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Continuous versus intermittent tacrolimus for graft-versus-host disease prophylaxis in pediatric hematopoietic stem cell transplantation patients (Tic Tac). 连续与间歇他克莫司预防儿童造血干细胞移植患者移植物抗宿主病(Tic Tac)
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2025-01-12 DOI: 10.1177/10781552241312925
Demi Asleson, Roxane Carr, Jacob Rozmus, Jennifer Kendrick

Background: Tacrolimus is administered via a continuous or intermittent IV infusion to prevent acute graft versus host disease (aGvHD) in pediatric hematopoietic stem cell transplant (HSCT) recipients. Limited comparison data is available.

Objectives: The primary objective was to compare the proportion of therapeutic tacrolimus trough levels in the first 30 days post-stem cell infusion. Secondary outcomes were prevalence of aGvHD, intra-patient variability (IPV) and safety.

Study design: This was a retrospective cohort study that included pediatric HSCT recipients between March 1, 2015 and October 31,2021 at BC Childrens Hospital. Adverse events were assessed using the Naranjo scoring tool.

Results: Overall, 60 transplants in 59 patients were included; n = 36 intermittent IV and n = 24 continuous IV. Median proportion of blood levels (intermittent and continuous) within 8-12 ug/L was 38% and 56%, respectively (p = 0.04). IPV was 33% and 31% and aGvHD was 39% and 38% in intermittent and continuous respectively. There was a higher proportion of adverse effects in the intermittent group with the exception of hypomagnesemia.

Conclusions: Continuous IV tacrolimus provided a higher proportion of levels within therapeutic range. Neither achieved therapeutic trough levels in more than 56% of transplants. However, there was large intra-patient variability in both groups.

背景:他克莫司可通过连续或间歇静脉输注预防小儿造血干细胞移植(HSCT)受者的急性移植物抗宿主疾病(aGvHD)。对比数据有限:主要目的是比较干细胞输注后头30天内治疗性他克莫司谷值的比例。次要结果为副坏死发生率、患者内变异性(IPV)和安全性:这是一项回顾性队列研究,研究对象包括2015年3月1日至2021年10月31日期间在不列颠哥伦比亚省儿童医院接受造血干细胞移植的儿科患者。不良事件采用纳兰霍评分工具进行评估:共纳入59名患者的60例移植,其中间歇性静脉注射36例,连续性静脉注射24例。血药浓度(间歇性和持续性)在 8-12 微克/升以内的中位比例分别为 38% 和 56%(p = 0.04)。间歇式和持续式中,IPV 的比例分别为 33% 和 31%,AGvHD 的比例分别为 39% 和 38%。除低镁血症外,间歇组出现不良反应的比例较高:结论:持续静脉注射他克莫司的治疗范围内的比例较高。在 56% 以上的移植中,两者均未达到治疗谷值。不过,两组患者的体内变异性都很大。
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引用次数: 0
Withdrawal pain following patients discontinuing Trk inhibitors. 患者停用 Trk 抑制剂后的戒断痛。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2025-01-01 Epub Date: 2024-08-27 DOI: 10.1177/10781552241279196
Alan Chin, Sheila Lindsay, Emily K Bergsland, Hyunseok Kang

Objective: This article aims to expand on the existing literature regarding the incidence of withdrawal pain following discontinuation of Trk inhibitors and to explore strategies that mitigate this withdrawal pain.

Data source: A retrospective observational study was conducted among patients who were at least 18 years-old or older and had documentation of starting larotrectinib or entrectinib at University of California, San Francisco (UCSF) between November 2018 and November 2022. Data were collected from electronic records and pharmacy databases and a total of 21 patients were identified in this study.

Data summary: Of the 21 patients included in this study, five patients (24%) experienced pain during temporary or permanent discontinuation of Trk inhibitor with the onset of withdrawal pain ranging from a few hours to three days following discontinuation. Various strategies were implemented to manage this pain including restarting of Trk inhibitor, tapering of Trk inhibitor on discontinuation, minimizing dose interruptions and use of prescription pain medications.

Conclusion: This article illustrates the presence of withdrawal pain syndrome in patients stopping a Trk inhibitor treatment and highlight the need for patient education to avoid missing any doses and for development of a guideline for Trk inhibitor discontinuation.

摘要本文旨在对现有文献中有关停用 Trk 抑制剂后停药疼痛发生率的内容进行扩展,并探讨减轻停药疼痛的策略:在 2018 年 11 月至 2022 年 11 月期间,加利福尼亚大学旧金山分校(UCSF)对至少 18 岁或以上且有文件证明开始使用拉罗替尼或恩替替尼的患者进行了一项回顾性观察研究。数据收集自电子记录和药房数据库,本研究共确定了21名患者。数据摘要:在纳入本研究的21名患者中,有5名患者(24%)在暂时或永久停用Trk抑制剂期间出现疼痛,停药疼痛的发作时间从停药后几小时到三天不等。我们采取了各种策略来控制这种疼痛,包括重新开始使用 Trk 抑制剂、停用 Trk 抑制剂时逐渐减量、尽量减少剂量中断以及使用处方止痛药:本文说明了停用 Trk 抑制剂治疗的患者会出现戒断痛综合征,并强调有必要对患者进行教育,以避免漏服任何剂量,同时有必要制定 Trk 抑制剂停药指南。
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引用次数: 0
Optimizing chemotherapy medication leftover management circuit in a centralized chemotherapy preparation unit: A comprehensive FMECA risk analysis and continuous improvement approach. 优化中央化疗准备单位的化疗药物剩余管理回路:全面的 FMECA 风险分析和持续改进方法。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2025-01-01 Epub Date: 2023-12-18 DOI: 10.1177/10781552231221450
Soumaya El Baraka, Meryem Chennaq, Jean-Marie Ouedraogo, Ali Cherif Chefchaouni, Oumaima Shytry, Mohammed-Jaouad Belahcen, Younes Rahali

Objective: Chemotherapy medications are usually having high costs, and new targeted drugs can be especially expensive, representing a challenge on healthcare, particularly in low- and middle-income countries. As cytotoxic leftover management is crucial for reducing medication wastage, the aim of this study is to evaluate and optimize leftover management circuit in NIO'S Pharmacy Centralized Chemotherapy Preparation Unit (CCPU) through a Failure Mode, Effects and Criticality Analysis (FMECA), and propose continuous improvement element to enhance the security of the process.

Method: The FMECA were conducted in NIO's CCPU from March to May 2023, then continuous improvement plan was established to enhance the security of the process. The failure modes, their causes, impact, and criticality were assessed through criticality index calculation (CI = severity × frequency × detectability), and the risk concerned safety and effectiveness disruptions in chemotherapy preparation circuit using cytotoxic leftover.

Results: Leftover management circuits were described in flowchart form, where 18 failure modes were detected in four different steps of the process from chemotherapy preparation to disposal. Failure with highest critical index were detected in the case of equipment malfunction, improper storage temperature, and humidity. Continuous improvement recommendations were proposed in a table form.

Conclusion: FMECA analysis applied to NIO's chemotherapy leftover management process allowed us to evaluate, secure, and optimize the circuit, and to propose several actions to implement in a perspective of continuous improvement.

目的:化疗药物的成本通常很高,新的靶向药物尤其昂贵,这对医疗保健是一个挑战,尤其是在低收入和中等收入国家。由于细胞毒性剩药管理对减少药物浪费至关重要,本研究旨在通过故障模式、影响和关键度分析(FMECA),评估和优化国家医疗信息办公室药房集中化疗制剂室(CCPU)的剩药管理回路,并提出持续改进措施,以提高流程的安全性:方法:在 2023 年 3 月至 5 月期间,对 NIO 的 CCPU 进行了 FMECA 分析,然后制定了持续改进计划,以提高流程的安全性。通过计算临界指数(临界指数=严重性×频率×可探测性)评估了失效模式、失效原因、影响和临界度,并对使用细胞毒性残留物的化疗准备回路的安全性和有效性中断进行了风险评估:结果:以流程图的形式描述了残留物管理回路,在从化疗准备到处置的四个不同步骤中发现了 18 种故障模式。在设备故障、储存温度和湿度不当的情况下,发现了关键指数最高的故障。以表格形式提出了持续改进建议:将 FMECA 分析应用于 NIO 的化疗遗留物管理流程,使我们能够对电路进行评估、保护和优化,并从持续改进的角度提出了几项行动建议。
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引用次数: 0
Clinical significance of coadministration of moderate to strong CYP enzyme inhibitors with doxorubicin in breast cancer patients receiving AC chemotherapy. 接受 AC 化疗的乳腺癌患者在多柔比星与中强 CYP 酶抑制剂联合用药时的临床意义。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2025-01-01 Epub Date: 2024-01-09 DOI: 10.1177/10781552231223125
Amy Priest Dawson, Chrissy D Frick, Megan Burd, Brette Conliffe

Introduction: Cytochrome P450 (CYP) enzyme inhibitors may increase the toxicity of many chemotherapies. Medication databases classify doxorubicin coadministration with CYP2D6 or CYP3A4 inhibitors as either a major interaction or contraindication. This study assessed the incidence of toxicity secondary to doxorubicin given with or without CYP enzyme inhibitors in breast cancer patients receiving doxorubicin and cyclophosphamide.

Methods: This retrospective study included female breast cancer patients treated with doxorubicin and cyclophosphamide (AC). Patients were divided into three arms: no moderate or strong CYP inhibitor interactions, moderate or strong CYP2D6 inhibitor interactions, or moderate or strong CYP3A4 inhibitor interactions. Primary outcomes included incidence of doxorubicin-associated toxicity, unplanned medical visits, chemotherapy treatment delays, and doxorubicin dose reductions. The secondary endpoint was time to toxicity.

Results: There were 171 patients included (n = 20 patients in the CYP2D6 inhibitor group and n = 15 in the CYP3A4 inhibitor group). Neither CYP inhibitor group showed a difference in incidence of hepatotoxicity, cardiotoxicity, myelotoxicity, moderate/severe nausea, or treatment delays. Compared to the no CYP inhibitor group, the CYP2D6 inhibitor group experienced a higher incidence of unplanned medical visits (45% vs. 19.4%; p = 0.023) and more frequent doxorubicin dose reductions (30% vs. 7.2%; p = 0.006). The CYP3A4 inhibitor group did not differ from the no CYP inhibitor group for these outcomes.

Conclusions: CYP inhibitors, particularly CYP2D6 inhibitors, may affect doxorubicin tolerability, as seen in this study by an increased incidence of unplanned medical visits and doxorubicin dose reductions.

简介细胞色素 P450(CYP)酶抑制剂可能会增加许多化疗药物的毒性。药物数据库将多柔比星与 CYP2D6 或 CYP3A4 抑制剂合用列为主要相互作用或禁忌症。本研究评估了接受多柔比星和环磷酰胺治疗的乳腺癌患者在使用或不使用 CYP 酶抑制剂的情况下多柔比星继发毒性的发生率:这项回顾性研究纳入了接受多柔比星和环磷酰胺(AC)治疗的女性乳腺癌患者。患者被分为三组:无中度或强烈 CYP 抑制剂相互作用、中度或强烈 CYP2D6 抑制剂相互作用、中度或强烈 CYP3A4 抑制剂相互作用。主要结果包括多柔比星相关毒性的发生率、非计划就诊、化疗延迟和多柔比星剂量减少。次要终点是出现毒性的时间:共纳入 171 例患者(CYP2D6 抑制剂组 20 例,CYP3A4 抑制剂组 15 例)。CYP抑制剂组和CYP3A4抑制剂组在肝毒性、心脏毒性、骨髓毒性、中度/重度恶心或治疗延迟的发生率方面均无差异。与无 CYP 抑制剂组相比,CYP2D6 抑制剂组的非计划就诊率更高(45% 对 19.4%;P = 0.023),多柔比星剂量减少的频率更高(30% 对 7.2%;P = 0.006)。CYP3A4抑制剂组与无CYP抑制剂组在这些结果上没有差异:结论:CYP抑制剂,尤其是CYP2D6抑制剂,可能会影响多柔比星的耐受性,本研究中的非计划就诊率和多柔比星剂量减少率都有所增加。
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引用次数: 0
Assessing the effectiveness of gabapentin in paclitaxel-induced arthralgia, myalgia, and neuropathic pain: An observational, cohort study. 评估加巴喷丁对紫杉醇引起的关节痛、肌痛和神经性疼痛的疗效:一项观察性队列研究。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2025-01-01 Epub Date: 2024-01-05 DOI: 10.1177/10781552231225148
Prashantkumar Patel, Hemraj Singh Rajput, Khushboo Chavda, Smit Mistry, Sandesh Bhagat, Rajesh Hadia, Moinuddin Saiyed, Avinash Khadela

Background and objectives: Arthralgia, myalgia, and neuropathic pain are the most common side effects observed due to paclitaxel chemotherapy. The aim of this study was to investigate the prophylactic role, maintenance, remission, and re-occurrence of arthralgia, myalgia, and neuropathic pain post-gabapentin therapy.

Methodology: This study was conducted in the Department of Oncology, Dhiraj Hospital, Vadodara with a sample of 51 patients. Newly detected cancer patients who observed arthralgia, myalgia, and neuropathic pain due to paclitaxel were taken and a baseline pain assessment was done using the Common Terminology Criteria for Adverse Events (CTCAE) and painDETECT questionnaire. Gabapentin was given in the first cycle after symptoms appeared and prophylactic treatment was given in the subsequent three cycles and evaluation of pain was done post-gabapentin therapy to assess the symptomatic as well as prophylactic effect.

Results: At baseline, neuropathic pain score was 22.7 ± 3.6 which reduced to 0.01 ± 0.14 on subsequent follow-ups. Grade 2 arthralgia, myalgia, and neuropathic pain were more observed at baseline which reduces to Grade 0 in the third cycle. The difference in baseline and post-gabapentin therapy was statistically analyzed by conducting t-test which showed p-value <0.00001 and t-value was less than -2 which indicated a statistically significant result.

Conclusion: This study shows that gabapentin reduces neuropathic pain. Prophylactic usage of gabapentin was highly effective at bringing about quick pain relief when compared to symptomatic treatment. In further follow-ups, it was noted that gabapentin maintained the impact throughout the cycles.

背景和目的:关节痛、肌痛和神经痛是紫杉醇化疗最常见的副作用。本研究旨在探讨加巴喷丁治疗后关节痛、肌痛和神经病理性疼痛的预防作用、维持、缓解和复发情况:本研究在瓦多达拉 Dhiraj 医院肿瘤科进行,抽样调查了 51 名患者。新发现的癌症患者因使用紫杉醇而出现关节痛、肌痛和神经性疼痛,研究人员使用不良事件通用术语标准(CTCAE)和疼痛DETECT问卷对患者进行了基线疼痛评估。在出现症状后的第一个周期给予加巴喷丁治疗,在随后的三个周期给予预防性治疗,并在加巴喷丁治疗后进行疼痛评估,以评估对症治疗和预防性治疗的效果:基线时,神经病理性疼痛评分为 22.7 ± 3.6,在随后的随访中降至 0.01 ± 0.14。基线时观察到的 2 级关节痛、肌痛和神经痛较多,在第三个周期时降至 0 级。通过 t 检验对基线和加巴喷丁治疗后的差异进行了统计分析,结果显示 p 值 t 值小于-2,表明结果具有统计学意义:本研究表明,加巴喷丁可减轻神经病理性疼痛。与对症治疗相比,预防性使用加巴喷丁在快速缓解疼痛方面非常有效。在进一步的随访中,人们注意到加巴喷丁在整个周期内都能保持疗效。
{"title":"Assessing the effectiveness of gabapentin in paclitaxel-induced arthralgia, myalgia, and neuropathic pain: An observational, cohort study.","authors":"Prashantkumar Patel, Hemraj Singh Rajput, Khushboo Chavda, Smit Mistry, Sandesh Bhagat, Rajesh Hadia, Moinuddin Saiyed, Avinash Khadela","doi":"10.1177/10781552231225148","DOIUrl":"10.1177/10781552231225148","url":null,"abstract":"<p><strong>Background and objectives: </strong>Arthralgia, myalgia, and neuropathic pain are the most common side effects observed due to paclitaxel chemotherapy. The aim of this study was to investigate the prophylactic role, maintenance, remission, and re-occurrence of arthralgia, myalgia, and neuropathic pain post-gabapentin therapy.</p><p><strong>Methodology: </strong>This study was conducted in the Department of Oncology, Dhiraj Hospital, Vadodara with a sample of 51 patients. Newly detected cancer patients who observed arthralgia, myalgia, and neuropathic pain due to paclitaxel were taken and a baseline pain assessment was done using the Common Terminology Criteria for Adverse Events (CTCAE) and painDETECT questionnaire. Gabapentin was given in the first cycle after symptoms appeared and prophylactic treatment was given in the subsequent three cycles and evaluation of pain was done post-gabapentin therapy to assess the symptomatic as well as prophylactic effect.</p><p><strong>Results: </strong>At baseline, neuropathic pain score was 22.7 ± 3.6 which reduced to 0.01 ± 0.14 on subsequent follow-ups. Grade 2 arthralgia, myalgia, and neuropathic pain were more observed at baseline which reduces to Grade 0 in the third cycle. The difference in baseline and post-gabapentin therapy was statistically analyzed by conducting <i>t</i>-test which showed <i>p</i>-value <0.00001 and <i>t</i>-value was less than -2 which indicated a statistically significant result.</p><p><strong>Conclusion: </strong>This study shows that gabapentin reduces neuropathic pain. Prophylactic usage of gabapentin was highly effective at bringing about quick pain relief when compared to symptomatic treatment. In further follow-ups, it was noted that gabapentin maintained the impact throughout the cycles.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"81-89"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139098078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical characteristics and risk factors for oxaliplatin hypersensitivity reactions in patients with colorectal cancer. 结直肠癌患者奥沙利铂超敏反应的临床特征和风险因素。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2025-01-01 Epub Date: 2023-12-12 DOI: 10.1177/10781552231220542
Jeong Hye Kim, Mi Kyoung Jung

Introduction: Oxaliplatin is an anticancer drug used primarily for cancers of the gastrointestinal tract, and oxaliplatin hypersensitivity reaction is a rare but serious side effect. This study aimed to identify the clinical characteristics and risk factors for oxaliplatin hypersensitivity reactions in patients with colorectal cancer.

Methods: This retrospective study included 280 patients who developed oxaliplatin hypersensitivity reactions and 476 patients who did not.

Results: Logistic regression analysis indicated that a history of allergy (odds ratio (OR) = 2.232, 95% confidence interval (CI) (1.209, 4.119), P = .010), previous oxaliplatin exposure (OR = 8.081, 95% CI (3.024, 21.593), P < .001), and chemotherapy regimen (OR = 2.148, 95% CI (1.411, 3.271), P < .001) were risk factors for oxaliplatin hypersensitivity reactions. These reactions averaged 7.29 ± 2.78 (median 7, 1-16) cycles, with a mean cumulative dose of 589.53 ± 274.43 mg. Grade 2 oxaliplatin hypersensitivity reactions were the most common, occurring in 197 patients (70.4%), followed by grade 3 reactions in 68 patients (24.3%), and grade 4 reactions in 9 patients (3.2%). The most common symptom of oxaliplatin hypersensitivity reactions was itching (211 patients, 75.4%), followed by facial flushing (133 patients, 47.5%), and chest discomfort (77 patients, 27.5%).

Conclusions: We identified a history of allergy to previous oxaliplatin exposure and chemotherapy regimens as risk factors for oxaliplatin hypersensitivity reactions. Healthcare providers should be aware of the risk factors for oxaliplatin hypersensitivity reactions and carefully monitor patients receiving oxaliplatin.

简介奥沙利铂是一种主要用于胃肠道癌症的抗癌药物,奥沙利铂超敏反应是一种罕见但严重的副作用。本研究旨在确定结直肠癌患者发生奥沙利铂超敏反应的临床特征和风险因素:这项回顾性研究纳入了 280 例发生奥沙利铂超敏反应的患者和 476 例未发生奥沙利铂超敏反应的患者:逻辑回归分析表明,过敏史(几率比(OR)=2.232,95%置信区间(CI)(1.209,4.119),P=0.010)、既往奥沙利铂暴露史(OR=8.081,95%CI(3.024,21.593),P 结论:我们确定了既往奥沙利铂暴露史和过敏史:我们发现既往奥沙利铂过敏史和化疗方案是奥沙利铂超敏反应的风险因素。医疗服务提供者应了解奥沙利铂超敏反应的风险因素,并仔细监测接受奥沙利铂治疗的患者。
{"title":"Clinical characteristics and risk factors for oxaliplatin hypersensitivity reactions in patients with colorectal cancer.","authors":"Jeong Hye Kim, Mi Kyoung Jung","doi":"10.1177/10781552231220542","DOIUrl":"10.1177/10781552231220542","url":null,"abstract":"<p><strong>Introduction: </strong>Oxaliplatin is an anticancer drug used primarily for cancers of the gastrointestinal tract, and oxaliplatin hypersensitivity reaction is a rare but serious side effect. This study aimed to identify the clinical characteristics and risk factors for oxaliplatin hypersensitivity reactions in patients with colorectal cancer.</p><p><strong>Methods: </strong>This retrospective study included 280 patients who developed oxaliplatin hypersensitivity reactions and 476 patients who did not.</p><p><strong>Results: </strong>Logistic regression analysis indicated that a history of allergy (odds ratio (OR) = 2.232, 95% confidence interval (CI) (1.209, 4.119), P = .010), previous oxaliplatin exposure (OR = 8.081, 95% CI (3.024, 21.593), P < .001), and chemotherapy regimen (OR = 2.148, 95% CI (1.411, 3.271), P < .001) were risk factors for oxaliplatin hypersensitivity reactions. These reactions averaged 7.29 ± 2.78 (median 7, 1-16) cycles, with a mean cumulative dose of 589.53 ± 274.43 mg. Grade 2 oxaliplatin hypersensitivity reactions were the most common, occurring in 197 patients (70.4%), followed by grade 3 reactions in 68 patients (24.3%), and grade 4 reactions in 9 patients (3.2%). The most common symptom of oxaliplatin hypersensitivity reactions was itching (211 patients, 75.4%), followed by facial flushing (133 patients, 47.5%), and chest discomfort (77 patients, 27.5%).</p><p><strong>Conclusions: </strong>We identified a history of allergy to previous oxaliplatin exposure and chemotherapy regimens as risk factors for oxaliplatin hypersensitivity reactions. Healthcare providers should be aware of the risk factors for oxaliplatin hypersensitivity reactions and carefully monitor patients receiving oxaliplatin.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"17-21"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138804912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Systemic therapy for non-clear cell renal cell carcinomas: A systematic review. 非透明细胞肾细胞癌的系统治疗:系统综述。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2025-01-01 Epub Date: 2024-11-11 DOI: 10.1177/10781552241289920
Balqees Ara, Anum Babar, Durkho Atif, Bushra Ghafoor, Mustafa Shah, Syed Maaz Abdullah, Danish Safi, Amir Kamran

Objective: Renal cell carcinoma (RCC) is the most common kidney cancer, with clear cell RCC being the predominant subtype. However, non-clear cell RCC constitutes a significant proportion of cases, presenting distinct challenges in treatment due to its varied histological subtypes. Despite recent advancements, the optimal therapeutic approach for non-clear cell RCC remains uncertain due to limited high-quality evidence. This systematic review aims to evaluate the efficacy of systemic therapies in nccRCC subgroups.

Data source: A comprehensive literature search identified studies from 2010 to 2024, using PubMed and Clinicaltrials.gov databases focusing on clinical trials and treatment outcomes.

Data summary: Results highlight the evolving therapeutic landscape, with targeted agents and immunotherapy demonstrating promising anti-tumor effects. Notably, tyrosine kinase inhibitors (TKIs) such as sunitinib and mTOR inhibitors like temsirolimus have shown efficacy across different subtypes. Combination therapies, including immunotherapy-based regimens, have also shown favorable outcomes. immune checkpoint inhibitors such as nivolumab and pembrolizumab demonstrated encouraging antitumor activity. Furthermore, specific targeting of signaling pathways, such as the c-MET pathway, has demonstrated efficacy in certain PapillaryRCC.

Conclusion: While combination therapies, including immunotherapies, have shown positive outcomes, immune checkpoint inhibitors like nivolumab and pembrolizumab have demonstrated encouraging antitumor activity. Additionally, targeting the c-MET pathway has proven effective in certain papillary RCC. Further research is warranted to establish optimal treatment strategies and improve outcomes for patients with non-clear cell RCC. Systemic therapy for non-clear cell RCC is complex and evolving. Further research is needed to delineate optimal treatment strategies for different histological subtypes and improve patient outcomes.

目的:肾细胞癌(RCC)是最常见的肾癌,其中透明细胞癌是最主要的亚型。然而,非透明细胞 RCC 占了相当大的比例,由于其组织学亚型各不相同,给治疗带来了独特的挑战。尽管最近取得了一些进展,但由于高质量证据有限,非透明细胞 RCC 的最佳治疗方法仍不确定。本系统综述旨在评估系统疗法在非透明细胞RCC亚组中的疗效:数据来源:利用PubMed和Clinicaltrials.gov数据库对2010年至2024年的研究进行了全面的文献检索,重点关注临床试验和治疗结果:研究结果凸显了不断发展的治疗前景,靶向药物和免疫疗法显示出良好的抗肿瘤效果。值得注意的是,舒尼替尼等酪氨酸激酶抑制剂(TKIs)和temsirolimus等mTOR抑制剂已在不同亚型中显示出疗效。免疫检查点抑制剂(如 nivolumab 和 pembrolizumab)显示出令人鼓舞的抗肿瘤活性。此外,针对信号通路(如 c-MET 通路)的特异性靶向治疗已在某些乳头状 RCC 中显示出疗效:结论:包括免疫疗法在内的综合疗法已显示出积极的疗效,nivolumab 和 pembrolizumab 等免疫检查点抑制剂已显示出令人鼓舞的抗肿瘤活性。此外,靶向 c-MET 通路已被证明对某些乳头状 RCC 有效。为确立最佳治疗策略并改善非透明细胞 RCC 患者的预后,还需要进一步的研究。非透明细胞 RCC 的系统治疗非常复杂且不断发展。需要开展进一步研究,为不同组织学亚型确定最佳治疗策略,改善患者预后。
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引用次数: 0
Trastuzumab-induced optic neuritis: "blindness" side effect. 曲妥珠单抗引发的视神经炎:"失明 "副作用
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2025-01-01 Epub Date: 2024-08-14 DOI: 10.1177/10781552241275538
Tuğba Önder, Cengiz Karaçin

Introduction: Trastuzumab improved the prognosis of patients with human epidermal growth factor receptor 2 (HER2)+ breast cancer (BC). Here, we present a patient who developed acute vision loss due to optic atrophy in both eyes after trastuzumab.

Case report: A 60-year-old female patient was diagnosed with locally advanced HER2+ BC in January 2021. After four cycles of neoadjuvant anthracycline-based chemotherapy followed by four cycles of docetaxel, trastuzumab, and pertuzumab combined treatment, the patient underwent a right modified radical mastectomy. Three days after the end of the second cycle of adjuvant trastuzumab, she presented with acute vision loss. The patient's visual acuity was 90% in the right eye and 60% in the left eye. The left eye had optic nerve edema and spindle hemorrhages. First, on suspicion of optic neuritis, the patient was given a 1 gram/day pulse steroid for three days. However, optic neuritis was not considered during the follow-up. Metastasis was considered at the exit of the left optic nerve. Trastuzumab was started by making a mutual decision with the patient. Six days after the sixth dose of adjuvant trastuzumab, she presented with almost complete vision loss.

Management and outcome: The patient was diagnosed with optic neuritis, and a pulse steroid was administered. Trastuzumab was permanently discontinued. However, the patient's visual acuity in both eyes remained at 5-10%.

Discussion: Vision loss due to optic neuritis is a devastating side effect. Understanding that trastuzumab-induced optic neuritis may develop will help clinicians detect side effects early and manage them more effectively.

简介曲妥珠单抗改善了人表皮生长因子受体2(HER2)+乳腺癌(BC)患者的预后。在此,我们介绍了一名在使用曲妥珠单抗后因双眼视神经萎缩而导致急性视力丧失的患者:病例报告:一名 60 岁的女性患者于 2021 年 1 月被诊断为局部晚期 HER2+ 乳腺癌。经过四个周期的新辅助蒽环类化疗和四个周期的多西他赛、曲妥珠单抗和百妥珠单抗联合治疗后,患者接受了右侧改良根治性乳房切除术。曲妥珠单抗辅助治疗第二周期结束三天后,患者出现急性视力下降。患者右眼视力为 90%,左眼视力为 60%。左眼出现视神经水肿和纺锤形出血。首先,由于怀疑是视神经炎,医生给患者注射了每天 1 克的脉冲类固醇,连续注射了三天。但在随访过程中并未考虑视神经炎。考虑到转移发生在左视神经出口处。经与患者共同决定,开始使用曲妥珠单抗。第六剂曲妥珠单抗辅助治疗后六天,她的视力几乎完全丧失:患者被诊断为视神经炎,并接受了脉冲类固醇治疗。曲妥珠单抗被永久停用。然而,患者双眼的视力仍为 5-10%:讨论:视神经炎导致的视力下降是一种毁灭性的副作用。了解曲妥珠单抗可能诱发视神经炎,将有助于临床医生及早发现副作用并更有效地处理它们。
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引用次数: 0
A multifaceted role of bisphosphonates from palliative care to anti-cancer therapy in solid tumors. 双膦酸盐在实体瘤中从姑息治疗到抗癌治疗的多方面作用。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2025-01-01 Epub Date: 2024-07-26 DOI: 10.1177/10781552241265304
Sindhusha Veeraballi, Sai Samyuktha Bandaru, Chrystina Kiwan, Kok Hoe Chan, Hamid S Shaaban

Introduction: Bisphosphonates (P-C-Ps) also called diphosphonates are the structural analogs of naturally occurring pyrophosphates. Bisphosphonates are traditionally used and shown to provide long-term success in the treatment and prevention of osteoporosis and other bone loss pathologies. Furthermore, bisphosphonates are gaining popularity in the present era of cancer therapeutics and prevention. The usage of bisphosphonates as adjuvant or neoadjuvant therapy, either as a single agent or combined with other chemotherapy, has been studied in different solid tumors. This review aims to present the various roles of bisphosphonates in solid tumors.

Data sources: Articles in MEDLINE/PubMed and the National Institutes of Health Clinical Trials Registry (http://www. Clinicaltrials.gov) between 1 January 2011 and 1 February 2022 were extracted using MeSH terms "bisphosphonates/diphosphosphonates and mechanism," "bisphosphonates and breast cancer," "bisphosphonates and prostate cancer," "bisphosphonates and lung cancer," "bisphosphonates and cancer risk," and "bisphosphonates and adverse events." Manual searches of some major oncology journals were also conducted.

Discussion: This review article focuses on the antitumor activity of bisphosphonates, safety profile, and the role of bisphosphonates as preventive, neoadjuvant, and adjuvant chemotherapy. A significant improvement in overall survival and cancer-specific survival and recurrence-free survival with the usage of bisphosphonates is noted in breast cancer patients, particularly in post-menopausal women. Though great progress has been achieved in over 20 years, further research is needed to identify the subgroup of patients that are most likely to benefit from adjuvant bisphosphonate therapy and to determine regimens with greater efficacy and better safety profile.

简介:双膦酸盐(P-C-Ps)又称二膦酸盐,是天然存在的焦磷酸盐的结构类似物。双膦酸盐历来被用于治疗和预防骨质疏松症和其他骨质流失病症,并取得了长期的成功。此外,双膦酸盐在当今癌症治疗和预防领域也越来越受欢迎。在不同的实体瘤中,双膦酸盐作为辅助或新辅助疗法,无论是作为单一药物还是与其他化疗联合使用,都得到了研究。本综述旨在介绍双膦酸盐在实体瘤中的各种作用:使用MeSH术语 "双膦酸盐/二膦酸盐和机制"、"双膦酸盐和乳腺癌"、"双膦酸盐和前列腺癌"、"双膦酸盐和肺癌"、"双膦酸盐和癌症风险 "以及 "双膦酸盐和不良事件 "提取2011年1月1日至2022年2月1日期间MEDLINE/PubMed和美国国立卫生研究院临床试验注册中心(http://www. Clinicaltrials.gov)中的文章。此外,还对一些主要的肿瘤学期刊进行了人工检索:这篇综述文章主要介绍了双膦酸盐的抗肿瘤活性、安全性以及双膦酸盐作为预防性化疗、新辅助化疗和辅助化疗的作用。使用双膦酸盐后,乳腺癌患者,尤其是绝经后妇女的总生存期、癌症特异性生存期和无复发生存期均有明显改善。虽然 20 多年来取得了巨大进步,但仍需进一步研究,以确定最有可能从双膦酸盐辅助治疗中获益的患者亚群,并确定疗效更好、安全性更高的治疗方案。
{"title":"A multifaceted role of bisphosphonates from palliative care to anti-cancer therapy in solid tumors.","authors":"Sindhusha Veeraballi, Sai Samyuktha Bandaru, Chrystina Kiwan, Kok Hoe Chan, Hamid S Shaaban","doi":"10.1177/10781552241265304","DOIUrl":"10.1177/10781552241265304","url":null,"abstract":"<p><strong>Introduction: </strong>Bisphosphonates (P-C-Ps) also called diphosphonates are the structural analogs of naturally occurring pyrophosphates. Bisphosphonates are traditionally used and shown to provide long-term success in the treatment and prevention of osteoporosis and other bone loss pathologies. Furthermore, bisphosphonates are gaining popularity in the present era of cancer therapeutics and prevention. The usage of bisphosphonates as adjuvant or neoadjuvant therapy, either as a single agent or combined with other chemotherapy, has been studied in different solid tumors. This review aims to present the various roles of bisphosphonates in solid tumors.</p><p><strong>Data sources: </strong>Articles in MEDLINE/PubMed and the National Institutes of Health Clinical Trials Registry (http://www. Clinicaltrials.gov) between 1 January 2011 and 1 February 2022 were extracted using MeSH terms \"bisphosphonates/diphosphosphonates and mechanism,\" \"bisphosphonates and breast cancer,\" \"bisphosphonates and prostate cancer,\" \"bisphosphonates and lung cancer,\" \"bisphosphonates and cancer risk,\" and \"bisphosphonates and adverse events.\" Manual searches of some major oncology journals were also conducted.</p><p><strong>Discussion: </strong>This review article focuses on the antitumor activity of bisphosphonates, safety profile, and the role of bisphosphonates as preventive, neoadjuvant, and adjuvant chemotherapy. A significant improvement in overall survival and cancer-specific survival and recurrence-free survival with the usage of bisphosphonates is noted in breast cancer patients, particularly in post-menopausal women. Though great progress has been achieved in over 20 years, further research is needed to identify the subgroup of patients that are most likely to benefit from adjuvant bisphosphonate therapy and to determine regimens with greater efficacy and better safety profile.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"107-118"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Role of thrombopoietin receptor agonists in chemotherapy-induced thrombocytopenia: A meta-analysis. 血小板生成素受体激动剂在化疗引起的血小板减少中的作用:荟萃分析
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2025-01-01 Epub Date: 2023-12-28 DOI: 10.1177/10781552231219003
Gerard Gurumurthy, Filip Kisiel, Samantha Gurumurthy, Juditha Gurumurthy

Introduction: Chemotherapy-induced thrombocytopenia (CIT) is a significant challenge in cancer treatment, often leading to dose reductions and reduced number of cycles. The limited effectiveness of platelet transfusions in managing CIT highlights the need for alternative treatments. Thrombopoietin receptor agonists (TPO-RA), including romiplostim, eltrombopag and avatrombopag, have shown potential in increasing platelet counts in CIT patients, necessitating a comprehensive analysis of their efficacy.

Methods: This meta-analysis followed the Preferred Reporting Items for Systemic Reviews and Meta-analysis guidelines, searching Ovid databases up to 5 October 2023. The primary metric of interest was platelet count changes post-TPO-RA administration in CIT patients.

Results: From the initial 867 studies obtained, 7 studies were selected based on the inclusion criteria. The analysis included 348 patients. A significant association was found between TPO-RA administration and platelet count increase, with a combined-effect increase of 69.52 ± 2.24 × 109/l. Subgroup analysis based on Romiplostim use suggested an increase of approximately 70.11 ± 39.07 × 109/l, while non-Romiplostim TPO-RAs showcased an increase of about 68.09 ± 82.58 × 109/l.

Conclusions: The meta-analysis demonstrates the effectiveness of TPO-RAs in managing CIT. Further research comparing platelet increases across standardised TPO-RA regimens is recommended to refine treatment strategies. This analysis provides valuable insights for clinicians in tailoring CIT treatment using TPO-RAs.

简介化疗引起的血小板减少症(CIT)是癌症治疗中的一个重大挑战,往往导致剂量减少和周期数减少。血小板输注对控制 CIT 的效果有限,这凸显了对替代疗法的需求。血小板生成素受体激动剂(TPO-RA),包括romiplostim、eltrombopag和avatrombopag,已显示出增加CIT患者血小板计数的潜力,因此有必要对其疗效进行全面分析:这项荟萃分析遵循《系统综述和荟萃分析首选报告项目》指南,检索了截至2023年10月5日的Ovid数据库。研究的主要指标是CIT患者服用TPO-RA后血小板计数的变化:从最初获得的 867 项研究中,根据纳入标准筛选出 7 项研究。分析包括 348 名患者。研究发现,服用 TPO-RA 与血小板计数增加之间存在明显联系,两者的综合效应为 69.52 ± 2.24 × 109/l。基于罗米波司汀使用情况的亚组分析表明,血小板计数增加约为 70.11 ± 39.07 × 109/升,而非罗米波司汀的 TPO-RA 显示血小板计数增加约为 68.09 ± 82.58 × 109/升:该荟萃分析表明,TPO-RAs 在治疗 CIT 方面效果显著。建议进一步研究比较各种标准化 TPO-RA 方案的血小板增加情况,以完善治疗策略。这项分析为临床医生使用TPO-RA量身定制CIT治疗方案提供了有价值的见解。
{"title":"Role of thrombopoietin receptor agonists in chemotherapy-induced thrombocytopenia: A meta-analysis.","authors":"Gerard Gurumurthy, Filip Kisiel, Samantha Gurumurthy, Juditha Gurumurthy","doi":"10.1177/10781552231219003","DOIUrl":"10.1177/10781552231219003","url":null,"abstract":"<p><strong>Introduction: </strong>Chemotherapy-induced thrombocytopenia (CIT) is a significant challenge in cancer treatment, often leading to dose reductions and reduced number of cycles. The limited effectiveness of platelet transfusions in managing CIT highlights the need for alternative treatments. Thrombopoietin receptor agonists (TPO-RA), including romiplostim, eltrombopag and avatrombopag, have shown potential in increasing platelet counts in CIT patients, necessitating a comprehensive analysis of their efficacy.</p><p><strong>Methods: </strong>This meta-analysis followed the Preferred Reporting Items for Systemic Reviews and Meta-analysis guidelines, searching Ovid databases up to 5 October 2023. The primary metric of interest was platelet count changes post-TPO-RA administration in CIT patients.</p><p><strong>Results: </strong>From the initial 867 studies obtained, 7 studies were selected based on the inclusion criteria. The analysis included 348 patients. A significant association was found between TPO-RA administration and platelet count increase, with a combined-effect increase of 69.52 ± 2.24 × 10<sup>9</sup>/l. Subgroup analysis based on Romiplostim use suggested an increase of approximately 70.11 ± 39.07 × 10<sup>9</sup>/l, while non-Romiplostim TPO-RAs showcased an increase of about 68.09 ± 82.58 × 10<sup>9</sup>/l.</p><p><strong>Conclusions: </strong>The meta-analysis demonstrates the effectiveness of TPO-RAs in managing CIT. Further research comparing platelet increases across standardised TPO-RA regimens is recommended to refine treatment strategies. This analysis provides valuable insights for clinicians in tailoring CIT treatment using TPO-RAs.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"4-11"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139058449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Oncology Pharmacy Practice
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