205 Background: Lapatinib causes diarrhea in about 40-50% of patients treated with it for HER-2 positive breast cancer. It is the major dose and treatment limiting toxicity of lapatinib. Methods: This is a retrospective review of a cohort of patients treated with lapatinib for HER2 positive breast cancer at the Kirklin clinic at the University of Alabama at Birmingham from January 1, 2009 through September 30, 2013. Loperamide 2-8mg before lapatinib dose was recommended for prophylaxis in patients who developed clinically significant diarrhea. Additional doses of loperamide were used if needed. Results: 44 eligible patients were identified, 7 had stage IA, 10 had IIA, 7 had IIB, 5 had IIIA, 5 had IIIB and 6 had stage IV disease. Median age was 52 years (28-72 years) with 75% Caucasians. Starting dose of lapatinib was 1000mg oral daily. Overall 33 patients experienced diarrhea. 14 had NCI grade I, 5 had grade II, 10 had grade III and 3 had grade IV diarrhea. Other side effects encountered included rash, nausea, vomiting, LFT elevation, fatigue and allergic reaction. 17/33 patients received prophylactic loperamide. Median treatment duration with lapatinib for all patients was 6 months, range 1-60 months for patients receiving prophylactic loperamide and 1-22 months for others. 12/17 patients who received prophylactic loperamide had early improvement in diarrhea to NCI grade I or less vs. 4/16 for others. 5/17 patients who received prophylactic antidiarrheals required dose reduction due to diarrhea vs. 8/16 for others. Grade III and IV diarrhea was more common in standard treatment patients (8 vs. 5). 14 patients did not complete expected treatment duration, 5 due to diarrhea, all of whom had not received prophylactic antidiarrheals. Conclusions: Our study suggests that the use of prophylactic antidiarrheal treatment with lapatinib is possibly an effective strategy in getting patient to their therapy goals without interruptions or dose adjustments. The discontinuation rate and dose reduction rate in our population is lower than previously reported. Larger prospective studies will be of interest to evaluate this strategy further. Similar strategy could be applied to other agents causing diarrhea.
Agranulocytosis is a rare condition with a reported incidence ranging from one to five cases per million population per year. Most commonly, agranulocytosis is secondary to chemotherapeutic agents, however, other medications have also been associated with it. An immune mediated destruction of circulating granulocytes and/or granulocyte precursors secondary to drug-dependent or drug-induced antibodies is the postulated mechanism. Agranulocytosis has also been reported secondary to recreational drug use. Cocaine is one of the most commonly used recreational drugs and is often laced with Levamisole to enhance its psychostimulatory properties. Levamisole is an immune modulator and can cause bone marrow suppression. It can be detected in urine by gas chromatography-mass spectrometry.We report two cases of recurrent agranulocytosis in non-oncology patients secondary to chronic cocaine abuse, who were treated with granulocyte colony-stimulating factor (GCSF) and broad spectrum antibiotics without sustained response.The high prevalence of cocaine use continues to be a serious public health concern. This case series discusses the association of adulterated cocaine as an etiology of unexplained neutropenia and highlights the diverse clinical complications of chronic cocaine abuse. Currently, the available literature is reviewed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.