ASCO: Stop Underdosing Obese Cancer Patients - OncologySTAT

ASCO: Stop Underdosing Obese Cancer Patients - OncologySTAT



Excerpt:





"Chemotherapy doses should be tailored for obese cancer patients based on their actual body weight, not their ideal body weight, according to a new practice guideline from the American Society of Clinical Oncology.



There is no evidence that full-weight-based chemotherapy doses cause greater toxicity than adjusted doses, and concerns about "overdosing" obese cancer patients are unfounded, a panel of experts wrote in a report published online April 2 in the Journal of Clinical Oncology.



A systematic review of the literature showed that many overweight and obese cancer patients continue to receive underdoses of intravenous and oral cytotoxic drugs because of "considerable uncertainty among physicians about optimal dose selection," even though research has confirmed that full-weight-based dosing is both safe and crucial to the patients' survival.



"Many oncologists continue to use either ideal body weight or adjusted ideal body weight, or to cap the body surface area at, for example, 2.0 m², rather than use actual body weight to calculate body surface area," said Dr. Jennifer J. Griggs of the University of Michigan, Ann Arbor, and her associates on the expert panel for ASCO's new practice guideline.



As a result, chemotherapy dosing varies widely in overweight and obese patients, with as many as 40% receiving less than optimal dosing. This "may explain, in part, the significantly higher cancer mortality observed in overweight and obese individuals," they noted."

***

"

Most of the studies concerned breast, ovarian, colon, and lung cancers, the authors said. As little data in the literature addressed dosing for novel agents such as tyrosine kinase inhibitors, immunotherapies such as interleukin-2 or interferon, or monoclonal antibodies, the guideline did not address these agents.



A summary of the guideline (J. Clin. Oncol. 2012 [doi:10.1200/JCO.2011.39.9436]) lists these key recommendations:



• Actual body weight should be used to select cytotoxic chemotherapy doses, regardless of obesity status. There is no evidence that either short- or long-term toxicity is increased with this approach.

• Use the same strategy in obese patients as in other patients for dose reductions, taking into account the type and severity of toxicity, any comorbid conditions, and whether the aim of treatment is cure or palliation. There is no evidence that greater dose reductions are needed for obese patients. Also, consider resuming the full-weight-based dose for subsequent chemotherapy cycles, especially if a possible cause of toxicity (such as impaired renal or liver function) has resolved.

• Consider fixed dosing only with select cytotoxic agents for which maximal dosing limits have been established, such as vincristine, carboplatin, or bleomycin.

• Calculate body surface area using any of the standard formulas currently available. There is no evidence to support using one formula over any other.

• Further research is needed into the pharmacokinetics and pharmacogenetics of chemotherapy dosing for obese patients, who have been excluded from many anticancer drug trials."



{Reference link and to read full article: OncoSTAT}

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Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials

NYCTCM Acupuncture Clinic visit (Photo credit: NYCTCM)

Pain Management - Oncology News Article | Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials |3998569

OncoPRN Commentary: Those working in any way in supportive oncology encounter a myriad of question with respect to complementary and alternative therapies (CAT). This article may better equip one to deal with the question of acupuncture and its use in cancer pain.

Excerpt:

Supportive Care in Cancer, 03/30/2012  Evidence Based Medicine

Choi TY et al. – The comparison between acupuncture plus drug therapy and drug therapy alone demonstrated a significant difference in favour of the combination therapy. The results of this systematic review provide no strong evidence for the effectiveness of acupuncture in the management of cancer pain. The total number of randomised clinical trials (RCTs) included in the analysis and their methodological quality were too low to draw firm conclusions.

Methods:

"Fourteen databases were searched from their inception through April 2011.

Randomised clinical trials (RCTs) were included if acupuncture was used as the sole treatment or as a part of a combination therapy for cancer pain.

Studies were included if they were controlled with a placebo or controlled against a drug-therapy or no-treatment group.

The Cochrane criteria were used to assess the risk of bias.


Results:

• A total of 15 RCTs met the inclusion criteria.
• All of the included RCTs were associated with a high risk of bias.
• The majority of acupuncture treatments or combination therapies with analgesics exhibited favourable effects compared with conventional treatments in individual studies.
• However, a meta-analysis suggested that acupuncture did not generate a better effect than drug therapy (n=886; risk ratio (RR), 1.12; 95% CI 0.98 to 1.28; P=0.09).
• The comparison between acupuncture plus drug therapy and drug therapy alone demonstrated a significant difference in favour of the combination therapy (n=437; RR, 1.36; 95% CI 1.13 to 1.64; P=0.003).
• The results of this systematic review provide no strong evidence for the effectiveness of acupuncture in the management of cancer pain."

{Reference Link}

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Deep Brain Stimulation: TEDxUF - Michael Okun and Kelly Foote - We Control Your Brain

Deep Brain Stimulation (Photo credit: Ryan Somma)

A presentation at TEDxUF (University of Florida) by a neurologist and neurosurgeon and the amazing utilization of a procedure/technique/intervention called Deep Brain Stimulation. 


The uses:

• multiple sclerosis
• essential tremors
• bipolar
• dystonia

I wonder about its potential in neuropathic pain.

The presenters also discuss the ethics surrounding the procedure given the ability to control the brain.

Summary:
1. Identify the abnormal circuit in the brain
2. Intervene with deep brain stimulation
3. Personalize/tailor to the individual

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Introducing…the CAPhO Compass Blog

The CAPhO Compass is the latest initiative I have undertaken via the CAPhO Communications Committee as another means to communicate with CAPhO (Canadian Association of Pharmacy in Oncology) members. The Compass marks the official CAPhO entry into the blogosphere!

Excerpt:

Contents of the blog:The CAPhO Compass intends to help navigate CAPhO members through resources on the world wide web, oncology pharmacy news and happenings, and much more.
Here are some of the exciting new things to look forward to:

• CAPhO Research Project Updates (For instance, Sean Hopkins will be providing updates on his progress)

• Top 10 News/Articles/Highlights of the past 10 days

• Highlighting awards open to members

• Drug shortage updates

• Member spotlights

• Pearls of Wisdom

• What’s happening and initiatives that are happening provincially/regionally

• What’s happening in other relevant organizations – HOPA, ISOPP, CSHP, BOPA, etc.

• Pharmacy related and relevant videos

*To view the blog click here:

http://www.capho.org/blog 

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OxyNeo: Innovation In Pain Management or Patent Extender of OxyContin?

The premise is great; OxyNeo is a fairly innovative oral tablet (Concerta [methylphenidate controlled release] also utilizes this formulation) to possibly help curb abuse of one of the most highly abused prescription medications - OxyContin.

OxyNeo is not clear of problems, however, and is actually NOT desirable in a variety of patient populations.

OxyNeo tablets are formulated to make them harder to break or crush, making it difficult for people to chew OxyNeo to release all of the drug at once or crush it into a powder to snort. If one attempts to dissolve the tablets in water or alcohol, the result is a gummy gel that cannot be drawn up in a syringe.

OxyNeo and OxyContin are bioequivalent but there are slight differences:

• OxyNeo takes slightly longer to reach peak levels, which may be perceived as being less effective.
• have a slightly higher peak, which may ptentially lead to more side effects.

Of course, OxyNeo will not curb all abuse. Patients can still take larger amounts orally. As well, creative people are already trying to figure out how to get oxycodone more readily out of the new tablets.  Crushing the tablets followed by dissolution can release over 75% of the dose, depending on the solvent utilized.  There is no proof that OxyNeo is less subject to abuse or diversion.


Patients have to be cautioned NOT to wet or lick OxyNeo tablets prior to putting them in their mouth. There are reports of patients choking because the tablet forms a gummy gel when it is wet. Patients are to be told to swallow each tablet one at a time if they have to take multiple tablets per dose.

This poses a major risk to cancer patients, especially those in head and neck tumour groupings who have fiddiculties swallowing as it is.
One is left to ponder if this is simply a case of altering the controlled release formulation to allow a pharmaceutical company to extend the patent (although I admittely am not certain of what that date would be and company did not disclose when asked).

 
Reference:
Pharmacist Letter 

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Paul Ehrlich: "Father of Chemotherapy"

Image via Wikipedia

Paul Ehrlich: "Father of Chemotherapy"

Born March 14, 1854 - Paul Ehrlich

*Information below gathered from: http://www.medindia.net/patients/patientinfo/chemotherapy-history.htm

Much of the original work leading to the ‘magic bullets’ is credited to a German bacteriologist from Frankfurt - Paul Ehrlich.

He was awarded a Nobel prize in Physiology or Medicine in 1908 for some of his pioneering work and is considered the ‘father of modern Immunology and Chemotherapy’

After Ehrlich laid down the principles, the treatment of cancer cells using chemotherapeutic agents was first carried out in the 1950s.

The first drug used in treating cancer is an accidental discovery. During the World War II, mustard gas was used as a warfare agent. It was discovered that individuals who were accidentally exposed to mustard gas had low WBC counts.

It was reasoned that an agent with such an effect on the rapidly-dividing WBC could have the same effect on cancer cells too.

As a result, the drug was intravenously used to treat individuals with late-stage lymphomas with dramatic early results.

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Genetic Marker Predicts Taxane-Induced Neuropathy - OncologySTAT

Genetic Marker Predicts Taxane-Induced Neuropathy - OncologySTAT

This is from May 2011:

Optimism for a Genetic Predictor of Taxane Neurotoxicity

"The first potential biomarker useful in predicting taxane neurotoxicity may be near. A marker in the RWDD3 gene was identified in an ECOG study of 2204 patients with early-stage breast cancer after 12 weeks of weekly paclitaxel. Results are to be presented at ASCO. Divided into 3 genetic subgroups, neuropathy occurred in 27%, 40%, and 60% of patients at 15 months. A subset analysis is underway for African American patients, who had a twofold increase in neuropathy.
***
Older people and blacks, the same study found, are at elevated risk of developing neuropathy, which affects up to a third of people receiving chemotherapy with taxane drugs such as paclitaxel.
***
By looking at more than 1.2 million SNPs in each patient, Dr. Schneider and his colleagues were able to identify genetic subgroups most likely to develop neuropathy. "Those who carried two normal nucleotides in a specific regulatory gene had a 27% chance of experiencing neuropathy," the investigators wrote in their abstract. "But those who carried one normal nucleotide and one SNP had a 40% chance and those who carried two SNPs had a 60% chance."

Dr. Schneider and his colleagues also found that older patients and blacks were much more likely to have peripheral neuropathy. The likelihood of neuropathy increased 12.9% with every decade of age. Blacks saw a twofold increase in the likelihood of developing neuropathy.

Read full article @
http://oncologystat.com/news/Genetic_Marker_Predicts_Taxane-Induced_Neuropathy_US.html

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