Dosage Adjustments for Chemotherapy and Targeted Therapies in Colorectal and Pancreatic Cancer Patients with Hepatic Impairment

Khalid, Sidra; Khalid, Aariez; Clark, Bernadette A; Haddad, Abdo; Spiro, Timothy Pp; Daw, Hamed

doi:10.7759/cureus.2798

Cited by 4 publications

(4 citation statements)

References 12 publications

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“…Our findings of ALT, AST, and ALP levels agree with some studies, such as a study done by Vincenzi et al, who studied the serum ALT, AST, and ALP levels in colorectal cancer with hepatotoxicity by the folinic acid, fluorouracil, and irinotecan (FOLFIRI) treatment [ 26 ]. Moreover, our results are in agreement with the study of Khalid et al, who studied the dosage adjustments for chemotherapy in colorectal and pancreatic cancer patients [ 28 ].…”

Section: Discussionsupporting

confidence: 93%

Assessing the Hepatotoxic Effects of Fluoropyrimidine Chemotherapy in Male Iraqi Colorectal Cancer Patients

Challoob,

Mohammed

2024

Cureus

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Introduction: Colorectal cancer (CRC) is one the most frequently occurring cancer types among various populations. Fluoropyrimidine is the backbone of first-line chemotherapy, the oral capecitabine, or intravenous 5-fluorouracil (5-FU) in various combinations and schedules the chemotherapy regime in the treatment of a wide variety of gastrointestinal cancers. The enzyme dihydropyrimidine dehydrogenase (DPD) functions as the rate-limiting step in the metabolism of fluoropyrimidine chemotherapies, and patients with complete or partial DPD deficiency are at increased risk of severe and fatal toxicity during treatment with fluorouracil. Aim: This study aimed to examine the chemotoxicity of the 5-FU drug on hepatocytes in male Iraqi CRC patients. Materials and methods: This research is a cross-sectional study conducted between November 2022 and April 2023. The study included 80 male participants who had undergone surgical intervention for stage III CRC under the care of the Misan Health Directorate, Misan Center for Tumors Treatment, located in Misan, Iraq. Based on their subsequent surgical treatment, the participants were divided into two groups. The first group, comprising 45 males aged between 41 and 71 years, experienced a relapse despite receiving adjuvant therapy, which involved a singular cycle of fluoropyrimidine-based chemotherapy (5-FU). The second group consisted of 35 male patients with CRC, aged between 40 and 57 years, who did not experience a relapse post-adjuvant therapy. Their adjuvant therapy involved a single round of fluoropyrimidine-based chemotherapy with 5-FU. Relapse in patients was determined by assessing the white blood cell count (WBC). Results: Liver enzymes were significantly increased after 5-FU treatment, while the concentration of albumin was significantly decreased. Conclusion: The findings of our study clearly indicate that 5-FU induced hepatic injury, lowering the hepatocyte function with elevated levels of hepatic enzymes and low concentration of albumin in the blood, which is an important predictive marker of chemotherapy toxicity.

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Section: Discussionsupporting

confidence: 93%

Assessing the Hepatotoxic Effects of Fluoropyrimidine Chemotherapy in Male Iraqi Colorectal Cancer Patients

Challoob,

Mohammed

2024

Cureus

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“…Since jaundice is commonly reported in PC, the feasibility of chemotherapy in these patients is limited by the number of studies. Some studies recommend lowering chemotherapy doses in cancer patients with hyperbilirubinemia [262][263][264]. However, these studies are limited by small sample sizes and variable degrees of liver function impairment [261].…”

Section: Bile Acids Affect Therapy Outcomesmentioning

confidence: 99%

Bile Acids and Microbiota Interplay in Pancreatic Cancer

Malhotra

Palanisamy

Caparrós-Martín

et al. 2023

Cancers

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Evidence suggests the involvement of the microbiota, including oral, intra-tumoral and gut, in pancreatic cancer progression and response to therapy. The gut microbiota modulates the bile acid pool and is associated with maintaining host physiology. Studies have shown that the bile acid/gut microbiota axis is dysregulated in pancreatic cancer. Bile acid receptor expression and bile acid levels are dysregulated in pancreatic cancer as well. Studies have also shown that bile acids can cause pancreatic cell injury and facilitate cancer cell proliferation. The microbiota and its metabolites, including bile acids, are also altered in other conditions considered risk factors for pancreatic cancer development and can alter responses to chemotherapeutic treatments, thus affecting patient outcomes. Altogether, these findings suggest that the gut microbial and/or bile acid profiles could also serve as biomarkers for pancreatic cancer detection. This review will discuss the current knowledge on the interaction between gut microbiota interaction and bile acid metabolism in pancreatic cancer.

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“…[8][9][10] Treatment of jaundice is typically required prior to starting chemotherapy without dose reduction and can also improve symptoms of pruritus and anorexia. [11][12][13][14] Since its first description, ERCP has become the preferred initial treatment for biliary obstruction from pancreatic cancer given decreased adverse events, greater survival, and improved quality of life. 9,[15][16][17][18] Despite known benefits of ERCP, there is emerging evidence of regional and racial variations in the receipt of ERCP versus PTBD.…”

Section: Introductionmentioning

confidence: 99%

“…Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are the two most common interventions to treat painless jaundice from pancreatic cancer 8–10 . Treatment of jaundice is typically required prior to starting chemotherapy without dose reduction and can also improve symptoms of pruritus and anorexia 11–14 . Since its first description, ERCP has become the preferred initial treatment for biliary obstruction from pancreatic cancer given decreased adverse events, greater survival, and improved quality of life 9,15–18 …”

Section: Introductionmentioning

confidence: 99%

Accessibility to ERCP‐performing hospitals among patients with pancreatic cancer living in SEER regions

Tavakkoli,

Beauchamp,

Prasad

et al. 2024

Cancer Medicine

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Background and AimsThe two most common interventions used to treat painless jaundice from pancreatic cancer are endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD). Our study aimed to characterize the geographic distribution of ERCP‐performing hospitals among patients with pancreatic cancer in the United States and the association between geographic accessibility to ERCP‐performing hospitals and biliary interventions patients receive.MethodsThis is a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)‐Medicare database for pancreatic cancer from 2005 to 2013. Multilevel models were used to examine the association between accessibility to ERCP hospitals within a 30‐ and 45‐min drive from the patient's residential ZIP Code and the receipt of ERCP treatment. A two‐step floating catchment area model was used to calculate the measure of accessibility based on the distribution across SEER regions.Results7464 and 782 patients underwent ERCP and PTBD, respectively, over the study period. There were 808 hospitals in which 8246 patients diagnosed with pancreatic cancer in SEER regions from 2005 to 2013 received a procedure. Patients with high accessibility within both 30‐ and 45‐min drive to an ERCP‐performing hospital were more likely to receive an ERCP (30‐min adjusted odds ratio [aOR]: 1.53, 95% confidence interval [CI]: 1.17–2.01; 45‐min aOR: 1.31, 95% CI: 1.01–1.70). Furthermore, in the adjusted model, Black patients (vs. White) and patients with stage IV disease were less likely to receive ERCP than PTBD.ConclusionsPatients with pancreatic cancer and high accessibility to an ERCP‐performing hospital were more likely to receive ERCP. Disparities in the receipt of ERCP persisted for Black patients regardless of their access to ERCP‐performing hospitals.

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Dosage Adjustments for Chemotherapy and Targeted Therapies in Colorectal and Pancreatic Cancer Patients with Hepatic Impairment

Cited by 4 publications

References 12 publications

Assessing the Hepatotoxic Effects of Fluoropyrimidine Chemotherapy in Male Iraqi Colorectal Cancer Patients

Assessing the Hepatotoxic Effects of Fluoropyrimidine Chemotherapy in Male Iraqi Colorectal Cancer Patients

Bile Acids and Microbiota Interplay in Pancreatic Cancer

Accessibility to ERCP‐performing hospitals among patients with pancreatic cancer living in SEER regions

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