Journal of Chemotherapy最新文献

Novel therapeutic interventions are required to address the critical antimicrobial resistance caused by multidrug-resistant Pseudomonas aeruginosa (MDR-PA) infections. This study examines the impact of combining delafloxacin with antibiotics on MDR-PA isolated from various samples. The minimum inhibitory concentrations (MICs) of delafloxacin, alone and in combination with other antibiotics, were determined against forty distinct MDR-PA isolates using the broth microdilution method. Time-kill curve assays were used to determine the bactericidal and synergistic effects of delafloxacin alone and in combination with other antibiotics in vitro against the selected five strains. Our studies showed delafloxacin exhibited four times greater in-vitro activity against MDR-PA strains than levofloxacin compared with both MIC₅₀ and MIC₉₀ results. Delafloxacin + tobramycin and delafloxacin + ceftazidime/avibactam showed synergy in two out of five strains tested at concentrations equal to the MIC. The outcomes of this research also suggest that these combinations may replace therapy for MDR-PA strains.

This cross-sectional study aimed to analyze the associated factors of poor nutrition in non-small cell lung cancer (NSCLC) patients after chemotherapy. Concretely, 176 NSCLC patients who attended our hospital from June 2020 to December 2022 were enrolled. Standard-compliant patients were categorized into nutrition group (n = 38) and malnutrition group (n = 70) according to different nutrition statuses. Baseline characteristics and nutrition level were assessed. Associated factors of poor nutrition were analyzed by logistic regression analysis. There were obvious differences between nutrition group and malnutrition group in terms of age (P = 0.041), body mass index (BMI, p = 0.021), residence (P  = 0.023), per capita monthly income of family (P  = 0.023), tumor staging (P  = 0.017), Karnofsky (KPS) score (P  < 0.001), effect of chemotherapy (P  = 0.045), and nutrition support before chemotherapy only (P  = 0.023) and perichemotherapy (P = 0.011). The higher proportion of NSCLC patients was found in malnutrition group relative to nutrition group in terms of having poor nutritional cognition (67.14% vs. 47.37%, P  = 0.045), and lacking access to vitamins (65.71% vs. 44.74%, P  = 0.047) and trace elements (57.14% vs. 36.84%, P  = 0.044). BMI <18.5 (OR = 3.707, P = 0.007, 95%CI (1.434-9.586)), residence in village (OR = 3.426, P = 0.013, 95%CI (1.291-9.092)), and KPS score ≤70 (OR = 7.608, P < 0.001, 95%CI (2.842-20.367)) were associated factors for poor nutrition. Collectively, BMI, residence, and KPS score were associated factors of poor nutrition in NSCLC patients after chemotherapy.

We report a case of a 66 year-old male with recurrent stage IIIA non-small cell lung cancer (NSCLC) and no prior arthritis or bone disease who developed hypertrophic osteoarthropathy (HOA) prior to immunotherapy treatment. Approximately one month after the first durvalumab infusion and without other interventions for symptom management, the patient reported improvements to his hand pain, with complete resolution of symptoms after five durvalumab treatments. Repeat x-ray after nine cycles of durvalumab showed decreased periosteal thickening of the phalanges bilaterally. He had no evidence of recurrent NSCLC based on serial computed tomography one year after durvalumab initiation. To our knowledge, there are no documented reports on the isolated effect of immune-checkpoint inhibitor (ICI) therapy on HOA. This case suggests that durvalumab may have a positive role in the management of HOA in NSCLC patients. Further research is needed to better understand the interaction of ICIs, HOA and other paraneoplastic syndromes.

Trastuzumab is primarily utilized in the treatment of patients with human epidermal growth factor receptor 2 (HER2) positive breast cancer. This study aimed to investigate the incidence of cardiac toxicity associated with trastuzumab in HER2-positive breast cancer patients at Iran Hospital in 2023, as well as the factors influencing this toxicity. In this cross-sectional study, 200 patients diagnosed with HER2-positive breast cancer and receiving trastuzumab were included. The criteria for heart failure in this study were defined as an ejection fraction (EF) of less than 50% or a decrease of greater than 10% in EF. Descriptive statistics, the chi-square statistical test, Fisher's exact test, and logistic regression analyses were employed to assess the variables. A p-value of less than 0.05 was deemed statistically significant. The mean age of the participants was 51.5 ± 2.5 years. The odds ratio (OR) for the variable of anthracyclines was 1.3 (95% CI: 1.2-1.4); for opium use, the OR was 2.7 (95% CI: 0.9-8.5); for diabetes, the OR was 2.7 (95% CI: 1.2-5.9); for ischemic heart disease, the OR was 3.5 (95% CI: 1.6-7.7); and for hypertension, the OR was 4.8 (95% CI: 2.1-10.7). The OR for obesity was 1.45 (95% CI: 1.01-2.18), and the OR for age was 1.10 (95% CI: 1.01-1.12). No statistically significant association was found between opium use and cardiotoxicity (p = 0.07). This research contributes to the identification of factors that may predict responses to anthracyclines and the potential for cardiotoxicities. Ultimately, this information could inform the development of more personalized treatment strategies.

We review the case of a 58-year-old female on extracorporeal membrane oxygenation (ECMO) support diagnosed with invasive pulmonary aspergillosis (IPA). Intravenous isavuconazole was started, requiring dose escalation to achieve isavuconazole trough concentration (ISA-Cmin) within the therapeutic range (2.5-5.0 μg/mL). For more than 4 months, she maintained a dose of 200 mg q12h, with a median ISA-Cmin of 3.4 (interquartile range [IQR]: 3.1-4.9) µg/mL. Throughout this interval, 17 assessments of ISA-Cmin were performed (weekly). Of these, 82% (14/17) were within the therapeutic range, with an intra-individual variability of 36.8%. Although no signs of hepatotoxicity were observed, she experienced short-term gastrointestinal adverse events related to potential isavuconazole over-exposure (ISA-Cmin > 5.0 μg/mL). ECMO circuit changes did not appear to affect ISA-Cmin. She was not obese (IMC ≈ 25 kg/m²) and did not require other extracorporeal therapy, but hypoalbuminemia may have contributed to an increase in unbound isavuconazole fraction and consequently its clearance.

Polymer-based nanoparticles (PNPs) are emerging as a cornerstone in cancer therapy due to their ability to enhance drug solubility, improve pharmacokinetics and achieve precise tumor targeting. Nanoparticles, encompassing liposomes, dendrimers, and metallic particles, include typical characteristics such as improved surface area, regulated release and the capacity to encapsulate diverse therapeutic compounds augmenting the pharmacokinetics and bioavailability of anticancer drugs. Recent studies demonstrate drug loading efficiencies of 80-90%, circulation half-life extensions of 2-5 fold, and tumor accumulation improvements of 3-10 times compared to free drugs. FDA-approved formulations such as Abraxane^® (albumin-bound paclitaxel) and clinical candidates like Genexol-PM^® (polymeric micelles) highlight the translational relevance of PNPs. This review consolidates advancements in polymeric nanocarriers, including nanospheres, nano-capsules and hybrid composites, while addressing limitations in regulatory approval and personalized oncology integration. This study shows that nanoparticle-based cancer therapeutics hold immense potential to improve treatment efficacy and patient outcomes in clinical oncology.

To promote the accurate administration of linezolid, this study aimed to evaluate its dosage regimens in critically ill patients with varying renal functions. This evaluation was based on a combined analysis of pharmacokinetic (PK), pharmacodynamic (PD), and toxicodynamic (TD) indices. The percentage of therapeutic target attainment (PTTA) was used as the index for PK/PD/TD, defined as simultaneously meeting two PK/PD criteria (AUC_0-24h/MIC ≥ 100 and C_ss between 2.6-7.8 mg/L) and adjusted for toxicity probability, with MICs ranging from 0.5 to 8 mg/L. The recommended doses of linezolid for patients: 600 mg every 12 h for normal renal function or mild renal impairment, 300 mg every 12 h for severe renal impairment, 450 mg every 12 h for moderate renal impairment, and 600 mg every 8 h for supra-normal renal function. In conclusion, specific dosing regimens should be adopted for patients with varying renal functions, combined with therapeutic drug monitoring, to ensure the safety and efficacy of linezolid.

Anti-tumor drugs cause hand-foot syndrome through a variety of pathogenic mechanisms. Some chemotherapeutic medications that can cause HFS include 5FU, doxorubicin, capecitabine, high dose cytarabine, and others. These medications each have a unique mechanism resulting in HFS. The histopathological characteristics, clinical manifestations, and variations in gender, ethnicity, or genetic makeup might also impact the development of HFS as an adverse drug reaction. Even though the disease might not become life-threatening, it is nevertheless vital to manage it with therapeutic interventions or by withholding the medication in order to enhance the patient's outcome. Current developments in pharmacological and non-pharmacological therapeutic approaches for managing symptoms also emphasis the same.

Teicoplanin is a glycopeptide antibiotic with a long elimination half-life (50 hours) that allows administration thrice a week, though it is approved for daily use. The aim of this retrospective, single-arm study is to assess the clinical outcome of using thrice-weekly teicoplanin (TWT) as outpatient parenteral antibiotic therapy (OPAT) for deep (DSIs) and non-deep-seated infections (NDSIs). We included 37 outpatients (25 with DSIs and 12 with NDSIs) treated with TWT between 01/2021 and 10/2023. The outcome was favorable in 78% of them (80% with DSI, 75% with NDSIs) and Therapeutic drug monitoring (TDM) was performed in all cases. 8 patients required dosage modification because of inadequate trough levels; they were younger and had a higher creatinine clearance. 6/37 patients experienced adverse events, mostly skin rash (4/6). TWT can be a good option for OPAT; its pharmacokinetic reduces the number of hospital accesses and TDM permits to tailor the dosage.