Undergoing Cancer Chemotherapy Research Articles

Adverse drug reactions due to cancer chemotherapy in a tertiary care teaching hospital.

An adverse drug reaction (ADR) is defined by World Health Organization (WHO) as 'Any response to a drug which is noxious, unintended and occurs at doses used in man for prophylaxis, diagnosis or therapy'. ADRs associated with cancer chemotherapy warrant analysis on their severity and preventability. The outcome would create awareness among health care providers and prevent their recurrence. We have performed a hospital-based prospective observational study designed to analyze the pattern of ADRs to chemotherapeutic agents in cancer patients of a tertiary care hospital. A total of 119 cancer patients were monitored for suspected ADRs during the course of chemotherapy from November 2014 to December 2015. Clinical events were recorded and analyzed with regard to the demographics and drug details of the patients. A total of 106 ADRs were recorded from 119 cases. The ADRs commonly encountered included constipation, nausea, vomiting, alopecia and hematological changes. Cisplatin, cyclophosphamide, paclitaxel and 5-FU were used for the treatment of commonly found cancers in this region affecting the lungs, esophagus and lymphomas. Naranjo's causality assessment showed 86.7% possible (score 4) and 13.2% probable (score 5-6). Severity of adverse reactions showed 77.4% mild, 18.9% moderate and 3.8% severe. A total of 45.3% of ADRs were preventable reactions such as nausea, vomiting and constipation. This study highlights the role of active monitoring as an important tool for early detection, assessment and timely management of ADRs in patients undergoing cancer chemotherapy. The observed ADRs were preventable although ADRs such as hiccough, anemia, neutropenia and alopecia were not preventable.

Prevalence of cancer chemotherapy-related problems, their relation to health-related quality of life and associated supportive care: a cross-sectional survey

The purpose of this study was to identify the treatment-associated problems that most impact on patients undergoing cancer chemotherapy, how problems relate to experiences of supportive care and variations in experience between cancer treatment centres. A survey administered to patients at six cancer centres in England explored variations of prevalence of 17 cancer chemotherapy-associated problems and associated supportive care. Problem items were identified as the most frequently experienced and severe when experienced in a scoping and consensus exercise. A health-related quality of life (HRQoL) measure, the EQ5D, was included to measure impact of problems. A total of 363 completed questionnaires were returned (response rate 43%, median 61%). The most prevalent problem was 'tiredness/fatigued' (90%), followed by 'changes in taste & smell' (69%) and 'difficulty managing everyday tasks' (61%). Significant variations in problem prevalence existed between centres, and some common problems were rarely reported in the literature. Regression analysis found that almost all problems were significantly associated with HRQoL, with social/emotional problems having as much impact on HRQoL as physical/psychological side effects of treatment. Greatest effect size was for difficulty managing everyday tasks. Respondents reported significant variations in supportive care between centres, with more supportive care received for physical/psychological problems than for social/emotional problems. Findings indicated that patients who received increased supportive care experienced less severe problems. The most common and distressing chemotherapy-associated problems were identified. These problems are mitigated by quality supportive care. Routine measurement and monitoring of problem items and supportive care are warranted to facilitate benchmarking and service improvements both within and between cancer centres.

Evaluation of the role and usefulness of a pharmacist outpatient service for patients undergoing monotherapy with oral anti-cancer agents.

Introduction When rapid feedback to physicians must be provided, e.g. monitoring therapy with the oral anticoagulant warfarin or providing therapeutic support for patients undergoing cancer chemotherapy, the involvement of pharmacists is required for outpatients. We launched a pharmacist outpatient service for patients with cancer taking oral anti-cancer agents. We evaluated the role and usefulness of the pharmacist outpatient service for these patients undergoing oral monotherapy with anti-cancer agents. Methods Data regarding prescription recommendations were collected from the drug management guidance records of 154 patients who consulted the pharmacist outpatient service between July 2013 and September 2015. In addition, the rates of prescription recommendation adherence were calculated. Between April and August 2015, a self-reported questionnaire was administered to 47 patients undergoing therapy with oral anti-cancer agents who were visiting the pharmacist outpatient service at the Ogaki Municipal Hospital (Ogaki, Japan). Results Prescription recommendations were given to 235 cases. The total rate of adherence to the prescription recommendations was 94.9% (223/235 cases). The majority of prescription recommendations regarding supportive care were those for moisturizing agents (20.9%), analgesics (20.9%), steroid ointments (12.7%), and antihypertensive agents (10.8%). When continued guidance was provided, significant changes were observed for survey items 3 (knowing the side effects of the medication), 8 (worrying about side effects), and 12 (interest in prescribed medicine) ( p = 0.0049, p < 0.0001, and p = 0.0164, respectively). Conclusion Our study showed that continued pharmaceutical intervention resulted in a deeper understanding of the medications' side effects, and it reduced anxiety levels in patients undergoing monotherapy with oral anti-cancer agents.

The safety and efficacy of NEPA (netupitant and palonosetron) in the treatment of chemotherapy-induced nausea and vomiting

Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life. The combination of a 5-hydroxytryptamine-3 (5-HT3) receptor antagonist, dexamethasone, and a neurokinin-1 (NK-1) receptor antagonist has significantly improved the control of CINV. Palonosetronis a second generation 5-HT3 receptor antagonist. Netupitant is a new NK-1 receptor antagonist with a high binding affinity and a long half-life of 90 hours. NEPA is an oral fixed-dose combination of netupitant and palonosetron (300 mg of netupitant plus 0.50 mg of palonosetron). Phase II and phase III clinical trials have demonstrated that NEPA significantly improved the prevention of CINV compared to the use of palonosetron alone in patients receiving either highly or moderately emetogenic chemotherapy. Adverse events were similar for the NEPA and the palonosetron groups. NEPA (Akynzeo) has recently been approved by the Food and Drug Administration (FDA) to treat nausea and vomiting in patients undergoing cancer chemotherapy.

Comprehensive outcomes of on- and off-antiviral prophylaxis in hepatitis B patients undergoing cancer chemotherapy: A competing risks analysis.

Although antiviral prophylaxis is essential in hepatitis B patients in the context of cancer chemotherapy, there is little evidence-based consensus regarding the appropriate prevention strategy depending on the underlying type of cancer and viral status. This retrospective study included a comprehensive cohort of 302 hepatitis B surface antigen-positive patients with various cancers undergoing chemotherapy and antiviral prophylaxis. The rates of hepatitis B virus (HBV) reactivation during antiviral therapy (>1 log10 IU/mL increase or positive conversion of serum HBV DNA) and relapse when off antivirals ([re]appearance of HBV DNA >2,000 IU/ml with related alanine aminotransferase elevation) were evaluated, together with the associated risk factors, in a competing risks analysis where cancer death was considered as the competing event. During antiviral prophylaxis, HBV was reactivated in six patients (1.9%), who had leukemia (n = 4) or lymphoma (n = 2) and were treated with lamivudine (n = 4) or entecavir (n = 2). The incidence rate of HBV relapse in 127 off-prophylaxis patients was 21.3% during a median post-antiviral period of 11.7 months. Lymphoma, pre-prophylactic HBV DNA ≥2,000 IU/ml, and age ≥50 years were independent predictors of off-treatment HBV relapse (adjusted hazard ratios 5.25, 3.07, and 0.34, respectively; Ps < 0.05). Antiviral and anticancer drugs, duration of consolidation on antiviral prophylaxis, and HBeAg positivity were not independent predictors. In conclusion, hepatitis B flare-ups are not rare in patients receiving cancer chemotherapy during and after anti-HBV prophylaxis, even when potent antivirals are used. Patients with hematopoietic or lymphoid neoplasms or high viral burdens should receive prolonged and powerful HBV prophylaxis. J. Med. Virol. 88:1576-1586, 2016. © 2016 Wiley Periodicals, Inc.

Bioactive glass combined with bisphosphonates provides protection against biofilms formed by the periodontal pathogen Aggregatibacter actinomycetemcomitans

Biofilms play a pivotal role in the progression of periodontitis and they can be treated with antiseptics (i.e. chlorhexidine) or antibiotics, but these therapeutic alternatives are unable of ameliorating periodontal alveolar bone loss, which has been, on the other hand, successfully treated with bone-preserving agents. The improved bone formation achieved in animal models by the combination of two such agents: bioactive glass (BAG) and bisphosphonates has attracted the interest for further exploring dental applications. However, the antimicrobial effects that may result from combining them have not been yet investigated. Here, our aim was to explore the anti-biofilm effects that could result from combining BAG with bisphosphonates, particularly in a dental biofilm model. The experiments were performed with an oral cavity single-specie (Aggregatibacter actinomycetemcomitans) biofilm assay, which was optimized in this contribution. Risedronate displayed an intrinsic anti-biofilm effect, and all bisphosphonates, except clodronate, reduced biofilm formation when combined with BAG. In particular, the anti-biofilm activity of risedronate was significantly increased by the combination with BAG. Since it has been proposed that some of the antimicrobial effects of BAG are caused by local pH changes, studies of pH variations were performed to gain a mechanistic understanding. However, the observed anti-biofilm effects could not be explained with lowered pHs. Overall, these results do provide further support for the promising use of bisphosphonate-BAG combinations in dental applications. These findings are particularly relevant for patients undergoing cancer chemotherapy, or osteoporotic patients, which are known to be more vulnerable to periodontitis. In such cases, bisphosphonate treatment could play a double positive effect: local treatment of periodontitis (in combination with BAG) and systemic treatment of osteoporosis, prevention of hypercalcemia and metastases.

Absence of human herpesvirus 6B detection in association with illness in children undergoing cancer chemotherapy.

The lymphotropic herpesviruses, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesvirus 6B (HHV-6B) can reactivate and cause disease in organ transplant recipients; the contributions of HHV-6A and HHV-7 to disease are less certain. Less is known about their pathogenic roles in children undergoing treatment for malignancies. Children with newly diagnosed cancer were followed for 24 months. Clinical information and blood samples were collected during routine visits and during acute visits for fever or possible viral infections. Lymphotropic herpesvirus DNA in blood was measured by polymerase chain reaction (PCR). Although HHV-6B DNA was detected at least once in about half of the patients; the other viruses were seldom detected. There was no association between HHV-6B detection and individual acute clinical events, however, HHV-6B detection was more common in children who experienced more frequent acute clinical events. In children being treated for various malignancies, HHV-6B detection was common, but was not associated with individual events of acute illness. Thus, if HHV-6B is not assessed longitudinally, clinical events may be misattributed to the virus. The elevated frequency of detection of HHV-6B in sicker children is consistent with prior reports of its detection during apparently unrelated acute clinical events. J. Med. Virol. 88:1427-1437, 2016. © 2016 Wiley Periodicals, Inc.

Cancer Related Fatigue and Quality of Life in Patients with Advanced Prostate Cancer Undergoing Chemotherapy.

Cancer related fatigue (CRF) is a common and debilitating symptom that can influence quality of life (QoL) in cancer patients. The increase in survival times stresses for a better understanding of how CRF affects patients' QoL. This was a cross-sectional descriptive study with 148 randomly recruited prostate cancer patients aiming to explore CRF and its impact on QoL. Assessments included the Cancer Fatigue Scale, EORTC QLQ-C30, and EORTC QLQ-PR25. Additionally, 15 in-depth structured interviews were performed. Quantitative data were analyzed with simple and multiple regression analysis and independent samples t-test. Qualitative data were analyzed with the use of thematic content analysis. The 66.9% of the patients experienced CRF with higher levels being recorded for the affective subscale. Statistically significant differences were found between the patients reporting CRF and lower levels of QoL (mean = 49.1) and those that did not report fatigue and had higher levels of QoL (mean = 72.1). The interviews emphasized CRF's profound impact on the patients' lives that was reflected on the following themes: “dependency on others,” “loss of power over decision making,” and “daily living disruption.” Cancer related fatigue is a significant problem for patients with advanced prostate cancer and one that affects their QoL in various ways.

Qualitative Research to Investigate the Needs of Pharmacists and Drug Therapy of Cancer Patients

We performed a survey of cancer patients' needs for drug treatment and support from pharmacists during treatment and evaluated the support that cancer patients can expect from community pharmacists in the future. The patients consisted of 16 members of the Cancer Patient Association in Aichi prefecture who underwent chemotherapy. The results of a semistructured group interview were qualitatively analyzed using the grounded theory method. Patients undergoing chemotherapy had high hopes for its effectiveness but were worried about side effects and medical costs. To overcome these problems, they hoped for a decrease in the economic burden, compassionate-use system, and development of novel drugs. The patients had anxiety because the side effects of chemotherapy often caused physical and psychological damage. Despite patients' confusion, pharmacists sometimes did not give adequate explanations to them. The patients expected more from pharmacists regarding medication support and hoped for a system allowing continuous side effect monitoring and consultation without hesitation. For patients undergoing cancer chemotherapy who are confused regarding side effects, pharmacists should understand the patient explanatory model and become more involved with patients as partners in treatment.

Development of a Thai version of the neutropenia subscale for the Functional Assessment of Cancer Therapy–Neutropenia questionnaire

Background: There is a need for a validated translation of the neutropenia subscale (NS) of the Functional Assessment of Cancer Therapy–Neutropenia (FACT-N) questionnaire used to assess neutropenia-specific concerns and health-related quality of life for Thai patients receiving cancer chemotherapy. Objectives: To translate the NS of the FACT-N questionnaire into Thai and examine the psychometric properties of the Thai version. Methods: The 19 item NS was translated into Thai in accordance with the guidelines of the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology. The psychometric properties of the translated version were then tested. We randomly selected 260 patient participants with hematological malignancies from four hospitals in Thailand. All participants completed the Thai version of FACT-N at the time of expected neutropenia (7–14 days after receiving chemotherapy). The Thai NS content validity was evaluated by a panel of 5 experts. The construct validity of the Thai NS was tested by confirmatory factor analysis (CFA). The internal consistency of the Thai NS was tested with Cronbach’s ? coefficients. Results: The Thai version of the NS was semantically equivalent to the English version. The content validity index was good at 0.95. The CFA of the Thai NS indicated acceptable construct validity. All 19 items on the Thai NS had significant estimated factor loadings (P Conclusions: The Thai NS, as part of FACT-N, is appropriate in terms of translation and psychometric properties for assessing specific neutropenia-related concerns in Thai patients undergoing cancer chemotherapy. Keywords: FACT-N, health-related quality of life, hematological malignancies, neutropenia subscale, scale translation, scale validation

Morbidity-mortality conference for adverse events associated with totally implanted venous access for cancer chemotherapy.

Although considered safer than central venous catheters for administration of cancer chemotherapy, totally implanted venous access (TIVA) is associated with adverse events that may impair prognosis and quality of life of patients receiving chemotherapy. Our aim was to assess the feasibility and interest of surveillance of cancer chemotherapy TIVA-adverse events (AE), associated with morbidity-mortality conferences (MMCs) on TIVA-AE. We performed a prospective interventional study in two hospitals (a university hospital and a comprehensive care center). For each cancer chemotherapy care pathway within each hospital, we set up surveillance of TIVA-AE and MMC on these events. Patients included in surveillance were those with a TIVA either placed or used for chemotherapy cycles in one of the participating wards. Feasibility of MMC was assessed by the number of MMC meetings that actually took place and the number of participants at each meeting. The interest of MMC was assessed by the number of TIVA-AE identified and analyzed, and the number and type of improvement actions selected and actually implemented. We recorded 0.41 adverse events per 1000 TIVA-day. MMCs were implemented in all care pathways, with sustained pluriprofessional attendance throughout the survey; 39 improvement actions were identified during meetings, and 18 were actually implemented. Surveillance of TIVA-AE associated with MMC is feasible and helps change practices. It could be useful for improving care of patients undergoing cancer chemotherapy.

G414(P) A retrospective analysis of steroid induced bradycardia in childhood malignancy: clinical relevance?: Abstract G414(P) Table 1

Aims Determine incidence, clinical significance and management of steroid induced bardycardia in children undergoing cancer chemotherapy Methodology Retrospective, observational, case note review of children treated at a tertiary paediatric oncology centre between 1 st January 2013 and 1 st September 2014 (21 months). Patients were subdivided into four groups based on steroid type, dose and indication. High dose dexamethasone (10 mg/m 2 /day) Standard dose dexamethasone (6 mg/m 2 /day) Non-Hodgkin Lymphoma prednisolone (60 mg/m 2 /day) Other (variable dosing) Simultaneous data collected on age, baseline heart rate (HR) at presentation, lowest HR on steroids, blood pressure (BP), ECG and intra-ocular pressure (IOP). Statistics: P values calculated Bradycardia of ≥30% was considered significant as it correlated with a Paediatric Early Warning Score (PEWS) of 2. Results Total of 136 patients were diagnosed, 6 notes were not located. 60/130 had steroid treatment. 47/60 (78.3%) experienced significant bradycardia (Table 1). There was no statistically significant difference in the degree of bradycardia between the different dosages and types of steroids used. Infants were not at a significantly higher risk for bradycardia (n = 3). ECG on 11/47 patients showed either no change or sinus bradycardia. IOP was raised in 2/3 measured patients. Conclusions This is the first clinical study reviewing the clinical relevance of steroid induced bradycardia in paediatric cancer. Majority of patients on steroid treatment for cancer showed significant bradycardia with no clinical decompensation. No risk factors were identified with respect to dose, type of steroid or age group. We recommend correlation with BP, ECG, probably IOP measurement in the monitoring of patients on steroid treatment for cancer chemotherapy. Appropriate PEWS charting and escalation of management should still be followed. This is also the first study to document clinically relevant steroid induced glaucoma in paediatric malignancy treatment. This has led to a further collaborative study to investigate the interaction/mechanism of steroid induced glaucoma and bradycardia in paediatric malignancy.

New Antiemetic for Chemotherapy-Induced Nausea

* Akynzeo, a combination of two drugs (netupitant and palonosetron), has been approved to prevent nausea and vomiting in patients undergoing cancer chemotherapy. * The most common adverse effects are headache, asthenia, dyspepsia, fatigue, constipation, and erythema. Patients should be monitored for symptoms of serotonin syndrome.

がん薬物療法領域における自動車の運転に影響を与える薬剤服用患者の調査と薬剤選択の提案に関する取り組み

がん薬物療法領域における自動車の運転に影響を与える薬剤服用患者の調査と薬剤選択の提案に関する取り組み

The Effect of a Psycho-Educational Intervention on Quality of Life of Patients with Advanced Lung Cancer Undergoing Chemotherapy

Objective: Cancer patients undergoing chemotherapy commonly experience depression and anxiety, which, along with adverse effects of chemotherapy, inevitably compromise quality of life (QOL) of the patients. The aim of this study was to investigate the effect of a psycho-educational intervention on the quality of life (QOL) of patients with advanced lung cancer undergoing chemotherapy. Methods: Two hundred in-patients with unresectable advanced lung cancer undergoing chemotherapy in Shanxi Cancer Hospital from January to October 2013 were randomized into the intervention group (n = 100) and the control group (n = 100). Patients in the intervention group received a purposely designed and nurse-delivered psycho-educational intervention in addition to routine caring and chemotherapy, whereas those in the control group underwent chemotherapy and routine caring only. QOL of patients was assessed according to QOL instrument for lung cancer (QLICP-LU). The impact of the psycho-educational intervention on QOL was analyzed using independent-sample t test and χ2 test. Results: The psychological, physical, and social function, and the overall QOL scores were significantly improved in patients who received the psycho-educational intervention compared with those in the control group. Conclusions: A nurse-delivered psycho-educational intervention is a useful strategy to improve QOL of patients with advanced lung cancer undergoing chemotherapy.

Profile of netupitant/palonosetron (NEPA) fixed dose combination and its potential in the treatment of chemotherapy-induced nausea and vomiting (CINV).

Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life. The emetogenicity of the chemotherapeutic agents, repeated chemotherapy cycles, and patient risk factors significantly influence CINV. The use of a combination of a 5-hydroxytryptamine-3 (5-HT3) receptor antagonists, dexamethasone, and a neurokinin-1 (NK-1) receptor antagonist has significantly improved the control of acute and delayed emesis in single-day chemotherapy. Palonosetron, a second generation 5-HT3 receptor antagonist with a different half-life, different binding capacity, and a different mechanism of action than the first generation 5-HT3 receptor antagonists, appears to be the most effective agent in its class. Netupitant, is a new NK-1 receptor antagonist with a high binding affinity, a long half-life of 90 hours, is metabolized by CYP3A4, and is an inhibitor of CYP3A4. NEPA is an oral fixed-dose combination of netupitant and palonosetron which has recently been employed in Phase II and Phase III clinical trials for the prevention of CINV in patients receiving moderately and highly emetogenic chemotherapy (MEC and HEC). The clinical trials demonstrated that NEPA (300 mg of netupitant plus 0.50 mg of palonosetron) significantly improved the prevention of CINV compared to the use of palonosetron alone in patients receiving either HEC or MEC. The clinical efficacy was maintained over multiple cycles of chemotherapy. NEPA (Akynzeo®) has recently been approved by the Food and Drug Administration (FDA) to treat nausea and vomiting in patients undergoing cancer chemotherapy.

Quality of life and adverse drug reaction measured in patients undergoing cancer chemotherapy.

214 Background: Cancer prevalence in India is estimated around 2.0-2.5 million, 0.7- 0.8 million new cases identified every year, and cancer deaths reported per year is 0.4-0.5 Million. The objective of this study was to analyze and compare patient-reported QoL (quality of life), and their physical/psychosocial symptom and adverse drug reaction in cancer patients. Methods: Study done by questionnaire EORTC QLQ-C30. Comparison among 3 distinctive groups (G) (varied number of Chemotherapy cycles) was done. ADR measured appropriately Results: 131 patients were recruited and QoL scoring GHS (global health status) and 4 items of symptom scale i.e. insomnia, pain, appetite loss, constipation, and financial difficulties attained a significance difference. GHS significantly improved in G3 as compared to G1, indicating that the patient overall health improved as the chemotherapy sessions progressed. Female patients had more ADR (mean 3.2/person) and G3 had more ADR (mean 3.96). Conclusions: QoL score didn’t show significant improvement in all areas (except insomnia, pain, appetite loss, constipation &amp; financial difficulties), a judicious diagnosis with an appropriate treatment including chemotherapy may lessen the negative perception of cancer. [Table: see text]

Effect of Empowering Caregivers of Children with Cancer Undergoing Chemotherapy on Their Adherence to Preventive Health Recommendations for Oral Ulcer

Inflammation of the oral mucosa is a common and debilitating complication of chemotherapy that is preventable and manageable following health advices. Empowering the primary caregiver can be helpful in management of this condition. Aim: To determine the effect of empowering the caregivers on preventing inflammation of oral mucosa in children with cancer undergoing chemotherapy. Methods: This non-randomized clinical trial was conducted in 60 children's caregivers aged between 3 and 18 years old undergoing chemotherapy in Sheikh Hospital of Mashhad in two groups of intervention and control. In the intervention group, training was based on clinical guide in 5 sessions and according to Gibson empowerment model in 4 steps. Data were gathered based on questionnaire of side effects of chemotherapy and adherence questionnaire of the prevention and treatment of mouth ulcers in three stages: the first, the sixth and the 12th week of intervention. For data analysis, SPSS version 18 and paired and independent t-tests, Spearman correlation coefficient and the Mann-Whitney tests were used. Results: 61.7% of the patients were men and 38.3 were women. The average ages of the children and caregivers were 5/6±3/2 and 32/1±8/1 years, respectively. The average adherence to prevention recommendations for oral ulcers in the empowerment group increased from 53/6±24/3 to 82/2±11/7 (p<0.001). The occurrence rate of mouth ulcers in the empowerment group in the first week of intervention was 1/8±1/1, in the sixth week 1/7±1/0, and in the twelfth week of treatment was 1/1±0/2 (p<0/001). Conclusion: The empowerment program can help the main caregiver to discover and use critical thinking skills, enhance their ability and increase adherence, which results in decrease of mouth ulcers in children undergoing chemotherapy.

MS-20, A Chemotherapeutical Adjuvant, Reduces Chemo-Associated Fatigue and Appetite Loss in Cancer Patients

A small pilot study of the fermented soybean extract MicrSoy-20(MS-20) demonstrated its ability to restore chemotherapy-induced immunosuppression and improve quality of life (QoL). This randomized, cross-over, comparative trial was conducted to confirm the effects of MS-20 on QoL and to understand its underlying mechanism when used in conjunction with chemotherapy. One hundred forty-three patients undergoing cancer chemotherapy were randomly assigned to 2 groups. Group 1 was administered MS-20 for 1 wk followed by 3 wk of concomitant MS-20 plus chemotherapy. Group 2 was administered chemotherapy for 3 wk. QoL was assessed by the EORTC/QLQ-C30 questionnaire and visual analogue scales (VAS). Changes in immunological parameters and antioxidant profiles were also examined. Significant increases were observed in EORTC/QLQ-C30 scores for physical (4.45, P = 0.023) and social (3.99, P = 0.023) functioning in Group 1 patients compared to Group 2 patients. VAS scores for fatigue and appetite loss significantly improved with MS-20 treatment (P < 0.001). Group 1 patients exhibited smaller decreases in peripheral blood mononuclear cells compared to Group 2 patients (P = 0.026). Other immunological parameters, antioxidant, and safety profiles were not significantly different between treatment groups. Addition of MS-20 as an adjuvant to chemotherapy can be effective in improving QoL for cancer patients.

Parathyroid hormone linked to a collagen binding domain promotes hair growth in a mouse model of chemotherapy-induced alopecia in a dose-dependent manner

Chemotherapy-induced alopecia is a major source of psychological stress in patients undergoing cancer chemotherapy, and it can influence treatment decisions. Although there is currently no therapy for alopecia, a fusion protein of parathyroid hormone and collagen binding domain (PTH-CBD) has shown promise in animal models. The aim of this study was to determine whether there are dose-dependent effects of PTH-CBD on chemotherapy-induced alopecia in a mouse model. C57BL/6J mice were waxed to synchronize hair follicles; treated on day 7 with vehicle or PTH-CBD (100, 320, and 1000 mcg/kg subcutaneous injection); and treated on day 9 with vehicle or cyclophosphamide (150 mg/kg intraperitoneally). Mice were photographed every 3-4 days and killed on day 63 for histological analysis. Photographs were quantified by gray scale analysis to assess hair content. Mice not receiving chemotherapy showed regrowth of hair 2 weeks after waxing and normal histology after 2 months. Mice receiving chemotherapy alone showed marked hair loss after chemotherapy, which was sustained for 10 days and was followed by rapid regrowth of a normal coat. Histological analysis revealed rapid cycling dystrophic anagen/catagen follicles. Animals receiving chemotherapy and PTH-CBD showed decreased hair loss and more rapid regrowth of hair than that seen with chemotherapy alone (increased hair growth by gray scale analysis, P<0.05), and the effects were dose dependent. Histologically, hair follicles in animals receiving the highest dose of PTH-CBD were in a quiescent phase, similar to that in mice that did not receive chemotherapy. Single-dose subcutaneous administration of PTH-CBD showed dose-dependent effects in minimizing hair loss and speeding up recovery from chemotherapy-induced alopecia.