Search

Aims Background: Temozolomide is an oral chemotherapy drug widely used in the treatment of glial tumours. This is generally well tolerated however, immediate and delayed hypersensitivity reactions have been described, necessitating treatment interruption that could significantly impact survival. Method Case description: We report a case of a 39-year-old young woman with WHO grade 2 IDH1mutant diffuse astrocytoma (MGMT promoter methylated) of the left temporal lobe. She had tumour resection in 2012 followed by radical radiotherapy. Afterwards, she had close surveillance with regular brain imaging. The tumour started to progress in early 2020. We agreed to commence on temozolomide to control tumour growth. She developed an itchy rash with easy bruising towards the end of the first cycle. It responded to a course of prednisolone. We proceeded with the second cycle and she developed a worsening rash on the third day. However she did not have signs or symptoms of anaphylaxis. This episode was again managed by a course of steroids and oral antibiotics. Since Temozolomide was the optimal treatment to control the disease progression at this stage, we agreed to persevere with temozolomide using a rapid desensitisation protocol. Results On the first day of third cycle, she was brought to the day chemotherapy unit and given prednisolone 30mg, fexofenadine 180mg and ondansetron 8mg, 30 minutes before the treatment. Our protocol was as follows; 5mg, 10mg, 20mg, 30mg, 50mg and 90mg of temozolomide at an interval of 30 minutes between the doses. She was advised to follow the same regime for the next four days of the third cycle. On days 6 -28, she has been advised to take fexofenadine 180mg once daily. Although there was a minor rash appeared on days 6/7, they subsided gradually. She tolerated the treatment without sinister symptoms or signs. We proceeded with the next 4 chemotherapy cycles adhering to the same protocol. The intensity of the rash gradually improved, and she became almost completely asymptomatic by the 7th cycle. It was also encouraging to see the radiological response of the tumour with the treatment. Conclusion Although the published literature is minimal, rapid desensitisation is shown to be a safe and effective method to counteract temozolomide hypersensitivity. In an era where there is still a paucity of systemic treatment options for primary brain tumours, adopting rapid desensitisation to induce tolerability to temozolomide, a drug which has shown to improve survival, would be a valuable addition in managing our patients. Further, our experience suggests that this protocol is safe, effective, and does not necessitate inpatient admission.

Introduction: Previous research has shown that nurses are not meeting recommended moderate-to-vigorous intensity PA (MVPA) guidelines (≥150 minutes/week) for optimal cardiovascular disease risk reduction. Socio-ecological approaches have been used to explore the determinants of PA levels. We examined personal, social and environmental factors associated with the MVPA levels of Canadian nurses. Methods: Secondary analysis of data from a multi-site cross-sectional study was undertaken. Nurses were recruited from 14 hospitals in Ontario, Canada. An accelerometer (ActiGraph GT3X) was used to measure MVPA levels (minutes/day). Socio-ecological variables were derived from sociodemographic, anthropometric and cardiometabolic data, and questionnaires assessing determinants of PA (Table 1). Multivariate generalized estimating equations (GEE) were used to explore associations between socio-ecological variables and MVPA levels while accounting for hospital sites. Variables were selected for multivariate analyses if they were significant ( p Results: A total of 257 nurses (42±12 years) had complete accelerometer (≥10 hours of wear time for ≥4 days) and questionnaire data. Of these nurses, 54% were overweight/obese and 6% were smokers. Multivariate analyses showed positive associations between MVPA levels and high perceived capability to exercise despite common barriers (e.g. poor weather; β=0.13, p =0.02) and feeling connected to their exercise peers (β=1.34, p =0.01). Greater shiftwork associated daytime sleepiness and/or insomnia were inversely associated with MVPA levels (β=-4.87, p Conclusion: Future endeavors to accentuate nurses’ PA levels should address modifiable socio-ecological variables such as encouraging exercise despite common barriers, and with peers to whom they feel connected. Nurses should consider increasing time spent engaging in MVPA to minimize the negative effects of shiftwork.