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Zhang M, Miao Y, Zhao C, Liu T, Wang X, Wang Z, Zhong W, He Z, Tian C, Sun J. Fine-tuning the activation behaviors of ternary modular cabazitaxel prodrugs for efficient and on-target oral anti-cancer therapy. Asian J Pharm Sci 2024; 19:100908. [PMID: 38623486 PMCID: PMC11017284 DOI: 10.1016/j.ajps.2024.100908] [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: 12/06/2023] [Revised: 01/27/2024] [Accepted: 02/25/2024] [Indexed: 04/17/2024] Open
Abstract
The disulfide bond plays a crucial role in the design of anti-tumor prodrugs due to its exceptional tumor-specific redox responsiveness. However, premature breaking of disulfide bonds is triggered by small amounts of reducing substances (e.g., ascorbic acid, glutathione, uric acid and tea polyphenols) in the systemic circulation. This may lead to toxicity, particularly in oral prodrugs that require more frequent and high-dose treatments. Fine-tuning the activation kinetics of these prodrugs is a promising prospect for more efficient on-target cancer therapies. In this study, disulfide, steric disulfide, and ester bonds were used to bridge cabazitaxel (CTX) to an intestinal lymph vessel-directed triglyceride (TG) module. Then, synthetic prodrugs were efficiently incorporated into self-nanoemulsifying drug delivery system (corn oil and Maisine CC were used as the oil phase and Cremophor EL as the surfactant). All three prodrugs had excellent gastric stability and intestinal permeability. The oral bioavailability of the disulfide bond-based prodrugs (CTX-(C)S-(C)S-TG and CTX-S-S-TG) was 11.5- and 19.1-fold higher than that of the CTX solution, respectively, demonstrating good oral delivery efficiency. However, the excessive reduction sensitivity of the disulfide bond resulted in lower plasma stability and safety of CTX-S-S-TG than that of CTX-(C)S-(C)S-TG. Moreover, introducing steric hindrance into disulfide bonds could also modulate drug release and cytotoxicity, significantly improving the anti-tumor activity even compared to that of intravenous CTX solution at half dosage while minimizing off-target adverse effects. Our findings provide insights into the design and fine-tuning of different disulfide bond-based linkers, which may help identify oral prodrugs with more potent therapeutic efficacy and safety for cancer therapy.
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Affiliation(s)
- Mingyang Zhang
- Department of Pharmaceutics, Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Yifan Miao
- Department of Pharmaceutics, Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Can Zhao
- Department of Pharmaceutics, Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Tong Liu
- Liaoning Provincial Institute of Drug Inspection and Testing, Shenyang 110036, China
| | - Xiyan Wang
- Department of Pharmaceutics, Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Zixuan Wang
- Department of Pharmaceutics, Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Wenxin Zhong
- Department of Pharmaceutics, Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Zhonggui He
- Department of Pharmaceutics, Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
- Joint International Research Laboratory of Intelligent Drug Delivery Systems, Ministry of Education, Shenyang 110016, China
| | - Chutong Tian
- Department of Pharmaceutics, Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
- Key Laboratory of Advanced Drug Delivery Systems of Zhejiang Province, Hangzhou 310058, China
- Joint International Research Laboratory of Intelligent Drug Delivery Systems, Ministry of Education, Shenyang 110016, China
| | - Jin Sun
- Department of Pharmaceutics, Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
- Joint International Research Laboratory of Intelligent Drug Delivery Systems, Ministry of Education, Shenyang 110016, China
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Koppinger S, Weil E, Ruffcorn N, McGurty E, Creal K, Rhoades M. Identifying metrics and designing measurable outcomes in the electronic health record to evaluate pharmacist intervention in an oral chemotherapy program. J Oncol Pharm Pract 2024:10781552241240439. [PMID: 38523336 DOI: 10.1177/10781552241240439] [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] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Due to the increased utilization of oral anticancer agents, pharmacist-led oral anticancer programs have emerged to meet the needs of oral anticancer management. Currently, at Froedtert & MCW, there is a lack of established tools to collect metrics which demonstrate the value of a pharmacist-led oral anticancer program. METHODS The purpose of this project is to establish metrics that reflect the interventions pharmacists are performing, and second, to develop a documentation tool which can reliably extract discrete data on the identified metrics. RESULTS Eight of the 10 desired metrics were included in the documentation tool. Two questionnaires were created to allow for easy data retrieval of the metrics. The "initial" questionnaire focuses on interventions made at the time of starting an oral anticancer agent, while the "follow-up" questionnaire focuses on interventions made during the subsequent monitoring. The introduction of the questionnaire tool was well received by end users and did not add to the pharmacist's overall workload. CONCLUSIONS By establishing metrics that reflect pharmacist interventions in a pharmacist-led oral anticancer program and creating a documentation tool to collect discrete data related to those metrics from the electronic health record, we at Froedtert & MCW are better able describe the workload of the ambulatory oncology pharmacists with regard to their interventions and monitoring of oral anticancer agents. This data will be used to establish differences in pharmacist workload between clinics, justify pharmacist resources, and provide a snapshot of the patient population served as part of the oral anticancer program.
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Affiliation(s)
- Shelby Koppinger
- Department of Pharmacy, Clinical Oncology Pharmacist at the time of the project and manuscript development, Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Pharmacy, Clinical Oncology Pharmacist, Oregon Health & Science University, Portland, OR, USA
| | - Elizabeth Weil
- Department of Pharmacy, Clinical Oncology Pharmacist, Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nichole Ruffcorn
- Department of Pharmacy, Clinical Oncology Pharmacist, Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Erin McGurty
- Department of Pharmacy, Clinical Oncology Pharmacist, Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin Creal
- Department of Information Technology, Informatics Pharmacist, Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melissa Rhoades
- Department of Pharmacy, Clinical Oncology Manager, Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
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Anderson MK, Bettencourt EV, LeFebvre KB. Defining the Role and Responsibilities of the Oral Anticancer Medication Nurse Navigator. Semin Oncol Nurs 2024:151582. [PMID: 38290927 DOI: 10.1016/j.soncn.2024.151582] [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: 12/01/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES The goal of this article is to define the role and responsibilities of the oral anticancer medication nurse navigator. METHODS This article combines findings from a review of scientific literature including research studies, quality improvement projects, case studies, standards, and guidelines combined with the experience and professional insights of the authors in the role creation and function of the oral anticancer medication nurse navigator. RESULTS The role of the oral anticancer medication nurse navigator includes coordination of patient care, pre-treatment assessment of barriers to adherence, patient and caregiver education, planned follow-up and coaching, and symptom management. Professionally, the role includes the development of interdisciplinary workflows, coordination of care with internal and external stakeholders, clinical staff education, the application of technology, and advocacy. CONCLUSION The oral anticancer medication nurse navigator uses the nursing process to coordinate care of the individual taking these medications. The role optimizes patient outcomes and benefits the healthcare organization through reduced healthcare costs and the ability to meet accreditation needs. IMPLICATIONS FOR NURSING PRACTICE The role of the oral anticancer medication nurse navigator provides value to patients taking oral anticancer medications and to the healthcare team.
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Affiliation(s)
- Mary K Anderson
- Senior Manager of Nursing Initiatives, NCODA, Louisville, KY.
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Huang CL, Wang GY, Lou JH, Chen L, Li QJ, Li KP, Liang XY, Li YQ, Sun Y, Ma J, Guo R, Tang LL, Chen L. Oral chemotherapy versus observation alone in nasopharyngeal carcinoma patients with persistently detected circulating cell-free Epstein-Barr virus DNA during follow-up. Radiother Oncol 2024; 190:110032. [PMID: 38007040 DOI: 10.1016/j.radonc.2023.110032] [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: 07/11/2023] [Revised: 10/18/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
AIM Despite the high risk of tumor recurrence, patients with nasopharyngeal carcinoma (NPC) with persistently (at least twice) detected circulating cell-free Epstein-Barr virus (EBV) DNA levels during follow-up are routinely recommended to keep observation. For these patients, whether administering more aggressive treatment could improve survival outcomes remains unknown. MATERIALS AND METHODS We retrospectively included 431 patients with nonmetastatic NPC with persistently detected EBV DNA during follow-up, who do not have clinical or imaging evidence of recurrence. Among these patients, 79 were administered oral chemotherapy, and the remaining 352 underwent observation alone. Baseline characteristics were balanced with propensity score matching (PSM) analysis. The primary endpoint was modified disease-free survival (mDFS), defined as time from detectable EBV DNA result to tumor recurrence or death. The secondary endpoints were disease-free survival (DFS) and overall survival (OS). RESULTS One-to-three PSM resulted in 251 eligible patients (oral chemotherapy group, 73; observation group, 178). In the matched cohort, the oral chemotherapy group had higher median mDFS (12.9 months [95 % confidence interval [CI] 9.6-16.3] vs. 6.8 months [95 % CI 5.8-7.8], p = 0.009) and DFS (24.1 months [95 % CI 18.5-29.7] vs. 16.7 months [95 % CI 14.4-19.1], p = 0.035) than the observation group. The median OS was numerically higher in the oral chemotherapy group than in the observation group (57.9 months [95 % CI 42.5-73.3] vs. 50.8 months [95 % CI 39.7-61.9], p = 0.71). A consistent benefit favoring oral chemotherapy was observed for mDFS in all subgroups analyses for male, <45 years, stage III-IVa disease, pretreatment EBV DNA load ≥ 4,000 copies/mL, no induction chemotherapy, or a detectable EBV DNA load ≥ 1,200 copies/mL. After adjusting for other confounders in the multivariate analysis, oral chemotherapy remained a significantly favorable factor for both mDFS (hazard ratio [HR] 0.67, 95 % CI 0.50-0.89; p = 0.006) and DFS (HR 0.68, 95 % CI 0.51-0.91; p = 0.01), but not a significant factor for OS (HR 0.89, 95 % CI 0.62-1.27; p = 0.52). CONCLUSIONS In patients with NPC having persistently detected EBV DNA levels but without clinical or imaging evidence of recurrence during follow-up, oral chemotherapy significantly prolongs mDFS and DFS. Employing oral chemotherapy as a more aggressive treatment option, as opposed to mere observation, could potentially benefit these patients, although further prospective validation is necessitated.
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Affiliation(s)
- Cheng-Long Huang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Gao-Yuan Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Jia-Hao Lou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Lin Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Qing-Jie Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Kun-Peng Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Xiao-Yu Liang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Ying-Qin Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Rui Guo
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Ling-Long Tang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Lei Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China.
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Sapet M, Migala C, Daguenet E, Collet P, Boussoualim K, Thomas T, Guyotat D, Augeul-Meunier K. Advanced practice nurse management in multiple myeloma treated with oral therapy. Bull Cancer 2023; 110:1251-1259. [PMID: 37696744 DOI: 10.1016/j.bulcan.2023.07.010] [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: 06/05/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Therapeutic approaches in Multiple Myeloma (MM) have considerably changed over the last few years, with effective oral chemotherapy and continuous treatment. In this context, the objective of this study was to examine the circuitry of an advanced practitioner nurse (APN)-led intervention that provided supportive care for MM patients treated with oral chemotherapy. METHODS This population-based study was conducted at the hematology department - Institut de Cancérologie Lucien Neuwirth (ICLN, Saint-Priest-en-Jarez), from April 2017 to September 2020. A follow-up program was established with a specialized APN in oncology. RESULTS All APN interventions were recorded, representing 1240 phone calls and 162 consultations for 42 MM patients. Eighty-two calls were referred to the physician with 45 consultations triggered. Most of the calls were frequent within the few first months, with a high request for information and reassurance, especially for treatment-naive or relapsed patients. In our study, the APN was able to manage multiple side effects through care organization (i.e., hospitalizations, transfusions) and a careful coordination between the primary care team and the hospital. DISCUSSION In order to respond to the high need for care pathway and safety improvement, especially in elderly population, we have initiated an original follow-up by an APN for MM patients treated with oral chemotherapy. While the role of APN has become prominent in the oncology field in recent years, its holistic approach has to be emphasized in further studies to bring a comprehensive perspective to health care coordination in the future.
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Affiliation(s)
- Manon Sapet
- University Hospital of Saint-Étienne, Department of Rheumatology, 42055 Saint-Étienne cedex 2, France.
| | - Cécile Migala
- Cancer Institute Lucien Neuwirth, Coordination platform, Saint-Priest-en-Jarez, France
| | - Elisabeth Daguenet
- Cancer Institute Lucien Neuwirth, Hematology Department, Saint-Priest-en-Jarez, France
| | - Philippe Collet
- Cancer Institute Lucien Neuwirth, Hematology Department, Saint-Priest-en-Jarez, France
| | - Karima Boussoualim
- University Hospital of Saint-Étienne, Department of Rheumatology, 42055 Saint-Étienne cedex 2, France
| | - Thierry Thomas
- University Hospital of Saint-Étienne, Department of Rheumatology, 42055 Saint-Étienne cedex 2, France
| | - Denis Guyotat
- Cancer Institute Lucien Neuwirth, Hematology Department, Saint-Priest-en-Jarez, France
| | - Karine Augeul-Meunier
- Cancer Institute Lucien Neuwirth, Hematology Department, Saint-Priest-en-Jarez, France
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Mugnier L, Espitalier F, Menegotto J, Bell S, Ré MI. Solid amorphous formulations for enhancing solubility and inhibiting Erlotinib crystallization during gastric-to-intestinal transfer. Pharm Dev Technol 2023; 28:697-707. [PMID: 37432652 DOI: 10.1080/10837450.2023.2233612] [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: 11/05/2022] [Revised: 06/23/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
The objective of this study was to improve the solubility and inhibit the crystallisation during the gastric-to-intestinal transfer of Erlotinib (ERL), a small molecule kinase inhibitor (smKI) compound class, which is classified as class II drug in the Biopharmaceutical Classification System (BCS). A screening approach combining different parameters (solubility in aqueous media, inhibitory effect of drug crystallisation from supersaturated drug solutions) was applied to selected polymers for the development of solid amorphous dispersions of ERL. ERL solid amorphous dispersions formulations were then prepared with 3 different polymers (Soluplus®, HPMC-AS-L, HPMC-AS-H) at a fixed drug: polymer ratio (1:4) by two different production methods (spray drying and hot melt extrusion). The spray-dried particles and cryo-milled extrudates were characterized by thermal properties, shape and particle size, solubility and dissolution behavior in aqueous media. The influence of the manufacturing process on these solid characteristics was also identified during this study. Based on the obtained results, it is concluded that the cryo-milled extrudates of HPMC-AS-L displayed better performance (enhanced solubility, reduced ERL crystallization during the simulated gastric-to-intestinal transfer) and represents a promising amorphous solid dispersion formulation for oral administration of ERL.
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Affiliation(s)
- L Mugnier
- Université de Toulouse, IMT Mines Albi, UMR CNRS 5302, Centre RAPSODEE, Albi, France
| | - F Espitalier
- Université de Toulouse, IMT Mines Albi, UMR CNRS 5302, Centre RAPSODEE, Albi, France
| | | | - S Bell
- Boehringer Ingelheim, Duluth, GA, USA
| | - M I Ré
- Université de Toulouse, IMT Mines Albi, UMR CNRS 5302, Centre RAPSODEE, Albi, France
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Nguyen AL. Impact of oral chemotherapy pharmacists on cost avoidance of oral oncolytics in an integrated health system. J Oncol Pharm Pract 2023; 29:1369-1373. [PMID: 36002947 DOI: 10.1177/10781552221122034] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND While the impact of oncology pharmacist interventions on patient outcomes has been well-documented in previous studies, there is a scarcity of articles relating to oncology pharmacists' impact on cost avoidance of oral oncolytics within an integrated health care system. Cost savings and cost avoidance studies are needed to help promote the expansion of clinical services provided by the oncology pharmacy department. OBJECTIVE The primary objective of this study was to analyze interventions made by oncology pharmacists in the Oral Chemotherapy Treatment Program (OCTP) at the Kaiser Permanente-San Diego Service Area and determine the direct cost avoidance effects over one year. A secondary objective was to evaluate oncologists' satisfaction with OCTP. METHODS This was a retrospective, observational, single-arm study where the drug cost avoidance impact resulting from oncology pharmacists' interventions was calculated. A report containing all documented oncology pharmacist interventions made in OCTP from 1 January to 31 December 2021 were reviewed for study inclusion. A retrospective chart review was conducted to verify that the interventions were made by the oncology pharmacists. The average wholesale price of drugs listed on Lexicomp as of 1 November 2021 was used to calculate drug cost avoidance values. RESULTS A total of 238 OCTP oncology pharmacist interventions associated with direct drug cost avoidance values were identified, amounting to a total cost avoidance of $2,521,844 and an annual return on investment of 440%.
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Affiliation(s)
- Analia L Nguyen
- Kaiser Permanente-San Diego Service Area, San Diego, CA, USA
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Liu X, Wang Z, Ren X, Chen X, Tao J, Guan Y, Yang X, Tang R, Yan G. pH-triggered dynamic erosive small molecule chlorambucil nano-prodrugs mediate robust oral chemotherapy. Asian J Pharm Sci 2023; 18:100832. [PMID: 37583708 PMCID: PMC10423923 DOI: 10.1016/j.ajps.2023.100832] [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: 03/08/2023] [Revised: 05/05/2023] [Accepted: 06/30/2023] [Indexed: 08/17/2023] Open
Abstract
Currently, the dynamic erosive small molecule nano-prodrug is of great demand for oral chemotherapy, owing to its precise structure, high drug loading and improved oral bioavailability via overcoming various physiologic barriers in gastrointestinal tract, blood circulation and tumor tissues compared to other oral nanomedicines. Herein, this work highlights the successful development of pH-triggered dynamic erosive small molecule nano-prodrugs based on in vivo significant pH changes, which are synthesized via amide reaction between chlorambucil and star-shaped ortho esters. The precise nano-prodrugs exhibit extraordinarily high drug loading (68.16%), electric neutrality, strong hydrophobicity, and dynamic large-to-small size transition from gastrointestinal pH to tumoral pH. These favorable physicochemical properties can effectively facilitate gastrointestinal absorption, blood circulation stability, tumor accumulation, cellular uptake, and cytotoxicity, therefore achieving high oral relative bioavailability (358.72%) and significant tumor growth inhibition while decreasing side effects. Thus, this work may open a new avenue for robust oral chemotherapy attractive for clinical translation.
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Affiliation(s)
| | | | - Xiaodie Ren
- Engineering Research Center for Biomedical Materials, Anhui Key Laboratory of Modern Biomanufacturing, School of Life Sciences, Anhui University, Hefei 230601, China
| | - Xinyang Chen
- Engineering Research Center for Biomedical Materials, Anhui Key Laboratory of Modern Biomanufacturing, School of Life Sciences, Anhui University, Hefei 230601, China
| | - Jinjin Tao
- Engineering Research Center for Biomedical Materials, Anhui Key Laboratory of Modern Biomanufacturing, School of Life Sciences, Anhui University, Hefei 230601, China
| | - Yuanhui Guan
- Engineering Research Center for Biomedical Materials, Anhui Key Laboratory of Modern Biomanufacturing, School of Life Sciences, Anhui University, Hefei 230601, China
| | - Xuefeng Yang
- Engineering Research Center for Biomedical Materials, Anhui Key Laboratory of Modern Biomanufacturing, School of Life Sciences, Anhui University, Hefei 230601, China
| | - Rupei Tang
- Engineering Research Center for Biomedical Materials, Anhui Key Laboratory of Modern Biomanufacturing, School of Life Sciences, Anhui University, Hefei 230601, China
| | - Guoqing Yan
- Engineering Research Center for Biomedical Materials, Anhui Key Laboratory of Modern Biomanufacturing, School of Life Sciences, Anhui University, Hefei 230601, China
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Talens-Bolós A, López-Pintor E, Guilabert-Mora M, Aznar-Saliente T, Orozco-Beltrán DL, Lumbreras-Lacarra B. Design and validation of an adherence scale to oral antineoplastic drugs. Farm Hosp 2023; 47:80-84. [PMID: 36894358 DOI: 10.1016/j.farma.2022.11.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/14/2022] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To design and validate a questionnaire to measure adherence to oral antineoplastic drugs. The availability of a simple, validated tool that can be applied to routine care will make it possible to detect and identify non-adherence in order to establish strategies to improve adherence and optimize the quality of healthcare services. METHOD Validation study of the questionnaire designed to assess adherence to antineoplastic drugs in a sample of outpatients who collect their medication in two Spanish hospitals. Its validity and reliability will be analyzed, based on a previous qualitative methodology study, using classical test theory and Rasch analysis. We will examine its performance, item fit, response structure and person fit to the predictions of the model, as well as dimensionality, item-person reliability, the appropriateness of the level of difficulty of the items to the sample, and the differential performance of the items according to gender.
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Affiliation(s)
- Amparo Talens-Bolós
- Servicio de Farmacia, Hospital General Universitario de Elda, Alicante, España; Departamento de Ingeniería, Área de Farmacia y Tecnología Farmacéutica, Universidad Miguel Hernández, Alicante, España.
| | - Elsa López-Pintor
- Departamento de Ingeniería, Área de Farmacia y Tecnología Farmacéutica, Universidad Miguel Hernández, Alicante, España; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | | | - Teresa Aznar-Saliente
- Departamento de Ingeniería, Área de Farmacia y Tecnología Farmacéutica, Universidad Miguel Hernández, Alicante, España; Servicio de Farmacia, Hospital General Universitario de San Juan de Alicante, Alicante, España
| | | | - Blanca Lumbreras-Lacarra
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, España; Departamento de Salud Pública e Historia de la Ciencia, Universidad Miguel Hernández, Alicante, España
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Elston Lafata J, Nguyen B, Staresinic C, Johnson M, Gratie D, Muluneh B. Interpersonal communication-, education- and counselling-based interventions to support adherence to oral anticancer therapy: a systematic review. J Oncol Pharm Pract 2023; 29:358-369. [PMID: 35048768 DOI: 10.1177/10781552211073576] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background. Many factors contribute to oral anti-cancer therapy adherence, including counselling and educational support. Objective. We systematically review the literature evaluating the effectiveness of interpersonal communication-, counselling- and education-based interventions on patient adherence to oral anticancer therapy. Methods. Using search terms pertaining to medication adherence, oral anticancer therapy, and communication, education, and counselling, we conducted a systematic search for full-text, original research articles prior to 3/13/20. Two reviewers independently reviewed each paper for inclusion and charted study information. Results. Twenty-four articles were included. All considered the use of oral anticancer therapy between two defined time points. Four studies also considered the length of time a patient persisted on therapy. Half (n = 12) of the studies reported a statistically significant relationship between the intervention and medication adherence, with no consistent pattern among intervention structure/content and effectiveness. Programmes offering in-person counselling and those targeting patients with chronic myeloid leukemia (CML), tended to report positive findings. Most studies faced substantial risk of bias, and only two reported using a behavioural theory to guide interventional content. Conclusions. Findings highlight the infancy of evidence base and need for rigorous and large-scale studies grounded in established behavioural theories to advance patient-targeted educational and counselling practices supporting adherence to oral anti-cancer therapy.
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Chen Y, Chen Z, Jin H, Chen Y, Bai J, Fu G. Associations of financial toxicity with symptoms and unplanned healthcare utilization among cancer patients taking oral chemotherapy at home: a prospective observational study. BMC Cancer 2023; 23:140. [PMID: 36765325 PMCID: PMC9912596 DOI: 10.1186/s12885-023-10580-4] [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: 05/18/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Cancer patients with financial toxicity experience psychological distress and often miss medical appointments and quit treatments early, which could be a barrier to the effective management of oral chemotherapy drugs at home. This study explores whether financial toxicity predicts symptoms and unplanned healthcare utilization among cancer patients taking oral chemotherapy at home, which will contribute to the safe management of oral chemotherapy. METHODS Data in this study was from a prospective observational study, which was conducted between October 2018 and December 2019. 151 patients completed the Comprehensive Score for Financial Toxicity at discharge and completed the MD Anderson Symptom Inventory and unplanned healthcare utilization questionnaires after finishing one cycle of oral chemotherapy at home. Regression analyses were conducted to explore the associations of financial toxicity with symptoms and unplanned healthcare utilization. RESULTS Among 151participants, 88.08% reported severe or moderate financial toxicity, 43.05% reported symptom interference, and 31.79% reported unplanned healthcare utilization while taking oral chemotherapy at home. Patients between the age of 45-60y (p = 0.042) have higher financial toxicity, while those living in urban areas (p = 0.016) have lower financial toxicity. Patients with worse financial toxicity suffered increased symptoms of fatigue, emotional distress, disturbed sleep, and lack of appetite. Consequently, their mood and personal relation with other significant suffered. However, no statistical differences in unplanned healthcare utilization were found among patients with different levels of financial toxicity. CONCLUSION Middle-aged adults and those living in suburban or rural areas experienced worse financial toxicity than other groups. Patients with worse financial toxicity experienced more severe psychological symptoms (e.g., fatigue, distress, disturbed sleep, and lack of appetite) and affective interference (e.g., mood and relations with others). Identifying at-risk patients is necessary to offer tailored support for psychological symptom management.
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Affiliation(s)
- Yongfeng Chen
- grid.410652.40000 0004 6003 7358Nursing Department, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhenxiang Chen
- grid.410652.40000 0004 6003 7358The Department of Chemotherapy, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Haiyun Jin
- grid.410652.40000 0004 6003 7358The Department of Chemotherapy, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yanrong Chen
- grid.410652.40000 0004 6003 7358The Department of Chemotherapy, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, 30322, Atlanta, GA, USA.
| | - Guifen Fu
- Nursing Department, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China. .,Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, 530021, Nanning, China.
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12
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Talens-Bolós A, López-Pintor E, Guilabert-Mora M, Aznar-Saliente T, Orozco-Beltrán DL, Lumbreras B. [Translated article] Design and validation of a scale to measure adherence to oral antineoplastic drugs. Farm Hosp 2023; 47:T80-T84. [PMID: 36681553 DOI: 10.1016/j.farma.2022.12.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/14/2022] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Design and validate a scale to measure adherence to oral antineoplastic drugs. The availability of a simple, validated tool that can be applied to routine care will make it possible to detect and identify non-adherence in order to establish strategies to improve adherence and optimize the quality of healthcare services. METHOD Validation study of the scale designed to assess adherence to antineoplastic drugs in a sample of outpatients who collect their medication in two Spanish hospitals. Its validity and reliability will be analyzed, based on a previous qualitative methodology study, using classical test theory and Rasch analysis. We will examine its performance, item fit, response structure and person fit to the predictions of the model, as well as dimensionality, item-person reliability, the appropriateness of the level of difficulty of the items to the sample, and the differential performance of the items according to gender.
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Affiliation(s)
- Amparo Talens-Bolós
- Servicio de Farmacia, Hospital General Universitario de Elda, Alicante, Spain; Departamento de Ingeniería Área de Farmacia y Tecnología Farmacéutica, Universidad Miguel Hernández, Alicante, Spain.
| | - Elsa López-Pintor
- Departamento de Ingeniería Área de Farmacia y Tecnología Farmacéutica, Universidad Miguel Hernández, Alicante, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Teresa Aznar-Saliente
- Departamento de Ingeniería Área de Farmacia y Tecnología Farmacéutica, Universidad Miguel Hernández, Alicante, Spain; Servicio de Farmacia. Hospital General Universitario de San Juan de Alicante, Alicante, Spain
| | | | - Blanca Lumbreras
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departamento de Salud Pública e Historia de la Ciencia, Universidad Miguel Hernández, Alicante, Spain
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Abstract
INTRODUCTION Patients on oral oncolytics are responsible for self-monitoring adherence and adverse drug reactions (ADRs). Oncology pharmacists are in position to focus on quality and safety of care for patients on oncolytics while providing communication between the patient, physician, and specialty pharmacies. This pilot aimed to monitor patients treated by our leukemia team initiated on oral oncolytics. METHODS From July 2020 to February 2021, patients treated by our leukemia team newly started on oncolytics were included. Pharmacists performed medication reconciliation and drug interaction screening on initiation of oral oncolytic. Pharmacists followed up at predefined intervals. On follow up adherence was assessed using the Morisky Medication Adherence Scale-8 (MMAS-8) and patient reported outcomes (PROs) were assessed using the revised Edmonton Symptom Assessment Scale (ESAS-r). After each follow-up, a note was placed in the chart with assessment scores and recommendations. RESULTS A total of 32 patients were screened with 19 patients included. Oral oncolytics included: imatinib (4), dasatinib (5), ponatinib (1), gilteritinib (2), enasidenib (1), and venetoclax (6). Fourteen drug interactions were identified, 11 medications discontinued, nine medications added, and two medications doses were changed. Twenty-six adherence assessments were performed with 21, 4, and 1 assessment demonstrating adherence, medium adherence, and low adherence, respectively. 62 ESAS-r assessments were performed with 64% reported as no symptoms, 17% as mild, 13% as moderate, and 5% as severe symptoms. Twenty laboratory tests were ordered from pharmacist recommendation on initiation and follow-up. CONCLUSION This pilot demonstrated the role pharmacists play in oral oncolytic monitoring and symptom management.
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Affiliation(s)
- Jessie Signorelli
- Department of Pharmacy, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Bell
- Department of Pharmacy, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Stephanie Monaco
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York City, NY, USA
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Canadeo A, Fournogerakis M, Zook F. A Multi-disciplinary Approach to Managing Chronic Myelogenous Leukemia Patients on Oral Anticancer Therapy at a Large Academic Medical Center. Curr Hematol Malig Rep 2021; 16:509-516. [PMID: 34618316 DOI: 10.1007/s11899-021-00659-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/08/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Since the discovery of imatinib, an oral breakpoint cluster region-Abelson murine leukemia tyrosine kinase inhibitor, chronic myelogenous leukemia transformed from a hematologic malignancy primarily treated with intravenous chemotherapy to a disease almost solely managed with oral agents. While certainly there are benefits to taking a medication at home, this change in treatment modality also came with unique challenges, including patient adherence, medication acquisition and cost, and toxicity management. RECENT FINDINGS Pharmacists are uniquely equipped to assist with educating patients, safe prescribing, and access to medications. Several studies have described the benefits of an integrated oral anticancer medication management program in the ambulatory setting, including improvements in patient adherence, side effect management, patient comprehension, and drug-interaction detection. Pharmacists are also specially trained to assist with medication dose adjustments, relative lab monitoring, and co-pay assistance. Here, we describe the multidisciplinary workflows established to manage oral therapies in chronic myelogenous leukemia patients in a malignant hematology clinic at a large academic medical center. By using the unique talents of the clinic pharmacist, clinic nurse, and specialty retail pharmacy group, patients can be triaged to help ensure the correct skill set is used to optimally care for patients. An acuity-based monitoring structure can improve the ability to reach and safely monitor a large volume of patients.
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Affiliation(s)
- Angela Canadeo
- Froedtert & Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | - Mary Fournogerakis
- Froedtert & Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Felicia Zook
- Froedtert & Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
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15
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O'Mahony C, Murphy KD, Byrne S. A mixed methods analysis of the monitoring of oral anti-cancer therapies. Eur J Oncol Nurs 2021; 54:102026. [PMID: 34487968 DOI: 10.1016/j.ejon.2021.102026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/05/2021] [Accepted: 09/01/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE Oral anti-cancer therapies offer advantages over parenteral therapies in terms of their non-invasive nature and reduced intrusiveness. However, the shift from directly observed administration of these therapies to home administration means that continuous monitoring is needed. The oral anti-cancer therapy market is rapidly growing, with an ever-increasing number of new medicines available for the patients presenting with cancer illnesses. This study aims to (i) evaluate both the cost of providing monitoring consultations of oral anti-cancer therapies, and (ii) to assess the experience of cancer therapy nurses responsible for the monitoring and their opinions of the quality of the service. METHODS This study provides a mixed methods evaluation of the monitoring of oral anti-cancer therapies. Nurses were asked to record the time taken for them to perform their monitoring duties, and staff related costs were calculated using publicly available salary data. Patient-related costs were calculated using the Human Capital method. Nurses were asked to discuss their experience of monitoring oral anti-cancer therapies in semi-structured interviews. These interviews were subsequently analysed using thematic analysis. RESULTS 201 recordings and their associated costs were documented. The median consultation time was 33 min, costing €22.10 using Clinical Nurse Specialist salary figures and €26.51 using Advanced Nurse Practitioner salary figures. The associated patient cost was €14.06. Themes of the effect of Covid-19 on the service, expanding and complicated care package requirements, the need for dedicated oral clinics and the future of the service emerged from the interview data. CONCLUSION The monitoring service provided by nurses may be undervalued. The commitment to fully dedicated oral anti-cancer therapy clinics and an increase in staff to align with the ongoing increase in service demand is seen as vital for the continued safe and effective delivery of this specialist cancer service.
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Affiliation(s)
- Cian O'Mahony
- Pharmaceutical Care Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland.
| | - Kevin D Murphy
- Pharmaceutical Care Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland
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16
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Kharmoum S, Najdi A, Rahhali R, Meliani M, Boutayeb S, Mrabti H, El Ghissassi I, Afqir S, Mellas N, Ichou M, El M'Rabet FZ, Errihani H. [Evaluation of the practice of prescribing oral chemotherapy type "Capecitabine" by medical oncologist: A first study from Morocco]. Bull Cancer 2021:S0007-4551(21)00246-0. [PMID: 34281729 DOI: 10.1016/j.bulcan.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/25/2021] [Accepted: 04/29/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Oral anticancer therapy is becoming increasingly developed; their prescription has become a common practice in oncology. However, there is a variability and diversity in prescription practice. Its magnitude has been very little studied in scientific literature. To our knowledge, this is the first study in Morocco and North Africa to evaluate the practice of prescribing oral chemotherapy. METHODS The authors conducted a national exhaustive cross-sectional survey, to evaluate the practice of the oral chemotherapy "Capecitabine" type prescription by Moroccan oncologists and to identify strategies to promote an adherence to oral anti-neoplasic therapy. RESULTS Ninety-one medical oncologists answered out of 118, from public oncology centres (29.7%), Hospital University (58.2%), and private sector (12.1%). Thirty-four of the oncologists replied by email, 33 through phone conversation and 24 by filling paper questionnaires. In total, 32% of the cases were handwritten prescriptions, and 51.6% electronically generated. Forty-six percent of medical oncologists dedicated more time to the oral chemotherapy type Capecitabine prescription versus its intravenous equivalent 5FU. However, 33% medical oncologists take less time to this prescription, and 20.9% of them take the same time. Adherence to oral chemotherapy was evaluated by simply questioning of patients in most of the cases (94%) and 4% of medical oncologist declared that they did not evaluate this adherence. In total, 87.9% of Moroccan medical oncologists revealed that they have not received any specific training in the therapeutic education of the patient with oral anti-cancer treatment. CONCLUSION In Morocco, there is a great variability in prescription and follow-up practice for patients receiving oral chemotherapy. There is a lack of a national standardization with regards to the procedures of prescribing and monitoring patients to ensure the quality and safety of the oral chemotherapy prescription.
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Karaaslan-Eşer A, Ayaz-Alkaya S. The effect of a mobile application on treatment adherence and symptom management in patients using oral anticancer agents: A randomized controlled trial. Eur J Oncol Nurs 2021; 52:101969. [PMID: 33991868 DOI: 10.1016/j.ejon.2021.101969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/23/2021] [Accepted: 04/18/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE The use of mobile health technologies in the management of oral anticancer agents (OAA) can be beneficial in terms of treatment adherence and symptom management. This study was conducted to investigate the effect of a mobile application developed for patients using OAA on treatment adherence and symptom management. METHOD The study was conducted using a randomized controlled trial design, and it was carried out on 77 patients. Data were collected from the Oral Chemotherapy Adherence Scale (OCAS), and the Memorial Symptom Assessment Scale (MSAS). Data were collected at the beginning of the research, and face-to-face interviews were conducted after one, three, and six months. Patients in the intervention group were followed up for six months using the mobile application. RESULTS It was found that there was no difference between the intervention and control groups in the baseline OCAS mean scores (p > 0.05), and the mean score of the intervention group increased over the first, third- and sixth-month measurements (p < 0.05). It was found that there was no difference between the intervention and control groups in the MSAS mean scores (p > .05), and there was a decrease in the mean MSAS score of the intervention group between the third- and sixth-month follow-up (p < .05). CONCLUSION The present study results showed that the mobile application is effective in managing symptoms and increasing treatment adherence. A well-designed mobile health application that increases treatment adherence, decreases symptom severity, and supports patients' self-management could be beneficial for patients using OAA. CLINICALTRIALS. GOV IDENTIFIER NCT04626830.
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18
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Zhang Q, Feng Z, Wang H, Su C, Lu Z, Yu J, Dushkin AV, Su W. Preparation of camptothecin micelles self-assembled from disodium glycyrrhizin and tannic acid with enhanced antitumor activity. Eur J Pharm Biopharm 2021; 164:75-85. [PMID: 33878433 DOI: 10.1016/j.ejpb.2021.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/23/2020] [Revised: 03/30/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
Natural compounds as carriers for hydrophobic drugs have been increasingly used in drug delivery systems. In this study, disodium glycyrrhizin (Na2GA), tannic acid (TA) and camptothecin (CPT) were firstly used to prepare the camptothecin solid dispersion (CPT SD). When dissolved in a solution medium, Na2GA self-assembled to form micelles and CPT was encapsulated in micelles, meanwhile, TA connected with Na2GA through hydrogen bonds to form a contract shell. The average diameter of the CPT-loaded micelles is 80 nm with the critical micellar concentration of 0.303 mg/mL, the zeta potential of -33 mV, the PDI of 0.25 and drug loading 6.22%. In vitro experiments confirmed that the drug-loaded micelles exhibited excellent stability and permeability in the intestinal environment. Furthermore, the formulation showed excellent anti-tumor activity in vitro and in vivo. These findings imply that this nano-micelles provide a more potential and efficacious oral drug formulation for chemotherapy.
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Affiliation(s)
- Qihong Zhang
- National Engineering Research Center for Process Development of Active Pharmaceutical Ingredients, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, PR China
| | - Zongmiao Feng
- Key Laboratory for Green Pharmaceutical Technologies and Related Equipment of Ministry of Education, College of Pharmaceutical Sciences, Zhejiang University of Technology, Hangzhou 310014, PR China
| | - Hui Wang
- National Engineering Research Center for Process Development of Active Pharmaceutical Ingredients, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, PR China
| | - Chen Su
- National Engineering Research Center for Process Development of Active Pharmaceutical Ingredients, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, PR China
| | - Zhaohui Lu
- National Engineering Research Center for Process Development of Active Pharmaceutical Ingredients, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, PR China
| | - Jingbo Yu
- National Engineering Research Center for Process Development of Active Pharmaceutical Ingredients, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, PR China
| | - Alexandr V Dushkin
- Institute of Solid State Chemistry and Mechanochemistry, Novosibirsk, Russia
| | - Weike Su
- National Engineering Research Center for Process Development of Active Pharmaceutical Ingredients, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, PR China; Key Laboratory for Green Pharmaceutical Technologies and Related Equipment of Ministry of Education, College of Pharmaceutical Sciences, Zhejiang University of Technology, Hangzhou 310014, PR China.
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Gönderen Çakmak HS, Kapucu S. The Effect of Educational Follow-Up with the Motivational Interview Technique on Self-Efficacy and Drug Adherence in Cancer Patients Using Oral Chemotherapy Treatment: A Randomized Controlled Trial. Semin Oncol Nurs 2021; 37:151140. [PMID: 33766423 DOI: 10.1016/j.soncn.2021.151140] [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: 07/20/2020] [Revised: 01/20/2021] [Accepted: 01/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study aimed to determine the effect of educational follow-up with the motivational interview technique on drug adherence and self-efficacy in patients with cancer using at least one oral chemotherapy drug. DATA SOURCES A total of 80 patients with cancer were randomly allocated to the intervention group or the control group. Educational follow-up with the motivational interview technique was applied to the patients with phone calls during weeks 1, 3, 6, and 9. Patients in the intervention and control groups were evaluated during both the first interview and at week 12 using a questionnaire, the medication adherence self-efficacy scale (MASES), and oral chemotherapy adherence scale (OCAS). CONCLUSION At the end of the study, the level of drug adherence and self-efficacy of patients who received educational follow-up with the motivational interview technique by phone call increased significantly (P < .001). Additionally, the level of drug self-efficacy of patients increased (P < .001). IMPLICATIONS FOR NURSING PRACTICE This study emphasizes treatment compliance problems of patients with cancer using oral chemotherapy. Designed with communication techniques that will be added to our counseling process, interventions can allow nurses to use their time effectively.
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Affiliation(s)
| | - Sevgisun Kapucu
- Faculty of Nursing, Internal Medicine Nursing Department, Hacettepe University, Ankara, Turkey
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20
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Poort H, Jacobs JM, Pirl WF, Temel JS, Greer JA. Fatigue in patients on oral targeted or chemotherapy for cancer and associations with anxiety, depression, and quality of life. Palliat Support Care 2020; 18:141-7. [PMID: 31535613 DOI: 10.1017/S147895151900066X] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Oral treatment (targeted or chemotherapy) for cancer is being increasingly used. While fatigue is a known side effect of intravenous chemotherapy, the rate of fatigue and the impact of fatigue on other patient-reported outcomes are not well described. METHOD At Massachusetts General Hospital Cancer Center, 180 adult patients prescribed oral targeted or chemotherapy for various malignancies enrolled in a randomized controlled trial of adherence and symptom management. Patients completed baseline self-reported measures of fatigue (Brief Fatigue Inventory; BFI), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale; HADS), and quality of life, including subscales for physical, social, emotional, and functional well-being ([QOL] Functional Assessment of Cancer Therapy - General; FACT-G). We examined clinically relevant fatigue using a validated cut-off score for moderate-severe fatigue (BFI global fatigue ≥4) and tested the associations with anxiety symptoms, depressive symptoms, and QOL with independent samples t-tests. RESULTS At baseline, 45 of 180 participants (25.0%) reported moderate-severe fatigue. Fatigued patients experienced more anxiety symptoms (mean diff. 3.73, P < 0.001), more depressive symptoms (mean diff. 4.14, P < 0.001), and worse QOL on the total FACT-G score (mean diff. -19.58, P < 0.001) and all subscales of the FACT-G compared to patients without moderate-severe fatigue. SIGNIFICANCE OF RESULTS One in four patients on oral treatment for cancer experienced clinically relevant fatigue that is associated with greater anxiety and depressive symptoms and worse QOL.
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21
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Leong C, Czaykowski P, Geirnaert M, Katz A, Dragan R, Yogendran M, Raymond C. Outpatient oral anticancer agent utilization and costs in Manitoba from 2003 to 2016: a population-based study. Can J Public Health 2021; 112:530-540. [PMID: 33471346 DOI: 10.17269/s41997-020-00464-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 12/03/2020] [Indexed: 11/17/2022]
Abstract
INTERVENTION In April 2012, the Manitoba Home Cancer Drug Program (HCDP) was introduced to allow 100% coverage for eligible oral anticancer agents (OAA) and supportive medications for Manitobans with cancer requiring these therapies. RESEARCH QUESTIONS What is the extent of use and cost of OAAs among outpatients in Manitoba from 2003/04 to 2015/16? Did the HCDP change OAA user and prescription patterns? METHODS This was a retrospective, population-based study using administrative data to measure the prevalence of drug utilization over time and the impact of HCDP on OAA use and prescriptions using generalized linear models. Manitobans with cancer who filled an OAA or supportive medication covered by HCDP from 2003/04 to 2015/16 were included. RESULTS This study included 22,393 people with cancer who filled an OAA prescription. The prevalence of OAA use increased from 222 per 100,000 to 328 per 100,000 from 2003/04 to 2015/16. Hormone therapy for breast cancer was the most common class of OAA used (increased from 154 per 100,000 to 231 per 100,000). We observed a 2.6-fold decrease in the prevalence of oral alkylating agents and a 10.7-fold increase in the prevalence of protein kinase inhibitors during the study period. The total cost of targeted OAAs per year for all Manitobans with cancer increased from $1.8 million to $19 million. CONCLUSION We observed an increase in OAA prevalence and the cost of oral targeted chemotherapy is high. Our findings underline the need for addressing these high-cost medications in future developments of a national drug program.
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Affiliation(s)
- Christine Leong
- College of Pharmacy, University of Manitoba, 219 Apotex Centre, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada.
| | - Piotr Czaykowski
- CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Internal Medicine, Section of Haematology/Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Alan Katz
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | | | - Colette Raymond
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
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22
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Abstract
Background With the increase of oral chemotherapy drugs, patients receiving cancer treatment prefer oral chemotherapy versus intravenous, given equal efficacy and toxicity. However, they need to take an active part in their care, which is vital with home-based oral therapy, therefore the self-management is important for patients with oral chemotherapy. Unfortunately, the development of self-management assessment tools for oral chemotherapy still lags behind. Methods The OCSMS item pool was formulated based on literature review and semi-structured interviews, An initial scale containing 5 dimensions and 38 items was constructed through research seminar, Delphi survey and pilot testing. To assess the validity and reliability, We recruited 261 patients from cancer hospital in China. Results A 36-item scale was developed with five dimensions identified through factor analysis: daily life management, symptom management, medication management, emotional cognitive management and social support. Cronbach’s coefficient Alpha, split-half coefficient, test-retest reliability and S-CVI/UA scores were 0.929, 0.773, 0.966 and 0.833, respectively, indicating that OCSMS has good reliability and validity. Conclusions The OCSMS is a valid, reliable measurement method of the self-management ability of patients with oral chemotherapy. The OCSMS shows potential as a tool to ensure the safety of patients with cancer. The OCSMS may help evaluate the effectiveness of interventions to improve the self-management ability of patients.
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Affiliation(s)
- Qi Peng
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, East Banshan Road, Gongshu District, Hangzhou, Zhejiang, People's Republic of China, 310022
| | - Wanying Wu
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, East Banshan Road, Gongshu District, Hangzhou, Zhejiang, People's Republic of China, 310022.
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Marmorat T, Rioufol C, Ranchon F, Préau M. Encounters between medical and lay knowledge in therapeutic patient education. A qualitative study based on an oral chemotherapy program. Patient Educ Couns 2020; 103:537-543. [PMID: 31685357 DOI: 10.1016/j.pec.2019.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The growing number of cancer patients treated with Oral Chemotherapy (OC) at home, is prompting many healthcare centers to develop Therapeutic Patient Education (TPE) programs. This study aimed to 1) describe the different forms of knowledge shared and learned in these programs, and 2) better understand how self-care and psychosocial skills are promoted in the TPE context. METHOD This study used qualitative data from the French "ONCORAL" program. Data collection was conducted with non-participant observations. The corpus comprised 42 TPE sessions. RESULTS Analysis highlighted that TPE specifically helps patients' functional health, revealed the medical expectations and social norms that shape the patient's role, and exposed the difficulties faced by the patient when acquiring self-care skills. Self-care skills and psychosocial skills also appeared to be mutually dependent in the context of TPE. CONCLUSION TPE programs which focus more on developing medical knowledge inevitably give less importance to psychosocial skills. Yet the recognition and promotion of the latter in TPE may lead to positive coping strategies related to medical outcomes, such as adherence. PRACTICE IMPLICATION Dedicated TPE program objectives for patients undergoing oral chemotherapy should recognize not only the value of medical knowledge but also of lay knowledge.
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Affiliation(s)
- Thibaud Marmorat
- Social Psychology Research Group (EA 4163 GRePS), Lyon 2 University, Lyon University, Lyon, France.
| | - Catherine Rioufol
- Parmacy Department, Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils of Lyon, Pierre-Bénite, France; Université Lyon 1, EMR 3738, Lyon, France
| | - Florence Ranchon
- Parmacy Department, Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils of Lyon, Pierre-Bénite, France; Université Lyon 1, EMR 3738, Lyon, France
| | - Marie Préau
- Social Psychology Research Group (EA 4163 GRePS), Lyon 2 University, Lyon University, Lyon, France
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N Heck J, A Null A. Frequency of appropriate lab monitoring of oral chemotherapy in an outpatient setting. J Oncol Pharm Pract 2019; 26:1097-1102. [PMID: 31684819 DOI: 10.1177/1078155219882077] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study is to understand the frequency of appropriate laboratory monitoring of oral chemotherapy at the Eastern Colorado Health Care System (ECHCS) compared to recommendations set forth in the 2012 Veterans Health Administration (VHA) Guidance on Dispensing and Monitoring of Oral Chemotherapy. METHODS This study is a retrospective chart review of patients who have received a subset of oral chemotherapy drugs at ECHCS. Patients 18 to 89 years of age with an active cancer diagnosis who initiated therapy at ECHCS between September 1, 2010 and August 31, 2014 were included in the study. Initial and subsequent prescription fill dates, appropriate labs as defined by VHA guidance and baseline and follow-up lab monitoring dates, and appropriate labs as defined by VHA guidance were collected for up to 12 cycles of chemotherapy per patient. Baseline labs were defined as within three months of the first prescription fill date, and follow-up labs were defined as within seven days of subsequent prescription fill dates. RESULTS Results are presented as complete, partial, or incomplete and as attempt or no attempt at monitoring according to the VHA guidance recommendations. There was 100% attempt at laboratory monitoring at baseline; however, there was a decline in attempt and complete follow-up monitoring overall as well as for drugs that require special monitoring. CONCLUSION Based on recommendations from the 2012 VHA Guidance on Dispensing and Monitoring Oral Chemotherapy, data presented here demonstrate that ECHCS could benefit from improved lab monitoring in order to ensure safe and effective use of oral chemotherapies. These results provide a unique opportunity to consider the potential role of clinical pharmacists in monitoring and management of patients receiving oral chemotherapies as well as patient and provider education regarding the importance of appropriate lab monitoring.
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Affiliation(s)
- Jessica N Heck
- VA Eastern Colorado Health Care System, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Aaron A Null
- VA Eastern Colorado Health Care System, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
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Aapro M, Ruiz-Borrego M, Hegg R, Kukielka-Budny B, Morales S, Cinieri S, Freitas-Junior R, Garcia-Estevez L, Szombara E, Borges GS, Passalacqua R, Hervieu H, Groc M, Villanova G. Randomized phase II study evaluating weekly oral vinorelbine versus weekly paclitaxel in estrogen receptor-positive, HER2-negative patients with advanced breast cancer (NorBreast-231 trial). Breast 2019; 45:7-14. [PMID: 30802822 DOI: 10.1016/j.breast.2019.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 10/30/2018] [Revised: 12/29/2018] [Accepted: 01/24/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Single-agent paclitaxel and vinorelbine are recommended treatments for advanced breast cancer (ABC) non-responsive to hormone therapy and without visceral crisis. This phase II trial compared first-line oral vinorelbine versus weekly paclitaxel for ABC. METHODS Eligible female patients had measurable locally recurrent/metastatic estrogen receptor-positive HER2-negative breast cancer and had received prior endocrine therapy (any setting) but no chemotherapy for ABC. Patients were stratified by prior taxane and visceral metastases and randomized to either oral vinorelbine 80 mg/m2 (first cycle at 60 mg/m2, escalated to 80 mg/m2 in the absence of grade 3/4 toxicity) or intravenous paclitaxel 80 mg/m2 on days 1, 8, and 15 every 3 weeks until disease progression or unacceptable toxicity. The primary endpoint was disease control rate (DCR; confirmed complete or partial response, or stable disease for ≥6 weeks). RESULTS The 131 randomized patients had received a median of 2 prior endocrine therapies; >70% had prior (neo)adjuvant chemotherapy and 79% visceral metastases. DCR was 75.8% (95% confidence interval: 63.6-85.5%) with vinorelbine and 75.4% (63.1-85.2%) with paclitaxel. The most common grade 3/4 adverse events were neutropenia (52%), fatigue (11%), and vomiting (5%) with vinorelbine, and neutropenia (17%), dyspnea (6%), hypertension (6%), and peripheral sensory neuropathy (5%) with paclitaxel. Grade 2 alopecia occurred in 2% of vinorelbine-treated and 34% of paclitaxel-treated patients. Neither arm showed relevant global health status changes. CONCLUSION Oral vinorelbine and paclitaxel demonstrated similar DCRs (∼75%). Safety profiles differed and, together with administration route and convenience, may influence treatment choice (EudraCT number, 2012-003530-16).
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Affiliation(s)
- Matti Aapro
- Breast Center, Genolier Cancer Center, Genolier, Switzerland.
| | - Manuel Ruiz-Borrego
- Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, Seville, 41013, Spain.
| | - Roberto Hegg
- Perola Byington Reference Center, Av Brig Luis Antonio 733, lj 8/9, São Paulo, Brazil.
| | - Bozena Kukielka-Budny
- Centrum Onkologii Ziemi Lubelskiej im. św. Jana z Dukli Oddział Onkologii Klinicznej, ul, Dr K. Jaczewskiego 7, 20-090, Lublin, Poland.
| | - Serafin Morales
- Hospital Arnau de Vilanova, Lleida, Calle Lleida 147, Alpicat 25110, Lleida, Spain.
| | - Saverio Cinieri
- Senatore Antonio Perrino Hospital, ASL Brindisi Via Statale 7 (Via Appia), 72100 Brindisi, Italy.
| | - Ruffo Freitas-Junior
- Breast and Gynecology Unit, Araujo Jorge Hospital, Goias Anticancer Association, Rua 239, 206 Setor Universitario, 74175-120, Goiania, Brazil.
| | | | - Ewa Szombara
- Marie Curie Oncology Center, ul. Roentgena 5, 02-781, Warsaw, Poland.
| | - Giuliano Santos Borges
- Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral Aderbal Ramos da Silva, 148, Centro, Itajaí/SC/Brasil, CEP, 88301-220, Brazil.
| | | | - Helene Hervieu
- Pierre Fabre Médicament, 45 Place Abel Gance, 92654, Boulogne-Billancourt, France.
| | - Mélanie Groc
- Pierre Fabre Laboratories, Langalde, 3 avenue Hubert Curien, BP13562, 31035, Toulouse, CEDEX, France.
| | - Gustavo Villanova
- Pierre Fabre Médicament, 45 Place Abel Gance, 92654, Boulogne-Billancourt, France.
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Lea CS, Bohra S, Moore T, Passwater C, Liles D. Exploring behaviors, treatment beliefs, and barriers to oral chemotherapy adherence among adult leukemia patients in a rural outpatient setting. BMC Res Notes 2018; 11:843. [PMID: 30497510 PMCID: PMC6267791 DOI: 10.1186/s13104-018-3935-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 08/11/2018] [Accepted: 11/21/2018] [Indexed: 01/06/2023] Open
Abstract
Objective Adherence to oral chemotherapy is essential for patients with chronic myeloid leukemia (CML) and multiple myeloma (MM) to remain in remission. Few studies have used a Likert-type scale to measure medication adherence in CML and MM patients. We applied a validated treatment adherence tool, the ASK-12 (Adherence Starts with Knowledge®) survey, which assessed inconvenience and forgetfulness, treatment beliefs, and medication-taking behaviors recorded on a five-point Likert-type scale at two visits. Results A medication adherence survey was administered to 42 newly diagnosed or pre-existing CML or MM patients at two outpatient oncology clinics affiliated with an academic medical center in rural eastern North Carolina. Thirty-one patients completed surveys at visit 1 and visit 2 (median 4.5 months apart). Most patients were treated for MM (65%), were non-Hispanic black (68%) and female (58%). Within subscales, mean adherence scores decreased between visits, signaling better adherence. Overall, visit scores were correlated (0.63, p = 0.001). Forgetting to take medication sometimes was the most common reason for non-adherence. Medication costs were not a barrier for MM patients. Greater patient–provider informed decision-making was identified as an opportunity for quality improvement among CML patients. The ASK-12 survey provided a strategy to obtain robust information on medication adherence. Electronic supplementary material The online version of this article (10.1186/s13104-018-3935-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Suzanne Lea
- Department of Public Health, Brody School of Medicine, East Carolina University, Mailstop 660, Greenville, NC, 27834, USA.
| | - Sulochana Bohra
- Department of Public Health, Brody School of Medicine, East Carolina University, Mailstop 660, Greenville, NC, 27834, USA.,, 3900 Paramount Parkway, Morrisville, NC, USA
| | - Tiffanie Moore
- Division of Hematology/Oncology, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA
| | - Chelsea Passwater
- Vidant Cancer Services, Vidant Medical Center, Greenville, NC, 27834, USA
| | - Darla Liles
- Division of Hematology/Oncology, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA
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Favier-Archinard C, Leguelinel-Blache G, Dubois F, Le Gall T, Bourquard P, Passemard N, Tora S, Rey A, Rossi M, Chevallier T, Cousin C, Favier M. [Development of a standardized guide for optimizing drug adherence information to be dispensed during a pharmaceutical counseling with a multiple myeloma patient: Initial validation]. Bull Cancer 2018; 105:475-485. [PMID: 29573809 DOI: 10.1016/j.bulcan.2017.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/28/2017] [Revised: 11/28/2017] [Accepted: 12/18/2017] [Indexed: 11/18/2022]
Abstract
The safety of the community treatment with oral anticancer therapies is a strong theme of the cancer plan 2014-2019. The objective of this study was to develop a Pharmaceutical Counseling Guide to improve medication adherence in patients treated for multiple myeloma with oral anticancer therapies. A multidisciplinary professional working group selected a list of relevant medication adherence-related items that served as the framework for the design of the pharmaceutical counseling support materials in patient-accessible language. The readability, understanding and memorization of the information were validated in ten patients treated for myeloma. Twelve items were selected for treatment information (5 items), treatment planning (5 items), and adverse drug effects (2 items). A pharmacist guide, a patient guide, a medication schedule, and three self-questionnaires to evaluate medication knowledge and understanding of patients were developed. The patient test resulted in changes in these documents. This study carried out the initial validation of documents to standardize the pharmaceutical counseling for patients treated for myeloma so that it can be reproduced from one patient to another regardless of the pharmacist, by standardizing the information issued. This study needs to be completed by a final validation in myeloma patients, free from oral anticancer therapies.
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Affiliation(s)
- Camille Favier-Archinard
- Centre hospitalier universitaire Carémeau, service de pharmacie, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Géraldine Leguelinel-Blache
- Centre hospitalier universitaire Carémeau, service de pharmacie, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Florent Dubois
- Centre hospitalier universitaire Carémeau, service de pharmacie, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Tanguy Le Gall
- Centre hospitalier universitaire Carémeau, service de pharmacie, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Pascal Bourquard
- Institut Gardois de cancérologie, service d'hématologie clinique, 30900 Nîmes, France
| | - Nadège Passemard
- Institut de formation aux métiers de la santé, 30000 Nîmes, France
| | - Sandrine Tora
- Centre hospitalier universitaire Carémeau, service de pharmacie, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Aurélie Rey
- Institut Gardois de cancérologie, service d'oncologie, 30900 Nîmes, France
| | - Marie Rossi
- Centre hospitalier universitaire Carémeau, Direction générale communication et culture, 30029 Nîmes cedex 9, France
| | - Thierry Chevallier
- Centre hospitalier universitaire Carémeau, laboratoire de biostatistique, épidémiologie, Santé publique, informatique médicale, 30029 Nîmes cedex 9, France
| | - Christelle Cousin
- Institut Gardois de cancérologie, unité pharmacie oncologique, 30900 Nîmes, France
| | - Mireille Favier
- Centre hospitalier universitaire Carémeau, service de pharmacie, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France.
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Betcher J, Dow E, Khera N. Oral Chemotherapy in Patients with Hematological Malignancies-Care Process, Pharmacoeconomic and Policy Implications. Curr Hematol Malig Rep 2016; 11:288-94. [PMID: 27086140 DOI: 10.1007/s11899-016-0325-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with hematologic malignancies are increasing being prescribed oral anticancer medications (OAMs) and/or biologics. These newer targeted OAMs are associated with a host of practical and pharmacoeconomic implications for patients and healthcare providers. Issues such as safety, procurement challenges, and the need for proactive involvement of all stakeholders to optimize adherence for successful use of these agents are increasingly being recognized. The current reactive model is negatively impacting the patient experience through delays in care, financial toxicity, and decreased safety. It also impacts the healthcare providers in the form of lost revenue and staff burnout due to labor-intensive procurement and patient financial assistance burdens. In this review, we describe some of the issues identified and discuss potential strategies to improve patient access, minimize healthcare burden, and review current policy initiatives and patient advocacy efforts to reduce financial toxicity.
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29
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Steger GG, Dominguez A, Dobrovolskaya N, Giotta F, Tubiana-Mathieu N, Pecherstorfer M, Ardizzoia A, Blasinska-Morawiec M, Espinosa E, Villanova G. Single-Agent Oral Vinorelbine as First-Line Chemotherapy for Endocrine-Pretreated Breast Cancer With Bone Metastases and No Visceral Involvement: NORBREAST-228 Phase II Study. Clin Breast Cancer 2018; 18:e41-7. [PMID: 28666812 DOI: 10.1016/j.clbc.2017.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/25/2017] [Accepted: 05/22/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Single-agent oral chemotherapy is widely used in patients with bone metastases without visceral involvement, especially in hormone receptor-positive metastatic breast cancer (mBC). However, this option has been poorly evaluated in clinical trials. METHODS Eligible patients had mBC with predominantly bone but not visceral metastases, were receiving bisphosphonate therapy, and had previously received endocrine therapy (any setting) but not chemotherapy for mBC. Patients received oral vinorelbine 60 mg/m2 on days 1, 8, 15, and 22 every 4 weeks (escalating to 80 mg/m2 from cycle 2 in the absence of grade 3/4 toxicity) until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS). Secondary endpoints included clinical benefit rate (complete/partial response or ≥24 weeks' stable disease), overall survival, and safety. RESULTS Seventy patients were treated for a median of 6 cycles (range 1-18). Most (73%) continued treatment until disease progression. After 43 months' median follow-up, median PFS was 8.2 months (95% confidence interval [CI], 5.5-9.8). The clinical benefit rate was 56% (95% CI, 43%-68%). Median overall survival was 35.2 months (95% CI, 26.8-47.1). The most common grade 3/4 adverse event was neutropenia (38% of patients); febrile neutropenia was absent. The most common grade 1/2 adverse events were bone pain, fatigue, and gastrointestinal toxicities. Alopecia was infrequent. CONCLUSIONS In patients with hormone receptor-positive mBC, bone disease, and prior endocrine therapy, first-line oral vinorelbine chemotherapy demonstrated long PFS and good tolerability. In this setting, it could be considered as an active oral alternative to intravenous chemotherapy.
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Lee JJ, Chu E. Adherence, Dosing, and Managing Toxicities With Trifluridine/Tipiracil (TAS-102). Clin Colorectal Cancer 2017; 16:85-92. [PMID: 28242161 PMCID: PMC5743195 DOI: 10.1016/j.clcc.2017.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/02/2017] [Accepted: 01/13/2017] [Indexed: 12/13/2022]
Abstract
Trifluridine/tipiracil (TAS-102) is a new oral combination therapy approved by the US Food and Drug Administration for the treatment of patients with metastatic colorectal cancer who are refractory to or intolerant of standard chemotherapy. This agent consists of a thymidine-based nucleoside analogue (trifluridine) and a thymidine phosphorylase inhibitor (tipiracil), which is included to reduce the degradative breakdown of trifluridine. In the phase III Randomized, double-blind, phase III Study of TAS-102 plus best supportive care [BSC] versus placebo plus BSC in patients with metastatic colorectal cancer [CRC] refractory to standard chemotherapies (RECOURSE) trial, trifluridine/tipiracil showed significant improvement in overall survival compared with placebo. Trifluridine/tipiracil is administered at a 35 mg/m2 dose orally twice daily in a 28-day cycle consisting of 5 treatment days/2 rest days for 2 weeks followed by a rest period of 2 weeks. Because trifluridine/tipiracil is a completely oral chemotherapy regimen, patient adherence to treatment is an important consideration. It is also critical to have strategies in place for managing toxicities, because side effects might have a negative effect on patient adherence. The most frequent adverse events reported in patients with metastatic colorectal cancer receiving trifluridine/tipiracil in the phase III RECOURSE trial were myelosuppression, nausea/vomiting, diarrhea, decreased appetite, and fatigue. In this review we aim to provide clinicians with practical recommendations for facilitating patient adherence to oral chemotherapy, managing trifluridine/tipiracil dosing, and address the most common adverse events in patients who receive trifluridine/tipiracil therapy.
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Affiliation(s)
- James J Lee
- Division of Hematology-Oncology, Department of Medicine, Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Edward Chu
- Division of Hematology-Oncology, Department of Medicine, Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
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31
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Middendorff G, Elsey R, Lounsbery B, Chadwell R. Impact of a specialty pharmacy case management service on adherence in patients receiving oral antineoplastic agents. J Oncol Pharm Pract 2017; 24:371-378. [PMID: 28509613 DOI: 10.1177/1078155217708022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Patients receiving treatment with oral antineoplastic agents encounter several barriers to adherence, which may include high medication costs, limited access to specialty medications, severe adverse effects, complex medication regimens, and special handling precautions. Medication nonadherence not only reduces the efficacy of drug therapy but also has the potential to increase healthcare expenditures due to disease-related hospitalizations. Although several previous studies have examined patient adherence to oral antineoplastic agents, few have examined the impact of a specialty pharmacy case management service. Methods Patient adherence to oral antineoplastic agents was evaluated through a retrospective analysis of pharmacy claims data and medical chart reviews. The medication possession ratio (MPR) was used to quantitatively measure adherence during two 6-month intervals, prior to and following the implementation of a case management service. Patients with an MPR greater than or equal to 0.8 were categorized as adherent, while those with an MPR less than 0.8 were categorized as non-adherent. Results During the first 6-month interval prior to implementation of the case management service (n = 40), a cumulative average MPR of 0.922 was observed. Following implementation of the case management service (n = 56), a non-statistically significant (p = 0.199) increase in MPR to 0.941 was identified. For patients categorized as non-adherent, a nonstatistically significant (p = 0.214) decrease from 15% to 7% was identified following the introduction of the case management service. Conclusion Study results from this retrospective review indicate that case management services provided through an outpatient specialty pharmacy may have the potential to improve patient adherence to oral antineoplastic agents.
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Affiliation(s)
- Grant Middendorff
- 1 Avera McKennan Hospital & University Health Center, Department of Pharmacy, Avera Cancer Institute, Sioux Falls, SD, USA
| | - Rachel Elsey
- 1 Avera McKennan Hospital & University Health Center, Department of Pharmacy, Avera Cancer Institute, Sioux Falls, SD, USA.,2 South Dakota State University College of Pharmacy, Department of Pharmacy Practice, Brookings, SD, USA
| | - Brian Lounsbery
- 3 Avera McKennan Hospital & University Health Center, Department of Pharmacy, Avera Specialty Pharmacy, Sioux Falls, SD, USA
| | - Roxanne Chadwell
- 3 Avera McKennan Hospital & University Health Center, Department of Pharmacy, Avera Specialty Pharmacy, Sioux Falls, SD, USA
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Engle JA, Traynor AM, Campbell TC, Wisinski KB, LoConte N, Liu G, Wilding G, Kolesar JM. Assessment of adherence and relative dose intensity with oral chemotherapy in oncology clinical trials at an academic medical center. J Oncol Pharm Pract 2017; 24:348-353. [PMID: 28457192 DOI: 10.1177/1078155217704989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background/Aims Oral chemotherapy is increasingly utilized leaving the patient responsible for self-administering an often complex regimen where adverse effects are common. Non-adherence and reduced relative dose intensity are both associated with poorer outcomes in the community setting but are rarely reported in clinical trials. The purpose of this study is to quantify adherence and relative dose intensity in oncology clinical trials and to determine patient and study related factors that influence adherence and relative dose intensity. Methods Patients were identified from non-industry-funded clinical trials conducted between 1 January 2009 and 31 March 2013 at the University of Wisconsin Carbone Cancer Center. Data were extracted from primary research records. Descriptive statistics and linear regression modeling was performed using SAS 9.4. Results A total of 17 clinical trials and 266 subjects were included. Mean adherence was greater than 97% for the first eight cycles. Mean relative dose intensity was less than 90% for the first cycle and declined over time. Male gender, a performance status of 1 or 2, metastatic disease, and traveling more than 90 miles to reach the cancer center were associated with higher relative dose intensity. Conclusions Patients with cancer enrolled in clinical trials are highly adherent but unlikely to achieve protocol specified relative dose intensity. Given that determining the phase II dose is the primary endpoint of phase I trials, incorporating relative dose intensity into this determination should be considered.
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Affiliation(s)
- Jeff A Engle
- 1 School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Anne M Traynor
- 2 Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - Toby C Campbell
- 2 Carbone Cancer Center, University of Wisconsin, Madison, WI, USA.,3 School of Nursing, University of Wisconsin, Madison, WI, USA
| | - Kari B Wisinski
- 2 Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - Noelle LoConte
- 2 Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - Glenn Liu
- 2 Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - George Wilding
- 4 MD Anderson Cancer Center, The University of Texas MD, Houston, TX, USA
| | - Jill M Kolesar
- 5 College of Pharmacy, University of Kentucky, Lexington, KY, USA
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Barni S, Freier B, Garau I, Mouysset JL, Sediva M, Zamagni C, Berdeaux G, de Almeida Agudo C. Burden of advanced breast cancer for patients and caregivers in Europe: comparison of two treatment forms of vinorelbine, oral and intravenous. Curr Med Res Opin 2016; 32:1807-1812. [PMID: 27388853 DOI: 10.1080/03007995.2016.1211518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Indexed: 10/21/2022]
Abstract
AIM To assess the burden of disease associated with advanced breast cancer (ABC) treated with oral (VinO) or intravenous vinorelbine (VinIV) from the perspective of patients and caregivers in five European countries. METHODS This was an observational, prospective, international, multicenter study. Patients were included in the study at the beginning of their second cycle of chemotherapy with vinorelbine and categorized into two groups depending on whether they received VinO or VinIV. At baseline (V0) and at the end of the second cycle of chemotherapy (V1), patients and caregivers were asked to complete self-administered questionnaires: SF-12 and burden of disease. RESULTS At baseline, the two groups were well balanced in demographic and clinical characteristics. However, while HER2+ (human epidermal growth factor receptor 2) disease was significantly more frequent in patients receiving VinIV, patients receiving VinO were predominantly treated with single-agent therapy and were older than those treated with VinIV (67.1 years versus 57.7 years [p = 0.05]). As measured with SF-12, patients with VinO had, at end of cycle 1 and end of cycle 2, significantly more favorable outcomes in physical summary score, role physical, role emotional and mental health (all p < 0.05) than those treated with VinIV. Trends for a better caregiver mental score and social functioning were also observed with VinO (cycle 1 and 2; p < 0.10). From a patient perspective, no major difference was reported on the burden of disease between the two groups, however, a trend for a better" overall impact on daily life" was observed in VinO patients. Major significant differences, showing a lower burden of disease with VinO, were also reported from caregivers. In addition, in patients treated with VinO, mental score was almost similar to the one of the general population. CONCLUSION VinO showed benefits over VinIV for both patients and caregivers, particularly in health related quality of life and burden of disease. Because of its observational design, results are only informative.
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Affiliation(s)
- Sandro Barni
- a ASST Bergamo Ovest Ospedale di Treviglio , Italy
| | - Beata Freier
- b Uniwersytecki Szpital Kliniczny , Wroclaw , Poland
| | | | | | | | - Claudio Zamagni
- f Oncologia Medica Addarii Policlinico S. Orsola Malpighi , Bologna , Italy
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Battis B, Clifford L, Huq M, Pejoro E, Mambourg S. The impacts of a pharmacist-managed outpatient clinic and chemotherapy-directed electronic order sets for monitoring oral chemotherapy. J Oncol Pharm Pract 2016; 23:582-590. [PMID: 27733666 DOI: 10.1177/1078155216672314] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Patients treated with oral chemotherapy appear to have less contact with the treating providers. As a result, safety, adherence, medication therapy monitoring, and timely follow-up may be compromised. The trend of treating cancer with oral chemotherapy agents is on the rise. However, standard clinical guidance is still lacking for prescribing, monitoring, patient education, and follow-up of patients on oral chemotherapy across the healthcare settings. The purpose of this project is to establish an oral chemotherapy monitoring clinic, to create drug and lab specific provider order sets for prescribing and lab monitoring, and ultimately to ensure safe and effective treatment of the veterans we serve. Methods A collaborative agreement was reached among oncology pharmacists, a pharmacy resident, two oncologists, and a physician assistant to establish a pharmacist-managed oral chemotherapy monitoring clinic at the VA Sierra Nevada Healthcare System. Drug-specific electronic order sets for prescribing and lab monitoring were created for initiating new drug therapy and prescription renewal. The order sets were created to be provider-centric, minimizing clicks needed to order necessary medications and lab monitoring. A standard progress note template was developed for documenting interventions made by the clinic. Patients new to an oral chemotherapy regimen were first counseled by an oncology pharmacist. The patients were then enrolled into the oral chemotherapy monitoring clinic for subsequent follow up and pharmacist interventions. Further, patients lacking monitoring or missing provider appointments were captured through a Clinical Dashboard developed by the US Department of Veterans Affairs (VA) Regional Office (VISN21) using SQL Server Reporting Services. Between September 2014 and April 2015, a total of 68 patients on different oral chemotherapy agents were enrolled into the clinic. Results Out of the 68 patients enrolled into the oral chemotherapy monitoring clinic, 31 patients (45%) were identified as having a therapy-related problem with their oral chemotherapy regimen on a gross measure for safety and appropriateness of medication management during the course of eight months follow-up between September 2014 and April 2015. In addition, the clinic helped to reestablish care for three patients (4.4%) who were lost to follow-up. The clinic identified 12 patients (17.6%) non-adherent to their prescribed regimen in some degree, where patients were suspected to miss doses due to delay in refilling prescriptions at least three days later than the expected date. However, these patients denied non-adherence. Among them, six patients (8.8%) were truly non-adherent. These patients stated that they had missed at least one day of therapy or were not taking the medication as prescribed. Medication regimen errors were discovered for five patients, accounting for a 7.3% medication-related error rate. Finally, seven patients (10.3%) were found to have an adverse reaction attributed to their oral chemotherapy. Two of them (2.9%) developed severe adverse reactions (Grade 3 and 4), which required hospitalization or immediate dose de-escalation. Conclusions The pilot clinic was able to identify current deficiencies and gaps in our practice settings for managing oral chemotherapy in a Veterans population. The oral chemotherapy monitoring clinic played a proactive role to identify preventable medication errors, monitor medication therapy, improve adherence, manage adverse drug reactions and re-establish care for patients who were lost to follow-up. The results suggest that close monitoring and follow-up of patients on oral chemotherapy is crucial to achieve therapeutic goals, improve patient safety and adherence, and to reduce drug adverse events and health care cost.
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Affiliation(s)
- Brandon Battis
- 1 Pharmacy Services, VA Sierra Nevada Healthcare System, Reno, NV, USA
| | - Linda Clifford
- 1 Pharmacy Services, VA Sierra Nevada Healthcare System, Reno, NV, USA
| | - Mostaqul Huq
- 1 Pharmacy Services, VA Sierra Nevada Healthcare System, Reno, NV, USA
| | - Edrick Pejoro
- 2 Medicine Services, VA Sierra Nevada Healthcare System, Reno, NV, USA
| | - Scott Mambourg
- 1 Pharmacy Services, VA Sierra Nevada Healthcare System, Reno, NV, USA
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Gassmann C, Kolbe N, Brenner A. Experiences and coping strategies of oncology patients undergoing oral chemotherapy: First steps of a grounded theory study. Eur J Oncol Nurs 2016; 23:106-14. [PMID: 27456382 DOI: 10.1016/j.ejon.2016.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 06/26/2015] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Chemotherapies are increasingly available for oral application. Previous studies have focussed on differences between orally and intravenously administered chemotherapies, mostly following quantitative designs surveying patients' preferences and adherence. The lived experience of patients undergoing oral chemotherapy has been rarely explored. Therefore, this study investigates how patients experience oral chemotherapy. METHOD We conducted open interviews with six patients and two spouses. Recruitment took place in the outpatient clinic of an urban Swiss hospital. Data collection and analysis followed the principles of Straussian grounded theory. RESULTS The participants reported physical and emotional reluctance towards oral chemotherapy as well as toxic side effects. Feeling responsible emerged as a core phenomenon. All participants intended to adhere to the therapy although this was challenging because of the complex medication regimen. Belief in the effectiveness of the therapy was a strengthening factor. CONCLUSIONS All participants reported to be highly adherent to oral chemotherapy. Although they experienced some toxic side effects, they did not react. Monitoring toxicities and support in everyday life should be a core feature of care.
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Affiliation(s)
- Catherine Gassmann
- FHS St. Gallen, University of Applied Sciences, Rosenbergstrasse 59, 9001, St. Gallen, Switzerland.
| | - Nina Kolbe
- FHS St. Gallen, University of Applied Sciences, Rosenbergstrasse 59, 9001, St. Gallen, Switzerland.
| | - Andrea Brenner
- FHS St. Gallen, University of Applied Sciences, Rosenbergstrasse 59, 9001, St. Gallen, Switzerland.
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Farhat F, Kattan JG, Ghosn M. Oral vinorelbine in combination with trastuzumab as a first-line therapy of metastatic or locally advanced HER2-positive breast cancer. Cancer Chemother Pharmacol 2016; 77:1069-77. [PMID: 27059339 DOI: 10.1007/s00280-016-3027-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 03/01/2016] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Vinorelbine-trastuzumab combination proved to be an effective first-line treatment for patients with locally advanced or metastatic breast cancer (MBC). Oral chemotherapy represents a step forward in MBC management. To improve patients' comfort using the oral form of vinorelbine, we conducted a multicenter phase II study to investigate the efficacy and safety of the oral vinorelbine-trastuzumab combination in women with MBC with human epidermal growth factor receptor 2 (HER2) overexpression. METHODS Main eligibility criteria: HER2-positive disease, no adjuvant chemotherapy within the last 6 months and no prior chemotherapy for MBC. Patients were treated with oral vinorelbine 80 mg/m(2) D1, D8, D15 (following first 3 administrations at 60 mg/m(2) during the first cycle) for a total of 8 cycles (1 cycle = 3 weeks), in combination with trastuzumab 6 mg/kg on D1 (loading dose: 8 mg/kg) every 3 weeks or 4 mg/kg (loading dose: 6 mg/kg) weekly. Response was evaluated every 2 cycles using RECIST 1.0. PRIMARY ENDPOINT objective response rate (ORR); secondary endpoints: duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety. RESULTS In the full population (n = 26), median age was 50.7 years and median WHO PS 0. Median disease-free interval was 50.7 months [95 % CI (43.6-57.9)]. In the evaluable patients population, ORR was 56 % [95 % CI (34.9-75.6)], including 3 complete responses (12 %) and 11 partial (44 %); 8 (32 %) patients had stable disease resulting in a clinical benefit (or disease control) rate of 88 % [95 % CI (68.8-97.5)]. Median DOR was 7.1 months [95 % CI (3.9-10.2)], median PFS 6.7 months (95 % CI 3.5-10), and median OS 27.9 months (95 % CI 17.4-38.3). Treatment was generally well tolerated with main observed grade 3/4 hematological toxicities being neutropenia (46 %) and anemia (4 %). Grade 3-4 nausea-vomiting were observed in 11.5 % of patients. CONCLUSIONS Our results confirm the efficacy of oral vinorelbine-trastuzumab combination as a first-line treatment in HER2-positive locally advanced or MBC patients with an acceptable safety profile. Oral vinorelbine-trastuzumab optimizes the convenience of this chemotherapy regimen, especially for patients receiving trastuzumab every 3 weeks.
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Affiliation(s)
- Fadi Farhat
- Department of Hematology-Oncology, Hammoud Hospital University Medical Centre, 652 G. Hammoud Street, Sidon, Lebanon. .,Faculty of Medicine, Lebanese University, Beirut, Lebanon. .,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - Joseph G Kattan
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Hematology-Oncology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Marwan Ghosn
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Hematology-Oncology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
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Tanigawa T, Matoda M, Yamamoto A, Nomura H, Okamoto S, Sakamoto K, Kondo E, Omatsu K, Kato K, Takeshima N. Clinical usefulness of the oral chemotherapy agent S-1 in heavily pre-treated patients with advanced or recurrent cervical cancer. Arch Gynecol Obstet 2016; 293:633-8. [PMID: 26305033 DOI: 10.1007/s00404-015-3866-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 08/18/2015] [Indexed: 01/10/2023]
Abstract
PURPOSE Our aim was to evaluate the efficacy and safety of S-1 in heavily pre-treated patients with advanced (FIGO stage IVB) or recurrent cervical cancer. METHODS The Institutional Review Board of our hospital approved the protocol for this retrospective phase II study. Patients with measurable disease received two oral doses of S-1 (35 mg/m(2)) daily for 4 weeks of a 6-week cycle or 2 weeks of a 3-week cycle. The antitumor effect, time to progression, overall survival, and adverse events were investigated. RESULTS We retrospectively analyzed relevant data of 28 patients with advanced or recurrent cervical cancer. Twenty-two patients had prior chemotherapy (not including chemoradiotherapy) and 27 had prior radiotherapy. The median number of prior chemotherapy regimens and cycles was 2 (range 0-4) and 7 (range 0-35), respectively. Two patients (7.1%) had partial response, and 10 patients (35.7%) had stable disease. Ten patients (35.7%) discontinued the therapy because of progressive disease. The response in 5 patients could not be evaluated because of termination of treatment in the middle of the first cycle. The disease control rate was 42.8%. After a median follow-up duration of 7.5 months, the median time to progression was 4.2 months (95% CI 2.7-5.4) and the median overall survival was 9.92 months (95% CI 9.20-NA). The two patients with partial response had received less prior chemotherapy. CONCLUSIONS Oral S-1 in palliative chemotherapy is a useful and well-tolerated treatment in heavily pre-treated patients with advanced or recurrent uterine cervical cancer.
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Abstract
AIM: To assess the adherence to oral chemotherapy and explore related factors in patients with gastrointestinal cancer, in order to provide a basis for nursing intervention and improve patient adherence.
METHODS: This study investigated 207 patients with gastrointestinal cancer who received oral chemotherapy by pill counting and questionnaire survey.
RESULTS: The rate of adherence to oral chemotherapy in patients with gastrointestinal cancer was 68.6%. The reasons for low adherence included forgetting to take, adjusting the dose for side effects, not taking drugs when out, and stopping medication as symptoms relieved. Factors related to adherence included gender, age, education level and whether there was a remainder (P < 0.05), however, diagnosis and hospitalized frequency had no significant impact on adherence (P > 0.05).
CONCLUSION: The adherence of gastrointestinal cancer patients to chemotherapy should be strengthened, especially in high-risk patients, like elderly patients, male patients, those with a low education level and those with no remainder.
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Curigliano G, Bagnardi V, Bertolini F, Alcalay M, Locatelli MA, Fumagalli L, Rabascio C, Calleri A, Adamoli L, Criscitiello C, Viale G, Goldhirsch A. Antiangiogenic therapy in recurrent breast cancer with lymphangitic spread to the chest wall: A randomized phase II trial of bevacizumab with sequential or concurrent oral vinorelbine and capecitabine. Breast 2015; 24:263-71. [PMID: 25772326 DOI: 10.1016/j.breast.2015.02.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 11/27/2014] [Revised: 02/10/2015] [Accepted: 02/22/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To assess efficacy of bevacizumab in combination with oral chemotherapy in patients with breast cancer with lymphangitic spread to the chest wall (LBC). To identify surrogate biomarkers of response to bevacizumab. PATIENTS AND METHODS We randomly assigned patients to receive bevacizumab plus either sequential or concurrent oral vinorelbine and capecitabine every 3 weeks. The primary endpoint was time to ultimate progression (TTP); the response rate and overall survival (OS) were secondary endpoints. We performed gene expression profiling on baseline tissue samples collected from triple negative LBC. We assessed circulating endothelial cells (CEC), circulating endothelial progenitors (CEP) and circulating pericyte progenitors (CPP). RESULTS A total of 66 patients were enrolled. There was no difference in TTP (median TTP 5.3 vs. 4.8 months, p = 0.21) and in OS (median OS 15.8 vs 11.9 months; p = 0.25) when comparing concurrent vs sequential treatment, respectively. Response rate was 25% vs 28% in the concurrent vs sequential arm (p = 1.00), respectively. A set of 16 genes predictive of response to bevacizumab was identified. The counts of CEPs and viable CECs below the median value were associated with an improved overall survival: 26.6 vs 9.5 months for CEPs and 22.6 vs 11.0 months for viable CECs, respectively (p = 0.02). CONCLUSIONS Oral chemotherapy and bevacizumab (BEVIX) is an active regimen in patients with LBC. We support the importance of using LBC as a biological model for investigating angiogenesis inhibitors. CECs and CEPs biomarkers have been identified as predictive markers of outcome and warrant further investigation.
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Affiliation(s)
- Giuseppe Curigliano
- Division of Experimental Therapeutics, Breast Health Program, Istituto Europeo di Oncologia, Italy.
| | - Vincenzo Bagnardi
- Division of Epidemiology and Biostatistics, Istituto Europeo di Oncologia, Italy; Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
| | | | - Myriam Alcalay
- Department of Experimental Oncology, Italy; University of Milano, School of Medicine, Milano, Italy
| | - Marzia Adelia Locatelli
- Division of Experimental Therapeutics, Breast Health Program, Istituto Europeo di Oncologia, Italy
| | - Luca Fumagalli
- Division of Experimental Therapeutics, Breast Health Program, Istituto Europeo di Oncologia, Italy
| | | | | | - Laura Adamoli
- Division of Experimental Therapeutics, Breast Health Program, Istituto Europeo di Oncologia, Italy
| | - Carmen Criscitiello
- Division of Experimental Therapeutics, Breast Health Program, Istituto Europeo di Oncologia, Italy
| | - Giuseppe Viale
- Department of Pathology, Istituto Europeo di Oncologia, Italy; University of Milano, School of Medicine, Milano, Italy
| | - Aron Goldhirsch
- Division of Experimental Therapeutics, Breast Health Program, Istituto Europeo di Oncologia, Italy
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Kavookjian J, Wittayanukorn S. Interventions for adherence with oral chemotherapy in hematological malignancies: A systematic review. Res Social Adm Pharm 2014; 11:303-14. [PMID: 25262600 DOI: 10.1016/j.sapharm.2014.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 06/29/2013] [Revised: 08/06/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Poor adherence to treatment for chronic diseases including some hematological malignancies impedes health outcomes and increases costs. Oral chemotherapy is an emerging trend that raises concern about nonadherence problems in these targeted patients. OBJECTIVES This systematic literature review explores evidence and gaps in the literature regarding interventions to enhance adherence with prescribed oral chemotherapy in patients with hematological malignancies. METHODS Searches of databases and abstracts from conferences were performed for 1987 to January 2013 using a modified Cochrane method. Studies measuring interventions to improve adherence alone or together with clinical, humanistic, and economic outcomes were included. Assessment of methodological quality was performed for each retained study. RESULTS The literature search generated 6 studies that met inclusion criteria. Four of these reported a statistically significant increase in the adherence outcome, compared with baseline. Tailored and educational interventions were widely used among the retained studies. Post-intervention adherence rates were 41-96.1%; intervention groups yielded higher rates than comparison groups. Two studies reported statistically significant improvement in clinical outcomes (cytogenetic response and survival time). One study reported that severity of illness was associated with survival time but not with adherence. Studies that used both tailored and educational interventions showed significant relationship between adherence and clinical outcomes; however, the study that used dosage simplification did not. None of the studies explored humanistic or economic outcomes. CONCLUSIONS Interventions to improve adherence with oral chemotherapies in hematological malignancies remain limited. Though they were heterogeneous in nature, interventions tested in the retained studies suggested a positive impact on the adherence outcome; some established a significant relationship between adherence and clinical outcomes. The results yielded limited evidences regarding characteristics of a specific intervention, but supported a general structure for methods to improve adherence and other outcomes in real-life settings. Further rigorous methodological studies are needed to fully examine impact on adherence and clinical outcomes.
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Affiliation(s)
- Jan Kavookjian
- Health Outcomes Research & Policy, Harrison School of Pharmacy, Auburn University, AL, USA.
| | - Saranrat Wittayanukorn
- Health Outcomes Research & Policy, Harrison School of Pharmacy, Auburn University, AL, USA
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Muthu MS, Leong DT, Mei L, Feng SS. Nanotheranostics - application and further development of nanomedicine strategies for advanced theranostics. Am J Cancer Res 2014; 4:660-77. [PMID: 24723986 PMCID: PMC3982135 DOI: 10.7150/thno.8698] [Citation(s) in RCA: 347] [Impact Index Per Article: 34.7] [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: 01/27/2014] [Accepted: 03/11/2014] [Indexed: 12/16/2022] Open
Abstract
Nanotheranostics is to apply and further develop nanomedicine strategies for advanced theranostics. This review summarizes the various nanocarriers developed so far in the literature for nanotheranostics, which include polymer conjugations, dendrimers, micelles, liposomes, metal and inorganic nanoparticles, carbon nanotubes, and nanoparticles of biodegradable polymers for sustained, controlled and targeted co-delivery of diagnostic and therapeutic agents for better theranostic effects with fewer side effects. The theranostic nanomedicine can achieve systemic circulation, evade host defenses and deliver the drug and diagnostic agents at the targeted site to diagnose and treat the disease at cellular and molecular level. The therapeutic and diagnostic agents are formulated in nanomedicine as a single theranostic platform, which can then be further conjugated to biological ligand for targeting. Nanotheranostics can also promote stimuli-responsive release, synergetic and combinatory therapy, siRNA co-delivery, multimodality therapies, oral delivery, delivery across the blood-brain barrier as well as escape from intracellular autophagy. The fruition of nanotheranostics will be able to provide personalized therapy with bright prognosis, which makes even the fatal diseases curable or at least treatable at the earliest stage.
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Golla K, Bhaskar C, Ahmed F, Kondapi AK. A target-specific oral formulation of Doxorubicin-protein nanoparticles: efficacy and safety in hepatocellular cancer. J Cancer 2013; 4:644-52. [PMID: 24155776 PMCID: PMC3805992 DOI: 10.7150/jca.7093] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [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: 07/04/2013] [Accepted: 09/03/2013] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND/AIMS Hepatocellular carcinoma (HCC) also known as malignant hepatoma is a most common liver cancer. Doxorubicin (Doxo) is an anti-cancer drug having activity against a wide spectrum of cancer types. Clinical Utility of doxo has been limited due to its poor bioavailability and toxicity to heart and spleen. Furthermore, cancer chemotherapeutics have limited oral absorption. Transferrin family proteins are highly abundant and plays important role in transport and storage of iron in cells and tissues. Since apotransferrin and lactoferrin receptors are highly expressed on the surface of metabolically active cancer cells, the principal objective of present study is to evaluate efficacy of doxorubicin loaded apotransferrin and lactoferrin nanoparticles (apodoxonano or lactodoxonano) in oral treatment of HCC in rats. STUDY DESIGN HCC was induced in rats by supplementing 100 mg/L of diethylnitrosamine (DENA) in drinking water for 8 weeks. A week after the last day of DENA administration, rats were divided into four groups, each group comprising of five animals. Each group was administered with one of the drug viz., saline, doxorubicin (doxo), apodoxonano and lactodoxonano (4 mg/ kg equivalent of drug). In each case, they received 8 doses of the drug orally with six day interval. One week after the last dose, anticancer activity was evaluated by counting the liver nodules, H & E analysis of tissue sections and expression levels of angiogenic and antitumor markers. RESULTS In rats treated with apodoxonano and lactodoxonano, the number of neoplastic nodules was significantly lower than that of rats administered with saline or with doxo. Apodoxonano and lactodoxonano did not exhibit decrease in mean body weight, which was markedly reduced by 22% in the case of doxo administered rats. In rats treated with nanoformulations, the number of liver nodules was found reduced by >93%. Both nanoformulations showed significantly high localization in liver compared to doxo. CONCLUSIONS Apodoxonano and lactodoxonano showed improved efficacy, bioavailability and safety compared to doxo for treatment of HCC in rats when administered orally.
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Affiliation(s)
- Kishore Golla
- 2. Department of Biochemistry, University of Hyderabad, and Hyderabad 500046 India; ; 3. Centre for Nanotechnology, University of Hyderabad, and Hyderabad 500046 India
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