Adverse Effects Of Chemotherapy Research Articles

Supplemental Preparations in Taxane-Induced Neuropathy Management

Taxane-induced peripheral neuropathy (TIPN) is a dose-limiting adverse effect of chemotherapy without any specific treatment. The aim of this paper is to evaluate the effects of natural products and supplements on TIPN. PubMed, Google Scholar and Web of Science databases were searched through August 2022 regarding TIPN and effects of natural products and supplement therapy. Data consists of preclinical studies, randomized controlled trials and case reports. After screening of 230 papers, we found 13 relevant animal and human studies regarding possible benefits of vitamin E, glutamine, omega-3, acetyl-L-carnitine and group of B vitamins on TIPN. Results demonstrated that vitamin E can be helpful on prevention and duration of TIPN. Glutamine and B vitamins showed hopeful results on reducing pain sensation. Omega-3 also shows promising results on incidence of TIPN. However, acetyl-L-carnitine might develop and worsen neuropathy. Although some supplements revealed promising effects on prevention and treatment of TIPN, researches are still limited and we need further long-term large sample size trials to confirm clinical efficacy of these supplements.

Cannabis-derived products antagonize platinum drugs by altered cellular transport

Cannabinoids, a class of compounds derived from Cannabis sativa L., have recently become more widely accessible for public consumption in the form of diverse cannabis products, in parallel with weakening the measures that so far restricted their availability. The US Food and Drug Administration has approved several cannabis-derived drugs for management of various diseases as well as chemotherapy-induced nausea and vomiting. Besides the attenuation of adverse effects of chemotherapy, numerous reports about cannabinoid-mediated anticancer effects further motivate cancer patients to support their therapy with such products. Here we present a set of preclinical data with human cell culture models, suggesting that cannabidiol and cannabis extracts may effectively counteract the anticancer effects of the clinically widely used standard-of-care platinum-based drugs. We show that even low concentrations of cannabinoids reduced the toxicity of cisplatin, oxaliplatin, and carboplatin, an effect which was accompanied by decreased platinum adduct formation and a set of commonly used molecular markers. Mechanistically, our results excluded the possibility that the observed enhanced survival of cancer cells was mediated transcriptionally. Instead, trace metal analyses strongly indicate an inhibitory impact of cannabinoids on intracellular platinum accumulation, thereby implicating changes in cellular transport and/or retention of these drugs as the likely cause of the observed biological effects. Our study raises the possibility that the desirable effect of counteracting adverse effects of chemotherapy might, at least for some cannabinoids, reflect impaired cellular availability, and consequently attenuation of the anticancer effects of platinum drugs. Data availabilityAll data supporting the conclusions are available in the article and supplementary files. Raw data are available upon request from the corresponding author.

Cannabinoid compounds in combination with curcumin and piperine display an anti-tumorigenic effect against colon cancer cells.

Currently, use of cannabinoids is limited to improve adverse effects of chemotherapy and their palliative administration during treatment is curiously concomitant with improved prognosis and regressed progression in patients with different tumor types. Although, non-psychoactive cannabidiol (CBD) and cannabigerol (CBG) display antineoplastic effects by repressing tumor growth and angiogenesis both in cell line and animal models, their use as chemotherapeutic agents is awaiting further investigation. Both clinical and epidemiological evidence supported by experimental findings suggest that micronutrients such as curcumin and piperine may present a safer strategy in preventing tumorigenesis and its recurrence. Recent studies demonstrated that piperine potentiates curcumin's inhibitory effect on tumor progression via enhancing its delivery and therapeutic activity. In this study, we investigated a plausible therapeutic synergism of a triple combination of CBD/CBG, curcumin, and piperine in the colon adenocarcinoma using HCT116 and HT29 cell lines. Potential synergistic effects of various combinations including these compounds were tested by measuring cancer cell proliferation and apoptosis. Our findings revealed that different genetic backgrounds of HCT116 and HT29 cell lines resulted in divergent responses to the combination treatments. Triple treatment showed synergism in terms of exhibiting anti-tumorigenic effects by activating the Hippo YAP signaling pathway in the HCT116 cell line.

Hepatic arterial infusion with nanoliposomal irinotecan leads to significant regression of tumor size of colorectal liver metastases in a CC531 rat model.

Long-term therapy for unresectable colorectal liver metastases remains challenging. Intraarterial treatments aim to avoid systemic adverse effects of chemotherapy. Nanoliposomal cytotoxic drugs manage to increase the drug concentration within the tumor while reducing toxicity in healthy tissue. In this study we analyzed the effect of hepatic arterial infusion (HAI) with nanoliposomal irinotecan with or without the combination of embolization particles in a rat model for colorectal liver metastases. For the study 32 WAG/Rij rats received subcapsular tumor implantation with CC531 rat colonic adenocarcinoma cells. After ten days tumor size was assessed via ultrasound and animals underwent HAI. One group served as control receiving NaCl 0.9 % (Sham), the three treatment groups received either nanoliposomal irinotecan (HAI nal iri), Embocept® S (HAI Embo) or Embocept® S and nanoliposomal irinotecan (HAI Embo+nal iri). Three days after treatment animals were sacrificed after assessment of tumor size. As a result all treatment groups showed a significant reduction in tumor growth compared to Sham (p<0.05). Expression of the apoptosis marker caspase-3 was enhanced in HAI nal iri and HAI Embo+nal iri compared to Sham and HAI Embo and even significantly enhanced after HAI Embo+nal iri in comparison to Sham (p<0.05). We were able to show thatHAI with Embocept® S led to significantly reduced tumor growth while HAI with nanoliposomal irinotecan alone or in combination with Embocept® S even led to a reduction of tumor size. Thus, we demonstrate that intraarterial treatment with nanoliposomal irinotecan effectively inhibits tumor growth in a rat model of colorectal liver metastases and demands further investigation.

Elaeagnus conferta Roxb. and chemotherapeutic agents-based anticancer therapy: Harnessing the dual approach

Cancer is the second leading cause of mortality globally and epidemiological evidences indicate that anti-oxidant rich diet reduces the risk of cancer. Recently, the alarming escalations of cancer further warrants better understanding of optimum therapeutic treatment strategies for cancer. Although number of conventional approaches such as chemotherapy, radiotherapy and surgical interventions are available for treating malignant tumors as well as localized lesions, they are associated with many adverse effects. Therefore, combating oxidative stress along with reducing adverse effects of chemotherapy could be the choice of treatment regimen for cancer. Elaeagnus conferta Roxb. is well reported for its ethnic use as anticancer and anti-oxidant. The phytochemical screening of E. conferta Roxb. seeds indicates the presence of bioactive constituents including quercetin, ascorbic acid, oleic acid and stearic acid, with immense anti-oxidant potential. Therefore, it is proposed that a combination of extract of E. conferta Roxb. with chemotherapeutic drugs (cisplatin, doxorubicin and paclitaxel) could be an effective multi-target approach for combating cancer while curbing adverse effects of chemotherapy.

Haematopoietic and Immunomodulatory Activity of Sap of Borassus flabellifer against Cyclophosphamide Mediated Haematotoxicity and Immunosuppression in Wistar Rats

Recent scientific evidence recommends that many of the adverse effects of chemotherapy can be prevented by remedying treatment with antioxidants, minerals, carbohydrates, proteins, and organic acids. The current research was performed to assess haematopoietic and immunomodulatory effects using sap of traditional tree, Borassus flabellifer, in cyclophosphamide induced haematotoxicity and immunosuppression in wistar rats. For eleven consecutive days, the animals were orally pre-treated with Borassus flabellifer sap (3.6 mL/kg). These animals were intra-peritoneally injected on the sixth day with cyclophosphamide (150 mg/kg) and sacrificed five days later. On the final day of the trial, blood samples were obtained from each rat and carried out evaluation of haematological (red blood cells, haemoglobin, mean corpuscular haemoglobin concentration, reticulocytes & serum iron content) and immunomodulatory (total leucocyte count, cellular immune response & tumor necrosis factor-α) parameters. To determine their index values, each rat's thymus and spleen were separated. By elevating red blood cells, haemoglobin, mean corpuscular haemoglobin concentration, reticulocytes & serum iron content, sap of Borassus flabellifer demonstrated an important protective role in cyclophosphamide mediated haematotoxicity. It has also shown substantial resistance against immunosuppression caused by cyclophosphamide by increasing the immunity boosting white blood cells and decreasing the hypersensitivity reaction and tumor necrosis factor-α level at the 3.6 mL/kg dose. The current research shows that therapy with traditional Borassus flabellifer sap has a major protective effect against oxidative stress, haematotoxicity and immunosuppression against cyclophosphamide induced haematotoxicity and immunosuppression.

The clinical research study for fosaprepitant to prevent chemotherapy-induced nausea and vomiting: A review.

In recent years, chemotherapy-induced nausea and vomiting (CINV) has become the most common adverse effect of chemotherapy in oncology patients. The CINV may reduce the quality of life in mild cases, or even make the patients resist or delay further treatment. Fosaprepitant is a newly marketed neurokinin-1 receptor antagonist (NK-1RA), which can be combined with 5-hydroxytryptamine 3 receptor antagonists (5-HT3RAs) and dexamethasone to prevent chemotherapy-induced vomiting. The dimeglumine salt form of fosaprepitant can be utilized as an intravenous injectable drug, which surpasses aprepitant's oral admistration limits. Fosaprepitant is effective and safe in the control of CINV in cancer patients receiving highly emetogenic chemotherapy (HEC), and may be an alternative option for antiemetic therapy. In general, fosaprepitant is worthy of clinical promotion and has a large market potential. This article reviews the clinical studies on fosaprepitant conducted in recent years, with the aim of providing a basis for the rational clinical selection of antiemetic drugs.

Effects of Voluntary Wheel Running Exercise on Chemotherapy-Impaired Cognitive and Motor Performance in Mice.

Chemotherapy-induced cognitive impairment (chemobrain) and muscle wasting (cachexia) are persisting side effects which adversely affect the quality of life of cancer survivors. We therefore investigated the efficacy of physical exercise as a non-pharmacological intervention to reverse the adverse effects of chemotherapy. We examined whether physical exercise in terms of voluntary wheel running could prevent chemotherapy-induced cognitive and motor impairments in mice treated with the multi-kinase inhibitor sorafenib. Adult male BALB/c mice were subdivided into runner and non-runner groups and orally administered with sorafenib (60 mg/kg) or vehicle continuously for four weeks. Mice could freely access the running wheel anytime during sorafenib or vehicle treatment. We found that sorafenib treatment reduced body weight gain (% of change, vehicle: 3.28 ± 3.29, sorafenib: -9.24 ± 1.52, p = 0.0004), impaired hippocampal-dependent spatial memory in the Y maze (exploration index, vehicle: 35.57 ± 11.38%, sorafenib: -29.62 ± 7.90%, p < 0.0001), increased anhedonia-like behaviour in the sucrose preference test (sucrose preference, vehicle: 66.57 ± 3.52%, sorafenib: 44.54 ± 4.25%, p = 0.0005) and impaired motor skill acquisition in rotarod test (latency to fall on day 1: 37.87 ± 8.05 and day 2: 37.22 ± 12.26 s, p > 0.05) but did not induce muscle wasting or reduce grip strength. Concomitant voluntary running reduced anhedonia-like behaviour (sucrose preference, sedentary: 44.54 ± 4.25%, runners: 59.33 ± 4.02%, p = 0.0357), restored impairment in motor skill acquisition (latency to fall on day 1: 50.85 ± 15.45 and day 2: 168.50 ± 37.08 s, p = 0.0004), but failed to rescue spatial memory deficit. Immunostaining results revealed that sorafenib treatment did not affect the number of proliferating cells and immature neurons in the hippocampal dentate gyrus (DG), whereas running significantly increased cell proliferation in both vehicle- (total Ki-67+ cells, sedentary: 16,687.34 ± 72.63, exercise: 3320.03 ± 182.57, p < 0.0001) and sorafenib-treated mice (Ki-67+ cells in the ventral DG, sedentary: 688.82.34 ± 38.16, exercise: 979.53 ± 73.88, p < 0.0400). Our results suggest that spatial memory impairment and anhedonia-like behaviour precede the presence of muscle wasting, and these behavioural deficits are independent of the changes in adult hippocampal neurogenesis. Running effectively prevents body weight loss, improves motor skill acquisition and reduces anhedonia-like behaviour associated with increased proliferating cells and immature neurons in DG. Taken together, they support physical exercise rehabilitation as an effective strategy to prevent chemotherapy side effects in terms of mood dysregulation and motor deficit.

Coadministration of olanzapine causes minor impacts on the diabetogenic outcomes induced by dexamethasone treatment in rats

AimsInvestigate whether the coadministration of olanzapine exacerbates the diabetogenic effects of dexamethasone, two agents used in the antiemetic cocktails indicated to mitigate the adverse effects of chemotherapy. Main methodsAdult Wistar rats (both sexes) were treated daily with dexamethasone (1 mg/kg, body mass (b.m.), intraperitoneal (i.p.)) with or without olanzapine (10 mg/kg, b.m., orogastric (o.g.)) for 5 consecutive days. During and at the end of the treatment, we evaluated biometric data and parameters involving glucose and lipid metabolism. Key findingsDexamethasone treatment resulted in glucose and lipid intolerance, higher plasma insulin and triacylglycerol levels, higher content of hepatic glycogen and fat, and higher islet mass in both sexes. These changes were not exacerbated by concomitant treatment with olanzapine. However, coadministration of olanzapine worsened the weight loss and plasma total cholesterol in males, while in females resulted in lethargy, higher plasma total cholesterol, and higher hepatic triacylglycerol release. SignificanceCoadministration of olanzapine does not exacerbate any diabetogenic dexamethasone effect on glucose metabolism and exerts a minor impact on the lipid homeostasis of rats. Our data favor the addition of olanzapine in the antiemetic cocktail considering the low incidence of metabolic adverse effects for the period and dosage analyzed in male and female rats.

Cancer rehabilitation effects on the quality of life on individuals with cancer: a scoping review

Introduction: This study aims to explore cancer rehabilitation practice from multiple researches and to review the effectiveness of these interventions to the quality of life of the individuals with cancer. Methods This research used articles, journals, and research from PubMed, ScienceDirect, NCBI, PEDro, and UpToDate. This study utilized randomized control trial studies from 2011 to the current year. The article's population should be solely cancer patients and has the quality of life as its primary outcome. The articles must have at least a score of 8 in PEDro, and only articles written or translated into English are included. Rayyan.ai ® was used in our research as our review too. Published by University of St. Augustine for Health Sciences on behalf of the Philippine Physical Therapy Association. ISSN: 2766-3086 Results: A total of 8 RCTs were included and reviewed in the study. The results were categorized based on the primary and secondary outcomes and formed into five outcomes: quality of life, fatigue, physical performance, pain, and balance. Eight articles were evaluated for QoL. Six out of all reported a significant effect of cancer rehabilitation among cancer individuals. The other two showed a statistical significance due to small population and insignificant differences aside from selfreported physical activity. Four studies were assessed for fatigue and showed a significant effect in improving and preventing worsening of it. One study reported a significant benefit in increasing physical performance of individuals with cancer. One study was evaluated for pain and gave a significant improvement on the level of pain. One of eight articles addressed balance and significantly improved balance among cancer individuals undergoing treatment. Discussion: Adverse effects of chemotherapy and radiation therapy among cancer patients alter their quality of life. Doing aerobic and resistance exercises reign superior across all outcomes that are recommended in a patient with cancer because based on the evidence, it shows that it improves the quality of life of individuals undergoing chemotherapy and diagnosed with cancer. The clinical effects that will benefit the body by doing these exercises are as follows: Increase lung volume, strengthen cardiac muscle, increase the level of HDL, increase bone density, and increase blood volume due to higher endurance during intense physical activity.

No role for electroencephalogram in the initial work-up of pediatric acute lymphoblastic leukemia

PurposeThe purpose of this study was to verify whether there is a prognostic benefit of electroencephalogram (EEG) performed during initial work-up of children with newly diagnosed acute lymphoblastic leukemia (ALL).MethodsIn this retrospective monocenter study, we analyzed the value of electroencephalogram (EEG) performed during initial work-up of children with newly diagnosed acute lymphoblastic leukemia (ALL). All pediatric patients were included in this study who were diagnosed with de novo ALL in our institution between January 1, 2005, and December 31, 2018, and in whom an EEG was performed for initial work-up within 30 days of diagnosis of ALL. EEG findings were associated with the occurrence and the etiology of neurologic complications occurring during intensive chemotherapy.ResultsOut of 242 children, EEG revealed pathological findings in 6 patients. Two of them developed a seizure at a later time point due to adverse effects of chemotherapy, whereas 4 children had an uneventful clinical course. In contrast, 18 patients with normal initial EEG findings developed seizures during therapy for different reasons.ConclusionWe conclude that routine EEG does not predict seizure susceptibility in children with newly diagnosed ALL and is unnecessary in the initial work-up as EEG investigation in young and often sick children requires sleep deprivation and/or sedation, and our data demonstrate no benefit in predicting neurological complications.

Prevention and Treatment of Chemotherapy-Induced Alopecia: What Is Available and What Is Coming?

Millions of new cancer patients receive chemotherapy each year. In addition to killing cancer cells, chemotherapy is likely to damage rapidly proliferating healthy cells, including the hair follicle keratinocytes. Chemotherapy causes substantial thinning or loss of hair, termed chemotherapy-induced alopecia (CIA), in approximately 65% of patients. CIA is often ranked as one of the most distressing adverse effects of chemotherapy, but interventional options have been limited. To date, only scalp cooling has been cleared by the US Food and Drug Administration (FDA) to prevent CIA. However, several factors, including the high costs not always covered by insurance, preclude its broader use. Here we review the current options for CIA prevention and treatment and discuss new approaches being tested. CIA interventions include scalp cooling systems (both non-portable and portable) and topical agents to prevent hair loss, versus topical and oral minoxidil, photobiomodulation therapy (PBMT), and platelet-rich plasma (PRP) injections, among others, to stimulate hair regrowth after hair loss. Evidence-based studies are needed to develop and validate methods to prevent hair loss and/or accelerate hair regrowth in cancer patients receiving chemotherapy, which could significantly improve cancer patients' quality of life and may help improve compliance and consequently the outcome of cancer treatment.

Anti-Inflammatory Effects of β-Cryptoxanthin on 5-Fluorouracil-Induced Cytokine Expression in Human Oral Mucosal Keratinocytes

Oral mucositis is a typical adverse effect of chemotherapy, causing oral pain that significantly reduces the patient's quality of life. β-cryptoxanthin (β-cry) is a carotenoid abundant in citrus fruits with antioxidant and anti-inflammatory effects. However, the β-cry effect on oral mucositis remains unclear. We investigated the effects of 5-fluorouracil (5-FU) and β-cry on human normal oral mucosal keratinocytes (hOMK). hOMK was seeded on a culture plate and cultured with 5-FU and β-cry. The cell number, mRNA expression of inflammatory cytokines and matrix metalloproteinases (MMPs), and production of inflammatory cytokines in hOMK were evaluated. Additionally, the cell count and inflammatory cytokine production were analyzed when hOMK was co-stimulated with Porphyromonas gingivalis lipopolysaccharide (P. gingivalis LPS) in addition to 5-FU. The numbers of hOMK significantly reduced with 5-FU stimulation, whereas it increased with β-cry treatment. mRNA expression of interleukin (IL)-6, IL-8, metalloproteinase (MMP)-2, and MMP-9 and protein production of IL-6 and IL-8 in hOMK were augmented on 5-FU stimulation. Simultaneously, β-cry treatment significantly suppressed IL-8 and MMP-9 mRNA expression, and IL-8 production was induced on 5-FU stimulation. Co-stimulation with P. gingivalis LPS and 5-FU enhanced IL-6 and IL-8 production in hOMK. β-cry could enhance cell proliferation and suppress 5-FU-induced expression of inflammatory cytokines and MMP in hOMK. Thus, β-cry can alleviate the symptoms of chemotherapy-induced oral mucositis, and its combination with oral care is effective in managing oral mucositis.

The Subjective Will and Psychological Experience of Home-Based Exercise in Lung Cancer Patients During Interval of Chemotherapy: A Qualitative Study.

This qualitative study explores the subjective will and psychological experience of home exercise in patients with lung cancer during the interval of chemotherapy. Semi-structured interviews were conducted with 15 lung cancer patients undergoing chemotherapy. Following the Colaizzi 7-step analysis method, the interview data were read carefully, meaningful statements related to the research questions were extracted, coded, collected and described in detail, and the authenticity of the theme was verified. The analysis revealed the home-based exercise experience of patients' in the interval period of chemotherapy, and identified three themes: 1) the perception experience of home-based exercise (beneficial home-based exercise experience, negative home-based exercise experience); 2) the influencing factors of home-based exercise (exercise rehabilitation knowledge, disease symptoms and adverse effects of chemotherapy, exercise history, exercise self-efficacy, social support, restrictions on objective conditions); 3) Patients with lung cancer expected to get professional guidance about home-based exercise rehabilitation knowledge from medical care providers. Patients' perception and attitude towards home-based exercise behavior is affected by many factors during the interval of chemotherapy, and they expect professional guidance from medical care providers. Medical care providers should know the problems and the influencing factors in the process of home-based exercise of patients, and formulate personalized exercise measures for patients based on their own characteristics and needs, so as to relieve the symptoms of discomfort and improve the quality of life of patients with lung cancer.

The Influence of Fish Oil Supplementation on the Adverse Effects of Chemotherapy in Patients with Hepatocellular Carcinoma

The Influence of Fish Oil Supplementation on the Adverse Effects of Chemotherapy in Patients with Hepatocellular Carcinoma

Sharing Patient Safety Management Skills in Oncology Pharmaceutical Outpatient Service

Important tasks performed by pharmacists include dispensing medicines based on prescriptions and explaining medication to patients. However, pharmacists are now required not only to perform these tasks but also to provide patients with pharmacotherapy that maximises the efficacy of drugs and minimises side effects. In particular, chemotherapy has a wide variety of side effects and a higher incidence of side effects than pharmacotherapy for lifestyle-related diseases. The Cancer Institute Hospital has conducted a oncology pharmacist outpatient clinic for patients undergoing chemotherapy, pharmacists meet with patients on an outpatient basis. The content of these visits includes assessing the severity of side effects and adherence to oral anti-cancer drugs, and proposing supportive therapy to doctors. This symposium will focus on hand-foot syndrome caused by 5-fluorouracil (5-Fu) anticancer drugs and molecular-targeted drugs, and will share information on skills in assessing the severity of these side effects and on side-effect management based on reducing doses of anticancer drugs, taking off drugs and proposing supportive therapy. Furthermore, how the pill counts and Self-report methods are used in clinical practice to assess adherence to oral anti-cancer drugs will be shared. Recently, trainees from insurance dispensing pharmacies have been accepted and training has been provided on the management of adverse effects of chemotherapy and adherence assessment of oral anticancer drugs in the oncology pharmacist outpatient clinic. This symposium will share details of pharmaceutical care practices such as side-effect management in chemotherapy and adherence assessment of oral anticancer drugs, and discuss the skills required for patient safety management.

Cisplatin-induced azoospermia and testicular damage ameliorated by adipose-derived mesenchymal stem cells

BackgroundThe testes are highly susceptible to the adverse effects of chemotherapy and radiation at all stages of life. Exposure to these threats mainly occurs during cancer treatment and as an occupational hazard in radiation centers. The present study investigated the regenerative ability of adipose-derived mesenchymal stem cells (ADMSCs) against the adverse effects of cisplatin on the structure and function of the testes.MethodsNew Zealand white rabbits (N = 15) were divided into three groups of five: a negative control group (no treatment), a cisplatin group (single dose of cisplatin into each testis followed three days later by a PBS injection), and a cisplatin + ADMSCs group (cisplatin injection followed three days later by an ADMSC injection). On day 45 post-treatment, serum testosterone levels were evaluated, and the testes and epididymis were collected for histology, oxidative stress examination, and epididymal sperm analysis.ResultsCisplatin caused damage to the testicular tissue and decreased serum testosterone levels, epididymal sperm counts, and oxidants. An antioxidant imbalance was detected due to increasing malondialdehyde (MDA) and reduced glutathione (GSH) levels in testicular tissue. The ADMSC-treated group displayed a moderate epididymal sperm count, adequate antioxidant protection, suitable hormone levels, and enhanced testicular tissue morphology.ConclusionsADMSCs treatment repaired damaged testicular tissue, enhanced biochemical parameters, and modified pathological changes caused by cisplatin.

An evaluation of the Index4 tool for chemotherapy toxicity prediction in cancer patients older than 70 years old

Chemotherapy, although beneficial for improving outcomes in both localized and metastatic cancers, may be associated with significant adverse effects, especially for patients with decreased functional reserves. Prediction of patients who will not tolerate well chemotherapy treatment may help in modifying treatment plans and in reallocating resources to vulnerable patients. One hundred seventeen consecutive cancer patients over the age of 70 scheduled for chemotherapy treatment in a single cancer center were included in the study. Prediction of adverse chemotherapy outcomes were calculated using a prediction tool proposed and validated from the Cancer and Aging Research Group (CARG) and a prediction tool proposed by us, called Index4. The 2 tools were compared for their ability to predict grade 3 and 4 toxicities, Emergency Department (ED) and hospital admissions and chemotherapy discontinuation. The accuracy of both predictive tools was suboptimal. A high CARG score had a sensitivity of 46.3% and a specificity of 82% and an Index4 of 1 or above had a sensitivity of 53.7% and a specificity of 60% in predicting grade 3–4 adverse effects. The performance of the 2 tools in predicting ED and hospital admissions and chemotherapy discontinuation was comparable. An Index4 score of 0 was superior in predicting absence of grade 3–4 toxicities than a low CARG score (p = 0.002, McNemar’s test). The CARG tool for chemotherapy adverse effect prediction in geriatric cancer patients and the Index4 were able to predict adverse outcomes with moderate accuracy. Given its ease of calculation Index4 may be an alternative to CARG tool, suitable for a busy oncology practice.

An Overview: Genetic Tumor Markers for Early Detection and Current Gene Therapy Strategies

Genomic instability is considered a fundamental factor involved in any neoplastic disease. Consequently, the genetically unstable cells contribute to intratumoral genetic heterogeneity and phenotypic diversity of cancer. These genetic alterations can be detected by several diagnostic techniques of molecular biology and the detection of alteration in genomic integrity may serve as reliable genetic molecular markers for the early detection of cancer or cancer-related abnormal changes in the body cells. These genetic molecular markers can detect cancer earlier than any other method of cancer diagnosis, once a tumor is diagnosed, then replacement or therapeutic manipulation of these cancer-related abnormal genetic changes can be possible, which leads toward effective and target-specific cancer treatment and in many cases, personalized treatment of cancer could be performed without the adverse effects of chemotherapy and radiotherapy. In this review, we describe how these genetic molecular markers can be detected and the possible ways for the application of this gene diagnosis for gene therapy that can attack cancerous cells, directly or indirectly, which lead to overall improved management and quality of life for a cancer patient.

Management of Adverse Effects of Chemotherapy in Ovarian Cancer through Ayurveda: A Case Report

Cancer is a condition where abnormal cells multiply uncontrollably and can invade nearby tissues. Only 30% of women with ovarian cancer can expect to live for more than 5 years, as 70% of cases are diagnosed at an advanced stage. Ovarian malignancies account for about 15 to 20% of genital malignancies. Surgical intervention and chemotherapy are conventional measures used to treat these conditions. However, due to the specific side effects of chemotherapy, there is a high demand for safer ayurvedic interventions. Hereby, the authors present, a 54-year-old female patient who was diagnosed with ovarian cancer and advised to undergo chemotherapy. After completing six cycles of chemotherapy, administered once every four weeks for six months, the patient experienced complaints of anorexia, nausea, vomiting, epigastric pain, and a burning sensation in the stomach and lower limbs. Despite taking antacids and other suggested medications by the oncologist, the symptoms did not subside. Therefore, the patient sought ayurvedic treatment. Shaman Ayurvedic Chikitsa (Jawahar Mohra Pisti, Keharva Pisti, Swarna Makshik, Mukta Pisti), Shatavari Ghrita, Turmeric Kwath, and Pathya Vihar were prescribed for three consecutive months. After 5-7 days, the patient noticed significant relief in the aforementioned symptoms and felt better. The frequency of vomiting, complaints of anorexia, and burning sensation were also significantly reduced. After three months of ayurvedic treatment, the functions of Apana Vayu, Samana Vayu, and Pachaka Pitta were normalised through appropriate treatment. The selected combination of ayurvedic medicines provided relief due to their Vata-Pitta Shamak, Sheeta guna, and Pittahara properties, which alleviated the burning sensation. In present case report, the aforementioned ayurvedic prescription significantly reduced the adverse effects of chemotherapy and radiotherapy due to its Vata-Pitta Shamak and Pittahara properties.