the tolerance of Chinese patients to commonly used chemotherapeutic regimens and targeted therapies for metastatic colorectal cancer. Studies on the pharmacogenomic differences in drug metabolizing and DNA repair enzymes between Chinese, North Asians, and Caucasian patients were also reviewed.
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Affiliation(s)
- Leung Li
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong Cancer Institute, Sha Tin, Hong Kong
| | - Brigette By Ma
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong Cancer Institute, Sha Tin, Hong Kong ; State Key Laboratory of South China, Sir YK Pao Cancer Center, Hong Kong Cancer Institute, Sha Tin, Hong Kong
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Li L, Ma BBY. Colorectal cancer in Chinese patients: current and emerging treatment options. Onco Targets Ther 2014; 7:1817-28. [PMID: 25336973 PMCID: PMC4199792 DOI: 10.2147/ott.s48409] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Colorectal cancer is the second most common cancer in Hong Kong and its incidence is rising in economically developed Chinese cities, including Hong Kong and Shanghai. Several studies conducted in the People's Republic of China have characterized the unique molecular epidemiology of familial colorectal cancer syndromes and molecular biomarkers such as microsatellite instability and genetic mutations (eg, KRAS, NRAS, BRAF, PIK3CA, ERCC1) in Chinese populations. Interethnic differences in anticancer drug response and toxicity have been well described in many cancers, and this review examined the literature with regard to the tolerance of Chinese patients to commonly used chemotherapeutic regimens and targeted therapies for metastatic colorectal cancer. Studies on the pharmacogenomic differences in drug metabolizing and DNA repair enzymes between Chinese, North Asians, and Caucasian patients were also reviewed.
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Affiliation(s)
- Leung Li
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong Cancer Institute, Sha Tin, Hong Kong
| | - Brigette BY Ma
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong Cancer Institute, Sha Tin, Hong Kong
- State Key Laboratory of South China, Sir YK Pao Cancer Center, Hong Kong Cancer Institute, Sha Tin, Hong Kong
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Yin H, Lu K, Qiao WB, Zhang HY, Sun D, You QS. Whole-liver Radiotherapy Concurrent with Chemotherapy as a Palliative Treatment for Colorectal Patients with Massive and Multiple Liver Metastases: a Retrospective Study. Asian Pac J Cancer Prev 2014; 15:1597-602. [DOI: 10.7314/apjcp.2014.15.4.1597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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