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Nasser N, Hathout RM, Abd-Allah H, Sammour OA. Simplex Lattice Design and Machine Learning Methods for the Optimization of Novel Microemulsion Systems to Enhance p-Coumaric Acid Oral Bioavailability: In Vitro and In Vivo Studies. AAPS PharmSciTech 2024; 25:56. [PMID: 38448576 DOI: 10.1208/s12249-024-02766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/10/2024] [Indexed: 03/08/2024] Open
Abstract
Novel p-coumaric acid microemulsion systems were developed to circumvent its absorption and bioavailability challenges. Simplex-lattice mixture design and machine learning methods were employed for optimization. Two optimized formulations were characterized using in vitro re-dispersibility and cytotoxicity on various tumor cell lines (MCF-7, CaCO2, and HepG2). The in vivo bioavailability profiles of the drug loaded in the two microemulsion systems and in the suspension form were compared. The optimized microemulsions composed of Labrafil M1944 CS (5.67%)/Tween 80 (38.71%)/Labrasol (38.71%)/water (16.92%) and Capryol 90 (0.50%)/Transcutol P (26.67%)/Tween 80 (26.67%)/Labrasol (26.67%)/water (19.50%), respectively. They revealed uniform and stable p-coumaric acid-loaded microemulsion systems with a droplet size diameter of about 10 nm. The loaded microemulsion formulations enhanced the drug re-dispersibility in contrast to the drug suspension which exhibited 5 min lag time. The loaded formulae were significantly more cytotoxic on all cell lines by 11.98-16.56 folds on MCF-7 and CaCo2 cells and 47.82-98.79 folds on HepG2 cells higher than the pure drug. The optimized microemulsions were 1.5-1.8 times more bioavailable than the drug suspension. The developed p-coumaric acid microemulsion systems could be considered a successful remedy for diverse types of cancer.
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Affiliation(s)
- Nayera Nasser
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, African Union Organization St., Cairo, 11566, Egypt
| | - Rania M Hathout
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, African Union Organization St., Cairo, 11566, Egypt.
| | - Hend Abd-Allah
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, African Union Organization St., Cairo, 11566, Egypt
| | - Omaima A Sammour
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, African Union Organization St., Cairo, 11566, Egypt
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Chen Y, Hu F, Guo C, Dong X, Wang H, Qin Y. Ecofriendly and scalable production of bioglass using an organic calcium source enhanced bioactivity for tissue repair. Biomed Mater 2024; 19:035001. [PMID: 38387060 DOI: 10.1088/1748-605x/ad2c1b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/22/2024] [Indexed: 02/24/2024]
Abstract
The eco-friendly and scalable production of bioglass remains a challenging but attractive strategy for advancing its widespread biomedical applications. Although the sol-gel method has been considered a valuable approach for bioglass production, the application of calcium nitrate as a calcium source markedly limits its industrialization owing to environmental pollution, high administration costs, and numerous calcium-rich regions in the as-prepared bioglass. Therefore, organic Ca has been proposed as an alternative to inorganic Ca. In the current study, bioglass was successfully prepared using a novel calcium source (calcium glycerol) and was named regeneration silicon (RegeSi). The biocompatibity of bioglass was examined by performing the methyl thiazolyl tetrazolium (MTT) assay using L929 fibroblasts. The biological and tissue repair properties of RegeSi were better than those of bioglass prepared with calcium nitrate using the sol-gel or traditional melting methods. The applicability of RegeSi was validated using suitable wound healing and dental restoration models. Notably, RegeSi ensured closure of a deep wound (1.6 cm diameter, 2 mm depth) within 11 d. Moreover, RegeSi facilitated tooth repair with a blocking rate of 97.1%. More importantly, large-scale production of RegeSi was achieved at low cost, high bioactivity, and using environmental technology, reaching a capacity of 100 kg/batch.
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Affiliation(s)
- Yun Chen
- Beijing Best Life Regenerative Medicine Technology Co., Ltd, Beijing 101200, People's Republic of China
- School of Materials Science and Engineering, Tsinghua University, Beijing 100084, People's Republic of China
| | - Fang Hu
- Beijing Best Life Regenerative Medicine Technology Co., Ltd, Beijing 101200, People's Republic of China
| | - Chuangzhou Guo
- Beijing Best Life Regenerative Medicine Technology Co., Ltd, Beijing 101200, People's Republic of China
| | - Xihua Dong
- Beijing Best Life Regenerative Medicine Technology Co., Ltd, Beijing 101200, People's Republic of China
| | - Hai Wang
- Beijing Best Life Regenerative Medicine Technology Co., Ltd, Beijing 101200, People's Republic of China
| | - Yue Qin
- Beijing Best Life Regenerative Medicine Technology Co., Ltd, Beijing 101200, People's Republic of China
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Chen R, Zhang G, Sun K, Chen AF. Aging-Associated ALKBH5-m 6A Modification Exacerbates Doxorubicin-Induced Cardiomyocyte Apoptosis Via AT-Rich Interaction Domain 2. J Am Heart Assoc 2024; 13:e031353. [PMID: 38156523 PMCID: PMC10863816 DOI: 10.1161/jaha.123.031353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/20/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Chemotherapy-induced cardiovascular disease is a growing concern in the elderly population who have survived cancer, yet the underlying mechanism remains poorly understood. We investigated the role of ALKBH5 (AlkB homolog 5), a primary N6-methyladenosine (m6A) demethylase, and its involvement in m6A methylation-mediated regulation of targets in aging-associated doxorubicin-induced cardiotoxicity. METHODS AND RESULTS To validate the relationship between doxorubicin-induced cardiotoxicity and aging, we established young and old male mouse models. ALKBH5 expression was modulated through adeno-associated virus 9 (in vivo), Lentivirus, and siRNAs (in vitro) to examine its impact on cardiomyocyte m6A modification, doxorubicin-induced cardiac dysfunction, and remodeling. We performed mRNA sequencing, methylated RNA immunoprecipitation sequencing, and molecular assays to unravel the mechanism of ALKBH5-m6A modification in doxorubicin-induced cardiotoxicity. Our data revealed an age-dependent increase in doxorubicin-induced cardiac dysfunction, remodeling, and injury. ALKBH5 expression was elevated in aging mouse hearts, leading to reduced global m6A modification levels. Through mRNA sequencing and methylated RNA immunoprecipitation sequencing analyses, we identified ARID2 (AT-rich interaction domain 2) as the downstream effector of ALKBH5-m6A modulation in cardiomyocytes. Further investigations revealed that ARID2 modulates DNA damage response and enhances doxorubicin-induced cardiomyocyte apoptosis. CONCLUSIONS Our findings provide insights into the role of ALKBH5-m6A modification in modulating doxorubicin-induced cardiac dysfunction, remodeling, and cardiomyocyte apoptosis in male mice. These results highlight the potential of ALKBH5-targeted treatments for elderly patients with cancer in clinical settings.
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Affiliation(s)
- Runtai Chen
- Center for Vascular Disease and Translational MedicineThe Third Xiangya Hospital of Central South UniversityChangshaHunanChina
- Department of CardiologyThe Third Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Guogang Zhang
- Center for Vascular Disease and Translational MedicineThe Third Xiangya Hospital of Central South UniversityChangshaHunanChina
- Department of CardiologyThe Third Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Kun Sun
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Alex F. Chen
- Center for Vascular Disease and Translational MedicineThe Third Xiangya Hospital of Central South UniversityChangshaHunanChina
- Department of CardiologyThe Third Xiangya Hospital of Central South UniversityChangshaHunanChina
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
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Shi N, Ching Wong AK, Yuet Wong FK, Zhang N, Zhu W, Shen K, Lai X, Jin Y, Gu C, Nie L, Dong X. Feasibility of a mobile health app-based self-management program for Chinese patients with breast cancer receiving chemotherapy: A randomized controlled pilot study. Digit Health 2024; 10:20552076241231560. [PMID: 38410790 PMCID: PMC10896051 DOI: 10.1177/20552076241231560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 01/19/2024] [Indexed: 02/28/2024] Open
Abstract
Objective There are currently an increasing number of mobile health (mHealth) programs offered to patients with breast cancer undergoing chemotherapy, but their rate of adherence to app usage has remained low. This study aimed to examine the feasibility of an mHealth app-based program such as the adherence rate of app usage and determine the preliminary effects on self-efficacy, quality of life, symptom burden and healthcare utilization in these patients. Methods We conducted a randomized controlled pilot trial. Ninety-six participants were randomly allocated into either an intervention group or a control group (routine care plus a placebo app). The intervention group engaged in a 6-week self-regulation activity and received nurse-led social support via the app. The intention-to-treat principle was adopted. The generalized estimating equation was utilized to analyze the between-group, within-group and interaction effectiveness of this program. Results Totally 96 participants were enrolled from 16 May to 23 August 2022. The average rate of adherence to app usage increased from 4.8% at week 3 to 51.2% at week 6. There was a statistically significant reduction in the physiological efficacy scores of the intervention (p < .001) and control groups (p < .001) at week 6, compared with the baseline. At week 6, the intervention group reported a significantly lower symptom burden (p = .042) and significantly better physical well-being than the control group (p = .024). Conclusions It is feasible to perform an mHealth app-based self-management program for patients with breast cancer receiving chemotherapy. Nurses can utilize this program to facilitate patient self-management of symptoms during chemotherapy. Registration Clinicaltrials.gov, https://clinicaltrials.gov, (NCT05192525).
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Affiliation(s)
- Nuo Shi
- School of Nursing, Dalian Medical University, Dalian, China
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | | | | | - Nan Zhang
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiyi Zhu
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobin Lai
- School of Nursing, Fudan University, Shanghai, China
| | - Yufei Jin
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengjia Gu
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijing Nie
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojing Dong
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zago E, Galluzzo A, Pradella S, Antonuzzo L, Maggi M, Petrone L, Sparano C. Cabozantinib for different endocrine tumours: killing two birds with one stone. A systematic review of the literature. Endocrine 2024; 83:26-40. [PMID: 37851242 PMCID: PMC10805963 DOI: 10.1007/s12020-023-03526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/06/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Cabozantinib is an oral multi-tyrosine kinase inhibitor (TKI) that has been approved in Europe for advanced renal cell carcinoma, hepatocellular carcinoma, locally advanced and metastatic medullary thyroid carcinoma (MTC) and radioiodine-refractory differentiated thyroid cancer. Merkel cell carcinoma (MCC) is a rare and highly aggressive cutaneous malignant neuroendocrine tumour that usually presents in sun-exposed skin areas of immunosuppressed patients. Conflicting data exist about cabozantinib for MCC and this TKI is currently under investigation in several onco-endocrine frameworks. METHODS We herein report a case of an 83-year-old man who was diagnosed with MCC during the treatment of an advanced metastatic MTC. The diagnosis of MCC was established based on clinical, histopathologic evaluation and immunohistochemistry. A systematic review of the literature on cabozantinib use for advanced endocrine and neuroendocrine tumours has been performed. RESULTS The patient was initially treated with surgery and adjuvant radiotherapy. Cabozantinib was therefore started to control both MTC and MCC. After 24 months, no sign of local or metastatic MCC relapse was evidenced. CONCLUSION Promising data on cabozantinib treatment for endocrine and neuroendocrine neoplasms is recently emerging in the literature. In our clinical case, we reported that, besides the good response for the MTC, cabozantinib also seems to effectively control metastatic MCC, along with efficient surgery and adjuvant radiotherapy. Further investigations are needed to determine the efficacy and safety of cabozantinib in MCC patients and in off-label endocrine tumours.
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Affiliation(s)
- Elena Zago
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Antonio Galluzzo
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Department of Experimental & Clinical Medicine, University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Luisa Petrone
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy.
| | - Clotilde Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
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Barathan M, Vellasamy KM, Mariappan V, Venkatraman G, Vadivelu J. Naturally Occurring Phytochemicals to Target Breast Cancer Cell Signaling. Appl Biochem Biotechnol 2023:10.1007/s12010-023-04734-0. [PMID: 37773580 DOI: 10.1007/s12010-023-04734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/01/2023]
Abstract
Almost 70% of clinically used antineoplastic drugs are originated from natural products such as plants, marine organism, and microorganisms and some of them are also structurally modified natural products. The naturally occurring drugs may specifically act as inducers of selective cytotoxicity, anti-metastatic, anti-mutagenic, anti-angiogenesis, antioxidant accelerators, apoptosis inducers, autophagy inducers, and cell cycle inhibitors in cancer therapy. Precisely, several reports have demonstrated the involvement of naturally occurring anti-breast cancer drugs in regulating the expression of oncogenic and tumor suppressors associated with carcinogen metabolism and signaling pathways. Anticancer therapies based on nanotechnology have the potential to improve patient outcomes through targeted therapy, improved drug delivery, and combination therapies. This paper has reviewed the current treatment for breast cancer and the potential disadvantages of those therapies, besides the various mechanism used by naturally occurring phytochemicals to induce apoptosis in different types of breast cancer. Along with this, the contribution of nanotechnology in improving the effectiveness of anticancer drugs was also reviewed. With the development of sciences and technologies, phytochemicals derived from natural products are continuously discovered; however, the search for novel natural products as chemoprevention drugs is still ongoing, especially for the advanced stage of breast cancer. Continued research and development in this field hold great promise for advancing cancer care and improving patient outcomes.
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Affiliation(s)
- Muttiah Barathan
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia.
| | - Kumutha Malar Vellasamy
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia
| | - Vanitha Mariappan
- Center of Toxicology and Health Risk Studies (CORE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Aziz, 50300, Kuala Lumpur, Malaysia
| | - Gopinath Venkatraman
- Universiti Malaya Centre for Proteomics Research, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Biochemistry, Saveetha Dental College, Saveetha Institute of Medical & Technical Sciences, Saveetha University, Chennai 600 077, India
| | - Jamuna Vadivelu
- MERDU, Faculty of Medicine, Universiti Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia.
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Feliu J, Custodio AB, Pinto-Marín A, Higuera O, Pérez-González M, del Pino L, Ruiz-Jiménez L, Sánchez-Cabero D, Viera I, Jurado A, Espinosa E. Predicting Risk of Severe Toxicity and Early Death in Older Adult Patients Treated with Chemotherapy. Cancers (Basel) 2023; 15:4670. [PMID: 37760638 PMCID: PMC10526243 DOI: 10.3390/cancers15184670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Determining the risk of grade 3-5 toxicity and early death (ED) is important to plan chemotherapy in older adult patients with cancer. Our objective was to identify factors predicting these complications at the time of treatment initiation. METHODS 234 patients aged ≥70 were subjected to a geriatric assessment and variables related to the tumor and the treatment were also collected. Logistic regression multivariable analysis was used to relate these factors with the appearance of grade 3-5 toxicity and ED. Predictive scores for both toxicity and ED were then developed. RESULTS Factors related to grade 3-5 toxicity were hemoglobin, MAX2 index, ADL, and the CONUT score. Factors related to ED were tumor stage and the GNRI score. Two predictive scores were developed using these variables. ROC curves for the prediction of toxicity and ED were 0.71 (95% CI: 0.64-0.78) and 0.73 (95% CI: 0.68-0.79), respectively. CONCLUSIONS Two simple and reliable scores were developed to predict grade 3-5 toxicity and ED in older adult patients with cancer. This may be helpful in treatment planning.
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Affiliation(s)
- Jaime Feliu
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
- Cátedra UAM-AMGEN de Oncología Médica y Medicina Paliativa, Facultad de Medicina, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red del Cáncer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ana Belén Custodio
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
- Centro de Investigación Biomédica en Red del Cáncer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alvaro Pinto-Marín
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Oliver Higuera
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Miriam Pérez-González
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Laura del Pino
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Leticia Ruiz-Jiménez
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Darío Sánchez-Cabero
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Isabel Viera
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Ana Jurado
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Enrique Espinosa
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
- Cátedra UAM-AMGEN de Oncología Médica y Medicina Paliativa, Facultad de Medicina, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red del Cáncer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Perret M, Bertaut A, Niogret J, Marilier S, Jouanny P, Manckoundia P, Bengrine-Lefevre L, Quipourt V, Barben J. Associated Factors to Efficacy and Tolerance of Immunotherapy in Older Patients with Cancer Aged 70 Years and Over: Impact of Coprescriptions. Drugs Aging 2023; 40:837-846. [PMID: 37429982 DOI: 10.1007/s40266-023-01048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Immunotherapy with immune checkpoint blockers (ICB) significantly improves the prognosis for an increasing number of cancers. However, data on geriatric populations taking ICB are rare. OBJECTIVE This study aimed to identify factors associated with the efficacy and tolerance of ICB in an older population. PATIENTS AND METHODS This retrospective monocentric study included consecutive patients aged ≥ 70 years with solid cancer who received ICB between January 2018 and December 2019. Efficacy was assessed by progression-free survival (PFS) and tolerance was defined as cessation of immunotherapy due to the occurrence of any adverse event. RESULTS One hundred and five patients (65.7% men) were included, mainly at the metastatic stage (95.2%); 50.5% had lung cancer. Most (80%) patients were treated with anti-PD1 (nivolumab, pembrolizumab), 19.1% with anti-PD-L1 (atezolizumab, durvalumab, and avelumab) and 0.9% with anti-CTLA4 ICB (ipilimumab). Median PFS was 3.7 months [95% confidence interval (CI) (2.75-5.70)]. PFS was shorter in univariate analysis when ICB was taken concomitantly with an antiplatelet agent (AP) [hazard ratio (HR) = 1.93; 95% CI (1.22-3.04); p = 0.005]. Tolerance was lower in univariate analysis for lung cancer [odds ratio (OR) = 3.03; 95% CI (1.07-8.56), p < 0.05] and in patients taking proton pump inhibitors (PPI) [OR = 5.50; 95% CI (1.96-15.42), p < 0.001]. There was a trend toward poorer tolerance among patients living alone [OR = 2.26; 95% CI (0.76-6.72); p = 0.14]. CONCLUSIONS In older patients taking ICB for solid cancers, concomitant AP may influence efficacy and concomitant PPI may influence tolerance. Further studies are needed to confirm these results.
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Affiliation(s)
- Marie Perret
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
| | - Aurélie Bertaut
- Unit of Methodology and Biostatistics, Centre Georges François Leclerc, Dijon, France
| | - Julie Niogret
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France
- Medical Oncology Department, Centre George François Leclerc, Dijon, France
| | - Sophie Marilier
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France
| | - Pierre Jouanny
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
| | - Patrick Manckoundia
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
- UMR INSERM U1093, University of Burgundy, Dijon, France
| | - Leïla Bengrine-Lefevre
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France
- Medical Oncology Department, Centre George François Leclerc, Dijon, France
| | - Valérie Quipourt
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France
| | - Jérémy Barben
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France.
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France.
- UMR INSERM U1231, University of Burgundy, Dijon, France.
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Zhang C, Sheng Y, Sun X, Wang Y. New insights for gynecological cancer therapies: from molecular mechanisms and clinical evidence to future directions. Cancer Metastasis Rev 2023; 42:891-925. [PMID: 37368179 PMCID: PMC10584725 DOI: 10.1007/s10555-023-10113-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/22/2023] [Indexed: 06/28/2023]
Abstract
Advanced and recurrent gynecological cancers lack effective treatment and have poor prognosis. Besides, there is urgent need for conservative treatment for fertility protection of young patients. Therefore, continued efforts are needed to further define underlying therapeutic targets and explore novel targeted strategies. Considerable advancements have been made with new insights into molecular mechanisms on cancer progression and breakthroughs in novel treatment strategies. Herein, we review the research that holds unique novelty and potential translational power to alter the current landscape of gynecological cancers and improve effective treatments. We outline the advent of promising therapies with their targeted biomolecules, including hormone receptor-targeted agents, inhibitors targeting epigenetic regulators, antiangiogenic agents, inhibitors of abnormal signaling pathways, poly (ADP-ribose) polymerase (PARP) inhibitors, agents targeting immune-suppressive regulators, and repurposed existing drugs. We particularly highlight clinical evidence and trace the ongoing clinical trials to investigate the translational value. Taken together, we conduct a thorough review on emerging agents for gynecological cancer treatment and further discuss their potential challenges and future opportunities.
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Affiliation(s)
- Chunxue Zhang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030 People’s Republic of China
- Shanghai Municipal Key Clinical Specialty, Female Tumor Reproductive Specialty, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Yaru Sheng
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030 People’s Republic of China
- Shanghai Municipal Key Clinical Specialty, Female Tumor Reproductive Specialty, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Xiao Sun
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030 People’s Republic of China
- Shanghai Municipal Key Clinical Specialty, Female Tumor Reproductive Specialty, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Yudong Wang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030 People’s Republic of China
- Shanghai Municipal Key Clinical Specialty, Female Tumor Reproductive Specialty, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
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Feng G, Parthipan M, Breunis H, Timilshina N, Soto-Perez-de-Celis E, Mina DS, Emmenegger U, Finelli A, Krzyzanowska MK, Clarke H, Puts M, Alibhai SMH. Daily physical activity monitoring in older adults with metastatic prostate cancer on active treatment: Feasibility and associations with toxicity. J Geriatr Oncol 2023; 14:101576. [PMID: 37421787 DOI: 10.1016/j.jgo.2023.101576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Physical activity may be associated with cancer treatment toxicity, but generalizability to geriatric oncology is unclear. As many older adults have low levels of physical activity and technology use, this area needs further exploration. We evaluated the feasibility of daily step count monitoring and the association between step counts and treatment-emergent symptoms. MATERIALS AND METHODS Adults aged 65+ starting treatment (chemotherapy, enzalutamide/abiraterone, or radium-223) for metastatic prostate cancer were enrolled in a prospective cohort study. Participants reported step counts (measured via smartphone) and symptoms (Edmonton Symptom Assessment Scale) daily for one treatment cycle (i.e., 3-4 weeks). Embedded semi-structured interviews were performed upon completion of the study. The feasibility of daily monitoring was evaluated with descriptive statistics and thematic analysis. The predictive validity of a decline in daily steps (compared to pre-treatment baseline) for the emergence of symptoms was examined using sensitivity and positive predictive value (PPV). Associations between a 15% decline in steps and the emergence of moderate (4-6/10) to severe (7-10/10) symptoms and pain in the next 24 h were assessed using logistic regression. RESULTS Of 90 participants, 47 engaged in step count monitoring (median age = 75, range = 65-88; 52.2% participation rate). Daily physical activity monitoring was found to be feasible (94% retention rate; 90.5% median response rate) with multiple patient-reported benefits including increased self-awareness and motivation to engage in physical activity. During the first treatment cycle, instances of a 15% decline in steps were common (n = 37, 78.7%), as was the emergence of moderate to severe symptoms overall (n = 40, 85.1%) and pain (n = 26, 55.3%). The predictive validity of a 15% decline in steps on the emergence of moderate to severe symptoms was good (sensitivity = 81.8%, 95% confidence interval [CI] = 68.7-95.0; PPV = 73.0%, 95% CI = 58.7-87.3), although the PPV for pain was poor (sensitivity = 77.8%, 95% CI = 58.6-97.0; PPV = 37.8%, 95% CI = 22.2-53.5). In the regression models, changes in daily physical activity were not associated with symptoms or pain. DISCUSSION Changes in physical activity had modest ability to predict moderate to severe symptoms overall. Although participation was suboptimal, daily activity monitoring in older adults with cancer appears feasible and may have other uses such as improving physical activity levels. Further studies are warranted.
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Affiliation(s)
- Gregory Feng
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Milothy Parthipan
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Henriette Breunis
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Narhari Timilshina
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Salvador Zubirán National Institute of Medical Science and Nutrition, Mexico City, Mexico
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Urban Emmenegger
- Division of Medical Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesia, Toronto General Hospital, Toronto, Ontario, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada.
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Lu S, Li X, Li X, Zhang Q, Wang Y, Peng R, Fu W, Wang H. The preoperative geriatric nutritional risk index predicts long-term prognosis in elderly locally advanced rectal cancer patients: a two-center retrospective cohort study. Aging Clin Exp Res 2023; 35:311-321. [PMID: 36399323 DOI: 10.1007/s40520-022-02297-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objective is to explore the value of preoperative geriatric nutritional risk index (GNRI) in evaluating long-term prognosis in elderly locally advanced rectal cancer (LARC) patients who accepted neoadjuvant chemoradiotherapy (NCRT) and to compare GNRI with established nutritional markers, including prognostic nutritional index (PNI) and controlling nutritional status (CONUT) score. METHODS Preoperative GNRI was retrospectively assessed in 172 LARC patients aged ≥ 60 years who underwent radical resection after NCRT at two centers. Optimal cutoff value of GNRI was determined by X-tile program. The association of GNRI with clinicopathological parameters and nutritional markers was analyzed. The survival ability of markers was evaluated using time-dependent receiver-operating characteristic (ROC) curve analysis. Finally, survival analysis was performed using Kaplan-Meier and Cox regression analysis. RESULTS GNRI was highly correlated with nutritional markers. An optimal cutoff value for the GNRI was 96. In the time-dependent ROC curve, GNRI demonstrated a stable predictive ability for both disease-free survival (DFS) and overall survival (OS). Multivariate analysis showed that GNRI was the only nutritional marker that independently predicted DFS (HR 2.457, 95% CI 1.066-5.665, P = 0.035) and OS (HR 9.002, 95% CI 3.100-26.146, P < 0.001). As an additional benefit, GNRI was able to stratify survival in subgroups of ypTNM and tumor response. CONCLUSION Preoperative GNRI is a promising predictor of long-term survival for elderly LARC patients undergoing NCRT, superior to the established nutritional markers.
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Affiliation(s)
- Siyi Lu
- Cancer Center, Peking University Third Hospital, Beijing, 100191, China
- Department of General Surgery, Cancer Center, Peking University Third Hospital, Beijing, 100191, China
| | - Xianan Li
- Department of Radiation Oncology, Peking University People's Hospital, Beijing, 100044, China
| | - Xuemin Li
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China
| | - Qiuxiang Zhang
- Department of Clinical Nutrition, Peking University Third Hospital, Beijing, 100191, China
| | - Yuxia Wang
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China
| | - Ran Peng
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China
| | - Wei Fu
- Cancer Center, Peking University Third Hospital, Beijing, 100191, China.
- Department of General Surgery, Cancer Center, Peking University Third Hospital, Beijing, 100191, China.
| | - Hao Wang
- Cancer Center, Peking University Third Hospital, Beijing, 100191, China.
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China.
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Li H, Zheng Y, Xu P, Li Z, Kuang Y, Feng X, He J, Li J, Chen X, Bai L, Tang KJ. Comparison of pneumonitis risk between immunotherapy alone and in combination with chemotherapy: an observational, retrospective pharmacovigilance study. Front Pharmacol 2023; 14:1142016. [PMID: 37124234 PMCID: PMC10133569 DOI: 10.3389/fphar.2023.1142016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023] Open
Abstract
Importance: Checkpoint inhibitor pneumonitis (CIP) is a rare but serious adverse event that may impact treatment decisions. However, there is limited information comparing CIP risks between immune checkpoint inhibitor (ICI) monotherapy and combination with chemotherapy due to a lack of direct cross-comparison in clinical trials. Objective: To determine whether ICI combination with chemotherapy is superior to ICI in other drug regimens (including monotherapy) in terms of CIP risk. Study Design and Methods: This observational, cross-sectional and worldwide pharmacovigilance cohort study included patients who developed CIP from the World Health Organization database (WHO) VigiBase and the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. Individual case safety reports (ICSR) were extracted from 2015 to 2020 in FAERS and from 1967 to 2020 in VigiBase. Timing and reporting odds ratio (ROR) of CIP in different treatment strategies were used to detect time-to-onset and the risk of pneumonitis after different immunotherapy regimens. Results: A total of 93,623 and 114,704 ICI-associated ICSRs were included in this study from VigiBase and FAERS databases respectively. 3450 (3.69%) and 3278 (2.86%) CIPs occurred after therapy initiation with a median of 62 days (VigiBase) and 40 days (FAERS). Among all the CIPs, 274 (7.9%) and 537 (16.4%) CIPs were associated with combination therapies. ICIs plus chemotherapy combination was associated with pneumonitis in both VigiBase [ROR 1.35, 95% CI 1.18-1.52] and FAERS [ROR 1.39, 95% CI 1.27-1.53]. The combination of anti-PD-1 antibodies and anti-CTLA-4 antibodies with chemotherapy demonstrated an association with pneumonitis in both VigiBase [PD-1+chemotherapy: 1.76, 95% CI 1.52-2.05; CTLA-4+chemotherapy: 2.36, 95% CI 1.67-3.35] and FAERS [PD-1+chemotherapy: 1.70, 95% CI 1.52-1.91; CTLA-4+chemotherapy: 1.70, 95% CI 1.31-2.20]. Anti-PD-L1 antibodies plus chemotherapy combinations did not show the association. Conclusion: Compared to ICI in other drug regimens (including monotherapy), the combination of ICI plus chemotherapy is significantly associated with higher pneumonitis toxicity. Anti-PD-1/CTLA4 medications in combination with chemotherapy should be obviated in patients with potential risk factors for CIP. Trial Registration: clinicaltrials.gov, ChiCTR2200059067.
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Affiliation(s)
- Huixia Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yifan Zheng
- Department of Clinical Pharmacy Translational Science, College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Peihang Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zimu Li
- Department of Pulmonary and Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yukun Kuang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoqing Feng
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Junhao He
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Jia Li
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lihong Bai
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Lihong Bai, ; Ke-Jing Tang,
| | - Ke-Jing Tang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Lihong Bai, ; Ke-Jing Tang,
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DU R, ZHU J, ZHOU H, MA L, Amare GETU M, CHEN C, WANG T. Experience of lung cancer patients with targeted therapy-related skin adverse drug reactions: A qualitative study. Asia Pac J Oncol Nurs 2022; 9:100115. [PMID: 36118625 PMCID: PMC9479359 DOI: 10.1016/j.apjon.2022.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/30/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To explore the experience of non-small-cell lung cancer patients with targeted therapy-related skin adverse drug reactions. Methods This is a descriptive quantitative study conducted in a comprehensive hospital in Henan, China. Purposive sampling was used to recruit patients with non-small-cell lung cancer and with targeted therapy-related skin adverse drug reactions. In total, 23 patients were approached when the data were saturated. Face-to-face interviews were conducted by an independent researcher using a semi-structured interview guide. Interview data were transcribed and analyzed by qualitative inductive content analysis. Results Based on the analysis, four main categories were identified according to patients’ descriptions of their experience: a lack of self-management ability, psychological and emotional problems, a barrier to social participation, and a need for social support. Suffering from persistent symptoms, insufficient knowledge, skills and strategies for skin adverse drug reaction management, psychological problems, social avoidance/withdrawal, and reduced willingness to work were core experiences that would affect patients' compliance with treatment, prognosis, and the overall quality of life. Conclusions This study revealed the real experience of patients with non-small-cell lung cancer and with targeted therapy-related skin adverse drug reactions which contributed to the development of targeted interventions to manage skin adverse reactions.
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Akter S, Rahman MA, Hasan MN, Akhter H, Noor P, Islam R, Shin Y, Rahman MH, Gazi MS, Huda MN, Nam NM, Chung J, Han S, Kim B, Kang I, Ha J, Choe W, Choi TG, Kim SS. Recent Advances in Ovarian Cancer: Therapeutic Strategies, Potential Biomarkers, and Technological Improvements. Cells 2022; 11:650. [PMID: 35203301 PMCID: PMC8870715 DOI: 10.3390/cells11040650] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
Aggressive and recurrent gynecological cancers are associated with worse prognosis and a lack of effective therapeutic response. Ovarian cancer (OC) patients are often diagnosed in advanced stages, when drug resistance, angiogenesis, relapse, and metastasis impact survival outcomes. Currently, surgical debulking, radiotherapy, and/or chemotherapy remain the mainstream treatment modalities; however, patients suffer unwanted side effects and drug resistance in the absence of targeted therapies. Hence, it is urgent to decipher the complex disease biology and identify potential biomarkers, which could greatly contribute to making an early diagnosis or predicting the response to specific therapies. This review aims to critically discuss the current therapeutic strategies for OC, novel drug-delivery systems, and potential biomarkers in the context of genetics and molecular research. It emphasizes how the understanding of disease biology is related to the advancement of technology, enabling the exploration of novel biomarkers that may be able to provide more accurate diagnosis and prognosis, which would effectively translate into targeted therapies, ultimately improving patients’ overall survival and quality of life.
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Feliu J, Espinosa E, Basterretxea L, Paredero I, Llabrés E, Jiménez-Munárriz B, Antonio-Rebollo M, Losada B, Pinto A, Custodio AB, del Mar Muñoz M, Gómez-Mediavilla J, Torregrosa MD, Soler G, Cruz P, Higuera O, Molina-Garrido MJ. Prediction of Chemotoxicity, Unplanned Hospitalizations and Early Death in Older Patients with Colorectal Cancer Treated with Chemotherapy. Cancers (Basel) 2021; 14:cancers14010127. [PMID: 35008291 PMCID: PMC8749992 DOI: 10.3390/cancers14010127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Chemotoxicity, unplanned hospitalizations (Uhs) and early death (ED) are common among older patients with cancer who receive chemotherapy. Our objective was to determine factors predicting these complications. A predictive score for these three complications based on geriatric, tumor and laboratory variables was developed in a series of 215 older patients with colorectal carcinoma receiving chemotherapy. The use of this score may reliably identify patients at risk to have excessive toxicity with chemotherapy, UH or ED, thus helping to plan treatment, implement adaptive measures, and intensify follow-up. Abstract Purpose: To identify risk factors for toxicity, unplanned hospitalization (UH) and early death (ED) in older patients with colorectal carcinoma (CRC) initiating chemotherapy. Methods: 215 patients over 70 years were prospectively included. Geriatric assessment was performed before treatment, and tumor and treatment variables were collected. The association between these factors and grade 3–5 toxicity, UH and ED (<6 months) was examined by using multivariable logistic regression. Score points were assigned to each risk factor. Results: During the first 6 months of treatment, 33% of patients developed grade 3–5 toxicity, 31% had UH and 23% died. Risk factors were, for toxicity, instrumental activities of daily living, creatinine clearance, weight loss and MAX2 index; for UH, Charlson Comorbidity Score, creatinine clearance, weight loss, serum albumin, and metastatic disease; and for ED, basic activities in daily living, weight loss, metastatic disease, and hemoglobin levels. Predictive scores were built with these variables. The areas under receiver operation characteristic (ROC) curves for toxicity, UH and ED were 0.70 (95% CI: 0.64–0.766), 0.726 (95% IC: 0.661–0.799) and 0.74 (95% IC: 0.678–0.809), respectively. Conclusion: Simple scores based on geriatric, tumor and laboratory characteristics predict severe toxicity, UH and ED, and may help in treatment planning.
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Affiliation(s)
- Jaime Feliu
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
- Correspondence: ; Tel./Fax: +3-491-727-7118
| | - Enrique Espinosa
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - Laura Basterretxea
- Oncology Department, Donostia University Hospital, 20014 Donostia, Spain; (L.B.); (J.G.-M.)
| | - Irene Paredero
- Oncology Department, Doctor Peset University Hospital, 46017 Valencia, Spain; (I.P.); (M.-D.T.)
| | - Elisenda Llabrés
- Oncology Department, Insular University Hospital of Gran Canarias, 35016 Las Palmas, Spain;
| | | | - Maite Antonio-Rebollo
- Oncohematogeriatrics Unit, Institut Català d’Oncologia, IDIBELL Hospitalet, 08908 Barcelona, Spain; (M.A.-R.); (G.S.)
| | - Beatriz Losada
- Oncology Department, University Hospital of Fuenlabrada, 28942 Madrid, Spain;
| | - Alvaro Pinto
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - Ana Belén Custodio
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - María del Mar Muñoz
- Oncology Department, Hospital Virgen de la Luz, 16002 Cuenca, Spain; (M.d.M.M.); (M.-J.M.-G.)
| | | | | | - Gema Soler
- Oncohematogeriatrics Unit, Institut Català d’Oncologia, IDIBELL Hospitalet, 08908 Barcelona, Spain; (M.A.-R.); (G.S.)
| | - Patricia Cruz
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - Oliver Higuera
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
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Hu X, Li H, Kang X, Wang X, Pang H, Liu C, Zhang J, Wang Y. Efficacy and Safety of Local Radiotherapy to All Oligometastatic Sites in Elderly Patients with Metachronous Oligometastatic Cancers After Initial Treatment for the Primary Tumor. Cancer Manag Res 2021; 13:9247-9259. [PMID: 34955655 PMCID: PMC8694577 DOI: 10.2147/cmar.s345871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/06/2021] [Indexed: 12/04/2022] Open
Abstract
Background and Purpose This study aimed to investigate the efficacy and safety of maintenance therapy combined with local radiotherapy at all oligometastatic sites (LRTOS) in elderly patients with metachronous oligometastatic cancers (MOC). Patients and Methods A total of 242 elderly patients with MOC (≤5 metastases) and primary tumor well controlled after definitive treatment was retrospectively analyzed between August 2014 and February 2020 at Beijing Geriatric Hospital and Air Force General Hospital. Patients were divided into maintenance therapy group (maintenance therapy alone) and local radiotherapy group (maintenance therapy combined with LRTOS). Results There were 86 patients in the local radiotherapy group and 156 patients in the maintenance therapy group. The median length of follow-up was 36 months (range, 8.0–62 months). Median overall survival (mOS) was 25 months (95% CI: 21.1–28.9) in the local radiotherapy group and 16 months (95% CI: 14.5–17.6) in the maintenance therapy group (p < 0.001). Multivariate analyses demonstrated that LRTOS (hazard ratio (HR) = 0.49, 95% confidence interval (CI): 0.35–0.67, p < 0.001), good Eastern Cooperative Oncology Group Performance Status (ECOG PS, HR = 0.69, 95% CI: 0.49–0.97, p = 0.032), longer duration between diagnosis of primary tumor and occurrence of progression (HR = 0.87, 95% CI: 0.78–0.97, p = 0.015), and subsequent systemic treatment (HR = 0.52, 95% CI: 0.38–0.72, p < 0.001) were independent predictors of good OS. In patients who did not receive subsequent systemic treatment, their mOS was 21 months (95% CI: 12.8–29.2) for those treated with LRTOS and 14 months (95% CI: 11.4–16.6) for those who did not receive local radiotherapy (p = 0.001). Further multivariate analysis showed that LRTOS was the only independent factor for predicting good OS (HR = 0.47, 95% CI: 0.26–0.83, p = 0.010). Patients with metachronous oligometastatic lung cancer, colorectal cancer, prostate cancer, and breast cancer had higher survival benefits following LRTOS. Most patients suffered from grade 1–2 toxicities, but no treatment-related death was recorded. Conclusion This retrospective study shows that elderly patients with MOC treated with LRTOS may have better survival outcomes.
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Affiliation(s)
- Xiaolong Hu
- Department of Radiation Oncology, Beijing Geriatric Hospital, Beijing, People's Republic of China
| | - Hongqi Li
- Department of Radiation Oncology, Air Force General Hospital, Beijing, People's Republic of China
| | - Xiaoli Kang
- Department of Radiation Oncology, Air Force General Hospital, Beijing, People's Republic of China
| | - Xuan Wang
- Department of Radiation Oncology, Air Force General Hospital, Beijing, People's Republic of China
| | - Haifeng Pang
- Department of Radiation Oncology, Air Force General Hospital, Beijing, People's Republic of China
| | - Chen Liu
- Department of Radiation Oncology, Air Force General Hospital, Beijing, People's Republic of China
| | - Jianchun Zhang
- Department of Radiation Oncology, Beijing Geriatric Hospital, Beijing, People's Republic of China
| | - Yingjie Wang
- Department of Radiation Oncology, Air Force General Hospital, Beijing, People's Republic of China
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Zhang S, Wang Y, Kong Z, Zhang X, Sun B, Yu H, Chen Q, Luo C, Sun J, He Z. Pure photosensitizer-driven nanoassembly with core-matched PEGylation for imaging-guided photodynamic therapy. Acta Pharm Sin B 2021; 11:3636-47. [PMID: 34900542 DOI: 10.1016/j.apsb.2021.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 12/20/2022] Open
Abstract
Pure drug-assembled nanomedicines (PDANs) are currently under intensive investigation as promising nanoplatforms for cancer therapy. However, poor colloidal stability and less tumor-homing ability remain critical unresolved problems that impede their clinical translation. Herein, we report a core-matched nanoassembly of pyropheophorbide a (PPa) for photodynamic therapy (PDT). Pure PPa molecules are found to self-assemble into nanoparticles (NPs), and an amphiphilic PEG polymer (PPa-PEG2K) is utilized to achieve core-matched PEGylating modification via the π‒π stacking effect and hydrophobic interaction between the PPa core and the PPa-PEG2K shell. Compared to PCL-PEG2K with similar molecular weight, PPa-PEG2K significantly increases the stability, prolongs the systemic circulation and improves the tumor-homing ability and ROS generation efficiency of PPa-nanoassembly. As a result, PPa/PPa-PEG2K NPs exert potent antitumor activity in a 4T1 breast tumor-bearing BALB/c mouse xenograft model. Together, such a core-matched nanoassembly of pure photosensitizer provides a new strategy for the development of imaging-guided theragnostic nanomedicines.
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Key Words
- ACQ, aggregation caused quenching
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- BUN, blood urine nitrogen
- CRE, creatinine
- Core-matched
- DCFH-DA, 2′,7′-dichlorofluorescein diacetate
- DDS, drug delivery system
- FBS, fetal bovine serum
- Imaging-guided
- NPs, nanoparticles
- NaCl, sodium chloride
- Nanoassembly
- PBS, phosphate buffer solution
- PDANs, pure drug-assembled nanomedicines
- PDT, photodynamic therapy
- PPa, pyropheophorbide a
- PS, photosensitizer
- Photodynamic therapy
- Pure drug-assembled nanomedicines
- Pure photosensitizer
- Pyropheophorbide a
- ROS, reactive oxygen species
- SDS, sodium dodecyl sulfate
- SOSG, Singlet Oxygen Sensor Green Reagent
- Self-assembly
- nano-DDS, nanoparticulate drug delivery systems
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Hsieh MC, Wang CC, Yang CC, Lien CF, Wang CC, Shih YC, Yeh SA, Hwang TZ. Tegafur-Uracil versus 5-Fluorouracil in Combination with Cisplatin and Cetuximab in Elderly Patients with Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: A Propensity Score Matching Analysis. Biology (Basel) 2021; 10:biology10101011. [PMID: 34681110 PMCID: PMC8533478 DOI: 10.3390/biology10101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
Simple Summary Elderly patients with recurrent or metastatic head and neck squamous cell carcinoma are a unique subset because they are at increased risks of miserable prognosis. Although cisplatin, 5-fluorouracil plus cetuximab (EXTREME) is the most commonly used regimen, chemotherapy de-escalation strategy was suggested in elderly patients due to toxicity. Herein, an oral tegafur–uracil is usually substituted for 5-fluorouracil and combined with cisplatin plus cetuximab (UPEx) as a novel agent for elderly patients with recurrent or metastatic head and neck squamous cell carcinoma. The median progression-free survival was 5.4 months in UPEx and 5.8 months in EXTREME (p = 0.451). The median overall survival was 10.8 months in UPEx and 10.2 months in EXTREME (p = 0.807). Grade 3/4 adverse events were much fewer in UPEx than in EXTREME (p < 0.001). Our study demonstrated that UPEx is effective with improving safety profiles. We suggested UPEx might be a better treatment option for elderly patients with recurrent or metastatic head and neck squamous cell carcinoma. Abstract There are increasing incidences of elderly patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC). However, the treatment is not yet established. We conducted a propensity score matching analysis to evaluate the efficacy and safety of tegafur–uracil versus 5-fluorouracil in combination with cisplatin plus cetuximab in elderly patients with R/M HNSCC. Elderly patients with R/M HNSCC treated with cetuximab-containing chemotherapy were recruited into this study. In order to reduce the selection bias, propensity score matching was performed. Kaplan–Meier curves were plotted for progression-free survival (PFS) and overall survival (OS). Toxicities were graded according to the National Cancer Institute’s Common Terminology Criteria V3.0. After propensity sore matching, 54 patients with tegafur–uracil, cisplatin plus cetuximab (UPEx), and 54 patients with 5-fluorouracil, cisplatin plus cetuximab (EXTREME) were identified. The median PFS was 5.4 months in UPEx and 5.8 months in EXTREME (p = 0.451). The median OS was 10.8 months in UPEx and 10.2 months in EXTREME (p = 0.807). The overall response rate (ORR) and disease control rate (DCR) were insignificant in both arms, accounting for 61% versus 59% (p = 0.680) and 72% versus 70% (p = 0.732) in the UPEx arm and the EXTREME arm, respectively. A multivariate analysis showed that age and ECOG PS were, independently, predictors. Grade 3/4 adverse events were much fewer in UPEx than in EXTREME (p < 0.001). Both cetuximab-containing chemotherapies are effective in elderly patients with R/M HNSCC. Safety profiles are improved when tegafur–uracil is substituted for 5-fluorouracil. Further prospective studies are warranted to validate our conclusions.
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Affiliation(s)
- Meng-Che Hsieh
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung City 82445, Taiwan;
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
| | - Chih-Chun Wang
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
- Department of Otolaryngology, E-Da Hospital, Kaohsiung City 82445, Taiwan
| | - Chuan-Chien Yang
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
- Department of Otolaryngology, E-Da Hospital, Kaohsiung City 82445, Taiwan
| | - Ching-Feng Lien
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
- Department of Otolaryngology, E-Da Hospital, Kaohsiung City 82445, Taiwan
| | - Chien-Chung Wang
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
- Department of Otolaryngology, E-Da Hospital, Kaohsiung City 82445, Taiwan
| | - Yu-Chen Shih
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
- Department of Otolaryngology, E-Da Cancer Hospital, Kaohsiung City 82445, Taiwan
| | - Shyh-An Yeh
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
- Department of Radiation Oncology, E-Da Hospital, Kaohsiung City 82445, Taiwan
| | - Tzer-Zen Hwang
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
- Department of Otolaryngology, E-Da Hospital, Kaohsiung City 82445, Taiwan
- Correspondence:
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19
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Choi HG, Yeom HA. Identifying optimal care coordination strategies for older adults with cancer. Geriatr Nurs 2021; 42:1349-1355. [PMID: 34562807 DOI: 10.1016/j.gerinurse.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Han-Gyo Choi
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea.
| | - Hye-Ah Yeom
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea.
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20
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Dupuis HGA, Chebbi A, Surlemont L, Rigal O, Di Fiore F, Pfister C, Nouhaud FX. Efficacy and safety of anti-vascular endothelial growth factor therapies in older patients for first line treatment of metastatic renal cell carcinoma. Transl Androl Urol 2021; 10:2418-2426. [PMID: 34295728 PMCID: PMC8261413 DOI: 10.21037/tau-20-1481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/17/2021] [Indexed: 12/09/2022] Open
Abstract
Background immunotherapy became the first line treatment of metastatic renal cell carcinoma (mRCC). Nevertheless, a better understanding of the specificities of targeted therapies (TT) in the elderly population could be helpful in order to improve the management of mRCC in this population. The aim of this retrospective study was to assess efficacy and safety of sunitinib and sorafenib used as first-line TT in 70 years older patients compared to younger patients. Methods Data were retrospectively collected for all consecutive mRCC patients receiving first line TT treatment by sunitinib or sorafenib for mRCC from January 2006 to November 2017. Patients were divided into two groups according to the age using a cut-off at 70 years old. Median progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier method and compared using log-rank test. Results In total, 147 patients were included; 94 (63.9%) were <70 and 53 (36.1%) were 70 years old or more. First line TT used was sunitinib in 123 (83.7%) patients or sorafenib in 24 (16.3%) patients. Median PFS was 8 months for elderly patients vs. 6 in younger group (P=0.68). Median OS were 26 vs. 36 months (P=0.08). Severe induced toxicity was more frequent among elderly patients: 34 (64.2%) vs. 46 patients (48.9%) (P=0.07). Rate of treatment discontinuation due to toxicity was 22 patients (23.4%) in younger group vs. 28 patients (52.8%) in the elderly group (P=0.0005). Results were similar in the 2 groups regarding the type of toxicities. Conclusions Our results suggest similar efficacy of anti-vascular endothelial growth factor (VEGF) agents as first-line treatment for mRCC among younger and older patients with an age cut-off of 70 years. Safety results suggest that these drugs can be safely used for older patients with a need of caution regarding toxicity prevention.
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Affiliation(s)
| | - Ala Chebbi
- Urology Department, Rouen University Hospital, Rouen, France
| | - Louis Surlemont
- Urology Department, Rouen University Hospital, Rouen, France
| | - Olivier Rigal
- Medical Oncology Unit, Henri Becquerel Center, Rouen, France
| | | | - Christian Pfister
- Urology Department, Rouen University Hospital, Rouen, France.,Clinical Investigation Center, Inserm 1404, Onco Urology, Rouen, France
| | - François-Xavier Nouhaud
- Urology Department, Rouen University Hospital, Rouen, France.,Clinical Investigation Center, Inserm 1404, Onco Urology, Rouen, France
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21
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Feliu J, Espinosa E, Basterretxea L, Paredero I, Llabrés E, Jiménez-Munárriz B, Losada B, Pinto A, Custodio AB, Muñoz MDM, Gómez-Mediavilla J, Torregrosa MD, Cruz P, Higuera O, Molina-Garrido MJ. Prediction of Unplanned Hospitalizations in Older Patients Treated with Chemotherapy. Cancers (Basel) 2021; 13:1437. [PMID: 33809852 PMCID: PMC8004134 DOI: 10.3390/cancers13061437] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To determine the incidence of unplanned hospitalization (UH) and to identify risk factors for UH in elderly patients with cancer who start chemotherapy. METHODS In all, 493 patients over 70 years starting new chemotherapy regimens were prospectively included. A pre-chemotherapy geriatric assessment was performed, and tumor and treatment variables were collected. The association between these factors and UH was examined by using multivariable logistic regression. Score points were assigned to each risk factor. RESULTS During the first 6 months of treatment, 37% of patients had at least one episode of UH. Risk factors were the use of combination chemotherapy at standard doses, a MAX2 index ≥1, a Charlson comorbidity score ≥2, albumin level <3.5 g/dL, falls in the past 6 months ≥1, and weight loss >5%. Three risk groups for UH were established according to the score in all patients: 0-1: 17.5%; 2: 34%; and 3-7: 57% (p < 0.001). The area under receiver operation characteristic (ROC) curve was 0.72 (95% CI: 0.67-0.77). CONCLUSION This simple tool can help to reduce the incidence of UH in elderly patients with cancer who are scheduled to initiate chemotherapy treatment.
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Affiliation(s)
- Jaime Feliu
- Oncology Department, Hospital Universitario La Paz. IDIPAZ, Cátedra UAM-AMGEN, Centro de Investigación Biomédica en Red de Cáncer, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - Enrique Espinosa
- Oncology Department, Hospital Universitario La Paz. IDIPAZ, Cátedra UAM-AMGEN, Centro de Investigación Biomédica en Red de Cáncer, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - Laura Basterretxea
- Oncology Department, Hospital Universitario de Donostia, 20014 Donostia, Spain; (L.B.); (J.G.-M.)
| | - Irene Paredero
- Oncology Department, Hospital Universitario Dr. Peset, 46017 Valencia, Spain; (I.P.); (M.D.T.)
| | - Elisenda Llabrés
- Oncology Department, Hospital Universitario Insular de Gran Canarias, 35016 Las Palmas, Spain;
| | | | - Beatriz Losada
- Oncology Department, Hospital Universitario de Fuenlabrada, 28942 Fuenlabrada, Spain;
| | - Alvaro Pinto
- Oncology Department, Hospital Universitario La Paz. IDIPAZ, Cátedra UAM-AMGEN, Centro de Investigación Biomédica en Red de Cáncer, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - Ana Belén Custodio
- Oncology Department, Hospital Universitario La Paz. IDIPAZ, Cátedra UAM-AMGEN, Centro de Investigación Biomédica en Red de Cáncer, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - María del Mar Muñoz
- Oncology Department, Hospital Virgen de la Luz, 16002 Cuenca, Spain; (M.d.M.M.); (M.J.M.-G.)
| | | | | | - Patricia Cruz
- Oncology Department, Hospital Universitario La Paz. IDIPAZ, Cátedra UAM-AMGEN, Centro de Investigación Biomédica en Red de Cáncer, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - Oliver Higuera
- Oncology Department, Hospital Universitario La Paz. IDIPAZ, Cátedra UAM-AMGEN, Centro de Investigación Biomédica en Red de Cáncer, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
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22
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Proescholdt M, Jünger ST, Schödel P, Schebesch KM, Doenitz C, Pukrop T, Höhne J, Schmidt NO, Kocher M, Schulz H, Ruge M, König K, Goldbrunner R, Grau S. Brain Metastases in Elderly Patients-The Role of Surgery in the Context of Systemic Treatment. Brain Sci 2021; 11:123. [PMID: 33477588 DOI: 10.3390/brainsci11010123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/25/2020] [Accepted: 01/11/2021] [Indexed: 12/15/2022] Open
Abstract
In patients with brain metastases (BM), advanced age is considered a negative prognostic factor. To address the potential reasons for that, we assessed 807 patients who had undergone BM resection; 315 patients aged at least 65 years (group A) were compared with 492 younger patients (group B). We analyzed the impact of the pre- and postoperative Karnofsky performance status (KPS), postoperative treatment structure and post-treatment survival. BM resection significantly improved KPS scores in both groups (p = 0.0001). Median survival after BM resection differed significantly between the groups (A: 5.81 vs. B: 8.12 months; p = 0.0015). In both groups, patients who received postoperative systemic treatment showed significantly longer overall survival (p = 0.00001). However, elderly patients less frequently received systemic treatment (p = 0.0001) and the subgroup of elderly patients receiving such therapies had a significantly higher postsurgical KPS score (p = 0.0007). In all patients receiving systemic treatment, age was no longer a negative prognostic factor. Resection of BM improves the functional status of elderly patients, thus enhancing the likeliness to receive systemic treatment, which, in turn, leads to longer overall survival. In the context of such a treatment structure, age alone is no longer a prognostic factor for survival.
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