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Xie L, Zhang Q, Zhu Q, Wang Y, Niu S, Zhang X, Huang Y, Li J, Liu X, Xue Z, Zhao X, Zheng Y. The Effect of Lipid Composition on the Liposomal Delivery of Camptothecin Developed by Active Click Loading. Mol Pharm 2024. [PMID: 38576375 DOI: 10.1021/acs.molpharmaceut.3c01140] [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: 04/06/2024]
Abstract
In the present study, we investigated the role of lipid composition of camptothecin (CPT)-loaded liposomes (CPT-Lips) to adjust their residence time, drug distribution, and therefore the toxicities and antitumor activity. The CPT was loaded into liposomes using a click drug loading method, which utilized liposomes preloaded with GSH and then exposed to CPT-maleimide. The method produced CPT-Lips with a high encapsulation efficiency (>95%) and sustained drug release. It is shown that the residence times of CPT-Lips in the body were highly dependent on lipid compositions with an order of non-PEGylated liposomes of unsaturated lipids < non-PEGylated liposomes of saturated lipids < PEGylated liposomes of saturated lipids. Interestingly, the fast clearance of CPT-Lips resulted in significantly decreased toxicities but did not cause a significant decrease in their in vivo antitumor activity. These results suggested that the lipid composition could effectively adjust the residence time of CPT-Lips in the body and further optimize their therapeutic index, which would guide the development of a liposomal formulation of CPT.
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Affiliation(s)
- Lei Xie
- School of Pharmacy, Key Laboratory of Sichuan Province for Specific Structure of Small Molecule Drugs, Chengdu Medical College, Chengdu 610083, China
| | - Qian Zhang
- School of Pharmacy, Key Laboratory of Sichuan Province for Specific Structure of Small Molecule Drugs, Chengdu Medical College, Chengdu 610083, China
| | - Qian Zhu
- School of Pharmacy, Key Laboratory of Sichuan Province for Specific Structure of Small Molecule Drugs, Chengdu Medical College, Chengdu 610083, China
| | - Yang Wang
- School of Pharmacy, Key Laboratory of Sichuan Province for Specific Structure of Small Molecule Drugs, Chengdu Medical College, Chengdu 610083, China
| | - Shuijiao Niu
- Shandong Institute for Food and Drug Control, Ji'nan 250101, China
| | - Xinyue Zhang
- School of Pharmacy, Key Laboratory of Sichuan Province for Specific Structure of Small Molecule Drugs, Chengdu Medical College, Chengdu 610083, China
| | - Yuting Huang
- School of Pharmacy, Key Laboratory of Sichuan Province for Specific Structure of Small Molecule Drugs, Chengdu Medical College, Chengdu 610083, China
| | - Jiayao Li
- School of Pharmacy, Key Laboratory of Sichuan Province for Specific Structure of Small Molecule Drugs, Chengdu Medical College, Chengdu 610083, China
| | - Xiaoxue Liu
- School of Pharmacy, Key Laboratory of Sichuan Province for Specific Structure of Small Molecule Drugs, Chengdu Medical College, Chengdu 610083, China
| | - Zhiyuan Xue
- School of Pharmacy, Key Laboratory of Sichuan Province for Specific Structure of Small Molecule Drugs, Chengdu Medical College, Chengdu 610083, China
| | - Xia Zhao
- Department of Pharmacy, The First Affiliated Hospital of Chengdu Medical College, Clinical Medical College, Chengdu Medical College, Chengdu 610083, China
| | - Yaxin Zheng
- School of Pharmacy, Key Laboratory of Sichuan Province for Specific Structure of Small Molecule Drugs, Chengdu Medical College, Chengdu 610083, China
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Tuchayi AM, Yadav S, Jiang F, Kim ST, Saelee RK, Morley A, Juarez R, Lawhn-Heath C, Wang Y, de Kouchkovsky I, Hope TA. Real-World Experience with 177Lu-PSMA-617 Radioligand Therapy After Food and Drug Administration Approval. J Nucl Med 2024:jnumed.123.266842. [PMID: 38485274 DOI: 10.2967/jnumed.123.266842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/13/2024] [Indexed: 04/22/2024] Open
Abstract
We report our initial real-world experience with 177Lu-PSMA-617 radioligand therapy. Methods: We performed a retrospective review of patients treated with 177Lu-PSMA-617. Pretreatment PSMA PET, laboratory findings, overall survival, a fall in prostate-specific antigen by 50% (PSA50), and toxicities were evaluated. Results: Ninety-nine patients were included. Sixty patients achieved a PSA50. Seven of 18 (39%) patients who did not meet the TheraP PSMA imaging criteria achieved a PSA50. Nineteen of 31 (61%) patients who did not meet the VISION laboratory criteria achieved a PSA50. Sixty-three patients had a delay or stoppage in therapy, which was due to a good response in 19 patients and progressive disease in 14 patients. Of 10 patients with a good response who restarted treatment, 9 subsequently achieved a PSA50 on retreatment. The most common toxicities were anemia (33%) and thrombocytopenia (21%). Conclusion: At our center, patients who did not meet the TheraP PSMA imaging criteria or the VISION laboratory criteria benefited from 177Lu-PSMA-617 radioligand therapy.
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Affiliation(s)
- Abuzar Moradi Tuchayi
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Surekha Yadav
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Fei Jiang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; and
| | - Sarasa T Kim
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Rachelle K Saelee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Amanda Morley
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Roxanna Juarez
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Courtney Lawhn-Heath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Yingbing Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Ivan de Kouchkovsky
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California;
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Chitapanarux N, Tharavichitkul E, Kittidachanan K, Muangwong P, Chakrabandhu S, Klunklin P, Onchan W, Jia-Mahasap B, Torapichattrakul P, Chitapanarux I. Retrospective Analysis of All Types of Adjuvant Radiotherapy in Endometrial Cancer: Single-Center Experiences in a Middle-Income Country. Asian Pac J Cancer Prev 2024; 25:485-494. [PMID: 38415534 DOI: 10.31557/apjcp.2024.25.2.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE We retrospectively analyzed the efficacy, focusing on overall survival (OS) and the patterns of failure, along with the toxicities of adjuvant radiotherapy (RT) in endometrial cancer patients. METHODS Two-hundred and nineteen patients with endometrial cancer patients who received adjuvant radiotherapy ± adjuvant chemotherapy (ACT) from January 2014 to December 2018 were investigated for overall survival (OS), local recurrence-free survival rate (LRFS), regional recurrence-free survival rate (RRFS), and distant metastasis-free survival rate (DMFS). RESULT Two-hundred and fourteen patients were evaluated. The numbers of VBT alone, EBRT plus VBT, and adjuvant chemotherapy (ACT) plus EBRT plus VBT were 65 (30.4%), 80 (37.4%), and 69 (32.2%) patients, respectively. Stage I (107 patients) was the most common followed by stage III (87 patients). With a median follow-up time of 67 months (IQR 56-78), the 5-year overall survival rates for VBT alone, EBRT plus VBT, and EBRT plus VBT plus ACT were 84.4%, 65%, and 57.4%, respectively. The most common severe (grade 3-4) acute toxicity was neutropenia (4.6%), followed by diarrhea (3.7%). Grade 3-4 late proctitis was found in only 1.9%. On multivariate analysis, advanced age (HR 6.15, p: 0.015), lymph node involvement (HR 6.66, p: 0.039), cervical involvement (HR 10.60, p: 0.029), and substantial LVSI (HR 21.46, p: 0.005) were associated with a higher risk of death. CONCLUSION Advanced age (>65), substantial LVSI, lymph node involvement, and cervical stromal involvement were associated with poor overall survival. These findings here will help identifying high-risk patients and would make it possible to avoid unnecessary adjuvant treatment among patients with a good prognosis.
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Affiliation(s)
| | | | | | - Pooriwat Muangwong
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Thailand
| | - Somvilai Chakrabandhu
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Thailand
| | | | - Wimrak Onchan
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Thailand
| | - Bongkot Jia-Mahasap
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Thailand
| | | | - Imjai Chitapanarux
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Thailand
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Smith A, Boby JM, Benny SJ, Ghazali N, Vermeulen E, George M. Immunotherapy in Older Patients with Cancer: A Narrative Review. Int J Gen Med 2024; 17:305-313. [PMID: 38298248 PMCID: PMC10830099 DOI: 10.2147/ijgm.s435001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024] Open
Abstract
Purpose Immunotherapies have revolutionized cancer treatment; however, relatively little is known about their efficacy and toxicity in the elderly, a cohort accounting for more than half of total cancer cases. In this review, we aim to provide insight into the current knowledge base regarding the clinical utility and side effects of immunotherapies in the geriatric population as well as identify key gaps in the literature where further research is essential. Methods We conducted a rapid critical review of available literature, focusing on studies reporting on use of immunotherapy in cancer patients aged ≥65 years. The review assessed studies that included different types of cancer, were of multiple study types (although predominantly retrospective), had different study duration, and reported different outcomes of interest. Owing to this heterogeneity, meta-analysis and a direct comparison between studies were not feasible. Results Overall, the review findings indicate that certain malignancies have shown comparable survival rates in younger and older age groups when managed with immunotherapeutic drugs, the incidence of immunotherapy-related side effects varies only slightly by age groups, and in general there is a lack of studies on the determinants of the clinical outcomes of immunotherapy in or including geriatric patients. Conclusion Enhanced clinical benefits along with better tolerability associated with immunotherapies make it an attractive alternative to conventional chemotherapeutic drugs, especially in elderly patients. There is currently a limited number of studies assessing the clinical outcomes of immunotherapies, particularly in the elderly. Overall, our findings reflect a need for further prospective studies focussing on geriatric patients representative of the real-life population, in order to derive a more precise understanding of the clinical utility, toxicity profile, and cost-effectiveness of immune checkpoint inhibitors in older patients with cancer.
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Affiliation(s)
- Alexandra Smith
- Tamworth Hospital, Hunter New England Local Health District (NSW Health), Tamworth, NSW, Australia
| | | | | | | | - Elke Vermeulen
- Tamworth Hospital, Hunter New England Local Health District (NSW Health), Tamworth, NSW, Australia
| | - Mathew George
- Tamworth Hospital, Hunter New England Local Health District (NSW Health), Tamworth, NSW, Australia
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Ulhaq ZS, Tse WKF. PFHxS Exposure and the Risk of Non-Alcoholic Fatty Liver Disease. Genes (Basel) 2024; 15:93. [PMID: 38254982 PMCID: PMC10815161 DOI: 10.3390/genes15010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Perfluorohexanesulfonic acid (PFHxS) is a highly prevalent environmental pollutant, often considered to be less toxic than other poly- and perfluoroalkyl substances (PFASs). Despite its relatively lower environmental impact compared to other PFASs, several studies have suggested that exposure to PFHxS may be associated with disruptions of liver function in humans. Nevertheless, the precise pathomechanisms underlying PFHxS-induced non-alcoholic fatty liver disease (NAFLD) remain relatively unclear. Therefore, this study applied our previously published transcriptome dataset to explore the effects of PFHxS exposure on the susceptibility to NAFLD and to identify potential mechanisms responsible for PFHxS-induced NAFLD through transcriptomic analysis conducted on zebrafish embryos. Results showed that exposure to PFHxS markedly aggravated hepatic symptoms resembling NAFLD and other metabolic syndromes (MetS) in fish. Transcriptomic analysis unveiled 17 genes consistently observed in both NAFLD and insulin resistance (IR), along with an additional 28 genes identified in both the adipocytokine signaling pathway and IR. These shared genes were also found within the NAFLD dataset, suggesting that hepatic IR may play a prominent role in the development of PFHxS-induced NAFLD. In conclusion, our study suggests that environmental exposure to PFHxS could be a potential risk factor for the development of NAFLD, challenging the earlier notion of PFHxS being safer as previously claimed.
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Affiliation(s)
- Zulvikar Syambani Ulhaq
- Laboratory of Developmental Disorders and Toxicology, Center for Promotion of International Education and Research, Faculty of Agriculture, Kyushu University, Fukuoka 819-0395, Japan
- Research Center for Pre-Clinical and Clinical Medicine, National Research and Innovation Agency Republic of Indonesia, Cibinong 16911, Indonesia
| | - William Ka Fai Tse
- Laboratory of Developmental Disorders and Toxicology, Center for Promotion of International Education and Research, Faculty of Agriculture, Kyushu University, Fukuoka 819-0395, Japan
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Akkad N, Thomas TS, Luo S, Knoche E, Sanfilippo KM, Keller JW. A real-world study of pneumonitis in non-small cell lung cancer patients receiving durvalumab following concurrent chemoradiation. J Thorac Dis 2023; 15:6427-6435. [PMID: 38249904 PMCID: PMC10797388 DOI: 10.21037/jtd-22-1604] [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: 01/31/2023] [Accepted: 10/11/2023] [Indexed: 01/23/2024]
Abstract
Background Locally advanced non-small cell lung cancer (LA-NSCLC) treated with the programmed death-ligand 1 inhibitor durvalumab has been associated with significant rates of pneumonitis, which has led to higher rates of discontinuation of therapy in real-world populations. Thus far there has been no consensus in the literature on the impact of pneumonitis on survival. Methods This is a retrospective cohort study of veterans receiving durvalumab between 12/5/2017 and 4/15/2020. Participants were identified using VINCI data services. Patients were followed through 9/14/2021. Development of clinical pneumonitis was assessed through review of documentation and graded using CTCAE 4.0 criteria. Univariate logistic regression analysis evaluated for associations between body mass index (BMI), age, race, co-morbidity index, chemotherapy regimen, chronic obstructive pulmonary disease (COPD) severity, and development of clinical pneumonitis. Progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier methods. Cox proportional hazards models were utilized to evaluate the association between risk of death at 1 and 2 years and candidate predictor variables. Results A total of 284 patients were included in this study. Sixty-one patients developed clinically significant pneumonitis, 7 patients developed grade 5 pneumonitis (death from pneumonitis). The median OS in patients that developed pneumonitis was 27.8 vs. 36.9 months in patients that did not develop pneumonitis (P=0.22). BMI was found to be a clinical predictor of pneumonitis (P=0.04). COPD severity, race, age at durvalumab start date, chemotherapy regimen, and Romano comorbidity index were not significant predictors of pneumonitis. Cox proportional hazards analysis failed to demonstrate an association between the development of pneumonitis and risk of death in this population. Conclusions The incidence of clinically significant pneumonitis is higher than noted in the PACIFIC trial in this cohort, however this high rate of pneumonitis does not have an impact on OS or PFS. Obesity was found to be a significant predictor of pneumonitis in this patient population.
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Affiliation(s)
- Neha Akkad
- Washington University School of Medicine/Barnes Jewish Hospital, St. Louis, MO, USA
| | - Theodore S. Thomas
- Washington University School of Medicine/Barnes Jewish Hospital, St. Louis, MO, USA
- St. Louis Veterans Health Administration Medical Center Research Service, St. Louis, MO, USA
| | - Suhong Luo
- Washington University School of Medicine/Barnes Jewish Hospital, St. Louis, MO, USA
| | - Eric Knoche
- Washington University School of Medicine/Barnes Jewish Hospital, St. Louis, MO, USA
- St. Louis Veterans Health Administration Medical Center Research Service, St. Louis, MO, USA
| | - Kristen M. Sanfilippo
- Washington University School of Medicine/Barnes Jewish Hospital, St. Louis, MO, USA
- St. Louis Veterans Health Administration Medical Center Research Service, St. Louis, MO, USA
| | - Jesse W. Keller
- Washington University School of Medicine/Barnes Jewish Hospital, St. Louis, MO, USA
- St. Louis Veterans Health Administration Medical Center Research Service, St. Louis, MO, USA
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Laumann RD, Pedersen LL, Andrés-Jensen L, Mølgaard C, Schmiegelow K, Frandsen TL, Als-Nielsen B. Hyperlipidemia in children and adolescents with acute lymphoblastic leukemia: A systematic review and meta-analysis. Pediatr Blood Cancer 2023; 70:e30683. [PMID: 37776083 DOI: 10.1002/pbc.30683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/25/2023] [Accepted: 09/07/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The established association between acute lymphoblastic leukemia (ALL) and hyperlipidemia has, in some studies, been linked to toxicities such as pancreatitis, thrombosis, and osteonecrosis. However, a systematic review investigating the incidence, management, and clinical implications of hyperlipidemia during childhood ALL treatment is lacking. OBJECTIVES Systematically assess the incidence of hyperlipidemia during ALL treatment, explore associations with risk factors and severe toxicities (osteonecrosis, thrombosis, and pancreatitis), and review prevalent management strategies. METHODS A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Data synthesis was descriptive, and a meta-analysis of hypertriglyceridemia and risk of severe toxicities was performed. RESULTS We included 13 studies with 3,425 patients. Hyperlipidemia incidence varied widely (6.7%-85%) but with inconsistent definitions and screening strategies across studies. Evidence regarding risk factors was conflicting, but age (> 10 years) and treatment with asparaginase and glucocorticosteroids seem to be associated with hyperlipidemia. Hypertriglyceridemia (grade 3/4) increased the risk for osteonecrosis (odds ratio (OR): 4.27, 95% confidence interval (CI): 2.77-6.61). No association could be established for pancreatitis (OR: 1.60, 95% CI: 0.53-4.82) or thrombosis (OR: 2.45, 95% CI: 0.86-7.01), but larger studies are needed to confirm this. CONCLUSION The overall evidence of this systematic review is limited by the small number of studies and risk of bias. Our review suggests that hypertriglyceridemia increases the risk for osteonecrosis. However, larger studies are needed to explore the clinical implications of hyperlipidemia and randomized trials investigating hyperlipidemia management and its impact on severe toxicities.
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Affiliation(s)
- Renate Dagsdottir Laumann
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Louise Lindkvist Pedersen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Liv Andrés-Jensen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Pediatric Nutrition Unit, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Leth Frandsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Bodil Als-Nielsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
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Kristjanson M, Lambert P, Decker KM, Bruin S, Tingey E, Skrabek P. Steroid-Induced Hyperglycemia and Its Effect on Outcomes of R-CHOP Chemotherapy for Diffuse Large B-Cell Lymphoma. Curr Oncol 2023; 30:10142-10151. [PMID: 38132372 PMCID: PMC10742719 DOI: 10.3390/curroncol30120738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Large doses of steroids are integral to R-CHOP, a first-line systemic therapy for diffuse large B-cell lymphoma (DLBCL), an aggressive form of non-Hodgkin Lymphoma (NHL). Patients on R-CHOP often develop clinically significant hyperglycemia from steroids. There is evidence of harms from steroid-induced hyperglycemia in the context of chemotherapy which are associated with a reduction in overall survival. The objective of our study was to characterize the effect of steroid-induced hyperglycemia on the outcomes of R-CHOP chemotherapy for DLBCL. METHODS We performed a retrospective chart review of 188 patients with DLBCL treated with R-CHOP through CancerCare Manitoba (CCMB) from 1 January 2010 to 31 December 2014. Patients diagnosed with DLBCL were identified using the Manitoba Cancer Registry. The CCMB electronic medical record was reviewed to examine the association between steroid-induced hyperglycemia and subsequent infection, including febrile neutropenic events and overall survival (OS). RESULTS Patients who developed hyperglycemia with steroid exposure became hyperglycemic during their first R-CHOP cycle. No significant differences in OS or rates of infection were found between euglycemic and hyperglycemic subjects. CONCLUSIONS Patients destined to develop steroid-induced hyperglycemia declare themselves early in the course of steroid exposure. No statistically significant reduction in overall survival attributable to steroid-induced hyperglycemia was found.
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Affiliation(s)
- Mark Kristjanson
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W2, Canada
- Urgent Cancer Care, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Pascal Lambert
- Paul Albrechtsen Research Institute CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada; (P.L.); (K.M.D.)
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Kathleen M. Decker
- Paul Albrechtsen Research Institute CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada; (P.L.); (K.M.D.)
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
| | - Sonja Bruin
- Ongomiizwin Health Services Institute of Indigenous Health and Healing, 745 Bannatyne Avenue, Winnipeg, MB R3E 3N4, Canada;
| | - Elizabeth Tingey
- Max Rady College of Medicine, Rady Faculty of Health Sciences 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada;
| | - Pamela Skrabek
- Department of Medical Oncology & Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada;
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W2, Canada
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Helwani AM, Al Suleimani YM, Al Baimani K, Abdelrahman AM. Relative dose intensity of taxane-based chemotherapy in breast cancer patients in a tertiary hospital. J Oncol Pharm Pract 2023:10781552231214467. [PMID: 37968875 DOI: 10.1177/10781552231214467] [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: 11/17/2023]
Abstract
INTRODUCTION Breast cancer (BC) is the most diagnosed tumor among women worldwide. The aim of this study was to investigate the incidence and causes of low relative dose intensity (RDI) < 85% for taxane-based chemotherapy regimens used in the treatment of BC in Sultan Qaboos University Hospital (SQUH). METHODS This was a retrospective study that included 303 BC patients, treated with taxane-based chemotherapy protocols at SQUH. RDI was calculated for each chemotherapy regimen and causes and predictors of low RDI < 85% were identified. Prophylactic and therapeutic supportive measures for certain toxicities were studied. RESULTS 50.8% of the patients had neoadjuvant chemotherapy, 38% had adjuvant chemotherapy, and 11.2% of patients were given palliative treatment. AC-T and AC-THP were the most used regimens (40.3% and 17.2%). Mean RDI of used taxane-based chemotherapy regimens was 93.4%. Dose delays, dose reductions, and treatment discontinuation occurred in 36.6%, 14.8%, and 11.5%, respectively. Thirty-eight patients (12.5%) had low RDI < 85% which was reduced to 9.9% after the use of an alternative taxane. Age and chemotherapy intent were significant risk factors. 83.8% received primary granulocyte colony stimulating factor. CONCLUSION An optimal RDI greater than 85% was achieved in most cases. Furthermore, prophylactic and therapeutic supportive measures were widely used.
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Affiliation(s)
- Amira M Helwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Yousuf M Al Suleimani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Khalid Al Baimani
- Department of Medicine, Sultan Qaboos Comprehensive Cancer Center, Muscat, Sultanate of Oman
| | - Aly M Abdelrahman
- Department of Pharmacology & Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
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Lee EM, Jiménez-Fonseca P, Galán-Moral R, Coca-Membribes S, Fernández-Montes A, Sorribes E, García-Torralba E, Puntí-Brun L, Gil-Raga M, Cano-Cano J, Calderon C. Toxicities and Quality of Life during Cancer Treatment in Advanced Solid Tumors. Curr Oncol 2023; 30:9205-9216. [PMID: 37887565 PMCID: PMC10605504 DOI: 10.3390/curroncol30100665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/04/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
The purpose of the study was to identify subgroups of advanced cancer patients who experienced grade 3-4 toxicities as reported by their oncologists as well as identify the demographic, clinical, and treatment symptom characteristics as well as QoL outcomes associated with distinct profiles of each patient. A prospective, multicenter, observational study was conducted with advanced cancer patients of 15 different hospitals across Spain. After three months of systemic cancer treatment, participants completed questionnaires that evaluated psychological distress (BSI-18), quality of life (EORTC QLQ-C30) and fatigue (FAS). The most common tumor sites for the 557 cancer patients with a mean age of 65 years were bronchopulmonary, digestive, and pancreas. Overall, 19% of patients experienced high-grade toxicities (grade 3-4) during treatment. Patients with recurrent advanced cancer, with non-adenocarcinoma cancer, undergoing chemotherapy, and a showing deteriorated baseline status (ECOG > 1) were more likely to experience higher toxicity. Patients who experienced grade 3-4 toxicities during cancer treatment had their treatment suspended in 59% of the cases. Additionally, 87% of the patients had a dose adjustment or a cycle delayed in their treatment due to a high risk of dying during treatment. Future research should focus on identifying interventions to reduce high-grade toxicities and improve quality of life in cancer patients.
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Affiliation(s)
- Eun Mi Lee
- Faculty of Psychology, University of Barcelona, 08007 Barcelona, Spain
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, 33011 Oviedo, Spain
| | - Rocio Galán-Moral
- Department of Medical Oncology, Hospital General Universitario de Ciudad Real, 13005 Madrid, Spain
| | - Sara Coca-Membribes
- Department of Medical Oncology, Hospital Universitario de Canarias, 38320 Tenerife, Spain
| | - Ana Fernández-Montes
- Department of Medical Oncology, Complejo Hospitalario Universitario de Ourense, 32005 Ourense, Spain
| | - Elena Sorribes
- Faculty of Psychology, University of Barcelona, 08007 Barcelona, Spain
| | | | - Laura Puntí-Brun
- Department of Medical Oncology, Consorcio Sanitario del Maresme, 08304 Mataró, Spain
| | - Mireia Gil-Raga
- Department of Medical Oncology, Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Juana Cano-Cano
- Department of Medical Oncology, Hospital General Universitario de Ciudad Real, 13005 Madrid, Spain
| | - Caterina Calderon
- Faculty of Psychology, University of Barcelona, 08007 Barcelona, Spain
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11
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Eggert MC, Janssen S, Yu NY, Rades D. Simultaneous vs. Sequential Boost for Adjuvant Breast Radiotherapy. Anticancer Res 2023; 43:4651-4655. [PMID: 37772551 DOI: 10.21873/anticanres.16660] [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: 07/27/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND/AIM During the last 10-15 years, alternative regimens for adjuvant radiotherapy (RT) of breast cancer have become more popular, including simultaneous integrated (SIB) instead of sequential boosts (SEB). We present long-term outcomes after conventional fractionation (CF) plus SIB vs. CF+SEB. PATIENTS AND METHODS Forty-eight patients receiving CF+SIB (treatment time=5.5 weeks) were matched to 72 patients (control group) receiving CF+SEB (6.5 weeks) considering twelve characteristics. Both groups were compared for radiation dermatitis, pneumonitis, local control (LC), metastases-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS Rates of grade ≥2 dermatitis were 35.4% (CF+SIB) and 45.8% (CF+SEB), respectively (p=0.26), and rates of grade ≥2 pneumonitis 0% and 4.2%, respectively (p=0.27). Six-year LC, MFS, CSS, and OS rates were 100% vs. 93% (p=0.11), 97% vs. 100% (p=0.29), 100% vs. 100% (p=1.00), and 98% vs. 100% (p=0.23), respectively. CONCLUSION CF+SIB was similar to CF+SEB in terms of toxicities and outcomes but reduces total treatment time by one week.
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Affiliation(s)
- Marie C Eggert
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
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12
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Boulch M, Cazaux M, Cuffel A, Ruggiu M, Allain V, Corre B, Loe-Mie Y, Hosten B, Cisternino S, Auvity S, Thieblemont C, Caillat-Zucman S, Bousso P. A major role for CD4 + T cells in driving cytokine release syndrome during CAR T cell therapy. Cell Rep Med 2023; 4:101161. [PMID: 37595589 PMCID: PMC10518592 DOI: 10.1016/j.xcrm.2023.101161] [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: 11/10/2022] [Revised: 04/21/2023] [Accepted: 07/26/2023] [Indexed: 08/20/2023]
Abstract
Anti-CD19 chimeric antigen receptor (CAR) T cell therapy represents a breakthrough for the treatment of B cell malignancies. Yet, it can lead to severe adverse events, including cytokine release syndrome (CRS), which may require urgent clinical management. Whether interpatient variability in CAR T cell subsets contributes to CRS is unclear. Here, we show that CD4+ CAR T cells are the main drivers of CRS. Using an immunocompetent model of anti-CD19 CAR T cell therapy, we report that CD4+, but not CD8+, CAR T cells elicit physiological CRS-like manifestations associated with the release of inflammatory cytokines. In CAR T cell-treated patients, CRS occurrence and severity are significantly associated with high absolute values of CD4+ CAR T cells in the blood. CRS in mice occurs independently of CAR T cell-derived interferon γ (IFN-γ) but requires elevated tumor burden. Thus, adjusting the CD4:CD8 CAR T cell ratio to patient tumor load may help mitigate CAR T cell-associated toxicities.
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Affiliation(s)
- Morgane Boulch
- Institut Pasteur, Université Paris Cité, INSERM U1223, Dynamics of Immune Responses Unit, Équipe Labellisée Ligue Contre le Cancer, 75015 Paris, France
| | - Marine Cazaux
- Institut Pasteur, Université Paris Cité, INSERM U1223, Dynamics of Immune Responses Unit, Équipe Labellisée Ligue Contre le Cancer, 75015 Paris, France
| | - Alexis Cuffel
- Université Paris Cité, Hôpital Saint-Louis, AP-HP Nord, Laboratoire d'Immunologie, Paris, France; INSERM UMR976, Institut de Recherche St-Louis, Paris, France
| | - Mathilde Ruggiu
- Institut Pasteur, Université Paris Cité, INSERM U1223, Dynamics of Immune Responses Unit, Équipe Labellisée Ligue Contre le Cancer, 75015 Paris, France
| | - Vincent Allain
- Université Paris Cité, Hôpital Saint-Louis, AP-HP Nord, Laboratoire d'Immunologie, Paris, France; INSERM UMR976, Institut de Recherche St-Louis, Paris, France
| | - Béatrice Corre
- Institut Pasteur, Université Paris Cité, INSERM U1223, Dynamics of Immune Responses Unit, Équipe Labellisée Ligue Contre le Cancer, 75015 Paris, France
| | - Yann Loe-Mie
- Institut Pasteur, Université Paris Cité, Bioinformatics and Biostatistics HUB, 75015 Paris, France
| | - Benoit Hosten
- Université Paris Cité, INSERM, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, 75006 Paris, France; Service de Pharmacie, Unité Claude Kellershohn - Radiopharmacie R&D, AP-HP, Hôpital Saint-Louis, 75475 Paris, France
| | - Salvatore Cisternino
- Université Paris Cité, INSERM, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, 75006 Paris, France; Service de Pharmacie, AP-HP, Hôpital Necker, 75015 Paris, France
| | - Sylvain Auvity
- Université Paris Cité, INSERM, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, 75006 Paris, France; Service de Pharmacie, AP-HP, Hôpital Necker, 75015 Paris, France
| | - Catherine Thieblemont
- Hémato-Oncologie, Hôpital Saint-Louis, AP-HP, Université Paris Cité, Inserm U1153, Paris, France
| | - Sophie Caillat-Zucman
- Université Paris Cité, Hôpital Saint-Louis, AP-HP Nord, Laboratoire d'Immunologie, Paris, France; INSERM UMR976, Institut de Recherche St-Louis, Paris, France
| | - Philippe Bousso
- Institut Pasteur, Université Paris Cité, INSERM U1223, Dynamics of Immune Responses Unit, Équipe Labellisée Ligue Contre le Cancer, 75015 Paris, France.
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13
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Digklia A, Dolcan A, Kucharczyk MA, Jones RL, Napolitano A. Optimal Delivery of Follow-Up Care Following Treatment for Adults Treated for Ewing Sarcoma. Cancer Manag Res 2023; 15:537-545. [PMID: 37351338 PMCID: PMC10284160 DOI: 10.2147/cmar.s362693] [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: 12/05/2022] [Accepted: 05/23/2023] [Indexed: 06/24/2023] Open
Abstract
Ewing sarcoma (ES) is a rare, highly malignant sarcoma. It usually presents in the second decade of life; however, patients can be diagnosed as early as newborns and as late as in their seventies. ES is most frequently found in the long bones of the extremities and the pelvis. In older patients, ES can also arise in the soft tissues. Currently, there is no standard schedule for surveillance of adult patients with ES after their initial treatment for localised disease, not only for the early detection of recurrence but also for long-term side effects. Follow-up is based on group recommendations using extrapolated data obtained primarily from studies with paediatric patients. The main objective of this review is to summarise the data available on treatment-associated complications in long-term survivors. Furthermore, we provide a set of recommendations for optimising the follow-up of adults ES survivors, as well as for managing the sequelae that result from intensive multimodal treatment.
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Affiliation(s)
- Antonia Digklia
- Department of Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, 1011, Switzerland
| | - Ana Dolcan
- Department of Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, 1011, Switzerland
| | | | - Robin L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Andrea Napolitano
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
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14
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Zwaan I, Soror T, Idel C, Pries R, Bruchhage KL, Hakim SG, Yu NY, Rades D. First Results of Concurrent Chemoradiation with Two Courses of 5 × 25 mg/m 2 Cisplatin for Locally Advanced Head and Neck Cancer. J Pers Med 2023; 13:1006. [PMID: 37373994 DOI: 10.3390/jpm13061006] [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: 05/31/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Many patients with squamous cell carcinoma of the head and neck (SCCHN) receive cisplatin-based chemoradiation. Cisplatin 100 mg/m2 every three weeks is toxic and alternative cisplatin regimens are desired. Two courses of 20 mg/m2/day 1-5 (cumulative 200 mg/m2) were shown to be similarly effective and better tolerated than 100 mg/m2 every three weeks. Previous studies suggested that cumulative doses >200 mg/m2 may further improve outcomes. In this study, 10 patients (group A) receiving two courses of 25 mg/m2/day 1-5 (cumulative 250 mg/m2) in 2022 were retrospectively matched and compared to 98 patients (group B) receiving two courses of 20 mg/m2/day 1-5 or 25 mg/m2/day 1-4 (cumulative 200 mg/m2). Follow-up was limited to 12 months to avoid bias. Group A achieved non-significantly better 12-month loco-regional control (100% vs. 83%, p = 0.27) and metastases-free survival (100% vs. 88%, p = 0.38), and similar overall survival (89% vs. 88%, p = 0.90). No significant differences were found regarding toxicities, completion of chemotherapy, and interruption of radiotherapy. Given the limitations of this study, chemoradiation with two courses of 25 mg/m2/day 1-5 appears an option for carefully selected patients as a personalized treatment approach. Longer follow-up and a larger sample size are needed to properly define its role.
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Affiliation(s)
- Inga Zwaan
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Tamer Soror
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Christian Idel
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, University of Lubeck, 23562 Lubeck, Germany
| | - Ralph Pries
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, University of Lubeck, 23562 Lubeck, Germany
| | - Karl L Bruchhage
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, University of Lubeck, 23562 Lubeck, Germany
| | - Samer G Hakim
- Department of Oral and Maxillofacial Surgery, University of Lubeck, 23562 Lubeck, Germany
- Department of Oral and Maxillofacial Surgery, MSH Medical School Hamburg, Schwerin Campus, 19055 Schwerin, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Dirk Rades
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
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15
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He LL, Xiao S, Jiang CH, Wu XW, Liu W, Fan CG, Ye X, Zhao Q, Wu WQ, Li YX, Wang H, Liu F. A randomized, controlled trial to investigate cognitive behavioral therapy in prevention and treatment of acute oral mucositis in patients with locoregional advanced nasopharyngeal carcinoma undergoing chemoradiotherapy. Front Oncol 2023; 13:1143401. [PMID: 37350940 PMCID: PMC10282775 DOI: 10.3389/fonc.2023.1143401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/15/2023] [Indexed: 06/24/2023] Open
Abstract
Purpose Oral mucositis is a common side effect of concurrent chemoradiotherapy (CCRT). This study aimed to determine whether cognitive behavioral therapy (CBT) could help prevent oral mucositis during chemoradiation therapy for locoregional advanced nasopharyngeal carcinoma (LA-NPC). Methods and materials Between July 15, 2020, and January 31, 2022, a randomized controlled phase II trial was conducted. Eligible patients (N=282, 18-70 years old) with pathologically diagnosed LA-NPC were randomly assigned to receive CBT or treatment as usual (TAU) during CCRT (computer-block randomization, 1:1). The primary endpoints were the incidence and latency of oral mucositis. Results The incidence of oral mucositis was significantly lower in the CBT group (84.8%; 95% confidence interval [CI], 78.7%-90.9%) than in the TAU group (98.6%; 95% CI, 96.6%-100%; P<0.001). The median latency period was 26 days and 15 days in the CBT and TAU groups, respectively (hazard ratio, 0.16; 95% CI, 0.12-0.22; P<0.001). CBT significantly reduced ≥ grade 3 oral mucositis (71.9% vs. 22.5%, P<0.001), dry mouth (10.8% vs. 3.7%, P=0.021), dysphagia (18% vs. 5.1%, P=0.001), and oral pain (10% vs. 3.6%, P=0.034) compared with TAU. Patients receiving CBT and TAU during CCRT had similar short-term response rates. Conclusions CBT reduced the occurrence, latency, and severity of oral mucositis in patients with LA-NPC during CCRT.
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Affiliation(s)
- Li-li He
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Shuai Xiao
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Cui-hong Jiang
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Xiang-wei Wu
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Wen Liu
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Chang-gen Fan
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Xu Ye
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Qi Zhao
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Wen-qiong Wu
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yan-xian Li
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Hui Wang
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Feng Liu
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
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16
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Medek S, Correa ZM, Huth B, Takiar V. Early treatment and toxicity outcomes for small posterior uveal melanomas treated using custom loaded eye plaques. Front Med (Lausanne) 2023; 10:1055141. [PMID: 37215721 PMCID: PMC10196105 DOI: 10.3389/fmed.2023.1055141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Iodine-125 loaded Collaborative Ocular Melanoma Study plaques can achieve excellent tumor control for patients diagnosed with uveal melanomas. Our ocular cancer team hypothesized that use of novel, partially loaded COMS plaques could ease and improve accurate plaque placement during treatment of small, posterior tumors while providing equivalent tumor control. Materials/methods Records of 25 patients treated with custom plaques were compared to 20 patients treated with fully loaded plaques, who had received treatment prior to our institution's adopting the use of these partial plaques. Tumors were matched with regards to location and dimensions as measured by the ophthalmologist. Retrospective analysis of dosing parameters, tumor control and toxicity outcomes were performed. Results There were no cancer related deaths, local recurrences or metastases in either cohort at an average follow up of 24 months for patients treated with custom plaques and 60.7 months for patients treated with fully loaded plaques. No statistically significant difference was found in regards to post-operative development of cataracts (χ2 = 0.76) or radiation retinopathy (χ2 = 0.22). Patients treated with custom loaded plaques noted significantly less clinical visual loss (χ2 = 0.006) and were more likely to have vision preserved at ≥20/200 (χ2 = 0.006). Conclusion Treatment of small, posterior uveal melanomas with partially loaded COMS plaques results in equivalent survival and recurrence outcomes as treatment with fully loaded plaques, while exposing the patient to less radiation. Additionally, treatment with partially loaded plaques reduces the incidence of clinically significant visual loss. These promising early results support the use of partially loaded plaques in well-selected patients.
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Affiliation(s)
- Sara Medek
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, OH, United States
| | - Zelia M. Correa
- Ocular Oncology, Bascom Palmer Eye Institute, University of Miami Health System, Miami, FL, United States
| | - Brad Huth
- Department of Radiation Oncology, St. Elizabeth’s Hospital, Edgewood, KY, United States
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, OH, United States
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17
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Barnwal A, Ganguly S, Bhattacharyya J. Multifaceted Nano-DEV-IL for Sustained Release of IL-12 to Avert the Immunosuppressive Tumor Microenvironment and IL-12-Associated Toxicities. ACS Appl Mater Interfaces 2023; 15:20012-20026. [PMID: 37068138 DOI: 10.1021/acsami.3c02934] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Interleukin-12 (IL-12) demonstrates potent antitumor activity by enhancing Th1/Th2 response, facilitating cytotoxic T-cell (CTL) recruitment into tumors, inhibiting tumor angiogenesis, and depleting immunosuppressive cells in the tumor microenvironment (TME). Despite having encouraging preclinical and some clinical results, further development of IL-12 is limited because dose-limiting toxicity is observed in early clinical trials with systemic administration of recombinant human IL-12. Hence, strategies aiming to lower the toxicity and to improve response rates are unmet needs. In this study, IL-12 was encapsulated in extracellular vesicles derived from mature dendritic cells (DEVs) activated with tumor antigens. IL-12-encapsulated DEVs (DEV-IL) delayed the growth of murine glioblastoma by facilitating the recruitment of CD8 T-cells, NK-cells, and DCs and effectively depleting immunosuppressive cells in the TME. DEV-IL shifted the Th1/Th2 ratio toward dominating Th1 cytokines which further led to the inhibition of angiogenesis. In addition, DEV-IL also modulated systemic immunity by enhancing CTL activity and the levels of proinflammatory cytokines in the spleen. Interestingly, DEV-IL did not impart hepatic and immunotoxicity which was observed with free IL-12 administration. Hence, our study established DEV-IL as a potent platform for the sustained delivery of cytokines and could be a promising immunotherapeutic strategy for the treatment of cancer.
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Affiliation(s)
- Anjali Barnwal
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Delhi 110016, India
- Department of Biomedical Engineering, All India Institute of Medical Science, Delhi 110029, India
| | | | - Jayanta Bhattacharyya
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Delhi 110016, India
- Department of Biomedical Engineering, All India Institute of Medical Science, Delhi 110029, India
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18
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Licaj I, Coquan E, Dabakuyo-Yonli TS, Dauchy S, Vaz Luis I, Charles C, Lemogne C, Tredan O, Vanlemmens L, Jouannaud C, Levy C, Rigal O, Fournier M, Petit T, Dalenc F, Rouanet P, Lemonnier J, Everhard S, Cottu P, Joly F. Baseline quality of life and chemotherapy toxicities in patients with early breast cancer. Cancer 2023; 129:1085-1095. [PMID: 36642837 DOI: 10.1002/cncr.34643] [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: 09/27/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND The authors used the French breast cancer Cancer and Toxicities (CANTO) cohort to study the associations between baseline quality of life and chemotherapy dose-reductions (CDRs) or postchemotherapy-toxicities (PCTs). METHODS In total, 3079 patients with breast cancer who received chemotherapy were included in this analysis. The associations between baseline physical functioning (PF) and fatigue measured using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30, and two endpoints-CDRs during adjuvant or neoadjuvant chemotherapy; and selected PCTs were estimated with odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) using logistic regression models. RESULTS Among the 3079 patients from the CANTO cohort who were included, 718 (33.0%) received chemotherapy in the neoadjuvant setting, and 2361 (67.0%) received chemotherapy as adjuvant treatment. The chemotherapy included taxanes in 94.2% of patients and anthracyclines in 90.5% of patients. Overall, 15.5% of patients experienced CDRs and, 31.0% developed PCTs. Women with low baseline PF scores (<83) had higher multivariate odds of developing CDRs compared with those who had PF scores ≥83 (OR, 1.54; 95% CI, 1.13-2.09). The corresponding OR for PCTs was 1.50 (95% CI, 1.13-2.00). Women with high baseline fatigue scores had higher odds of CDRs (OR, 1.43; 95% CI, 1.13-1.76) and PCTs (OR, 1.32; 95% CI, 1.10-1.59). CONCLUSIONS By using the national CANTO cohort, baseline PF and fatigue were independently associated with CDRs and PCTs.
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Affiliation(s)
- Idlir Licaj
- Clinical Research Department, Centre Francois Baclesse, Caen, France.,Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Elodie Coquan
- Clinical Research Department, Centre Francois Baclesse, Caen, France.,Medical Oncology, Centre Francois Baclesse, Caen, France
| | | | - Sarah Dauchy
- Supportive Care Department, Gustave Roussy, Villejuif, France
| | | | - Cecile Charles
- Supportive Care Department, Gustave Roussy, Villejuif, France
| | - Cedric Lemogne
- Psychiatry Department, Hopital Europeén Georges-Pompidou, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Olivier Tredan
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | | | | | - Christelle Levy
- Department of Clinical Research Unit and Medical Oncology, Centre François Baclesse, Caen, France
| | - Olivier Rigal
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Marion Fournier
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Philippe Rouanet
- Department of Surgery, Institut du Cancer de Montpellier, Montpellier, France
| | | | | | - Paul Cottu
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Florence Joly
- Clinical Research Department, Centre Francois Baclesse, Caen, France.,ANTICIPE Unit, Institut National de la Sante et de la Recherche Medicale, University of Caen Normandie, Caen, France.,Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, Caen, France
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19
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Couderc AL, Liuu E, Boudou-Rouquette P, Poisson J, Frelaut M, Montégut C, Mebarki S, Geiss R, ap Thomas Z, Noret A, Pierro M, Baldini C, Paillaud E, Pamoukdjian F. Pre-Therapeutic Sarcopenia among Cancer Patients: An Up-to-Date Meta-Analysis of Prevalence and Predictive Value during Cancer Treatment. Nutrients 2023; 15:nu15051193. [PMID: 36904192 PMCID: PMC10005339 DOI: 10.3390/nu15051193] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 02/03/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
This study will address the prevalence of pre-therapeutic sarcopenia (PS) and its clinical impact during cancer treatment among adult cancer patients ≥ 18 years of age. A meta-analysis (MA) with random-effect models was performed via a MEDLINE systematic review, according to the PRISMA statement, focusing on articles published before February 2022 that reported observational studies and clinical trials on the prevalence of PS and the following outcomes: overall survival (OS), progression-free survival (PFS), post-operative complications (POC), toxicities (TOX), and nosocomial infections (NI). A total of 65,936 patients (mean age: 45.7-85 y) with various cancer sites and extensions and various treatment modes were included. Mainly defined by CT scan-based loss of muscle mass only, the pooled prevalence of PS was 38.0%. The pooled relative risks were 1.97, 1.76, 2.70, 1.47, and 1.76 for OS, PFS, POC, TOX, and NI, respectively (moderate-to-high heterogeneity, I2: 58-85%). Consensus-based algorithm definitions of sarcopenia, integrating low muscle mass and low levels of muscular strength and/or physical performance, lowered the prevalence (22%) and heterogeneity (I2 < 50%). They also increased the predictive values with RRs ranging from 2.31 (OS) to 3.52 (POC). PS among cancer patients is prevalent and strongly associated with poor outcomes during cancer treatment, especially when considering a consensus-based algorithm approach.
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Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine Geriatrics and Therapeutic Unit, APHM, 13009 Marseille, France
- CNRS, EFS, ADES, Aix-Marseille University, 13015 Marseille, France
| | - Evelyne Liuu
- Department of Geriatrics, CHU Poitiers, 86000 Poitiers, France
- CIC1402 INSERM Unit, Poitiers University Hospital, 86000 Poitiers, France
| | - Pascaline Boudou-Rouquette
- Ariane Program, Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, APHP, 75014 Paris, France
- INSERM U1016-CNRS UMR8104, Cochin Institute, Paris Cancer Institute CARPEM, Paris Cité University, 75015 Paris, France
| | - Johanne Poisson
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
- Faculty of Health, Paris Cité University, 75006 Paris, France
| | - Maxime Frelaut
- Department of Medical Oncology, Gustave Roussy Institute, 94805 Villejuif, France
| | - Coline Montégut
- Internal Medicine Geriatrics and Therapeutic Unit, APHM, 13009 Marseille, France
- Coordination Unit for Geriatric Oncology (UCOG), PACA West, 13009 Marseille, France
| | - Soraya Mebarki
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Romain Geiss
- Department of Medical Oncology, Curie Institute, 92210 Saint-Cloud, France
| | - Zoé ap Thomas
- Department of Cancer Medicine, Gustave Roussy Institute, 94805 Villejuif, France
| | - Aurélien Noret
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Monica Pierro
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Capucine Baldini
- Drug Development Department, Gustave Roussy Institute, 94805 Villejuif, France
| | - Elena Paillaud
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
- INSERM, IMRB, Clinical, Epidemiology and Ageing, Université Paris-Est Creteil, 94010 Creteil, France
| | - Frédéric Pamoukdjian
- Department of Geriatrics, Avicenne Hospital, APHP, 93000 Bobigny, France
- INSERM UMR_S942 Cardiovascular Markers in Stressed Conditions MASCOT, Sorbonne Paris Nord University, 93000 Bobigny, France
- Correspondence:
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Pérez-Lamas L, Luna A, Boque C, Xicoy B, Giraldo P, Pérez López R, Ruiz Nuño C, De Las Heras N, Mora Casterá E, López Marín J, Segura Díaz A, Gómez V, Vélez Tenza P, Sierra Pacho M, Vera Goñi JA, Moreno Vega M, Alvarez-Larrán A, Cortés M, Pérez Encinas M, Carrascosa Mastell P, Angona A, Rosell A, Lakhwani S, Colorado M, Ramila E, Cervero C, Cuevas B, Villalón Blanco L, de Paz R, Paz Coll A, Fernández MJ, Felipe Casado L, Alonso-Domínguez JM, Anguita Arance MM, Salamanca Cuenca A, Jiménez-Velasco A, Prendes SO, Santaliestra M, Lis Chulvi MJ, Hernández-Boluda JC, García-Gutiérrez V. Toxicity of Asciminib in Real Clinical Practice: Analysis of Side Effects and Cross-Toxicity with Tyrosine Kinase Inhibitors. Cancers (Basel) 2023; 15. [PMID: 36831388 DOI: 10.3390/cancers15041045] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
(1) Background: Despite the prognostic improvements achieved with tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML), a minority of patients still fail TKIs. The recent introduction of asciminib may be a promising option in intolerant patients, as it is a first-in-class inhibitor with a more selective mechanism of action different from the ATP-competitive inhibition that occurs with TKIs. Therefore, our goal was to analyze toxicities shown with asciminib as well as to study cross-toxicity with previous TKIs. (2) Methods: An observational, multicenter, retrospective study was performed with data from 77 patients with CML with therapeutic failure to second-generation TKIs who received asciminib through a managed-access program (MAP) (3) Results: With a median follow-up of 13.7 months, 22 patients (28.5%) discontinued treatment: 32% (7/22) due to intolerance and 45% (10/22) due to resistance. Fifty-five percent of the patients reported adverse effects (AEs) with asciminib and eighteen percent grade 3-4. Most frequent AEs were: fatigue (18%), thrombocytopenia (17%), anemia (12%), and arthralgias (12%). None of the patients experienced cardiovascular events or occlusive arterial disease. Further, 26%, 25%, and 9% of patients required dose adjustment, temporary suspension, or definitive discontinuation of treatment, respectively. Toxicities under asciminib seemed lower than with prior TKIs for anemia, cardiovascular events, pleural/pericardial effusion, diarrhea, and edema. Cross-toxicity risk was statistically significant for thrombocytopenia, anemia, neutropenia, fatigue, vomiting, and pancreatitis. (4) Conclusion: Asciminib is a molecule with a good safety profile and with a low rate of AEs. However, despite its new mechanism of action, asciminib presents a risk of cross-toxicity with classical TKIs for some AEs.
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Højfeldt SG, Grell K, Hvitfeldt L, Wehner PS, Bjerre J, Albertsen BK. Correlation between asparaginase enzyme activity levels and coagulation parameters during childhood acute lymphoblastic leukemia treatment. Pediatr Blood Cancer 2023; 70:e30085. [PMID: 36377699 DOI: 10.1002/pbc.30085] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/30/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022]
Abstract
Thromboembolism is a serious toxicity in the treatment of acute lymphoblastic leukemia (ALL), but little is known about the correlation between asparaginase enzyme activity (ASA) levels and coagulation parameters. We included 65 non-high risk ALL patients, aged 1-17 years. Coagulation parameters and corresponding ASA levels were measured during asparaginase treatment. We found ASA to be negatively correlated with antithrombin and fibrinogen up to ASA levels of 250 IU/L, after which these parameters reached a plateau and did not decrease further with further increase of ASA. Patients with silent inactivation of asparaginase had normal coagulation parameters.
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Affiliation(s)
- Sofie Gottschalk Højfeldt
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kathrine Grell
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Pediatrics and Adolescent Medicine, University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lone Hvitfeldt
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peder Skov Wehner
- Department of Pediatric Hematology and Oncology, H. C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Jesper Bjerre
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Birgitte Klug Albertsen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Bentahila R, Giraud P, Decazes P, Kreps S, Nay P, Chatain A, Fabiano E, Durdux C. The impact of sarcopenia on survival and treatment tolerance in patients with head and neck cancer treated with chemoradiotherapy. Cancer Med 2023; 12:4170-4183. [PMID: 36263581 PMCID: PMC9972161 DOI: 10.1002/cam4.5278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Sarcopenia appears to be a negative prognostic factor for poor survival outcomes and worse treatment tolerance in patients with head-and-neck squamous cell carcinoma (HNSCC). We evaluated sarcopenia's impact on overall survival (OS), disease-free survival (DFS) and chemo-radiation tolerance in patients with head-and-neck cancer (HNC) treated with chemoradiotherapy (CRT) from a monocentric observational study. METHODS We identified patients with HNC treated by CRT between 2009 and 2018 with pretreatment imaging using positron emission tomography-computed tomography scans (PET/CT). Sarcopenia was measured using the pretreatment PET/CT at the L3 vertebral body using previously published methods. Clinical variables were retrospectively retrieved. RESULTS Of 216 patients identified, 54 patients (25.47%) met the criteria for sarcopenia. These patients had a lower mean body mass index before treatment (21.92 vs. 25.65 cm/m2 , p < 0.001) and were more likely to have a history of smoking (88.89% vs. 71.52%, p = 0.01), alcohol use (55.56% vs. 38.61%, p = 0.03) and positive human papilloma virus status (67.74% vs. 41.75%, p = 0.011). At 3 years of follow-up, OS and DFS were 75% and 70% versus 82% and 85% for sarcopenic and non-sarcopenic patients, respectively (p = 0.1 and p = 0.00015). On multivariate analysis, sarcopenia appeared as a pejorative factor on DFS (hazard ratio 2.174, p = 0.0001) in the overall cohort. Sarcopenic patients did not require more chemotherapy and radiation-treatment interruptions and did not suffer from more chemo-induced and radiation-induced grade 3-4 toxicities than their non-sarcopenic counterparts. CONCLUSION Sarcopenia in HNSCC patients is an independent adverse prognostic factor for DFS after definitive chemoradiotherapy.
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Affiliation(s)
- Rita Bentahila
- Department of Radiation Oncology, European Georges Pompidou Hospital, Paris, France
| | - Philippe Giraud
- Department of Radiation Oncology, European Georges Pompidou Hospital, Paris, France
| | - Pierre Decazes
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, France
| | - Sarah Kreps
- Department of Radiation Oncology, European Georges Pompidou Hospital, Paris, France
| | - Paula Nay
- Department of Radiation Oncology, European Georges Pompidou Hospital, Paris, France
| | - Augustin Chatain
- Department of Radiation Oncology, European Georges Pompidou Hospital, Paris, France
| | - Emmanuelle Fabiano
- Department of Radiation Oncology, European Georges Pompidou Hospital, Paris, France
| | - Catherine Durdux
- Department of Radiation Oncology, European Georges Pompidou Hospital, Paris, France
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Lefebvre M, Duchatelet M, El Hajj H, De Courrèges A, Wallet J, Bellier C, Le Tinier F, Le Deley MC, Martinez Gomez C, Leblanc E, Narducci F, Hudry D. Stage I Clear Cell and Serous Uterine Carcinoma: What Is the Right Adjuvant Therapy? Curr Oncol 2023; 30:1174-1185. [PMID: 36661739 PMCID: PMC9858549 DOI: 10.3390/curroncol30010090] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
This single-center study aimed to retrospectively evaluate the survival outcomes of patients with FIGO stage I clear cell and serous uterine carcinoma according to the type of adjuvant treatment received. The data were collected between 2003 and 2020 and only patients with stage I clear cell or serous uterine carcinoma treated with primary surgery were included. These were classified into three groups: No treatment or brachytherapy only (G1), radiotherapy +/- brachytherapy (G2), chemotherapy +/- radiotherapy +/- brachytherapy (G3). In total, we included 52 patients: 18 patients in G1, 16 in G2, and 18 in G3. Patients in the G3 group presented with poorer prognostic factors: 83.3% had serous histology, 27.8% LVSI, and 27.8% were FIGO stage IB. Patients treated with adjuvant radiotherapy showed an improved 5-year overall survival (OS) (p = 0.02) and a trend towards an enhanced 5-year progression-free survival (PFS) (p = 0.056). In contrast, OS (p = 0.97) and PFS (p = 0.84) in the chemotherapy group with poorer prognostic factors, were similar with increased toxicity (83.3%). Radiotherapy is associated with improved 5-year OS and tends to improve 5-year PFS in women with stage I clear cell and serous uterine carcinoma. Additional chemotherapy should be cautiously considered in serous carcinoma cases presenting poor histological prognostic factors.
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Affiliation(s)
- Manon Lefebvre
- Department of Gynecologic Oncology, Centre Oscar Lambret, 59000 Lille, France; (M.D.); (H.E.H.); (C.M.G.); (E.L.); (F.N.); (D.H.)
| | - Mathilde Duchatelet
- Department of Gynecologic Oncology, Centre Oscar Lambret, 59000 Lille, France; (M.D.); (H.E.H.); (C.M.G.); (E.L.); (F.N.); (D.H.)
| | - Houssein El Hajj
- Department of Gynecologic Oncology, Centre Oscar Lambret, 59000 Lille, France; (M.D.); (H.E.H.); (C.M.G.); (E.L.); (F.N.); (D.H.)
| | - Antoine De Courrèges
- Methodology and Biostatistics Department, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France; (A.D.C.); (J.W.); (M.C.L.D.)
| | - Jennifer Wallet
- Methodology and Biostatistics Department, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France; (A.D.C.); (J.W.); (M.C.L.D.)
| | - Charlotte Bellier
- Department of Medical Oncology, Centre Oscar Lambret, 59000 Lille, France;
| | - Florence Le Tinier
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France;
| | - Marie Cécile Le Deley
- Methodology and Biostatistics Department, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France; (A.D.C.); (J.W.); (M.C.L.D.)
| | - Carlos Martinez Gomez
- Department of Gynecologic Oncology, Centre Oscar Lambret, 59000 Lille, France; (M.D.); (H.E.H.); (C.M.G.); (E.L.); (F.N.); (D.H.)
- Univ. Lille, Inserm, CHU Lille, U1192—Protéomique Réponse Inflammatoire Spectrométrie de Masse—PRISM, 59000 Lille, France
| | - Eric Leblanc
- Department of Gynecologic Oncology, Centre Oscar Lambret, 59000 Lille, France; (M.D.); (H.E.H.); (C.M.G.); (E.L.); (F.N.); (D.H.)
- Univ. Lille, Inserm, CHU Lille, U1192—Protéomique Réponse Inflammatoire Spectrométrie de Masse—PRISM, 59000 Lille, France
| | - Fabrice Narducci
- Department of Gynecologic Oncology, Centre Oscar Lambret, 59000 Lille, France; (M.D.); (H.E.H.); (C.M.G.); (E.L.); (F.N.); (D.H.)
- Univ. Lille, Inserm, CHU Lille, U1192—Protéomique Réponse Inflammatoire Spectrométrie de Masse—PRISM, 59000 Lille, France
| | - Delphine Hudry
- Department of Gynecologic Oncology, Centre Oscar Lambret, 59000 Lille, France; (M.D.); (H.E.H.); (C.M.G.); (E.L.); (F.N.); (D.H.)
- Univ. Lille, Inserm, CHU Lille, U1192—Protéomique Réponse Inflammatoire Spectrométrie de Masse—PRISM, 59000 Lille, France
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Nielsen CG, Thomsen BL, Als-Nielsen B, Conyers R, Jeha S, Mateos MK, Mlynarski W, Pieters R, Rathe M, Schmiegelow K, Andrés-Jensen L. Physician-defined severe toxicities occurring during and after cancer treatment: Modified consensus definitions and clinical applicability in the evaluation of cancer treatment. Front Pediatr 2023; 11:1155449. [PMID: 37181427 PMCID: PMC10171426 DOI: 10.3389/fped.2023.1155449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/27/2023] [Indexed: 05/16/2023] Open
Abstract
Overall survival after cancer is increasing for the majority of cancer types, but survivors can be burdened lifelong by treatment-related severe toxicities. Integration of long-term toxicities in treatment evaluation is not least important for children and young adults with cancers with high survival probability. We present modified consensus definitions of 21 previously published physician-defined Severe Toxicities (STs), each reflecting the most serious long-term treatment-related toxicities and representing an unacceptable price for cure. Applying the Severe Toxicity (ST) concept to real-world data required careful adjustments of the original consensus definitions, translating them into standardized endpoints for evaluating treatment-related outcomes to ensure that (1) the STs can be classified uniformly and prospectively across different cohorts, and (2) the ST definitions allow for valid statistical analyses. The current paper presents the resulting modified consensus definitions of the 21 STs proposed to be included in outcome reporting of cancer treatment.
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Affiliation(s)
- Camilla Grud Nielsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Birthe Lykke Thomsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Bodil Als-Nielsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rachel Conyers
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Pharmacogenomics, Stem Cell Biology, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Children’s Cancer Centre, The Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Sima Jeha
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN, United States
| | - Marion K. Mateos
- Kids Cancer Centre, Sydney Children’s Hospital Randwick, Sydney, NSW, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Sydney, NSW, Australia
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Wojciech Mlynarski
- Department of Pediatrics, Oncology & Hematology, Medical University of Lodz, Lodz, Poland
| | - Rob Pieters
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Mathias Rathe
- Department of Pediatric Hematology and Oncology, Hans Christian Andersen’s Children’s Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Liv Andrés-Jensen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Correspondence: Liv Andrés-Jensen
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Chen L, Jiang H, Rao JJ, Wang LS, Yan W, Ye J, Lou J. Association between anlotinib trough plasma concentration and treatment outcomes in advanced non-small-cell lung cancer. Front Oncol 2023; 13:1146362. [PMID: 36937430 PMCID: PMC10020721 DOI: 10.3389/fonc.2023.1146362] [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: 01/17/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Background Efficacy and toxicities of anlotinib (ANL) show large inter-patient variation, which may partly be explained by differences in ANL exposure. Exposure-response/toxicities relationship have not been investigated for ANL. Therefore, the aim of the present study was to explore the association between the trough plasma concentration (Ctrough) of ANL and treatment outcomes in Chinese patients with advanced non-small cell lung cancer (NSCLC). Methods Patients with advanced NSCLC who started third-line or further ANL alone therapy between January 2021 and October 2022. This study examined the ANL Ctrough and clinical response evaluation at day 43 after initiation of ANL treatment. We evaluated the association between the ANL Ctrough and clinical efficacy and toxicities. Additionally, this study defined patients with complete response (CR), partial response (PR) and stable disease (SD) as responder. The receiver-operating characteristic (ROC) curve combined with Youden index was identify the potential threshold value of ANL Ctrough for the responder. Results 52 patients were evaluated for analyses. The median ANL Ctrough was 11.45ng/ml (range, 3.69-26.36 ng/ml). The ANL Ctrough values in the PR group (n=6, 15.51 ng/ml (range, 8.19-17.37 ng/ml)) was significantly higher than in the PD group (n=8, 7.44 ng/ml (range, 5.41-14.69 ng/ml), p=0.001). The area under the ROC curve (AUCROC) was 0.76 (95% confidence interval (CI), 0.58-0.93; p=0.022) and threshold value of ANL Ctrough predicting responder was 10.29 ng/ml (sensitivity 65.9% and specificity 87.5%, the best Youden index was 0.53). The disease control rate (DCR) was 84.6%, and DCR was significantly higher in the high-exposure group (≥10.29ng/ml) than low-exposure group (<10.29ng/ml) (96.67% vs 68.18%, p=0.005). Although there was no significant difference in ANL Ctrough between grade ≥ 3 and grade ≤2 toxicities, the incidence of any grade hand-foot syndrome (70.0% vs 36.36%, p=0.016) and thyroid-stimulating hormone elevation (53.33% vs 22.73%, p =0.026) was significantly higher in the high-exposure group compared with the low-exposure group. Conclusions Considering these results, we propose that maintaining ANL Ctrough ≥ 10.29ng/ml was important for achieving the response in advanced NSCLC patients treated with ANL.
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Affiliation(s)
- Ling Chen
- Department of Pharmacy, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Clinical Pharmacy, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Jiang
- Department of Cardiothoracic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun-jie Rao
- Department of Clinical Laboratory, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liu-sheng Wang
- Department of Respiratory, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Yan
- Department of Pharmacy, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Clinical Pharmacy, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Ye
- Department of Respiratory, Zhejiang Hospital, Hangzhou, China
| | - Jiang Lou
- Department of Pharmacy, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Clinical Pharmacy, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Jiang Lou,
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Abstract
Gastrointestinal toxicities secondary to immune checkpoint inhibitors are very frequent. Because in some instances this can be severe or fatal, it is essential to be able to identify immune-related adverse events rapidly. Prompt initiation of systemic immunosuppression can improve outcomes. A biopsy is often necessary to confirm the diagnosis of immune-related adverse events. Moderate or severe irAEs need an interruption of ICI. After the resolution of the toxicities, the rechallenge of immune checkpoint inhibitors must be discussed case by case.
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Soni A, Jadhav GK, Manocha S, Chauhan S, Goswami B, Verma M. Comparative evaluation of hypofractionated radiotherapy versus conventionally fractionated radiotherapy for patients with intermediate and high risk prostate cancer. Rep Pract Oncol Radiother 2022; 27:1001-1009. [PMID: 36632300 PMCID: PMC9826658 DOI: 10.5603/rpor.a2022.0116] [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: 09/21/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022] Open
Abstract
Background The purpose of this study was to comparatively evaluate an efficacy and toxicity profile of hypofractionated radiotherapy (67.5 Gy in 25 fractions) to conventionally fractionated radiotherapy (78 Gy in 39 fractions) in prostate cancer patients with intermediate and high-risk disease. Materials and methods From January 2015 to December 2018, 168 patients were randomized to hypofractionated radiation treatment and conventional fractionated radiation treatment schedules of volumetric modulated arc therapy (VMAT) to the prostate and seminal vesicles. All the patients also received androgen deprivation therapy (ADT) and radiation therapy started after ADT. Results The median (range) follow-up was 51 (31-63) and 53 (33-64) months in the hypofractionated and conventionally fractionated regimes, respectively. The 3-year biochemical no evidence of disease (bNED) rates were 86.9% and 73.8% in the hypofractionated and conventionally fractionated groups, respectively (p = 0.032, significant). The 3-year bNED rates in patients at a high risk [i.e., pretreatment prostate-specific antigen (PSA) > 20 ng/mL, Gleason score ≥ 8, or T ≥ 2 c], were 87.9% and 73.5% (p = 0.007, significant) in the hypofractionated and conventionally fractionated radiotherapy groups, respectively. No statistically significant difference was found for late toxicity between the two groups, with 3-year grade 2 gastrointestinal toxicity rates of 19% and 16.7% and 3-year grade 2 genitourinary toxicity rates of 15.5% and 11.9% in the hypofractionated and conventionally fractionated radiotherapy groups, respectively. Conclusion Hypofractionated schedule is superior to the conventional fractionation schedule of radiation treatment in terms of bNED in intermediate and high grade prostate cancer patients. Also, the late toxicity is found to be equivalent between the two treatment groups.
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Affiliation(s)
- Abhishek Soni
- Department of Radiation Oncology, PT Bhagwat Dayal Sharma, Rohtak, India
| | - Ganesh K Jadhav
- Department of Radiation Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sapna Manocha
- Department of Radiation Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sunil Chauhan
- Department of Radiation Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - Brijesh Goswami
- Department of Radiation Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - Monica Verma
- Department of Radiation Oncology, PT Bhagwat Dayal Sharma, Rohtak, India
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Garutti M, Bergnach M, Polesel J, Palmero L, Pizzichetta MA, Puglisi F. BRAF and MEK Inhibitors and Their Toxicities: A Meta-Analysis. Cancers (Basel) 2022; 15:cancers15010141. [PMID: 36612138 PMCID: PMC9818023 DOI: 10.3390/cancers15010141] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
PURPOSE This meta-analysis summarizes the incidence of treatment-related adverse events (AE) of BRAFi and MEKi. METHODS A systematic search of Medline/PubMed was conducted to identify suitable articles published in English up to 31 December 2021. The primary outcomes were profiles for all-grade and grade 3 or higher treatment-related AEs, and the analysis of single side effects belonging to both categories. RESULTS The overall incidence of treatment-related all-grade Aes was 99% for Encorafenib (95% CI: 0.97-1.00) and 97% for Trametinib (95% CI: 0.92-0.99; I2 = 66%) and Binimetinib (95% CI: 0.94-0.99; I2 = 0%). In combined therapies, the rate was 98% for both Vemurafenib + Cobimetinib (95% CI: 0.96-0.99; I2 = 77%) and Encorafenib + Binimetinib (95% CI: 0.96-1.00). Grade 3 or higher adverse events were reported in 69% of cases for Binimetinib (95% CI: 0.50-0.84; I2 = 71%), 68% for Encorafenib (95% CI: 0.61-0.74), and 72% for Vemurafenib + Cobimetinib (95% CI: 0.65-0.79; I2 = 84%). The most common grade 1-2 AEs were pyrexia (43%) and fatigue (28%) for Dabrafenib + Trametinib and diarrhea for both Vemurafenib + Cobimetinib (52%) and Encorafenib + Binimetinib (34%). The most common AEs of grade 3 or higher were pyrexia, rash, and hypertension for Dabrafenib + Trametinib (6%), rash and hypertension for Encorafenib + Binimetinib (6%), and increased AST and ALT for Vemurafenib + Cobimetinib (10%). CONCLUSIONS Our study provides comprehensive data on treatment-related adverse events of BRAFi and MEKi combination therapies, showing related toxicity profiles to offer a helpful tool for clinicians in the choice of therapy.
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Affiliation(s)
- Mattia Garutti
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Correspondence: ; Tel.: +39-04-3465-9092
| | | | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Lorenza Palmero
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Maria Antonietta Pizzichetta
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Department of Dermatology, University of Trieste, 34123 Trieste, Italy
| | - Fabio Puglisi
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Department of Medicine, University of Udine, 33100 Udine, Italy
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Geng J, Zhao M, Li Q. Severe immunochemotherapy-induced toxicities in a patient with dyskeratosis congenita and literature review. Hematology 2022; 27:1041-1045. [PMID: 36073719 DOI: 10.1080/16078454.2022.2120305] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Dyskeratosis congenita (DC) is a rare inherited disease characterized by the triad of reticulate hyperpigmentation, nail dystrophy and oral leukoplakia. DC patients are considered vulnerable to external pressure, such as immunochemotherapy. There are very few cases reporting severe therapy-induced toxicities in patients with DC. METHODS A 27-year-old woman was admitted to our hospital with a 4-month history of pancytopenia and a 7-day history of dyspnea with coughing. She was diagnosed with non-Hodgkin's lymphoma 5 months ago. She received immunochemotherapy due to non-Hodgkin's lymphoma but experienced recurrent fever, oral ulcer, pancytopenia, dyspnea and other symptoms during immunochemotherapy. On admission, she experienced an aggravation of respiratory symptoms, recurrent infections and acute heart failure. RESULTS Laboratory examination confirmed pancytopenia, and chest computed tomography showed interstitial lung disease (ILD). Genetic analysis results confirmed the presence of DC and a TINF2 gene mutation. With continuous supportive and anti-infection treatment, her condition finally stabilized. She was discharged from the hospital after nearly 2 months. DISCUSSION We reviewed similar cases and found common features that could be useful. However, the reported cases are very limited. More cases and studies are needed. CONCLUSION These cases indicate that DC patients seem more vulnerable to therapy toxicities; thus, physicians should be careful when treating these patients with chemotherapy drugs or radiation therapy. Reduced-intensity therapy may be considered.
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Affiliation(s)
- Jiayi Geng
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People's Republic of People's Republic of China
| | - Menglin Zhao
- Department of Cardiology, Peking University Third Hospital, Beijing, People's Republic of People's Republic of China
| | - Qiuyu Li
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People's Republic of People's Republic of China
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Ahmad V, Ansari MO. Antimicrobial Activity of Graphene-Based Nanocomposites: Synthesis, Characterization, and Their Applications for Human Welfare. Nanomaterials (Basel) 2022; 12:nano12224002. [PMID: 36432288 PMCID: PMC9694244 DOI: 10.3390/nano12224002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 05/15/2023]
Abstract
Graphene (GN)-related nanomaterials such as graphene oxide, reduced graphene oxide, quantum dots, etc., and their composites have attracted significant interest owing to their efficient antimicrobial properties and thus newer GN-based composites are being readily developed, characterized, and explored for clinical applications by scientists worldwide. The GN offers excellent surface properties, i.e., a large surface area, pH sensitivity, and significant biocompatibility with the biological system. In recent years, GN has found applications in tissue engineering owing to its impressive stiffness, mechanical strength, electrical conductivity, and the ability to innovate in two-dimensional (2D) and three-dimensional (3D) design. It also offers a photothermic effect that potentiates the targeted killing of cells via physicochemical interactions. It is generally synthesized by physical and chemical methods and is characterized by modern and sophisticated analytical techniques such as NMR, Raman spectroscopy, electron microscopy, etc. A lot of reports show the successful conjugation of GN with existing repurposed drugs, which improves their therapeutic efficacy against many microbial infections and also its potential application in drug delivery. Thus, in this review, the antimicrobial potentialities of GN-based nanomaterials, their synthesis, and their toxicities in biological systems are discussed.
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Affiliation(s)
- Varish Ahmad
- Health Information Technology Department, The Applied College, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Centre of Artificial Intelligence for Precision Medicines, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Correspondence:
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31
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Hu J, Hu W, Gao J, Yang J, Qiu X, Huang Q, Kong L, Lu JJ. The role of carbon-ion radiotherapy in the treatment of adenoid cystic carcinoma of the nasopharynx. Ann Transl Med 2022; 10:1198. [PMID: 36544666 PMCID: PMC9761180 DOI: 10.21037/atm-20-1767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/07/2020] [Indexed: 12/24/2022]
Abstract
Background Nasopharyngeal adenoid cystic carcinoma (NACC) is a distinct subgroup of adenoid cystic carcinoma (ACC) with limited surgical access but predilection of regional and distant metastasis. Although radiotherapy is an integral treatment for patients with NACC, photon-based radiotherapy yielded suboptimal local control. Because of its advantages in biology and physics properties, carbon-ion radiotherapy (CIRT) was attempted for the treatment of head and neck ACC; however, the use of CIRT specifically for NACC has not been investigated. Methods Patients with NACC that received CIRT alone or a combination of CIRT and proton beam therapy (PBT) at the Shanghai Proton and Heavy Ion Center (SPHIC) between July 2016 and March 2019 were included in the analysis. Patients with newly diagnosed NACC received combined therapy of CIRT (as boost) and PBT, and those with recurrent disease received CIRT alone. Overall survival (OS), local progression-free survival (LPFS), regional progression-free survival (RPFS), and distant metastasis-free survival (DMFS) were calculated by Kaplan-Meier method. Results A total of 22 patients were included in this analysis. Among those, 18 patients had newly diagnosed NACC (17 with locally advanced disease), and 4 had recurrent NACC including 2 failed previous irradiation. After a median follow-up of 30.9 months, the 2-year OS rate, PFS rate, LPFS rate, RPFS rate and DMFS rate were 100%, 84.8%, 94.4%, 100%, and 84.8%, respectively. Three patients experienced grade 3 mucositis or xerostomia. No late toxicity of grade ≥3 was observed. Conclusions CIRT alone or in combination with PBT appeared to be a promising modality for the treatment of NACC and produced satisfactory local disease control and toxicity profile. Distant metastasis remained to be a substantial mode for treatment failure. Further follow-up is necessary to evaluate long-term survivals and late toxicity profile.
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Affiliation(s)
- Jiyi Hu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China;,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Weixu Hu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China;,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Jing Gao
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China;,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Jing Yang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China;,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Xianxin Qiu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China;,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Qingting Huang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China;,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Lin Kong
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China;,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Center, Shanghai, China
| | - Jiade J. Lu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China;,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
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Dri A, Garattini SK, Cinausero M, Macerelli M, Fanelli M, Puglisi F, Fasola G, Ermacora P. Rare and Insidious Toxicities from New Combination Therapies in Metastatic Renal Cell Cancer: Lessons Learned from Real-Practice. Curr Oncol 2022; 29:6776-6786. [PMID: 36290810 PMCID: PMC9600961 DOI: 10.3390/curroncol29100533] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 01/13/2023] Open
Abstract
The advent of immune checkpoint inhibitors in combination with multitarget tyrosine kinase inhibitors has become a standard first-line treatment for metastatic renal cell cancer. Along with survival improvement, new toxicities have emerged. Such adverse events are still complex to be managed and some of them are rare and could be insidious or even fatal. Medical oncologists dispose of guidelines about the management of toxicities from immune checkpoint inhibitors but not for combinations. Therefore, it is still difficult to properly attribute and manage additive or overlapping adverse events. We report two clinical cases regarding rare treatment-related endocrine toxicities-hypophysitis and thyroiditis-with particular focus on their management. To this purpose, immune checkpoint-related toxicities guidelines represent the starting point. However, their implementation with additional measures is needed, considering the increasing complexity of current clinical scenarios. The goal is to correctly recognize adverse events and address side effects, so as not to discontinue effective treatments. We, therefore, aim at discussing the points of proper management of toxicities and individuating potential areas of improvement.
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Affiliation(s)
- Arianna Dri
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Department of Medical Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
- Correspondence:
| | - Silvio Ken Garattini
- Department of Medical Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Marika Cinausero
- Department of Medical Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Marianna Macerelli
- Department of Medical Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Martina Fanelli
- Department of Medical Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCSS, 33081 Aviano, Italy
| | - Gianpiero Fasola
- Department of Medical Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Paola Ermacora
- Department of Medical Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
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Hsu ML, Murray JC, Psoter KJ, Zhang J, Barasa D, Brahmer JR, Ettinger DS, Forde PM, Hann CL, Lam VK, Levy B, Marrone KA, Patel T, Peterson V, Sagorsky S, Turner M, Anagnostou V, Naidoo J, Feliciano JL. Clinical Features, Survival, and Burden of Toxicities in Survivors More Than One Year After Lung Cancer Immunotherapy. Oncologist 2022; 27:971-981. [PMID: 35972337 PMCID: PMC9632301 DOI: 10.1093/oncolo/oyac140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/01/2022] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Anti-PD-(L)1 immune checkpoint inhibitors (ICI) improve survival in patients with advanced non-small cell lung cancer (aNSCLC). The clinical features, survival, and burden of toxicities of patients with aNSCLC alive >1 year from ICI initiation are poorly understood. MATERIALS AND METHODS We defined ICI survivors as patients alive >1 year after ICI start and retrospectively reviewed demographics, treatment, and immune-related adverse events (irAEs). Long-term irAEs were defined as ongoing irAEs lasting >1 year; burden of toxicity measures were based on percentage of days a patient experienced toxicity. Using linear and logistic regression, we evaluated association between demographics and disease characteristics with burden of toxicity. RESULTS We identified 114 ICI survivors from 317 patients with aNSCLC. Half (52%) experienced an irAE of any grade, and 23.7% developed long-term irAEs. More ICI survivors with irAES in the first year had never smoked (P = .018) or received ICIs as frontline therapy (P = .015). The burden of toxicity in the first year significantly correlated with the burden of toxicity afterward (ρ = 0.72; P < .001). No patients with progressive disease had a high burden of toxicity, and they experienced 30.6% fewer days with toxicity than those with stable disease. Increased duration of therapy was associated with higher odds of experiencing toxicity. Half of ICI survivors with irAEs were still receiving treatment for unresolved irAEs at time of death or last follow-up. CONCLUSION Significant proportions of ICI survivors have unresolved long-term toxicities. These data support a growing need to understand long-term toxicity to optimize management of those treated with ICIs.
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Affiliation(s)
| | - Joseph C Murray
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA,Bloomberg-Kimmel institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Kevin J Psoter
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Jiajia Zhang
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA,Bloomberg-Kimmel institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Durrant Barasa
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA,Bloomberg-Kimmel institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Julie R Brahmer
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA,Bloomberg-Kimmel institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - David S Ettinger
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA,Bloomberg-Kimmel institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Patrick M Forde
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA,Bloomberg-Kimmel institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Christine L Hann
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA,Bloomberg-Kimmel institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Vincent K Lam
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA,Bloomberg-Kimmel institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Benjamin Levy
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA,Bloomberg-Kimmel institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Kristen A Marrone
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA,Bloomberg-Kimmel institute for Cancer Immunotherapy, Baltimore, MD, USA
| | | | | | | | - Michelle Turner
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA,Bloomberg-Kimmel institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Valsamo Anagnostou
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA,Bloomberg-Kimmel institute for Cancer Immunotherapy, Baltimore, MD, USA
| | | | - Josephine L Feliciano
- Corresponding author: Josephine Feliciano, MD, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Bayview, 301 Mason Lord Drive, Baltimore, MD 21224, USA. Tel: +1 410 550 1711; Fax: +1 410 550 1116.
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Lyu B, Yin Y, Zhao Y, Yang X, Gong J, Zhang M, Chai G, Li Z, Shi M, Hui Z, Zhao L. Long-Term Clinical Outcomes and Safety Analysis of Superficial Esophageal Cancer Patients Treated with Definitive or Adjuvant Radiotherapy. Cancers (Basel) 2022; 14:3423. [PMID: 35884483 PMCID: PMC9322572 DOI: 10.3390/cancers14143423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: The role of radiotherapy (RT) in superficial esophageal squamous cell cancer (ESCC) remains unclear. The objective of our study was to perform a detailed outcome and safety analysis of RT as a definitive or adjuvant treatment for T1N0M0 staged ESCC patients. (2) Methods: A total of 55 patients treated with endoscopic resection (ER) + RT/concurrent chemoradiotherapy (CCRT) or RT/CCRT from January 2011 to June 2021 were included in this study. Eighteen patients with risk factors received ER + RT/CCRT, and thirty-seven patients solely received RT/CCRT. Kaplan-Meier curves were used to calculate the clinical outcomes, and toxicities were scored. (3) Results: The median follow-up time was 51.9 months. The estimated 5-year local recurrence-free survival (LRFS) and overall survival (OS) were 88.9% and 94.4% in the ER + RT/CCRT group and 91.8% and 91.7% in the RT/CCRT group. The predominant failure pattern was in-field local failure (5.5%, 3/55), with one patient in the ER + RT/CCRT group and two patients in the RT/CCRT group. One patient (1.8%, 1/55) had lung metastasis in the RT/CCRT group. The most common toxicities were Grades 1-2 in all patients, including esophagitis (74.5%, 41/55), myelosuppression (49.1%, 27/55) and esophageal stricture after RT (27.3%, 15/55). Two patients (11.1%, 2/18) and four patients (10.8%, 4/37) had Grade 3 esophageal stricture after RT in the ER + RT/CCRT group and RT/CCRT group, respectively. No patients experienced a Grade 4 or higher toxicity, and there were no treatment-related deaths. (4) Conclusions: Definitive or adjuvant RT/CCRT is an effective treatment alternative for superficial ESCC patients with satisfactory clinical outcomes and acceptable toxicities.
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Affiliation(s)
- Bo Lyu
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710000, China; (B.L.); (Y.Y.); (J.G.); (M.Z.); (G.C.); (Z.L.); (M.S.)
| | - Yutian Yin
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710000, China; (B.L.); (Y.Y.); (J.G.); (M.Z.); (G.C.); (Z.L.); (M.S.)
| | - Yilin Zhao
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710000, China;
| | - Xu Yang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100000, China;
| | - Jie Gong
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710000, China; (B.L.); (Y.Y.); (J.G.); (M.Z.); (G.C.); (Z.L.); (M.S.)
| | - Mai Zhang
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710000, China; (B.L.); (Y.Y.); (J.G.); (M.Z.); (G.C.); (Z.L.); (M.S.)
| | - Guangjin Chai
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710000, China; (B.L.); (Y.Y.); (J.G.); (M.Z.); (G.C.); (Z.L.); (M.S.)
| | - Zhaohui Li
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710000, China; (B.L.); (Y.Y.); (J.G.); (M.Z.); (G.C.); (Z.L.); (M.S.)
| | - Mei Shi
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710000, China; (B.L.); (Y.Y.); (J.G.); (M.Z.); (G.C.); (Z.L.); (M.S.)
| | - Zhouguang Hui
- Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100000, China
| | - Lina Zhao
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710000, China; (B.L.); (Y.Y.); (J.G.); (M.Z.); (G.C.); (Z.L.); (M.S.)
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Al-Maqbali JS, Taqi A, Al-Hamadani B, Gamal S, Al-Lawati E, Himali NA, Bahram F, Al-Jabri S, Al-Sharji N, Homood S, Siyabi BA, Siyabi EA, Al-Ajmi S, Al-Balushi K, Al-Zakwani I. Levels of agreement among clinical pharmacists on the impact of pharmaceutical interventions in Oman: A retrospective analysis. Pharm Pract (Granada) 2022; 20:2708. [PMID: 36733521 PMCID: PMC9851816 DOI: 10.18549/pharmpract.2022.3.2708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
Objectives Disagreement between health care providers on medication-related interventions can affect clinical outcomes. We aimed to study the outcomes and significance of clinical pharmacists' interventions and evaluate the levels of agreement between different clinical pharmacists on the impact of pharmaceutical interventions. Methodology A retrospective study was conducted at a tertiary care hospital in Oman. The study included all documented interventions by clinical pharmacists for all categories of admitted patients that met the inclusion criteria. Results The originator clinical pharmacists interjected to improve the efficacy of treatment in (58%, n=1740) of the interventions, followed by toxicity reduction (24%). The level of agreement in the clinical significance resulted in substantial Scotts' kappa (k) between the originator and the first reviewer, the first and second reviewers, and the second reviewer and supervisor (86%; k=0.77; P<.001), (77%; k=0.63; P<.001), (84%; k=0.77; P<.001), respectively. In terms of grading of clinical significance, the originator clinical pharmacists recorded moderate significance in 50% of the interventions, followed by major (30%), not applicable (8.4%), and minor (7.3%). The level of agreement in the clinical significance resulted in substantial Scotts' k between the originator and the first reviewer, and between the second reviewer and supervisor (82%; k=0.72; P<.001), (84%; k=0.77; P<.001), respectively. The level of agreement between the first and second reviewer was fair (55%; k=0.28; p<0.001). Conclusion Clinical pharmacists' interventions have a crucial impact on patient safety, improving efficacy and reducing toxicities. Overall, there was a substantial agreement among clinical pharmacists on the clinical significance and grading of the interventions..
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Affiliation(s)
- Juhaina Salim Al-Maqbali
- Department of Pharmacy, Department of Pharmacology and Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | - Aqila Taqi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman.
| | | | - Sara Gamal
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Esra Al-Lawati
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Najwa Al Himali
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Fatima Bahram
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Suad Al-Jabri
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Nashwa Al-Sharji
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Saud Homood
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Bushra Al Siyabi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Ekram Al Siyabi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Samyia Al-Ajmi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Kifah Al-Balushi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Ibrahim Al-Zakwani
- Department of Pharmacy, Department of Pharmacology and Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.
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Kandra P, Nandigama R, Eul B, Huber M, Kobold S, Seeger W, Grimminger F, Savai R. Utility and Drawbacks of Chimeric Antigen Receptor T Cell (CAR-T) Therapy in Lung Cancer. Front Immunol 2022; 13:903562. [PMID: 35720364 PMCID: PMC9201083 DOI: 10.3389/fimmu.2022.903562] [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: 03/24/2022] [Accepted: 05/06/2022] [Indexed: 11/23/2022] Open
Abstract
The present treatments for lung cancer include surgical resection, radiation, chemotherapy, targeted therapy, and immunotherapy. Despite advances in therapies, the prognosis of lung cancer has not been substantially improved in recent years. Chimeric antigen receptor (CAR)-T cell immunotherapy has attracted growing interest in the treatment of various malignancies. Despite CAR-T cell therapy emerging as a novel potential therapeutic option with promising results in refractory and relapsed leukemia, many challenges limit its therapeutic efficacy in solid tumors including lung cancer. In this landscape, studies have identified several obstacles to the effective use of CAR-T cell therapy including antigen heterogeneity, the immunosuppressive tumor microenvironment, and tumor penetration by CAR-T cells. Here, we review CAR-T cell design; present the results of CAR-T cell therapies in preclinical and clinical studies in lung cancer; describe existing challenges and toxicities; and discuss strategies to improve therapeutic efficacy of CAR-T cells.
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Affiliation(s)
- Prameela Kandra
- Department of Biotechnology, Gandhi Institute of Technology and Management (GITAM) Institute of Technology, Gandhi Institute of Technology and Management (GITAM) Deemed to be University, Visakhapatnam, India
| | - Rajender Nandigama
- Max Planck Institute for Heart and Lung Research, Member of the German Center for Lung Research Deutsches Zentrum für Lungenforschung (DZL), Member of the Cardio-Pulmonary Institute (CPI), Bad Nauheim, Germany
| | - Bastian Eul
- Department of Internal Medicine, Member of the Deutsches Zentrum für Lungenforschung (DZL), Member of Cardio-Pulmonary Institute (CPI), Justus Liebig University, Giessen, Germany
| | - Magdalena Huber
- Institute for Medical Microbiology and Hygiene, Philipps-University Marburg, Marburg, Germany
| | - Sebastian Kobold
- Division of Clinical Pharmacology, Department of Medicine IV, Member of the Deutsches Zentrum für Lungenforschung (DZL), University Hospital Munich, Munich, Germany.,German Cancer Consortium Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner site Munich, Munich, Germany
| | - Werner Seeger
- Max Planck Institute for Heart and Lung Research, Member of the German Center for Lung Research Deutsches Zentrum für Lungenforschung (DZL), Member of the Cardio-Pulmonary Institute (CPI), Bad Nauheim, Germany.,Department of Internal Medicine, Member of the Deutsches Zentrum für Lungenforschung (DZL), Member of Cardio-Pulmonary Institute (CPI), Justus Liebig University, Giessen, Germany.,Institute for Lung Health (ILH), Justus Liebig University, Giessen, Germany
| | - Friedrich Grimminger
- Department of Internal Medicine, Member of the Deutsches Zentrum für Lungenforschung (DZL), Member of Cardio-Pulmonary Institute (CPI), Justus Liebig University, Giessen, Germany.,Institute for Lung Health (ILH), Justus Liebig University, Giessen, Germany
| | - Rajkumar Savai
- Max Planck Institute for Heart and Lung Research, Member of the German Center for Lung Research Deutsches Zentrum für Lungenforschung (DZL), Member of the Cardio-Pulmonary Institute (CPI), Bad Nauheim, Germany.,Department of Internal Medicine, Member of the Deutsches Zentrum für Lungenforschung (DZL), Member of Cardio-Pulmonary Institute (CPI), Justus Liebig University, Giessen, Germany.,Institute for Lung Health (ILH), Justus Liebig University, Giessen, Germany
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Yong C, Cambron-Mellott MJ, Seal B, Will O, Maculaitis MC, Clapp K, Mulvihill E, Cotarla I, Mehra R. Patient and Caregiver Preferences for First-Line Treatments of Metastatic Non-Small Cell Lung Cancer: A Discrete Choice Experiment. Patient Prefer Adherence 2022; 16:123-135. [PMID: 35068928 PMCID: PMC8769053 DOI: 10.2147/ppa.s338840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/15/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The approval of immune checkpoint inhibitors for metastatic non-small-cell lung carcinomas (mNSCLC) treatment has presented more care options. Therefore, it is important to identify the benefit-risk trade-offs patients and caregivers are willing to make among potential treatment options. This study quantified the preferences of patients and caregivers for attributes of mNSCLC treatment. METHODS Patients with mNSCLC and caregivers completed an online survey assessing preferences using a discrete choice experiment. Respondents chose between hypothetical treatment profiles, with varying levels for 7 attributes associated with first-line treatment, including overall survival (OS), progression-free survival, select adverse events (AEs), and regimen (caregivers). Hierarchical Bayesian modeling was used to estimate attribute-level preference weights. RESULTS Patients (n = 308) and caregivers (n = 166) most valued increasing OS from 11 to 30 months, followed by decreasing the risk of a serious AE (grade 3/4) that may lead to hospitalization from 70% to 18%. These attributes were over twice as important to both sets of respondents as the other attributes measured. Patients and caregivers would accept increases in the risks of a serious AE (grade 3/4) from 18% to 70% and all grades nausea from 10% to 69% if OS increased by 16.8 and 4.0 months, respectively. The least valued attributes were all grades of pneumonitis (patients) and all grades of skin rash (caregivers). CONCLUSION Patients and caregivers are willing to make trade-offs between efficacy and toxicity and may require up to 1.5 years of increased OS to accept a higher risk of AEs. These results can provide guidance to oncologists when engaging in shared-decision making discussions.
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Affiliation(s)
| | - M Janelle Cambron-Mellott
- Cerner Enviza, Malvern, PA, USA
- Correspondence: M Janelle Cambron-Mellott Cerner Enviza, 51 Valley Stream Pkwy, Malvern, PA, 19355, USATel +1 816 201 2190 Email
| | | | | | | | | | | | | | - Ranee Mehra
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA
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Katke A, Nanda R, Thejaswini B, Pasha T, Giri GV, Babu G, Pawar Y. Weekly vs. tri-weekly cisplatin based chemoradiation in carcinoma cervix: a prospective randomized study of toxicity and compliance. Rep Pract Oncol Radiother 2021; 26:948-954. [PMID: 34992867 PMCID: PMC8726454 DOI: 10.5603/rpor.a2021.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Addition of chemotherapy to radiation has improved 5-year survival by 6%. However, the optimal dose and schedule of concurrent cisplatin is not well defined, though widely accepted practice is the weekly schedule of 40 mg/m2 for 5 weeks. Repeated admissions for weekly cisplatin drain the limited resources in high volume centres. We intended to study the compliance and toxicity of two cisplatin schedules in our patients diagnosed with carcinoma cervix. MATERIALS AND METHODS Between 2007-2011, 212 patients, histologically proven squamous cell carcinoma with stages IIB to IIIB were randomized into two arms. All patients were planned for external beam radiotherapy 45 Gy/25 frs over 5 weeks followed by Intracavitary or Interstitial brachytherapy to a total BED dose of 75-85 Gy. Single agent cisplatin given concomitantly, was scheduled weekly (40 mg/m2/cycle, 5 cycles) in an arm A and three weekly (100 mg/m2/cycle, 2 cycles) in an arm B. Toxicity and compliance were evaluated weekly according to the RTOG guidelines. Analysis of the compiled data was done using SSPS version 20. RESULTS Of the evaluable 212, 109 patients received weekly cisplatin chemotherapy and 103 patients received three weekly cisplatin. The most common acute toxicity observed was grade I-II leucopoenia. The upper and lower gastrointestinal reactions were high in three weekly arms, which was statistically significant (57% and 42.7%, p < 0.05). Proctitis was observed in 10% of patients in both of the arms and only two patients had Gr1 Cystitis after 6 months of treatment. CONCLUSIONS Tri-weekly cisplatin based concurrent chemoradiation can be adopted in high volume centres with manageable haematological and gastrointestinal acute toxicities.
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Affiliation(s)
- Aradhana Katke
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - R Nanda
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - B Thejaswini
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Tanveer Pasha
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - G V Giri
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Govind Babu
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Yashwant Pawar
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
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Basak D, Arrighi S, Darwiche Y, Deb S. Comparison of Anticancer Drug Toxicities: Paradigm Shift in Adverse Effect Profile. Life (Basel) 2021; 12:48. [PMID: 35054441 DOI: 10.3390/life12010048] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023] Open
Abstract
The inception of cancer treatment with chemotherapeutics began in the 1940s with nitrogen mustards that were initially employed as weapons in World War II. Since then, treatment options for different malignancies have evolved over the period of last seventy years. Until the late 1990s, all the chemotherapeutic agents were small molecule chemicals with a highly nonspecific and severe toxicity spectrum. With the landmark approval of rituximab in 1997, a new horizon has opened up for numerous therapeutic antibodies in solid and hematological cancers. Although this transition to large molecules improved the survival and quality of life of cancer patients, this has also coincided with the change in adverse effect patterns. Typically, the anticancer agents are fraught with multifarious adverse effects that negatively impact different organs of cancer patients, which ultimately aggravate their sufferings. In contrast to the small molecules, anticancer antibodies are more targeted toward cancer signaling pathways and exhibit fewer side effects than traditional small molecule chemotherapy treatments. Nevertheless, the interference with the immune system triggers serious inflammation- and infection-related adverse effects. The differences in drug disposition and interaction with human basal pathways contribute to this paradigm shift in adverse effect profile. It is critical that healthcare team members gain a thorough insight of the adverse effect differences between the agents discovered during the last twenty-five years and before. In this review, we summarized the general mechanisms and adverse effects of small and large molecule anticancer drugs that would further our understanding on the toxicity patterns of chemotherapeutic regimens.
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Goyal U, Cheung MK, Suszko J, Laughlin B, Kim Y, Askam J, Arif-Tiwari H, Slane B, Gordon J, Stea B. Electronic brachytherapy for treatment of non-melanoma skin cancers: clinical results and toxicities. J Contemp Brachytherapy 2021; 13:497-503. [PMID: 34759973 DOI: 10.5114/jcb.2021.109753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/07/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose Although surgical approaches are standard for most non-melanomatous skin cancers, some patients are not candidates due to medical co-morbidities or functional or cosmetic or lesion location. High-dose-rate electronic brachytherapy (HDR-EBT) may be an alternative treatment modality. Material and methods A retrospective chart review was conducted from April 2011 to April 2013. All lesions were pathologically confirmed as malignant basal cell or squamous cell carcinoma. A HDR-EBT system delivered a median biological equivalent dose of 50 Gy total to a depth of 0.1-0.5 cm using various sizes of applicators. Treatment feasibility, acute and late toxicity, cosmetic outcomes, and local recurrence were assessed. Results Thirty-three patients with a mean age of 76 years with 50 cutaneous lesions were treated. Locations included 17 extremity lesions and 33 head and neck lesions. After treatments, acute grade 3 moist desquamation developed in 9 of the lesions (18%). Acute grade 4 ulceration developed in 3 lesions in the lower extremity (6%) and 1 upper lip lesion (2%). These toxicities were improved after a median of 20 days. Amongst the 4 lesions with grade 4 toxicities, a greater proportion were in lower extremity lesions compared to head and neck lesions (75% vs. 25%). There was no difference in the rate of grade 3 and 4 toxicities between patients aged ≤ 75 years and aged > 75 years (p = 0.082). With a mean long-term follow-up of 45.6 months, there was 1 local recurrence treated with surgery and no reported late toxicities. Conclusions Our experience with HDR-EBT for non-melanomatous skin cancers is encouraging in terms of efficacy and convenience for patients. Our long-term follow-up shows a good response in all treated sites. Caution should be used for extremity sites, and more fractionated regimens should be considered to avoid severe acute toxicities.
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Samarghandian S, Shirazi FM, Saeedi F, Roshanravan B, Pourbagher-Shahri AM, Khorasani EY, Farkhondeh T, Aaseth JO, Abdollahi M, Mehrpour O. A systematic review of clinical and laboratory findings of lead poisoning: lessons from case reports. Toxicol Appl Pharmacol 2021; 429:115681. [PMID: 34416225 DOI: 10.1016/j.taap.2021.115681] [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] [Received: 01/18/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 01/17/2023]
Abstract
Lead is one of the most toxic heavy metals in the environment. The present review aimed to highlight hazardous pollution sources, management, and review symptoms of lead poisonings in various parts of the world. The present study summarized the information available from case reports and case series studies from 2009 to March 2020 on the lead pollution sources and clinical symptoms. All are along with detoxification methods in infants, children, and adults. Our literature compilation includes results from 126 studies on lead poisoning. We found that traditional medication, occupational exposure, and substance abuse are as common as previously reported sources of lead exposure for children and adults. Ayurvedic medications and gunshot wounds have been identified as the most common source of exposure in the United States. However, opium and occupational exposure to the batteries were primarily seen in Iran and India. Furthermore, neurological, gastrointestinal, and hematological disorders were the most frequently occurring symptoms in lead-poisoned patients. As for therapeutic strategies, our findings confirm the safety and efficacy of chelating agents, even for infants. Our results suggest that treatment with chelating agents combined with the prevention of environmental exposure may be an excellent strategy to reduce the rate of lead poisoning. Besides, more clinical studies and long-term follow-ups are necessary to address all questions about lead poisoning management.
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Affiliation(s)
- Saeed Samarghandian
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
| | - Farshad M Shirazi
- Arizona Poison & Drug Information Center, The University of Arizona, College of Pharmacy and University of Arizona, Tucson, Arizona, USA
| | - Farhad Saeedi
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Babak Roshanravan
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | | | | | - Tahereh Farkhondeh
- Faculty of Pharmacy, Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Jan Olav Aaseth
- Elverum, and Research Department, Innlandet Hospital, Norway University of Applied Sciences, Brumunddal, Norway.
| | - Mohammad Abdollahi
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
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Samhouri L, Meheissen MAM, Ibrahimi AKH, Al-Mousa A, Zeineddin M, Elkerm Y, Hassanein ZMA, Ismail AA, Elmansy H, Al-Hanaqta MM, AL-Azzam OA, Elsaid AA, Kittel C, Micke O, Stummer W, Elsayad K, Eich HT. Impact of Adjuvant Radiotherapy in Patients with Central Neurocytoma: A Multicentric International Analysis. Cancers (Basel) 2021; 13:cancers13174308. [PMID: 34503124 PMCID: PMC8430823 DOI: 10.3390/cancers13174308] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/05/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Central neurocytoma is a rare tumor accounting for <0.5% of all intracranial tumors. We analyzed 33 patients treated with surgical resection with or without radiotherapy from ten closely cooperating institutions in Germany, Egypt, and Jordan. Patients who received radiotherapy had longer progression-free survival with an acceptable toxicity profile. Abstract Background: Central neurocytoma (CN) is a rare tumor accounting for <0.5% of all intracranial tumors. Surgery ± radiotherapy is the mainstay treatment. This international multicentric study aims to evaluate the outcomes of CNs patients after multimodal therapies and identify predictive factors. Patients and methods: We retrospectively identified 33 patients with CN treated between 2005 and 2019. Treatment characteristics and outcomes were assessed. Results: All patients with CN underwent surgical resection. Radiotherapy was delivered in 19 patients. The median radiation dose was 54 Gy (range, 50–60 Gy). The median follow-up time was 56 months. The 5-year OS and 5-year PFS were 90% and 76%, respectively. Patients who received radiotherapy had a significantly longer PFS than patients without RT (p = 0.004) and a trend towards longer OS. In addition, complete response after treatments was associated with longer PFS (p = 0.07). Conclusions: Using RT seems to be associated with longer survival rates with an acceptable toxicity profile.
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Affiliation(s)
- Laith Samhouri
- Department of Radiation Oncology, University Hospital Münster, Münster 48149, Germany; (L.S.); (C.K.); (H.T.E.)
| | - Mohamed A. M. Meheissen
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria 21500, Egypt; (M.A.M.M.); (Z.M.A.H.); (A.A.I.); (A.A.E.)
- Specialized Universal Network of Oncology (SUN), Alexandria 21500, Egypt; (Y.E.); (H.E.)
| | - Ahmad K. H. Ibrahimi
- Department of Radiotherapy and Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan; (A.K.H.I.); (A.A.-M.)
| | - Abdelatif Al-Mousa
- Department of Radiotherapy and Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan; (A.K.H.I.); (A.A.-M.)
| | - Momen Zeineddin
- Department of Pediatrics, King Hussein Cancer Center, Amman 11942, Jordan;
| | - Yasser Elkerm
- Specialized Universal Network of Oncology (SUN), Alexandria 21500, Egypt; (Y.E.); (H.E.)
- Cancer Management and Research Department, Medical Research Institute, Alexandria University, Alexandria 21500, Egypt
| | - Zeyad M. A. Hassanein
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria 21500, Egypt; (M.A.M.M.); (Z.M.A.H.); (A.A.I.); (A.A.E.)
- Specialized Universal Network of Oncology (SUN), Alexandria 21500, Egypt; (Y.E.); (H.E.)
| | - Abdelsalam Attia Ismail
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria 21500, Egypt; (M.A.M.M.); (Z.M.A.H.); (A.A.I.); (A.A.E.)
- Specialized Universal Network of Oncology (SUN), Alexandria 21500, Egypt; (Y.E.); (H.E.)
| | - Hazem Elmansy
- Specialized Universal Network of Oncology (SUN), Alexandria 21500, Egypt; (Y.E.); (H.E.)
- Cancer Management and Research Department, Medical Research Institute, Alexandria University, Alexandria 21500, Egypt
| | | | - Omar A. AL-Azzam
- Princess Iman Research Center, King Hussein Medical Center, Royal Medical Services, Amman 11942, Jordan;
| | - Amr Abdelaziz Elsaid
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria 21500, Egypt; (M.A.M.M.); (Z.M.A.H.); (A.A.I.); (A.A.E.)
- Specialized Universal Network of Oncology (SUN), Alexandria 21500, Egypt; (Y.E.); (H.E.)
| | - Christopher Kittel
- Department of Radiation Oncology, University Hospital Münster, Münster 48149, Germany; (L.S.); (C.K.); (H.T.E.)
| | - Oliver Micke
- Department of Radiotherapy and Radiation Oncology, Franziskus Hospital Bielefeld, 33699 Bielefeld, Germany;
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, 48149 Münster, Germany;
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital Münster, Münster 48149, Germany; (L.S.); (C.K.); (H.T.E.)
- Correspondence: ; Tel.: +490-2518347384
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Münster, Münster 48149, Germany; (L.S.); (C.K.); (H.T.E.)
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Song Y, Qu T, Zhang H, Sun Y, Cui C, Chi Y, Zhang W, Wang X, Yang L. The Real-World Practice of Fruquintinib for Chinese Patients with Metastatic Colorectal Cancer. Cancer Manag Res 2021; 13:6199-6205. [PMID: 34393513 PMCID: PMC8357312 DOI: 10.2147/cmar.s313275] [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: 06/03/2021] [Accepted: 07/26/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND In FRESCO trial, a phase III study of fruquintinib demonstrated a significant improvement on the overall survival (OS) of patients with metastatic colorectal cancer (mCRC) who failed to response to available standard treatments. The aim of the current study was to evaluate the safety and effectiveness of fruquintinib in Chinese mCRC patients in the real-world setting. METHODS Patients with mCRC treated with fruquintinib at our hospital were retrospectively reviewed. Patient demographics, treatment, adverse events and survival data were collected. OS and progression-free survival (PFS) were estimated using the Kaplan-Meier method. RESULTS In total, 76 patients were evaluated from December 2018 to January 2020. The median (range) age was 59.5 (34-86) years, ECOG PS 0-1/2 was 86.8%/13.2%, and 38 (50%)/30 (39.5%) patients had experienced more than two prior therapies for mCRC. The median treatment duration was 3.6 cycles. Treatment-related adverse events (TRAEs) resulted in dose reduction were 17.1% of the patients without any treatment discontinuation. The most common grade 3 or 4 TRAEs were hypertension (9.2%), hand-foot skin reaction (7.9%), thrombocytopenia (3.9%), anaemia (2.6%), increased ALT (1.3%), oral mucositis (1.3%), proteinuria (1.3%) and neutropenia (1.3%). The median PFS was 5.1 months (95% CI 3.8-6.4 months), and the median OS was 12.0 months (95% CI 8.0-16.1 months). In patients with hypertension or hypothyroidism, a survival extension approximate to 6 months was observed, but the difference is not yet statistically significant. CEA decreased after fruquintinib treatment could be considered as a potential predictor for better OS. CONCLUSION The outcome of this real-life study was consistent with that of the randomised controlled trial. There were no new safety concerns. Future studies of fruquintinib should be conducted to identify patients who tend to obtain more benefits from fruquintinib alone or in combination with other agents.
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Affiliation(s)
- Yan Song
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Tao Qu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Honggang Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Yongkun Sun
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Chengxu Cui
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Yihebali Chi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Wen Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Xingyuan Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Lin Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
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Press RH, Bakst RL, Sharma S, Kabarriti R, Garg MK, Yeh B, Gelbum DY, Hasan S, Choi JI, Barker CA, Chhabra AM, Simone CB, Lee NY. Clinical Review of Proton Therapy in the Treatment of Unilateral Head and Neck Cancers. Int J Part Ther 2021; 8:248-260. [PMID: 34285951 PMCID: PMC8270109 DOI: 10.14338/ijpt-d-20-00055.1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
Radiotherapy is a common treatment modality in the management of head and neck malignancies. In select clinical scenarios of well-lateralized tumors, radiotherapy can be delivered to the primary tumor or tumor bed and the ipsilateral nodal regions, while intentional irradiation of the contralateral neck is omitted. Proton beam therapy is an advanced radiotherapy modality that allows for the elimination of exit-dose through nontarget tissues such as the oral cavity. This dosimetric advantage is apt for unilateral treatments. By eliminating excess dose to midline and contralateral organs at risk and conforming dose around complex anatomy, proton beam therapy can reduce the risk of iatrogenic toxicities. Currently, there is no level I evidence comparing proton beam therapy to conventional photon radiation modalities for unilateral head and neck cancers. However, a growing body of retrospective and prospective evidence is now available describing the dosimetric and clinical advantages of proton beam therapy. Subsequently, the intent of this clinical review is to summarize the current evidence supporting the use of proton beam therapy in unilateral irradiation of head and neck cancers, including evaluation of disease site-specific evidence, unique challenging clinical scenarios, and ongoing clinical trials.
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Affiliation(s)
- Robert H Press
- Department of Radiation Oncology, New York Proton Center, New York, New York, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Madhur K Garg
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Brian Yeh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daphna Y Gelbum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shaakir Hasan
- Department of Radiation Oncology, New York Proton Center, New York, New York, USA
| | - J Isabelle Choi
- Department of Radiation Oncology, New York Proton Center, New York, New York, USA
| | - Chris A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Arpit M Chhabra
- Department of Radiation Oncology, New York Proton Center, New York, New York, USA
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York, USA
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Borghetti P, Imbrescia J, Volpi G, Costantino G, Cossali G, Greco D, Pastorello E, La Mattina S, Bonù ML, Tomasini D, Buglione M. Prevention and management of acute esophageal toxicity during concomitant chemoradiotherapy for locally advanced lung cancer. Tumori 2021; 108:470-476. [PMID: 34165018 DOI: 10.1177/03008916211025609] [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: 11/15/2022]
Abstract
BACKGROUND Standard treatment for locally advanced non-small cell lung cancer (LA-NSCLC) is concomitant chemoradiotherapy. The survival benefit of combined treatment is partially counterbalanced by an increased rate of acute esophageal toxicity. Several pharmaceutical products are available for prevention and management of esophagitis, including Faringel Plus. AIM To assess the incidence and the grade, identify the correlations with clinical, dosimetric, and therapeutic variables, and analyse the role of Faringel Plus as a pharmaceutical preventive measure against acute esophageal toxicity. METHODS Patients with LA-NSCLC treated with concomitant radiochemotherapy were retrospectively reviewed. Acute esophagitis and dysphagia were graded according to Common Terminology Criteria for Adverse Events version 5.0. Clinical, dosimetric, and therapeutic correlations were investigated using χ2 test. RESULTS Among the 23 analysed patients, 18 (78.3%) and 1 (4.3%) developed G2 and G3 esophagitis, respectively; G1-2 dysphagia were reported in 11 cases (47.8%). No statistically significant correlation between the variables considered and acute esophageal toxicity was identified. In the group of patients who received Faringel Plus as preventive treatment (10 subjects, 43.5%), dysphagia presentation time was significantly longer (p = 0.038); esophagitis onset time was longer and symptoms duration was shorter. Faringel Plus allowed a reduction in the use of analgesic drugs. CONCLUSIONS Acute mild esophageal toxicity was confirmed to be a common side effect in this setting. No clinical-dosimetric parameter has been demonstrated to be effective in predicting acute esophageal toxicity. The use of Faringel Plus appears effective as a therapeutic and prophylactic tool to manage acute esophageal toxicity.
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Affiliation(s)
- Paolo Borghetti
- Radiation Oncology Department, Spedali Civili of Brescia, University of Brescia, Lombardia, Italy
| | - Jessica Imbrescia
- Radiation Oncology Department, Spedali Civili of Brescia, University of Brescia, Lombardia, Italy
| | - Giulia Volpi
- Radiation Oncology Department, Spedali Civili of Brescia, University of Brescia, Lombardia, Italy
| | - Gianluca Costantino
- Radiation Oncology Department, Spedali Civili of Brescia, University of Brescia, Lombardia, Italy
| | - Gianluca Cossali
- Radiation Oncology Department, Spedali Civili of Brescia, University of Brescia, Lombardia, Italy
| | - Diana Greco
- Radiation Oncology Department, Spedali Civili of Brescia, University of Brescia, Lombardia, Italy
| | - Edoardo Pastorello
- Radiation Oncology Department, Spedali Civili of Brescia, University of Brescia, Lombardia, Italy
| | - Salvatore La Mattina
- Radiation Oncology Department, Spedali Civili of Brescia, University of Brescia, Lombardia, Italy
| | - Marco Lorenzo Bonù
- Radiation Oncology Department, Spedali Civili of Brescia, University of Brescia, Lombardia, Italy
| | - Davide Tomasini
- Radiation Oncology Department, Spedali Civili of Brescia, University of Brescia, Lombardia, Italy
| | - Michela Buglione
- Radiation Oncology Department, Spedali Civili of Brescia, University of Brescia, Lombardia, Italy
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Fischer JW, Bhattarai N. CAR-T Cell Therapy: Mechanism, Management, and Mitigation of Inflammatory Toxicities. Front Immunol 2021; 12:693016. [PMID: 34220853 PMCID: PMC8250150 DOI: 10.3389/fimmu.2021.693016] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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: 04/09/2021] [Accepted: 06/04/2021] [Indexed: 12/15/2022] Open
Abstract
Engineered T cell therapies such as chimeric antigen receptor (CAR) expressing T cells (CAR-T cells) have great potential to treat many human diseases; however, inflammatory toxicities associated with these therapies present safety risks and can greatly limit its widespread use. This article briefly reviews our current understanding of mechanisms for inflammatory toxicities during CAR T-cell therapy, current strategies for management and mitigation of these risks and highlights key areas of knowledge gap for future research.
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Affiliation(s)
- Joseph W Fischer
- Division of Cellular and Gene Therapies, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Nirjal Bhattarai
- Division of Cellular and Gene Therapies, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, United States
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47
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Carlet C, Dalle S, Leccia MT, Mortier L, Dalac-Rat S, Dutriaux C, Legoupil D, Montaudié H, Dereure O, De Quatrebarbes J, Granel-Brocard F, Le-Bouar M, Charles J, Brunet-Possenti F, Dreno B, Lefevre W, Allayous C, Lebbe C, Nardin C. Late-onset adverse events under anti-PD1 therapy in melanoma patients: an observational study from MELBASE, a nationwide prospective cohort. J Am Acad Dermatol 2021; 86:345-352. [PMID: 34153388 DOI: 10.1016/j.jaad.2021.06.849] [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: 01/07/2021] [Revised: 05/20/2021] [Accepted: 06/13/2021] [Indexed: 11/25/2022]
Abstract
The purpose was to evaluate late-onset AEs in melanoma patients treated with anti-PD1 administered at least 2 years in a real-life setting. Patients were screened from MelBase (NCT02828202), a French multicentric biobank dedicated to the prospective follow-up of unresectable stage III or IV melanoma. 119 patients who received anti-PD1 during at least 2 years from January 2013 to November 2019 were included. Median follow-up was 41.7 months (25.2-57.5). Patients received nivolumab (n=53) or pembrolizumab (n=66). AEs occurred in 99 patients (83%) with a median time of 13.3 months (0-53.9), including severe AEs (grade 3 or 4) in 30 patients (30%). Late-onset AEs, mostly grade 1-2, occurred in 51 (43%) patients and led to 5 (4%) hospitalizations of which 4 were severe. Factors associated with late-onset AEs in multivariate analysis were early-onset AEs (within the first two years of treatment) and treatment duration (p=0,02 and p=0,03 respectively). Our data demonstrate the possibility of late-onset AEs occurring after 2 years of anti-PD1 therapy. Late-onset AEs appear frequent and mostly mild or moderate. Early-onset AEs and prolonged anti-PD1 treatment may increase the risk of late-onset AEs.
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Affiliation(s)
| | - Stéphane Dalle
- Hospices Civils de Lyon, Immucare, Centre de Recherche en Cancérologie de Lyon
| | | | | | | | | | | | | | | | | | | | - Myrtille Le-Bouar
- Hospices Civils de Lyon, Immucare, Centre de Recherche en Cancérologie de Lyon
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Shen J, Yang D, Chen M, Jiang L, Dong X, Li D, Yu R, Yu H, Shi A. Hypofractionated Volumetric-Modulated Arc Radiotherapy for Patients With Non-Small-Cell Lung Cancer Not Suitable for Surgery or Conventional Chemoradiotherapy or SBRT. Front Oncol 2021; 11:644852. [PMID: 34221967 PMCID: PMC8244290 DOI: 10.3389/fonc.2021.644852] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/20/2021] [Indexed: 12/25/2022] Open
Abstract
Background Hypofractionated radiotherapy (HypoRT) has been used to pursue an alternative treatment regimen for patients with non-small-cell lung cancer (NSCLC) who are not eligible for stereotactic ablative radiotherapy (SABR), surgery or concurrent chemoradiotherapy (CCRT) and has shown good local control and safety. We analyzed the feasibility of using volumetric-modulated arc radiotherapy (VMAT) with the simultaneous integrated boost (SIB) technique to achieve high local control with few treatment-related toxicities. Patients and Methods A total of 55 patients with stage I-IV NSCLC who were not candidates for SABR, surgery or CCRT were included in the present study. All patients received a prescribed dose of 60 to 66 Gy in 15 fractions. Local progression-free survival (LPFS), PFS, overall survival (OS), and toxicities were retrospectively analyzed. Results Thirty-three patients (60.0%) had stage IV or recurrent disease in this study. The median follow-up time was 8 months (interquartile range: 5.0-16.3 months). The 1-year and 2-year OS rates were 84.3% and 69.9%, and the 1-year and 2-year LPFS rates were 91.0% and 63.0%. The median OS (mOS) and median LPFS (mLPFS) were not reached, and median PFS (mPFS) was 15 months. Twenty-eight (51.9%) patients had disease progression at the time of analysis. Of these, 7 (13.0%), 7 (13.0%) and 21 (38.9%) had local recurrence, locoregional failure and distant metastasis, respectively. All cases of local recurrence were found within the SIB region. Four patients had grade 2-3 pneumonitis, and 8 patients had grade 2-3 esophagitis. Patients with grade 2-3 esophagitis had significantly higher maximum dose and dose to 5 cm3 volume to esophagus than those with grade 0-1 esophagitis. No grade 4 or higher toxicity was observed. Conclusion The 60 to 66 Gy in 15 fractions RT regimen provides favorable local control and survival with well-tolerated toxicities. Hypofractionated VMAT+SIB is an alternative treatment option for patients with NSCLC who cannot tolerate standard definitive therapy.
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Affiliation(s)
- Junyue Shen
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Dan Yang
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Mailin Chen
- Departments of Radiology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Leilei Jiang
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Xin Dong
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Dongming Li
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Rong Yu
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Huiming Yu
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Anhui Shi
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
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Narkhede M, Mehta A, Ansell SM, Goyal G. CAR T-cell therapy in mature lymphoid malignancies: clinical opportunities and challenges. Ann Transl Med 2021; 9:1036. [PMID: 34277836 PMCID: PMC8267254 DOI: 10.21037/atm-20-5546] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
Abstract
The advent of chimeric antigen receptor T-cell (CAR T-cell) therapy has revolutionized the treatment paradigm of various hematologic malignancies. Ever since its first approval for treatment of acute lymphoblastic leukemia (ALL) in 2017, CAR T-cell therapy has been found to be efficacious in various other lymphoid malignancies, with recent approvals in diffuse large B-cell lymphoma (DLBCL) and mantle cell lymphoma (MCL). Although CAR T-cell therapeutics offer a novel immunotherapeutic approach to treat otherwise refractory malignancies, the plethora of studies/products and complexities in manufacturing and administration have led to several challenges for clinicians and the healthcare system as a whole. Some of the areas of unmet need include manufacturing delays, short persistence of CAR T-cells in circulation, lack of predictive biomarkers for efficacy and toxicity, and high cost of therapy. In this review, we evaluate the existing data on the efficacy and safety of CAR T-cell therapies in mature lymphoid malignancies [lymphomas, chronic lymphocytic leukemia (CLL), and multiple myeloma]. We also provide an in-depth review of the challenges posed by CAR T-cell therapeutics and potential strategies to overcome them. With newer CAR T-cell products and incorporation of measures to mitigate toxicities pertaining to cytokine release and neurological syndromes, there is a potential to overcome several of these challenges in the near future. Finally, as CAR T-cell therapy gains regulatory approval for more indications, there is a need to tackle the financial toxicity posed by this modality to sustain patient access.
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Affiliation(s)
- Mayur Narkhede
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amitkumar Mehta
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
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50
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Guan H, He Y, Su Y, Wei Z, Liu Z, Wang J, He L, Mu X, Li R, Hu X, Peng X. Assessment of different induction chemotherapy regimens in locally advanced nasopharyngeal carcinoma: Meta-analysis. Head Neck 2021; 43:2332-2341. [PMID: 33792110 DOI: 10.1002/hed.26699] [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] [Received: 09/16/2020] [Revised: 02/25/2021] [Accepted: 03/16/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A Bayesian network meta-analysis was performed to compare the efficacy and toxicities among different induction chemotherapy regimens in locally advanced nasopharyngeal carcinoma (LA-NPC). METHODS Electronic databases were searched for literature up to September 16, 2019. Two researchers independently selected the articles, evaluated the quality of the literature, and extracted and analyzed the data. RESULTS There were no significant differences in survival outcomes, mucositis, or gastrointestinal adverse events among the four regimens. The probability of GP being the best induction scheme to improve OS was 43.7%. The completion rate of concurrent chemotherapy with the GP regimen was significantly reduced than the other three regimens. CONCLUSIONS The survival outcomes of the four regimens in LA-NPC were comparable. Considering only OS, GP showed the highest probability of improving the survival of LA-NPC, while it also affected the completion of concurrent chemotherapy.
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Affiliation(s)
- Hui Guan
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yan He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yonglin Su
- West China Hospital, Sichuan University, Chengdu, China
| | - Zhigong Wei
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zheran Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jingjing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ling He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoli Mu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ruidan Li
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolin Hu
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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