Journal of Oncology Pharmacy Practice最新文献

ObjectiveThe article explores phytoconstituents as alternatives to corticosteroids for radiodermatitis, emphasizing antioxidant, antimicrobial, and anti-inflammatory properties. It summarizes recent research on phytoconstituents mitigating radiation-induced skin damage and contributing to "oncocosmetics" development for cancer patients undergoing radiotherapy.Data SourcesScientific literature was reviewed, including studies on radiodermatitis symptoms, phytoconstituent mechanisms, and their effectiveness in treating radiation-induced skin injuries. Search criteria included peer-reviewed articles on therapeutic applications and cosmeceutical formulations.Data SummaryRadiodermatitis affects 95% of individuals exposed to ionizing radiation during radiotherapy, presenting symptoms like erythema, pruritus, ulcers, and necrosis. Current treatments rely heavily on corticosteroids, which cause side effects like skin atrophy and systemic reactions. Phytoconstituents offer safer alternatives by neutralizing free radicals and protecting against radiation-induced skin damage. Their antioxidant, antimicrobial, and anti-inflammatory actions align with mechanisms involved in radiodermatitis healing. Research highlights their efficacy in preventing bacterial superinfection and promoting skin recovery. Phytoconstituents are increasingly incorporated into cosmeceutical products for cancer patients.ConclusionsPhytoconstituent-based preparations promise safer alternatives to corticosteroids for managing radiodermatitis. Their use in oncocosmetics can reduce side effects while improving patient outcomes. Further research into phytoconstituent formulations is needed for radiation-induced skin injuries.

IntroductionThe growing interest of cannabidiol (CBD) in medical care prompted French health authorities to explore the potential of CBD in cancer-related severe symptoms. This study aimed to assess the prevalence of CBD use among cancer patients with potential associated factors and to measure the cancer patient's health literacy (HL) on CBD consumption.MethodsIn a prospective study in oncology day-care hospital including patients from 29 October to 20 December 2021, we collected demographic, biological, and oncological characteristics. Patient CBD HL was measured by the hetero-questionnaire 8-item-CBD HL scale (HLS-8-CBD) whose conception has been validated by a psychometric analysis.ResultsAmong 363 participants, 20 patients (5.5%) reported CBD use. Factors associated with CBD use were: age <60 years (odd ratio = 7.80[1.36-13.32], p < 10^-4 versus ≥60 years), smoking history (OR = 5.53[1.81-16.88], p < 0.01), and no smoking cessation (OR = 5.07[1.66-15.46], p < 0.01). CBD use was also associated with a better CBD total HL score than non-users (p-value = 0.02).ConclusionIdentification of factors associated with CBD use and a relatively high patient CBD HL in CBD users showed that CBD use in cancer patients care represented a new concern and should enhance health professionals to consider CBD with its associated drug-related problems.

IntroductionVinorelbine, a semi-synthetic vinca alkaloid with anticancer activity by binding to tubulin, has shown to be successful in the treatment of cancer types including advanced non-small cell lung cancer, uterine cancer, and metastatic breast cancer. Myelosuppression, hematological effects, nausea, vomiting, exhaustion, and neuropathy are some of the most typical side effects of vinorelbine. We discuss the unusual presentation of vinorelbine-induced tetraplegia in a breast cancer patient.Case ReportA 66-year-old patient with breast cancer, who was followed up with adjuvant aromatase inhibitor therapy after mastectomy, presented with lung and bone metastases. She progressed in the follow-ups after receiving platinum and taxane chemotherapy, vinorelbine treatment was then started. The patient complained of weakness, weariness, and trouble walking after receiving a total dose of 180 mg. Tetraplegia was found after a neurological assessment.Management and OutcomeIt was thought that vinorelbine was responsible for the recent acute weakness. The patient's vinorelbine treatment was stopped. During follow-up, upper extremity paresis regressed, while lower extremities muscle strength remained unchanged.DiscussionVinorelbine, frequently used in oncology practice, causes some side effects. Although very rare in the literature, in this case severe peripheral neuropathy has been reported in the follow-up of post-vinorelbine quadriparesis.

BackgroundThe CREATE-X trial demonstrated that adjuvant capecitabine was effective in prolonging survival in high-risk triple-negative breast cancer (TNBC) patients. However, the recommended dose is generally not well tolerated by the US population. The goal of this study is to analyze dosing patterns in an ethnically diverse cohort to better characterize tolerability and inform future dosing guidelines.MethodsIn our single-center retrospective study, we evaluated safety and tolerability in TNBC patients undergoing adjuvant capecitabine treatment. The primary endpoint, relative dose intensity (RDI) across eight cycles, was examined alongside subgroup analyses based on age, race, BMI, and initial dose. Secondary endpoints include capecitabine-related side effects and survival.Results67 patients who completed adjuvant capecitabine at University of Chicago Medicine (UCM) between January 2017 and November 2022 were eligible. The mean RDI across eight cycles of treatment was 60.2% (95% CI: 0.554-0.650). When compared to the CREATE-X trial, the RDI in our population was significantly lower (0.602 vs. 0.787, p < 0.001). There was no statistically significant difference in average RDI across eight cycles for patients stratified by age, BMI, race, or initial starting dose. The most frequently reported adverse events were hand-foot syndrome (73%), diarrhea (27%), and fatigue (22%), consistent with prior studies.ConclusionsOur data demonstrates that a significant portion of patients have a lower tolerated dose of capecitabine in comparison to the recommended adjuvant dose. Acknowledging the limitations of our single-center analysis, RDI was not significantly affected by age, race, BMI, or initial starting dose.

BackgroundMany oral medications are manufactured as solid dosage forms, posing challenges for patients with dysphagia-including older adults and children-and creating occupational hazards for healthcare workers who must crush or manipulate hazardous drugs. Existing methods for preparing such medications often involve open systems, exposing staff to cytotoxic agents and risking cross-contamination.ObjectiveTo develop and evaluate a novel, single-use closed-system drug-transfer device (CSTD) designed to crush and dissolve or suspend solid oral medications within a sealed environment, enhancing safety for healthcare workers and improving medication access for patients with swallowing difficulties.MethodsWe developed a prototype CSTD comprising a 20 mL transparent barrel, a mechanical crushing piston with an integrated mesh, one-way fluid inlet, and a sealed outlet port for administration. Device sealing integrity was evaluated using vacuum methylene blue ingress testing, while drug extraction efficiency was quantified using high-performance liquid chromatography (HPLC) analysis of paracetamol solutions prepared with the device.ResultsSealing integrity tests demonstrated no dye ingress under vacuum conditions, confirming a robust closed system. HPLC analysis of paracetamol solutions showed recoveries exceeding 98%, indicating effective crushing and dissolution. The device offers a practical closed-system approach for handling hazardous oral medications and enables safe administration via oral or enteral routes.ConclusionThis novel CSTD represents a promising innovation to improve occupational safety during hazardous drug handling and to enhance treatment accessibility for patients with dysphagia. Further clinical evaluation and regulatory review are underway.

BackgroundLung cancer is a leading cause of cancer-related deaths, with Non-Small Cell Lung Cancer (NSCLC) comprising 85-90% of cases, most commonly adenocarcinoma. Key mutations include EGFR Exon 19 deletions and Exon 21 L858R. While third-generation TKIs like osimertinib, lazertinib, and aumolertinib are effective, resistance often arises. Amivantamab, a bispecific monoclonal antibody targeting EGFR and c-MET, shows promise, particularly against EGFR Exon 20 insertions.ObjectiveTo provide a comprehensive evaluation of the adverse effects associated with amivantamab in EGFR-mutant NSCLC, including their underlying pathophysiological mechanisms and evidence-based management strategies. In addition, this review aims to contextualize the clinical relevance of amivantamab by briefly outlining the therapeutic evolution of EGFR-targeted treatments, highlighting the rationale for its development, and current positioning in treatment paradigms.MethodsA comprehensive review of clinical trials, including CHRYSALIS, PAPILLON, MARIPOSA, and PALOMA-III, was conducted to assess the safety and efficacy of amivantamab. Practical and early insights into managing adverse effects of amivantamab are critical to better adherence and quality of life.ResultsAdverse effects were observed in most of the patients treated with amivantamab. Common side effects included cutaneous toxicities, diarrhea, infusion-related reactions (IRRs), vascular thrombosis and pneumonitis. The most frequent cutaneous side effects were rash, paronychia, pruritis, and stomatitis. Diarrhea occurred in patients primarily due to EGFR inhibition. IRRs were predominantly mild to moderate, occurring mainly during the first cycle. Thrombosis was a notable adverse effect observed, even in patients receiving anticoagulant prophylaxis. Pneumonitis was less common but severe.ManagementAdverse effects of amivantamab are managed based on severity. Cutaneous toxicities are treated with antibiotics, topical steroids, and dose adjustments. Diarrhea is managed with hydration, loperamide, and dose interruption. Infusion-related reactions (IRRs) are treated symptomatically, with epinephrine in severe cases. Anticoagulants are used for deep vein thrombosis or thromboembolism, and fibrinolytics or thrombectomy may be considered. Pneumonitis is managed by discontinuing amivantamab and using glucocorticoids.ConclusionsAmivantamab is effective for EGFR mutant NSCLC but can cause adverse effects. Understanding these effects and implementing management strategies can optimize outcomes, maintaining treatment efficacy.

IntroductionMultiple myeloma (MM) is a hematologic cancer characterized by the accumulation of monoclonal plasma cells in the bone marrow. Dexamethasone is included in preferred regimens for primary therapy for both transplant-eligible and transplant-ineligible candidates. To date, type III hypersensitivity reactions to dexamethasone have not been previously reported.Case reportA 61-year-old man diagnosed with multiple myeloma received treatment with bortezomib and dexamethasone, achieving complete remission. In 2017, he experienced his first relapse and was managed with bortezomib, thalidomide, and dexamethasone. In 2019, his regimen was changed to carfilzomib, which was subsequently discontinued due to hematologic toxicity. In 2022, he presented with relapse and an ankle fracture, leading to the suspension of treatment. In 2023, carfilzomib and dexamethasone were restarted at lower doses. During intravenous and oral dexamethasone treatment, the patient developed skin lesions on his lower extremities, and, following evaluation by the Allergy and Immunology team, drug-induced vasculitis was diagnosed.Management and outcomeGiven the need to reintroduce dexamethasone due to the lack of alternative therapeutic options, a dexamethasone desensitization protocol was implemented. A 5-step delayed desensitization protocol was successfully performed, with no reactivation of vasculitic lesions.DiscussionAlthough desensitization is generally contraindicated in type III hypersensitivity reactions, no prior cases of successful desensitization in dexamethasone-induced vasculitis have been reported. This is the first reported case of successful desensitization in a patient with dexamethasone-induced vasculitis. A limitation of this case report is that the mechanisms underlying drug tolerance remain unknown.