Adverse Effects Of Chemotherapy Research Articles

Effectiveness of the combination of netupitant and palonosetron in the prevention of nausea and vomiting during anthracycline-containing chemotherapy in patients with breast cancer

The incidence of early-stage breast cancer among young patients has shown a significant increase over the past twenty years, with a substantial portion of these patients requiring chemotherapy. Most treatment regimens used in both neo-adjuvant and adjuvant settings are characterized as moderately or highly emetogenic. Young patients typically lead socially active lives, balancing work and childcare, and strive to remain indistinguishable from healthy women. However, one of the most pronounced adverse effects of chemotherapy is nausea and vomiting, which significantly impair quality of life. One modern method for the prevention of nausea and vomiting involves the use of a combined NK1-receptor and 5-HT3-receptor antagonist, comprising the drugs netupitant and palonosetron (NEPA). This medication is administered as a single dose on the first day in conjunction with dexamethasone, without the need for additional medication on subsequent days. This review discusses the mechanisms of action of NEPA and pres ents studies focused on the effectiveness of the combination of netupitant and palonosetron in patients undergoing moderately and highly emetogenic therapy. According to literature the efficacy of NEPA in combination with dexamethasone reached 70.5% for complete response in the first cycle of treatment. A retrospective analysis involving 2,173 patients confirmed the high efficacy of NEPA, particularly in patients under 60 years of age. Data from real clinical practice further support the results of studies on the effectiveness of NEPA, demonstrating a complete control rate of nausea and vomiting ranging from 74 to 90%.

Adverse Effects of Chemotherapy and the Interaction With Anesthesia: A Narrative Review.

Many cancer patients have their main tumors surgically removed with the goal of curing them, or as part of palliative care. When a patient receives general anesthesia, the side effects of the administered chemotherapy regimens must be considered, especially those that may have significant repercussions during anesthetic care. The aim of this study is to review the existing literature to identify adverse effects of chemotherapy and known interactions between chemotherapy and anesthetic drugs, analyze the mechanisms underlying these interactions, and discuss relevant clinical implications. This integrative review searched for articles using the search terms: chemotherapy, anesthetic drugs, interaction, adverse effects, and drug combination. Negative perioperative outcomes may be related to the chemotherapy. Regarding the type of oncological surgery, factors such as blood loss, hypothermia, and extended operative time influence the increase in morbimortality. Many anesthetic drugs are related to immunomodulation and interact with chemotherapy, which may get better or worse cancer patients. It is crucial for anesthetists to have a comprehensive understanding of the potential adverse effects of chemotherapy drugs and their interactions with anesthetics.

Synergistic effects of doxorubicin loaded silk fibroin nanoparticles and Cu-TiO2 nanoparticles for local chemo-sonodynamic therapy against breast cancer.

A promising new approach to mitigate the adverse effects of chemotherapeutic drugs on healthy tissues involves combining sonodynamic therapy with topical chemotherapy to enhance the therapeutic efficacy of anticancer drugs. In this study, we introduce a multi-functional in situ chitosan hydrogel (CS) containing silk fibroin nanoparticles (SFNPs) loaded with doxorubicin (DOXSFNPs) and CuO/TiO2 nanoparticles (CTNPs) for combination therapy. The developed DOXSFNPs exhibited a size of 257±6nm, a zeta potential of -14.3±1.8mV, and a high loading capacity of 12.38±1.73%. The pH-dependent controlled release of DOX from DOXSF2/CS2 was observed to be more pronounced than that from DOX/CS2. MTT results indicated dose-dependent toxicity of CT/CS2 in response to ultrasaound radiation (US). Our findings revealed a 1.83-fold increase in reactive oxygen species (ROS) production with therapy, with the IC50 of CT3-DOXSF2/CS2-US showing a 58% reduction compared to CT3/DOXSF2/CS2. In vivo outcomes and histopathological staining demonstrated that the CT3/DOXSF2/CS2-US treatment group exhibited the highest tumor growth inhibition rate, reaching approximately 83.65%. These findings underscore the potential of this approach in minimizing the adverse effects of chemotherapy while maximizing therapeutic outcomes, offering a valuable contribution to the field of cancer therapy.

Flavonoid-Based Smart Drug Delivery Systems in Cancer Therapy: New Hope for Precision Medicine

Flavonoids are polyphenolic compounds that have powerful anticancer properties. Despite this, they are not suitable for treating cancer due to low solubility, instability, and bioavailability. To enhance their durability and bioavailability, it has been suggested that using delivery methods that include flavonoids to enhance their bioavailability may be a promising solution. Our analysis will focus on the most promising flavonoid-based delivery methods developed for anticancer medicines, particularly for cervical cancer. In addition to flavonoids' enormous therapeutic potential, delivery methods are critical to achieving positive results in cancer therapy. In addition to their anticancer properties, flavonoids are also polyphenolic compounds that occur naturally. However, these compounds are not suitable for treating cancer due to their insolubility, stability, and bioavailability. By adding flavonoids to delivery systems, the properties of flavonoids can be enhanced, resulting in higher bioavailability and durability Data obtained highlights flavonoids' great therapeutic potential as well as the importance of constructing good delivery mechanisms for cancer patients to achieve good outcomes. In conclusion, flavonoids may provide more efficient and individualized cancer treatment when incorporated into delivery systems. The adoption of flavonoid-based cervical cancer treatment methods could significantly improve the quality of life of millions of women. By encapsulating flavonoids in delivery systems, chemotherapy's adverse effects can be reduced, and patient outcomes may improve.

DEX Immunotherapy Pharmaco-Biotechnological Advances in Multimodal Therapy for Cancer

This article reviews the synergy between pulsed dendritic cell exosome (DEX) immunotherapy and chemotherapy in cancer treatment. DEX exosomes, which act as immune system modulators, enhance chemotherapy efficacy by modifying the tumor microenvironment and activating an immune response targeted against tumor cells. This combination not only amplifies cancer cell destruction but also protects healthy cells, thus reducing systemic adverse effects of chemotherapy. The article highlights preclinical and clinical advances demonstrating the effectiveness of this combined strategy, showing promising results in tumors resistant to conventional treatments. Despite the benefits, challenges such as the high production cost of exosomes and the need to optimize treatment protocols for different cancer types are identified. Additionally, future research directions are presented, focusing on improving personalized treatments through genetically modified exosomes. In conclusion, the combination of DEX and chemotherapy has the potential to revolutionize cancer treatment, enhancing both treatment tolerance and clinical efficacy.

Effect of Trailokya Vijya Vati in Various Disease – A Review

Introduction: One of the strongest traditional medicines is Trailokya Vijaya Vati, which contains vijaya as one of its main constituents. “Trailokya Vijaya Vati” means “victory over the outer three worlds” in literal translation. According to Ayurveda, the medication is considered a “Aashukari” or drug that offers immediate comfort since it directly affects motor neurons, or “Vaat-Vaahini Naadi.” Because of this, it offers prompt relief from conditions involving different kinds of pain. Materials and Methods: Information on trailokya vijya vati in various disease was gathered from the Laghutrayi, the Brihattrayi and its commentaries, and other Ayurvedic and modern texts. Results: The binary preparation known as Trailokya Vijaya Vati, which combines Vijaya sativa with Bambusa arundianaceae, was initially documented in Rasa Vigyana, a modern Ayurvedic Alchemy and Pharmaceutics treatise. Discussion: Apasmara (seizure disorders), Rajahkashtajanya Shoola (dysmenorrhea and related symptoms), Rajayakshma (tuberculosis and similar wasting diseases), Atisara (diarrhea, colitis, IBS, IBDs, etc.), and Shoola (acute and chronic pains emerging from varied pathologies and origins) are just a few of the plethora of health conditions for which this potent formulation is renowned for producing amazing therapeutic effects. Conclusion: Trailokya Vijaya Vati improves general health and well-being by balancing the three doshas (Pitta, Kapha, and Vata) in the body The main constituents in Trailokya Vijaya Vati, a traditional medicine, are Bambusa arundinacea and Vijaya. The Ayurvedic text Rasa Vigyana describes this powerful formulation, which has been shown to have therapeutic effects for a variety of health conditions, such as anxiety, insomnia, seizures, psychological and psychosomatic disorders, dysmenorrhea, diarrhea, tuberculosis, and acute and chronic pain. The medication helps to manage seizures and has a relaxing impact on the brain.[1] Trailokya Vijaya Vati is also effective in relieving neuropathic pain. One kind of persistent pain that results from harm to the nerve system is called neuropathic pain. Trailokya Vijaya Vati’s natural components have the potential to lessen inflammation and ease neuropathic pain. Chemotherapy adverse effects can be effectively mitigated using Trailokya Vijaya Vati. Abdominal pain and renal colic

TOXICITY DUE TO CHEMOTHERAPY & RADIOTHERAPY & ITS AYURVEDIC APPROACHES

Chemotherapy and radiotherapy are the treatment modalities for cancer that are extensively used in current times due to their effectiveness against many cancers. These therapies can cause severe toxicities, including loss of appetite, diarrhea, anorexia, constipation, vomiting, burning sensations, weakness, alopecia, and fever. Reduction in hemoglobin, white blood cells, and platelets is among other adverse effects of chemotherapy. In this context, Ayurveda can be an evidence-based proven approach to prevent and resist complications of cancer therapies. Several Ayurvedic drugs such as Brahmi, Brihamarasayan, Guduchi, Yasthimadhu, and Ashwagandha can help alleviate the side effects caused by chemotherapy and radiotherapy. These drugs also offer therapeutic benefits against cancer. Ayurvedic medicines reduce the burning sensation induced by chemotherapy, improve digestion, restore blood counts, remove toxins, and induce mental calmness. In this way, Ayurveda plays a significant role in preventing and managing complications of chemotherapy and radiotherapy. There is a need to explore such approaches that counteract the side effects of chemotherapy and radiotherapy. Considering this fact, the present article explores the role of Ayurvedic modalities in preventing and managing chemotherapy and radiotherapy complications.

Fertility-sparing surgical interventions for low-risk, non-metastatic gestational trophoblastic neoplasia.

The primary treatment approach for addressing low-risk nonmetastatic gestational trophoblastic neoplasia (LR-NMGTN) in women desiring fertility preservation involves chemotherapy. An alternative option for treatment is fertility-sparing surgical interventions, either alone or in combination with adjuvant chemotherapy. The hypothesised advantages of choosing fertility-sparing surgery in cases of LR-NMGTN include potential avoidance of adverse effects associated with chemotherapy, potential reduction in the number of chemotherapy cycles required to achieve complete remission, and potential reduction in time to remission. To measure the benefits and harms of fertility-sparing surgical interventions, with or without adjuvant chemotherapy, compared to primary chemotherapy alone, for the treatment of women with low-risk, non-metastatic gestational trophoblastic neoplasia (LR-NMGTN). We searched CENTRAL, MEDLINE, Embase, Web of Science, ClinicalTrials.gov and WHO ICTRP on 31 January 2024. We also searched abstracts of scientific meetings and reference lists of included studies. We included all randomised controlled trials (RCTs) comparing fertility-sparing surgical interventions, with or without subsequent adjuvant chemotherapy, versus primary chemotherapy as standard care for the treatment of women with LR-NMGTN. We employed standard Cochrane methodological procedures. We used the GRADE approach to assess the certainty of evidence for each outcome, if available. We focused on the following outcomes: treatment success rate, relapse, disease-specific mortality, death due to treatment, pregnancy rate, quality of life, and any adverse events. We included two RCTs, with a total of 151 participants contributing data to our analyses. Both studies used uterine curettage as the fertility-sparing surgical intervention. Fertility-sparing surgical intervention without subsequent adjuvant chemotherapy versus primary chemotherapy alone One RCT involving 62 participants with varying hCG (human chorionic gonadotrophin) levels evaluated this comparison. Most of our outcomes of interest were not measured in this study. The relative risk of experiencing any adverse event could not be estimated as chemotherapy adverse effects were not reported. The study reported that there were no surgical complications. Chemotherapy was administered to 50% of participants in the intervention group after curettage because their hCG levels increased. Fertility-sparing surgical intervention with subsequent adjuvant chemotherapy versus primary chemotherapy alone One RCT involving 89 participants with hCG levels < 5000 IU/L evaluated this comparison. We judged the risk of bias in the study to be high. The evidence was very uncertain about the effect of uterine curettage with subsequent adjuvant chemotherapy on treatment success rate (RR 1.03, 95% CI 0.86 to1.23; 86 participants), relapse (RR 0.5, 95% CI 0.05 to 5.31; 86 participants), pregnancy rate (RR 0.86, 95% CI 0.31 to 2.34; 86 participants), and rate of adverse events (RR 1.15, 95% CI 0.63 to 2.13; 86 participants), all very low certainty evidence. The relative risks of disease-specific mortality and death due to treatment could not be estimated as there were no deaths in either group. There were no results for quality of life as this outcome was not reported. Uterine curettage is the only fertility-sparing surgical intervention for LR-NMGTN that has been evaluated in a randomised controlled trial. The evidence is very uncertain about the benefits and harms of uterine curettage, with or without subsequent adjuvant chemotherapy, compared to primary chemotherapy alone. The two available studies are small with a high risk of bias, and future research may find substantially different results for all reported outcomes. Larger RCTs, with appropriate clinical outcome measures, would be required to determine the benefits or harms of fertility-sparing surgical interventions for this population.

Adjuvant therapy with zinc supplementation; anti-inflammatory and anti-oxidative role in multiple myeloma patients receiving autologous hematopoietic stem cell transplantation: a randomized controlled clinical trial.

Multiple myeloma (MM) patients are often accompanied by heightened levels of oxidative stress, even following bone marrow transplantation. Trace mineral supplements have been found to regulate and inhibit the activity of oxidative radicals and inflammatory factors, which are involved in the pathogenesis of MM. The study sought to evaluate the effectiveness of the supplementation by analyzing changes in oxidative, anti-oxidative, and inflammation markers. Patients were randomly assigned to a zinc or placebo group, with the former receiving 30mg of zinc or placebo tablets daily for 1month. Blood samples were collected from the patients on the day of transplantation, 15days, and 30days post-transplantation. Real-time PCR was employed to measure the expression of oxidative/antioxidative genes. Furthermore, the protein level of oxidative markers in serum samples was assessed. Finally, serum TNF-α concentrations were measured using the ELISA technique. The expression levels of SOD1, SOD2, and NRF2 genes were significantly higher on days 15 and 30 compared to the control group (P < 0.05), with a greater increase on day 30 (P < 0.05). Conversely, the expression levels of Keap1 and NOX2 genes were lower on day 30 than those of the control group (P < 0.05), with a further decrease from day 15 to day 30 (P < 0.05). The experimental group exhibited a notable reduction in TNF-α cytokine levels on day 30 compared to the control and placebo groups (P < 0.05). All findings were coordinated according to the nutritional questionnaire. Our findings suggest a potential benefit of zinc supplementation in managing the adverse effects of chemotherapy in MM patients, warranting further investigation.

Barriers to and facilitators of improving physical activity and nutrition behaviors during chemotherapy for breast cancer: a sequential mixed methods study.

Use qualitative and quantitative methods to explore factors influencing the adoption of guideline-based physical activity (PA) and dietary recommendations among participants enrolled in a lifestyle intervention during and after chemotherapy for breast cancer. Among women with stage I-III breast cancer who participated in the intervention arm of the Lifestyle, Exercise, and Nutrition early after diagnosis (LEANer) trial, we used stratified, purposeful sampling to interview women who met both, one, or neither intervention goal after the 1-year intervention: (1) 150min/week moderate-to-vigorous intensity exercise via a self-reported PA questionnaire and (2) improved self-reported diet quality measured by the Healthy Eating Index-2015. Semi-structured interviews were audio-recorded, transcribed verbatim, and analyzed using thematic content analysis. The 29 women interviewed were 52 ± 11years old on average, with a mean body mass index of 29.6 ± 7.7kg/m2. Three themes emerged regarding aspects of the LEANer intervention that facilitated behavior change: (1) providing a conduit of trustworthy, timely, and personalized support and education; (2) shifting mindsets and enhanced understanding of the benefits of PA and nutrition during chemotherapy; and (3) fostering a sense of control and alternative focus. Factors described as hindering adoption of goals included: (1) adverse effects of chemotherapy and (2) competing priorities. Women reported the external support, tailored education, and experiencing the physical and mental benefits of the LEANer intervention facilitated the adoption of the interventions' behavioral goals. Addressing chemotherapy-related symptoms and competing priorities may facilitate adherence to lifestyle interventions during chemotherapy for breast cancer.

Colorectal cancer treatment strategy: Targeting O-GlcNAcylation of Yes-associated protein utilizing diselenide-bridged nanovesicles

The limited treatment options for colorectal cancer (CRC) and its adverse effects of chemotherapy underscore the urgent need for innovative therapeutic strategies. Focusing on early cellular glycosylation, particularly through the targeting of O-GlcNAcylation with small-molecule inhibitors, emerges as a promising direction. In this study, we developed artificial cell-like nanovesicles with a bilayer membrane structure to encapsulate OSMI-1, a specific inhibitor of O-GlcNAc transferase, aimed at inhibiting CRC progression. To enhance the effectiveness and specificity of the treatment, these self-targeted nanovesicles (T–Se–Lip–OSMI) were reinforced using internal diselenide bridges enabling redox-responsive release within the tumor microenvironment. In vitro assays revealed that T–Se–Lip–OSMI substantially diminished CRC cell proliferation, migration, and invasion. This was further validated using patient-derived organoid models, which highlighted the superior therapeutic efficacy of T–Se–Lip–OSMI over nanovesicles without the diselenide bridge. Subsequent in vivo studies confirmed its targeted delivery and pronounced suppression of tumor growth. Further mechanistic analysis illustrated that the therapeutic effect was mediated through the inhibition of O-GlcNAcylation of the Yes-associated protein (YAP), ultimately preventing the nuclear translocation of YAP and the activation of oncogenic downstream targets. This study leverages the unique properties of the diselenide bridge to enhance stability and functionality of the nanovesicles, offering a novel avenue for targeted CRC treatment.

A comprehensive study of adverse effects of chemotherapy on female breast cancer patients in NORI Cancer Hospital, Islamabad in a developing country.

Breast cancer is one of the top three malignancies worldwide. While radiotherapy, hormone replacement therapys, and chemotherapy are treatments, chemotherapy causes adverse effects that hinder daily life activities. To assess the prevalence, severity, and association of symptomatic toxicities in female breast cancer patients affecting various organ systems post systemic chemotherapy (adjuvant and neoadjuvant), and their impact on daily activities. Additionally, to determine the severity of adverse effects in specific age groups and their association with family history and disease stage. An observational study was conducted on 253 female breast cancer patients receiving chemotherapy at NORI Cancer Hospital from May to October 2023. Data collection tools included the NCI-PRO-CTCAE standardized questionnaire and patient medical records. Analysis was performed using descriptive statistics, T-tests, and Chi-square tests. Among the 253 patients, 41.4% were aged 41-50. Significant weight changes (p = 0.034) were observed with more than three chemotherapy cycles. Notable associations included increased chemotherapy cycles with gastrointestinal (mouth/throat sores p = 0.031, vomiting p = 0.021), respiratory (cough p = 0.04), cardiovascular (arm/leg swelling p = 0.007, palpitations p = 0.052), integumentary (hair loss p = 0.000, skin dryness p = 0.054), and musculoskeletal (fatigue p = 0.002) adverse effects. Positive family history and the 18-30 age group also showed significant associations with adverse effect severity. Disease stage significantly influenced the nervous system (stage 2 p = 0.007, stage 3 p = 0.01). The severity of adverse effects varies among age groups, depending on disease stage, genetics, and treatment duration. These patient-reported outcomes highlight the need for better management strategies considering prognostic factors and treatment adverse effects.

The impact of Paclitaxel-based hyperthermic intraperitoneal chemotherapy in advanced high-grade serous ovarian cancer patients - interim analysis of safety and immediate efficacy of a randomized control trial (C-HOC trial)

ObjectiveThis study evaluates the potential superiority of combining paclitaxel-based hyperthermic intraperitoneal chemotherapy (HIPEC) with sequential intravenous neoadjuvant chemotherapy over intravenous neoadjuvant chemotherapy alone in Chinese patients with Federation of Gynecology and Obstetrics (FIGO) stage IIIC, IVA and IVB high-grade serous ovarian/fallopian tube carcinoma (HGSOC). This interim analysis focuses on the safety and immediate efficacy of both regimens to determine the feasibility of the planned trial (C-HOC Trial).MethodsIn a single-center, open-label, randomized control trial, FIGO stage IIIC, IVA, and IVB HGSOC patients (FAGOTTI score ≥ 8 during laparoscopic exploration) unsuitable for optimal cytoreduction in primary debulking surgery (PDS) were randomized 2:1 during laparoscopic exploration. The Experiment Group (HIPEC Group) received one cycle of intraperitoneal neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy (paclitaxel) followed by three cycles of intravenous chemotherapy (paclitaxel plus carboplatin), while the Control Group received only three cycles of intravenous chemotherapy. Both groups subsequently underwent interval debulking surgery (IDS). The adverse effects of chemotherapy, postoperative complications, and pathological chemotherapy response scores (CRS) after IDS were compared.ResultsAmong 65 enrolled patients, 39 HIPEC Group and 21 Control Group patients underwent IDS. Grade 3–4 chemotherapy-related adverse effects were primarily hematological with no significant differences between the two groups. The HIPEC Group exhibited a higher proportion of CRS 3 (20.5% vs. 4.8%; P = 0.000). R0 resection rates in IDS were 69.2% (HIPEC Group) and 66.7% (Control Group). R2 resection occurred in 2.6% (HIPEC Group) and 14.3% (Control Group) cases. No reoperations or postoperative deaths were reported, and complications were managed conservatively.ConclusionsCombining HIPEC with IV NACT in treating ovarian cancer demonstrated safety and feasibility, with no increased chemotherapy-related adverse effects or postoperative complications. HIPEC improved tumor response to neoadjuvant chemotherapy, potentially enhancing progression-free survival (PFS). However, the final overall survival results are pending, determining if HIPEC combined with IV NACT is superior to IV NACT alone.

Neuropathy As an Adverse Effect of Chemotherapy Diminished After Administration of Dietary Supplement with Iron Citrate – Case Study

Aims: This research examined how adding iron citrate (Synthesit) affected chemotherapy-induced nerve damage in a patient diagnosed with primary fallopian tube cancer. Methodology: A 51-year-old Lithuanian woman received adjuvant chemotherapy and iron citrate. The blood indices and inflammation markers were monitored. Results: The patient showed macrocytic normochromic anemia, fluctuating platelet parameters, and varied procalcitonin levels, suggesting Synthesit influences immune function and hematologic parameters during chemotherapy. Scientific Novelty: This study distinctively investigated the influence of iron citrate on changes in hematologic and immune parameters during chemotherapy. Conclusion: Synthesit may affect the blood counts, red blood cell production, and immune markers, aiding in chemotherapy-induced neuropathy management.

Efficacy of Early Health Intervention Programs on Adverse Effects of Chemotherapy Among Women With Breast Cancer: A Randomized Controlled Trial.

Aim Breast cancer is the most frequently diagnosed cancer and the primary cause of cancer-related mortality among women. Advances in medical science have led to chemotherapy drugs that significantly reduce cancer mortality and increase patient's life expectancy. However, the systemic nature of chemotherapy leads to a wide range of physical and psychosocial challenges. Chemotherapy is usually given on an outpatient basis and hence patients have tomanage treatment-related symptoms at home. This study aimed to evaluate the efficacy of early health intervention programs, specifically health education and progressive muscle relaxation, in managing the adverse effects of chemotherapy among women with breast cancer. Methods A randomized controlled trial was carried out at the chemotherapy unit of a tertiary care hospital in Thiruvananthapuram, Kerala, India. The research involved 340 female breast cancer patients receiving their initial chemotherapy cycle, divided equally into an experimental group and a control group.Patients in the intervention group received an early health intervention program on the day of their first chemotherapy cycle. These interventions included a 40-minute session comprising health education to manage the adverse effects of chemotherapy at home and a demonstration of progressive muscle relaxation techniques, which must be practiced by the patients two times daily till the end of chemotherapy. Participants in the control group received routine care from the hospital. The primary outcome variable was the adverse effects of chemotherapy. Sociodemographic and clinical information were collected using a structured questionnaire. The severity of adverse effects was assessed using the Common Terminology Criteria for Adverse Events, version 3 (CTCAE v3). Result The average age of participants was 54.7 ± 9.7 years in the control group and 52.4 ± 9 years in the experimental group. The majority in both groups had invasive breast cancer, with 144 (84.7%) in the control group and 153 (90%) in the experimental group. In the post-test, most participants in the control group experienced severe fatigue (136, 80%), mucositis (82, 48.2%), nausea (83, 49.1%), and vomiting (81, 47.6%). Conversely, the majority in the experimental group reported mild mucositis (110, 64.7%), nausea (92, 54.1%), and vomiting (93, 54.7%), along with moderate fatigue (116, 68.2%). Hair loss was incomplete for all participants in the control group and 115 (97.6%) participants in the experimental group. There was a significant difference between the experimental and control groups regarding fatigue (p < 0.001), insomnia (p < 0.01), anorexia (p < 0.01), mucositis (p < 0.01), nausea (p < 0.01), vomiting (p < 0.01), leukopenia (p = 0.001), neutrophil count (p < 0.01), hair loss (p < 0.05), and taste alteration (p < 0.01) during the post-test. Conclusion The study demonstrated that early health interventions, such as health education and progressive muscle relaxation, significantly reduced the adverse effects experienced by breast cancer patients undergoing chemotherapy. This suggests that providing supportive education and exercise training to both patients and caregivers can be beneficial in managing these side effects.

Mucocutaneous Manifestations among Patients with Malignancies at a Tertiary Care Center in Maharashtra: A Cross-Sectional Study

Abstract Background: Malignant disorders are a leading cause of mortality and morbidity. Cutaneous manifestations may be presenting features of internal malignancies, leading to diagnosis of occult tumors, while others may occur as adverse reactions to therapeutic modalities. Aims and Objectives: To classify cutaneous manifestations among patients with malignant disorders, document their clinical profile, and analyze them with respect to age, gender, type of malignancy, and treatment. Materials and Methods: One hundred twenty patients with proven malignancy presenting with mucocutaneous lesions were enrolled in the cross-sectional study. On the basis of history, clinical examination, investigations and skin biopsy, the lesions were classified as (1) Primary cutaneous malignancy, (2) Cutaneous metastasis, (3) Paraneoplastic syndromes, (4) Mucocutaneous manifestations not related to malignancies, (5) Adverse effects secondary to treatment modalities. Results: One hundred twenty patients comprised 70 females (58.3%) and 50 males (41.7%). They were categorized as primary cutaneous malignancy (20.2%), hematological malignancies (15%), solid organ malignancy (50.9%), and gastrointestinal malignancies (5%). HIV seropositivity was seen in two patients (1.6%). Maximum belonged to Category 5 (60, 50%), of which 52 (86.7%) were adverse effects of chemotherapy with single patient showing radiation dermatitis and one patient in Category 3 (0.8%). Eleven patients showed cutaneous metastasis (9.1%), predominantly carcinoma breast. Clinically, primary cutaneous malignancies often presented as ulceronodular growths with squamous cell carcinoma being the most common histopathological type (30%). Anagen effluvium was the most common (35%) manifestation overall and in solid organ malignancies followed by melanonychia (16, 13.33%), cutaneous xerosis (9, 7.5%), and mucocutaneous hyperpigmentation (23, 19.16%). Conclusions: Mucocutaneous manifestations need prompt attention to facilitate timely diagnosis and improved outcomes.

Efficacy of cryotherapy in the prevention of chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis.

The study investigates cryotherapy's efficacy in mitigating Chemotherapy-induced peripheral neuropathy (CIPN), an adverse effect of chemotherapy that often leads to dosage reduction or treatment discontinuation. The study was registered with PROSPERO (CRD42023428936). A literature search was conducted using the PubMed, Embase, and Cochrane Library databases. Randomized and nonrandomized controlled trials that investigated the effects of cryotherapy on CIPN were included for systematic review and meta-analysis. The primary outcome for prevention was the incidence of CIPN. We identified 17 trials involving 2,851 patients. In total, 11 trials compared the incidence of CIPN between cryotherapy and control groups. Significant differences in the incidence of CIPN at the midpoint and end of chemotherapy were observed, with risk ratios (RRs) of 0.23 (95% confidence interval [CI] = 0.13 to 0.43) and 0.54 (95% CI = 0.33 to 0.88), respectively. Cryotherapy also significantly reduced the incidence of sensory CIPN, with an RR of 0.67 (95% CI = 0.49 to 0.92). Additionally, cryotherapy demonstrated a significant reduction in the incidence of CIPN in patients with gynecological cancers (RR = 0.24, 95% CI = 0.14 to 0.41). Significantly favorable global quality of life scores following chemotherapy (standardized mean difference = 1.43; 95% CI = 0.50 to 2.36) and relieved neuropathic symptoms were found with cryotherapy. Cryotherapy demonstrates a pronounced preventive effect against the development of CIPN, providing substantial symptomatic relief and quality of life improvements for patients undergoing chemotherapy. The administration of cryotherapy through the use of frozen gloves and socks, or continuous-flow cooling systems, optimally initiated 15min prior to and concluded 15min following chemotherapy, is recommended for achieving maximum therapeutic efficacy.

Preventive Effect of Neuromuscular Training on Chemotherapy-Induced Neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is a highly prevalent and clinically relevant adverse effect of chemotherapy, negatively impacting patient quality of life. The lack of effective preventive or therapeutic options regarding CIPN often requires changes in cancer therapy, potentially resulting in reduced survival. To determine whether sensorimotor training (SMT) and whole-body vibration (WBV) training reduce symptoms and decrease the onset of CIPN. This prospective multicenter randomized clinical trial (STOP) followed up patients over 5 years at 4 centers in or near Cologne, Germany. Patients undergoing treatment with oxaliplatin or vinca alkaloids were recruited. Participants were recruited from May 2014 to November 2020. Data were last analyzed in June 2021. Participants in the intervention groups performed supervised SMT or WBV training sessions twice a week, each lasting approximately 15 to 30 minutes, concomitant to medical therapy. The primary end point was the incidence of CIPN. Secondary end points included subjective neuropathy symptoms, balance control, physical activity levels, quality of life, and clinical outcome. For cross-stratum evaluations, the Mantel-Haenszel test (MH) was used, and within individual strata, Fisher exact test was used for analysis. A total of 1605 patients were screened, and 1196 patients did not meet all inclusion criteria, with 251 further excluded or declining participation. A total of 158 patients (mean [SD] age, 49.1 [18.0-82.0] years; 93 [58.9%] male) were randomized into 1 of 3 groups: 55 (34.8%) in SMT, 53 (33.5%) in WBV, and 50 (31.6%) in treatment as usual (TAU). The incidence of CIPN in participants was significantly lower in both intervention groups compared to the control group (TAU): (SMT, 12 of 40 [30.0%; 95% CI, 17.9%-42.1%] and WBV, 14 of 34 [41.2%; 95% CI, 27.9%-54.5%] vs TAU, 24 of 34 [70.6%; 95% CI, 58.0%-83.2%]; P = .002 for intention to treat-MH). Patients receiving vinca alkaloids and performing SMT benefited the most. Results were more pronounced in a per-protocol analysis (>75% participation in the intervention) (SMT, 8 of 28 [28.6%; 95% CI, 16.6%-40.5%] and WBV, 9 of 24 [37.5%; 95% CI, 24.4%-50.5%] vs TAU, 22 of 30 [73.3%; 95% CI, 61.6%-85.6%]). Improvements in favor of SMT compared to TAU were found for balance control bipedal with eyes open; bipedal with eyes closed; monopedal, vibration sensitivity, sense of touch, lower leg strength, pain reduction, burning sensation, chemotherapy dose reductions, and mortality. This randomized clinical trial provides initial evidence that neuromuscular training decreases the onset of CIPN. German Clinical Trials Register: DRKS00006088.

Hemolysis attributed to high dose vitamin C: Two case reports

BACKGROUND High-dose vitamin C treatment (HVCT) can reduce the adverse effect of chemotherapy and enhance the effect of antitumor therapy, which has been considered one of the safest alternative treatments. However, the severity of its adverse effects may have been underestimated. The most serious adverse effect is hemolysis, which may result in acute kidney injury or death. Although glucose-6-phosphate dehydrogenase (G6PD) deficiency is considered to be the main cause, the probability and pathological mechanism are not completely understood, leading to a lack of effective and standardized treatment methods. CASE SUMMARY Two patients with colorectal cancer developed hemolytic anemia after using 1 g/kg HVCT. In contrast to previous cases, the lowest hemoglobin level in the two cases was &lt; 50 g/L, which was lower than previously reported. This may be because Case 1 had chronic hepatitis B for many years, which caused abnormal liver reserve function, and Case 2 had grade II bone marrow suppression. Both patients improved and were discharged after blood replacement therapy. Our cases had the most severe degree of hemolysis but the best prognosis, suggesting that our treatment may be helpful for rescue of drug-induced hemolysis. This is the first review of the literature on hemolysis caused by HVCT, and we found that all patients with G6PD deficiency developed hemolysis after HVCT. CONCLUSION G6PD deficiency should be considered as a contraindication to HVCT, and it is not recommended for patients with bone marrow suppression, moderate-to-severe anemia, hematopoietic abnormalities, or abnormal liver and kidney function. Early blood purification and steroid therapy may avoid acute kidney injury or death caused by HVCT-related hemolytic anemia.

Enhancing anti-cancer capacity: Novel class I/II HDAC inhibitors modulate EMT, cell cycle, and apoptosis pathways

Cancer has been a leading cause of death over the last few decades in western countries as well as in Taiwan. However, traditional therapies are limited by the adverse effects of chemotherapy and radiotherapy, and tumor recurrence may occur. Therefore, it is critical to develop novel therapeutic drugs. In the field of HDAC inhibitor development, apart from the hydroxamic acid moiety, 2-aminobenzamide also functions as a zinc-binding domain, which is shown in well-known HDAC inhibitors such as Entinostat and Chidamide. With recent successful experiences in synthesizing 1-(phenylsulfonyl)indole-based compounds, in this study, we further combined two features of the above chemical compounds and generated indolyl benzamides. Compounds were screened in different cancer cell lines, and enzyme activity was examined to demonstrate their potential for anti-HDAC activity. Various biological functional assays evidenced that two of these compounds could suppress cancer growth and migration capacity, through regulating epithelial–mesenchymal transition (EMT), cell cycle, and apoptosis mechanisms. Data from 3D cancer cells and the in vivo zebrafish model suggested the potential of these compounds in cancer therapy in the future.