science news: Menopause clinicians support new advice on steroid use (Corticosteroids/glucocorticoids)

Menopause clinicians support new advice on steroid use

 (Corticosteroids/glucocorticoids)


.............Dr Tobie de Villiers, President of the International Menopause Society (IMS), commented, "Bone loss is a concern for all women around the age of menopause, and especially for the almost 5% of postmenopausal women worldwide who take oral glucocorticoid therapy. The IMS encourages women to be aware of this potentially dangerous side-effect of therapy and to discuss what precautions can be taken with their doctors."
Continuing, Dr de Villiers said "The ovaries stop producing estrogen around the time of the menopause, meaning that women find that the risk of bone loss and osteoporosis increases. This is already difficult for many women to cope with, so we need to be especially careful that the medicines which women take for other conditions don't actually harm women's bones. Glucocorticoids are important and valuable medicines, but like all medicines they have side effects and their use must be customised and monitored. Women, especially women after their menopause, need to be more aware of the possibility of this serious side-effect. These guidelines are aimed at allowing national organisations to develop effectively."

Commentary: Aromatase inhibitors and musculoskeletal adverse events : The Lancet Oncology

Aromatase inhibitors and musculoskeletal adverse events : The Lancet Oncology

".........Because symptom collection is so variable between trials, researchers could look for correlations between changes in patient-reported quality of life and breast-cancer outcomes. Nevertheless, if clinical research confirms a link between emergent symptoms or changes in quality of life and breast-cancer outcomes, further pharmacogenomic and pharmacogenetic studies could help to elucidate the mechanisms. Although confirmation of the association between emergent symptoms with aromatase inhibitors and risk of breast-cancer recurrence would help to guide clinical advice, based on current evidence clinicians should not use the onset of musculoskeletal symptoms to infer which patient will, or will not, benefit from adjuvant treatment with aromatase inhibitors."

open access (pdf) Underestimating Cardiac Toxicity in Cancer Trials: Lessons Learned?

Underestimating Cardiac Toxicity in Cancer Trials:Lessons Learned?

Sunitinib (Sutent; Pfizer, New York, NY) represents one of the
most successful cancer therapies, with US Food and Drug Administration (FDA) approval for three malignancies and ongoing trials in more than 30 tumor types.1,2 It also represents an instructive example revealing how adverse events can be vastly underestimated. The purpose of this article is to critically evaluate the history of the underrecognition of the cardiac toxicity of sunitinib and to propose solutions to improve adverse event monitoring for future therapies.......

"Cardiac toxicity from a wide variety of tyrosine kinase inhibitors
is now recognized to be of importance, with toxicity observed
from both on- and off-target effects. In the case of sunitinib, which
inhibits more than 50 kinases, mechanisms likely include inhibition
of angiogenesis and disturbances of mitochondrial structure
and energy metabolism—both potentially similarly important for
tumor proliferation.11,13"

abstract: Critical Reviews in Oncology/Hematology - Chemotherapy-induced peripheral neurotoxicity (CIPN): An update

Critical Reviews in Oncology/Hematology - Chemotherapy-induced peripheral neurotoxicity (CIPN): An update

Abstract

The peripheral nervous system can be vulnerable to the toxic action of several drugs since it is not protected as effectively as the central nervous system from noxious exogenous agents. Drug-induced neurotoxicity can affect the nerve fibers or the neuronal bodies (generally the dorsal root ganglia of the primary sensory neurons). Among the neurotoxic drugs antineoplastic agents represent a major clinical problem, given their widespread use and the potential severity of their toxicity. In fact, the peripheral neurotoxicity of antineoplastic agents frequently represents one of their dose-limiting side effects. 

Moreover, even when antineoplastic agents’ peripheral neurotoxicity is not dose-limiting, its onset may severely affect the quality of life of cancer patients and cause chronic discomfort. 

Among the anticancer chemotherapy drugs, platinum derivates, antitubulins, thalidomide and bortezomib can induce the most severe effects on the peripheral nervous system of the treated patients. Therefore, we will review the features of chemotherapy-induced peripheral neurotoxicity (CIPN) resulting from the administration of these drugs with a focus on new classes of promising antineoplastic agents, such as epothilones and proteasome inhibitors.

Oral Cancer Drugs Not Effective When Mixed With Some Other Medications - MediLexicon

Oral Cancer Drugs Not Effective When Mixed With Some Other Medications - MediLexicon

...........The cancer drugs which the researchers studied are called oral kinase inhibitors. They included:

• imatinib (Gleevec®)
• erlotinib (Tarceva®)
• dasatinib (Sprycel®)
• everolimus (Afinitor®)
• lapatinib (Tykerb®)
• nilotinib (Tasigna®)
• pazopanib (Votrient®)
• sorafenib (Nexavar®)
• sunitinib (Sutent®)

The medications that pose a threat to the effectiveness of oncology drugs are:

• calcium channel blockers
• some antibiotics
• antifungal agents
• steroids
• proton pump inhibitors..........

Drug data reveal sneaky side effects : Nature News & Comment

Drug data reveal sneaky side effects : Nature 

 Mining of surveillance data highlights thousands of previously unknown consequences when drugs are taken together.

14 March 2012

An algorithm designed by US scientists to trawl through a plethora of drug interactions has yielded thousands of previously unknown side effects caused by taking drugs in combination.
The work, published today in Science Translational Medicine¹, provides a way to sort through the hundreds of thousands of 'adverse events' reported to the US Food and Drug Administration (FDA) each year. “It’s a step in the direction of a complete catalogue of drug–drug interactions,” says the study's lead author, Russ Altman, a bioengineer at Stanford University in California.........“Even if you show a drug is safe in a clinical trial, that doesn’t mean it’s going to be safe in the real world,” says Paul Watkins, director of the Hamner–University of North Carolina Institute for Drug Safety Sciences in Research Triangle Park, North Carolina, who was not involved in the work. “This approach is addressing a better way to rapidly assess a drug’s safety in the real world once it is approved.”.....

A Heart Helper May Come at a Price for the Brain - NYTimes.com

"Statins are the most prescribed drugs in the world, and there is no doubt that for people at high risk of cardiovascular problems, the drugs lower not only cholesterol but also the risk of heart attack and stroke. But for years doctors have been fielding reports from patients that the drugs leave them feeling “fuzzy,” and unable to remember small and big things, like where they left the car, a favorite poem or a recently memorized presentation. Last week, the Food and Drug Administration finally acknowledged what many patients and doctors have believed for a long time: Statin drugs carry a risk of cognitive side effects. The agency also warned users about diabetes risk and muscle pain...........

Correspondence: Emergency Hospitalizations for Adverse Drug Events — NEJM

To the Editor:

"We commend Budnitz and colleagues (Nov. 24 issue)1 for their contribution to our understanding of emergency hospitalizations caused by adverse drug events. However, as a result of detection bias, it is likely that the relative contribution of bleeding and hypoglycemic manifestations of adverse drug events have been overestimated and that the overall burden of disease has been underestimated. This is because the case-finding methods at institutions participating in the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project rely on coders who use a short list of symptoms that include “bleeding” and “hypoglycemia” to identify adverse drug events.2 Other commonly found manifestations of adverse drug events, such as neuropsychiatric, gastrointestinal, and cardiovascular symptoms, are not listed as triggers and therefore are less likely to be identified.3
In addition, emergency physicians frequently do not attribute emergency department presentations to adverse drug events, which leads to a lack of documentation in hospital records.4 Validation of the triggers in the NEISS-CADES project against a prospective criterion standard would enable a better estimate of the sensitivity of such measures. Prospective case-finding methods may yield more accurate data on the frequency and causes of adverse drug events and on the relative contribution of various adverse drug events to the overall disease burden."

March 2011 (Cancer) The use of recombinant erythropoietin for the treatment of chemotherapy-induced anemia in patients with ovarian cancer does not affect progression-free or overall survival

Abstract
BACKGROUND.

Studies have suggested that erythropoietin-stimulating agents (ESAs) may affect progression-free survival (PFS) and overall survival (OS) in a variety of cancer types. Because this finding had not been explored previously in ovarian or primary peritoneal carcinoma, the authors of this report analyzed their ovarian cancer population to determine whether ESA treatment for chemotherapy-induced anemia affected PFS or OS.

CONCLUSIONS.

The current results indicated that there was no difference in cancer-related PFS or OS with use of ESA in this cohort of women treated for ovarian cancer.

EvidenceUpdates - Bevacizumab (Avastin) increases risk for severe proteinuria in cancer patients including professional commentaries

article link:
http://plus.mcmaster.ca/EvidenceUpdates/NewArticles.aspx?Page=1&ArticleID=35795#Data

abstract link:
http://www.ncbi.nlm.nih.gov/pubmed/20538785?dopt=Abstract

Research: Effect of Anaesthetic and Other Perioperative Factors on Cancer Recurrence: Abstract and Introduction

Note: in research; long article

Role of Vitamin and Mineral Supplementation and Aspirin Use in Cancer Survivors (abstract)

Note: abstract does not reference ovarian cancer "The potential beneficial or adverse effects of dietary supplements and aspirin in survivors of cancer warrant further study."

Author's Reply to Correspondence: Endocrine Effects of Aromatase Inhibitors Journal of Clinical Oncology

" It is somehow astonishing that after approximately 15 years from the first clinical article on anastrozole, exemestane, and letrozole, we still have insufficient or weak knowledge of some of the consequences of their long-term use."

news item: Paxil Blocks Tamoxifen Lowers Survival Odds Against Breast Cancer - Breast Cancer

"Patients taking Paxil and tamoxifen should talk with their doctors about changing their antidepressant, Juurlink said. But he advised against abruptly discontinuing Paxil.
"There is a very real danger to stopping Paxil suddenly. There is a well-described withdrawal syndrome and the risk of depression becoming more severe," he said.
In addition, any transition to another antidepressant should be done gradually over several weeks, he said."

The Practice of Gastrostomy Tube Placement Across a Canadian Regional Health Authority

abstract: Association of Skeletal Muscle Wasting With Treatment With Sorafenib

Note: this study is not specific to ovarian cancer but may be of interest for those deciding on Sorafenib: