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Fatigue is frequent among oncologic patients. Unpurified Paullinia cupana dry extract showed encouraging results for chemotherapy-induced fatigue in our previous studies. We report two randomized, double-blind studies with a standardized dry purified Paullinia cupana extract named PC-18. For both studies, we recruited early breast cancer patients who had an increase in their fatigue scores after their first cycle of adjuvant chemotherapy. In the first study, we compared an oral dose of 37.5 mg of PC-18 twice daily with placebo. In the second study, we examined PC-18 at either 7.5 or 12.5 mg orally twice daily versus placebo. In both studies, PC-18 was not superior to placebo as assessed by both Chalder and Brief Fatigue Inventory (BFI) fatigue questionnaires, probably reflecting unexpectedly good placebo antifatigue activity. Since all capsules employed in both studies contained about 100 mg of magnesium silicate as an excipient, we retrospectively evaluated frozen serum samples from the second study and found a significant increase in magnesium levels after patients received placebo. By multivariate analysis, higher prerandomization magnesium levels and higher BFI scores together with the use of a 12.5 mg dose of PC-18 all correlated significantly with higher posttreatment BFI scores. We observed no significant toxicities in any of the trials. We conclude that the absence of differences between PC-18 and placebo may be due to the unexpectedly high antifatigue activity of the placebo in these studies. Further studies evaluating the role of magnesium supplementation for chemotherapy-induced fatigue are needed.

Hair loss is one of the most feared side effects for women experiencing cancer and chemotherapy. The purpose of this study was to examine the headwear-related needs of women experiencing chemotherapy-induced hair loss and to develop headwear to help improve their quality of life. The needs identified served as design criteria for developing the headwear. A mixed methods research strategy was used including personal interviews, user comments on a blog created for the purposes of this study and an on-line survey. The five-step design process outlined by Watkins and Dunne served as a framework for the study. Based on the 14 design criteria identified in the study, 3 headwear prototypes were developed. The headwear was evaluated by women in a cancer support group to determine how well the headwear addressed the design criteria and met user needs.

Chemotherapy-induced peripheral neurotoxicity (CIPN) has become a hot topic in oncological daily practice. It is a common condition, related to chemotherapy regimen used to treat breast, colorectal...

With the introduction of imatinib mesylate (IM), the first BCR-ABL1 tyrosine kinase inhibitor (TKI), the outcome of patients with chronic myeloid leukemia (CML) improved dramatically. Besides the i...

Background: This article provides an overview of the incidence and severity, presentation and impact of chemotherapy-induced alopecia (CIA), one of the most common and distressing side effects of cancer therapy. Furthermore, prevention of CIA by scalp cooling is described, as well as suggestions for improvement of scalp cooling application and clinical research approaches. Methods: This article focuses on the availability of options to treat CIA and on scalp cooling in particular. It presents an overview of 58 scalp cooling publications and three personal communications, describing its working mechanism, determinants of success rates, side effects and controversies. Results: CIA occurs in many chemotherapy regimens and is nearly always reversible. Up to now, scalp cooling is by far the best method to reduce CIA. Concerns about the protection of malignant cells in the scalp skin by scalp cooling have been proven to be exaggerated. The majority of patients tolerate scalp cooling very well. Scalp cooling is ...

A 74-year-old woman presenting with a 2-month history of bilateral cervical tumors, progressively increasing in size, was admitted to our hospital on 11 September 2006. Blood examination showed the...

Chemotherapy for early stage breast cancer has significantly improved survival outcomes but is associated with ovarian toxicity, resulting in early menopause for many premenopausal women. A qualitative study was conducted that generated a grounded theory explaining how women carried on with life in response to breast cancer and menopause. My purpose in this article is to describe three distinct types of responses from women in that study: making the best of it, struggling and barely noticing. The degree of menopausal symptom distress and perceived level of preparation for the menopause experience had the greatest influence on the type of response.

Side effects of chemo-radiotherapy reduce the quality and also the survivability of patients. The consequent fatigue and infections, related to myelodepression, act to reduce the dose-intensity of the protocol. Late side effects of chemo-radiotherapy include secondary tumours, acute myeloid leukemias and cardiotoxicity. Side effects of chemotherapy are related to oxidative stress produced by the treatment. Oxidative stress also reduces the efficacy of the treatment. Antioxidative treatment with natural (dietetic) or chemical agents has been reported to reduce the toxicity of chemo-radiotherapy and improve the efficacy of treatment. We here report our experience with SEQEX, an electromedical device that generates Extremely Low Frequency ElectroMagnetic Fields (ELF-EMF) to produce endogenic cyclotronic ionic resonance, to reduce myelotoxicity consequent to ABVD protocol in patients with Hodgkin's lymphoma.

Radiotherapy and chemotherapy are commonly used or treatment of cancer. Unfortunately, these treatments frequently cause acute and/or long-term bone marrow (BM) injury that can adversely affect the quality of life and the course of treatment. Our recent studies suggest that induction of hematopoietic stem cell (HSC) senescence by ionizing radiation (IR) and certain chemotherapeutic agents may contribute to long-term BM injury by impairing the ability of HSCs to self-renew. This suggestion is in agreement with a growing body of evidence demonstrating that HSCs from Bmi-1(-/-) and ATM(-/-) mice can lose their ability to self-renew by undergoing premature senescence. Interestingly, IR and different chemotherapeutic agents may induce HSC senescence and long-term BM injury in an agent-specific manner by activation of the p53-p21 and/or p16-Rb pathways. It will be of a great interest to determine if inhibition of these pathways can ameliorate radiotherapy and chemotherapy induced long-term BM injury.

Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life, and although the use of 5-hydroxytryptamine3 (5-HT3) receptor antagonists plus dexamethasone has significantly improved the control of acute CINV, delayed nausea and vomiting remain a significant clinical problem. Aprepitant is the first agent available in the new drug class of neurokinin-1 receptor antagonists. When added to a standard regimen of a 5-HT3 receptor antagonist and dexamethasone in patients receiving highly emetogenic chemotherapy, it improves the complete response rate of acute CINV. Aprepitant also improves the complete response of delayed CINV when used in combination with dexamethasone compared to dexamethasone alone. The use of aprepitant in patients receiving moderately emetogenic chemotherapy will await the review and analysis of recently completed phase III trials. The control of nausea is improved in some studies with the use of aprepitant when it is combined with a 5HT3 receptor antagonist and dexamethasone, but nausea control remains suboptimal. The current data suggest that the mechanism of action of the NK-1s appears to be different from the 5-HT3 receptor antagonists. Future studies may explore the use of aprepitant and other NK-1s in moderately and highly emetogenic chemotherapy, as well in the clinical settings of multiple-day chemotherapy and bone marrow transplantation.

Anticancer therapies can induce autophagy in tumor cells and the role of autophagy in these cells may depend on the type of tumor, the stage of tumorigenesis, and the nature and extent of the insult. Appropriate modification of autophagy, that is, suppression of cell-protective autophagy or enhancement of cell-killing autophagy could augment cytotoxicity caused by anticancer therapy. Imatinib mesylate is an inhibitor of tyrosine kinases and is used for the therapy of patients with tumors including leukemias, but is not effective as a monotherapy for malignant glioma. To seek a strategy to augment the therapeutic efficacy of imatinib, we examined the mode of cytotoxicity of imatinib in human malignant glioma cells. Since imatinib induced cytotoxicity associated with autophagy, we tested the effect of inhibition of autophagy on imatinib-induced cytotoxicity. We found that imatinib-induced cytotoxicity is attenuated by inhibition of autophagy at an early stage but augmented by inhibition of autophagy at a late stage through increasing apoptosis following mitochondrial damage. Though the mechanism of the stage-specific effect of inhibiting autophagy on cytotoxicity remains to be elucidated, our findings could be useful for developing a new strategy to enhance the efficacy of anticancer therapy by modulating autophagy.

Chemotherapeutic agents administered for the treatment of malignancies can result in the incidence of premature ovarian failure (POF). Ovarian failure is reflected by elevated serum follicle-stimulating hormone (FSH) levels that may reach menopausal levels, at which the chances of a pregnancy are considered extremely rare. We report a case of a 26-year-old female who experienced two successful pregnancies, despite her diagnosis with chemotherapy-induced POF. This case suggests that patients who suffer from POF secondary to chemotherapy might still retain enough ovarian function with good quality oocytes that could support a healthy pregnancy.

(1991). Effects of Ondansetron on Chemotherapy-induced Acute and Delayed Emesis—A Pilot Study. Acta Oncologica: Vol. 30, No. 5, pp. 649-651.

Feng-Yi Yang1, Ming-Che Teng1, Maggie Lu2, Hsiang-Fa Liang2, Yan-Ru Lee1, Chueh-Chuan Yen3, Muh-Lii Liang4,5, Tai-Tong Wong51Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, 2Drug Delivery Laboratory, Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, 3Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, 4Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, 5Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, TaiwanBackground: High-dose tissue-specific delivery of therapeutic agents would be a valuable clinical strategy. We have previously shown that repeated transcranial focused ultrasound is able to increase the delivery of Evans blue significantly into brain tissue. The present study shows that repeated pulsed high-intensity focused ultrasound (HIFU) can be used to deliver high-dose atherosclerotic plaque-specific peptide-1 (AP-1)-conjugated liposomes selectively to brain tumors.Methods: Firefly luciferase (Fluc)-labeled human GBM8401 glioma cells were implanted into NOD-scid mice. AP-1-conjugated liposomal doxorubicin or liposomal doxorubicin alone was administered followed by pulsed HIFU and the doxorubicin concentration in the treated brains quantified by fluorometer. Growth of the labeled glioma cells was monitored through noninvasive bioluminescence imaging and finally the brain tissue was histologically examined after sacrifice.Results: Compared with the control group, the animals treated with 5 mg/kg injections of AP-1 liposomal doxorubicin or untargeted liposomal doxorubicin followed by repeated pulsed HIFU not only showed significantly enhanced accumulation of drug at the sonicated tumor site but also a significantly elevated tumor-to-normal brain drug ratio (P < 0.001). Combining repeated pulsed HIFU with AP-1 liposomal doxorubicin or untargeted liposomal doxorubicin has similar antitumor effects.Conclusion: This study demonstrates that targeted or untargeted liposomal doxorubicin, followed by repeated pulsed HIFU, is a promising high-dose chemotherapy method that allows the desired brain tumor region to be targeted specifically.Keywords: repeated focused ultrasound, interleukin-4 receptor, blood-brain barrier, brain tumor, target drug delivery

(2008). CHEMOTHERAPY-INDUCED DIFFUSE MELANONYCHIA. Acta Clinica Belgica: Vol. 63, No. 6, pp. 427-427.