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Cannabidiol (CBD) in Cancer Management.

The plant Cannabis sativa has been in use medicinally for several thousand years. It has over 540 metabolites thought to be responsible for its therapeutic effects. Two of the key phytocannabinoids are cannabidiol (CBD) and tetrahydrocannabinol (THC). Unlike THC, CBD does not have potentially intoxicating effects. Preclinical and clinical research indicates that CBD has a wide range of therapeutic effects, and many of them are relevant to the management of cancer. In this article, we explore some of the potential mechanisms of action of CBD in cancer, and evidence of its efficacy in the integr

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… The National Academies of Sciences, Engineering and Medicine 2017 report on cannabis and cannabinoids which used only evidence from systematic reviews and randomised controlled trials (RCTs) concluded that there is conclusive or substantial evidence that oral cannabinoids are effective anti-emetics in … Parker reports that animal studies have found CBD can suppress nausea and vomiting within a limited dosage range, with the anti-nausea/emetic effects potentially mediated via indirect activation of somatodentritic 5-HT 1A receptors in the dorsal raphe nucleus which reduces release of 5-HT in terminal …

Provider billing margin and cancer treatment selection: population based cohort study.

ObjectiveTo estimate the association between the billing (profit) margin and clinical benefit of cancer treatments and use by oncologists.DesignRetrospective population based cohort study SETTING: Population based sample using fee-for-service Medicare claims data.ParticipantsMedicare beneficiaries with an incident cancer diagnosis from 2015 to 2020; included all patients with cancer treatment indications for which the available treatment options varied in clinical benefit and billing margin.Main outcomes and measuresThe primary outcome was the cancer treatment each patient received among treat

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… We included guideline concordant supportive care drugs (growth factors and anti-emetics). …

Challenges for cancer patients returning home during SARS-COV-19 pandemic after medical tourism - a consensus report by the emirates oncology task force.

BackgroundThe COVID-19 pandemic has caused a global health crisis. Numerous cancer patients from non-Western countries, including the United Arab Emirates (UAE), seek cancer care outside their home countries and many are sponsored by their governments for treatment. Many patients interrupted their cancer treatment abruptly and so returned to their home countries with unique challenges. In this review we will discuss practical challenges and recommendations for all cancer patients returning to their home countries from treatment abroad.MethodExperts from medical, surgical and other cancer subsp

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… Patients who have received palliative care input abroad for symptom control usually return to the UAE with a small supply of medication, including opioid analgesics, anti-emetics, neuropathic pain medicines and sedatives. …

Multiple myeloma: an overview of management.

Multiple myeloma represents 2% of all new cancer diagnoses in the United Kingdom and accounts for 2% of all cancer deaths. In the past few decades, there have been huge improvements in life expectancy which have been driven by novel therapeutic agents, autologous stem cell transplants and intensified supportive care. This review will discuss the pathogenesis of multiple myeloma, current management approaches and the direction of future treatments. In addition, this review will highlight the high burden of symptoms that patients experience and therefore the great benefits that can be gained fro

Ventricular Arrhythmia in Cancer Patients: Mechanisms, Treatment Strategies and Future Avenues.

Cardiovascular disease and cancer are the leading causes of morbidity and mortality in the US. Despite the significant progress made in cancer treatment leading to improved prognosis and survival, ventricular arrhythmias (VA) remain a known cardiovascular complication either exacerbated or induced by the direct and indirect effects of both traditional and novel cancer treatments. Although interruption of cancer treatment because of VA is rarely required, knowledge surrounding this issue is essential for optimising the overall care of patients with cancer. The mechanisms of cancer-therapeutic-i

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… cause prolonged QTc. 14 , 15 Additionally, confounding factors, such as electrolyte abnormalities, exacerbated by gastrointestinal adverse effects, such as nausea, vomiting and diarrhoea, as well as polypharmacy with medications, such as analgesics, antibiotics, antifungals, anti-depressants and anti-emetics …

A Phase II Study of the Efficacy and Safety of Oral Selinexor in Recurrent Glioblastoma.

PURPOSE: Selinexor is an oral selective inhibitor of exportin-1 (XPO1) with efficacy in various solid and hematologic tumors. We assessed intratumoral penetration, safety, and efficacy of selinexor monotherapy for recurrent glioblastoma. PATIENTS AND METHODS: Seventy-six adults with Karnofsky Performance Status ≥ 60 were enrolled. Patients undergoing cytoreductive surgery received up to three selinexor doses (twice weekly) preoperatively (Arm A; n = 8 patients). Patients not undergoing surgery received 50 mg/m2 (Arm B, n = 24), or 60 mg (Arm C, n = 14) twice weekly, or 80 mg once weekly (Arm

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… Study-related toxicities were managed using 5–hydroxytryptamine receptor 3 (5-HT3) antagonists and/or other anti-emetics, analgesics, short courses of low-dose oral steroids, and anti-diarrheal agents, as recommended in the study protocol. …

A phase I/II trial of hydroxychloroquine in conjunction with radiation therapy and concurrent and adjuvant temozolomide in patients with newly diagnosed glioblastoma multiforme.

Preclinical studies indicate autophagy inhibition with hydroxychloroquine (HCQ) can augment the efficacy of DNA-damaging therapy. The primary objective of this trial was to determine the maximum tolerated dose (MTD) and efficacy of HCQ in combination with radiation therapy (RT) and temozolomide (TMZ) for newly diagnosed glioblastoma (GB). A 3 + 3 phase I trial design followed by a noncomparative phase II study was conducted in GB patients after initial resection. Patients received HCQ (200 to 800 mg oral daily) with RT and concurrent and adjuvant TMZ. Quantitative electron microscopy and immun

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… Despite polypharmacy in this patient population, which included coadministration of corticosteroids, trimethoprim-sulfamethoxazole, and anti-emetics, the HCQ concentrations in whole blood from groups of patients receiving the same dose did not show a significant time-dependent trend ( Fig. S4A ). …

Outpatient CAR T-Cell Therapy as Standard of Care: Current Perspectives and Considerations.

Chimeric antigen receptor T-cell therapy (CAR-T) has altered the treatment landscape of several hematologic malignancies. Until recently, most CAR-T infusions have been administered in the inpatient setting, due to their toxicity profile. However, the advent of new product constructs, as well as improved detection and management of adverse effects, have greatly increased the safety in administering these therapies. CAR-T indications continue to expand, and inpatient administration is associated with increased healthcare resource utilization and overall cost. Therefore, transitioning CAR-T admi

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… off overnight updates and events to RN and/or APP RN reviews vital signs, performs neuro assessment and wellbeing assessment Provider assesses patient on outpatient CAR-T rounds RN provides supportive care measures per protocols as necessary (hydration, antimicrobials, electrolyte replacements, anti-emetics …

Current Data and Future Perspectives on Patients with Atrial Fibrillation and Cancer

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Quality of life and supportive care in multiple myeloma.

UnlabelledMultiple myeloma is the second most common haematological malignancy. Novel therapies have led to improvement in survival. Current myeloma management is matching the progress made in improved survival through disease control while optimising quality of life with effective supportive care. Supportive treatment is an essential part of the therapeutic management of myeloma patients because it is directed towards improving the patient's quality of life and also can improve survival. The aim of this review is to highlight the relationship among life of quality, supportive care, and improv

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… Adjuvant medications such as corticosteroids, anti-emetics, neuroleptics, antidepressants, and benzodiazepines should be given as required [ 32 ]. Supportive Care for Thromboembolism Myeloma and other plasma cell disorders have an association with venous thromboembolism (VTE) [ 59 ]. …

Cancer cachexia--pathophysiology and management.

About half of all cancer patients show a syndrome of cachexia, characterized by anorexia and loss of adipose tissue and skeletal muscle mass. Cachexia can have a profound impact on quality of life, symptom burden, and a patient's sense of dignity. It is a very serious complication, as weight loss during cancer treatment is associated with more chemotherapy-related side effects, fewer completed cycles of chemotherapy, and decreased survival rates. Numerous cytokines have been postulated to play a role in the etiology of cancer cachexia. Cytokines can elicit effects that mimic leptin signaling a

Total Body Irradiation in Haematopoietic Stem Cell Transplantation: A Comprehensive Literature Review and Institutional Experience from the Policlinico of Catania.

Background and Objectives: Total body irradiation (TBI) remains a cornerstone of conditioning for allogeneic haematopoietic stem-cell transplantation (HSCT). Whereas early research debated the need for irradiation, contemporary investigations focus on optimising dose, fractionation and delivery techniques. Material and Methods: We synthesised six decades of evidence, spanning from single-fraction cobalt treatments to modern helical tomotherapy and intensity-modulated total-marrow/lymphoid irradiation (TMI/TMLI). To complement the literature, we reported our institutional experience on 77 paedi

Gastrointestinal toxicities of proteasome inhibitor therapy.

PurposeProteasome inhibitors (PIs), which cause cell death via tumor suppressor and pro-apoptotic proteins, are integral to treatment of many hematologic malignancies but are limited by their gastrointestinal adverse effects. Evidence regarding these PI-related adverse effects is scant. In this study, we evaluated gastrointestinal adverse events caused by PIs and compared gastrointestinal toxicities between bortezomib, carfilzomib, and ixazomib.MethodsWe conducted a retrospective study of cancer patients treated with PIs at a tertiary care cancer center to investigate the clinical characterist

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… Adverse event treatment, clinical course, and outcomes In all 3 PI groups, the majority of patients were treated with supportive measures, such as intravenous fluids, anti-emetics, and antidiarrheals (79.2–83.3%). …

Analysis of Factors Associated with Hiccups Using the FAERS Database.

In this study, we used the large number of cases in the FDA adverse-event reporting system (FAERS) database to investigate risk factors for drug-induced hiccups and to explore the relationship between hiccups and gender. From 11,810,863 adverse drug reactions reported between the first quarter of 2004 and the first quarter of 2020, we extracted only those in which side effects occurred between the beginning and end of drug administration. Our sample included 1454 adverse reactions for hiccups, with 1159 involving males and 257 involving females (the gender in 38 reports was unknown). We perfor

High-dose chemotherapy and autologous stem cell transplantation of patients with multiple myeloma in an outpatient setting.

BACKGROUND: High-dose (HD) chemotherapy with melphalan and autologous blood stem cell transplantation (ABSCT) for treatment of symptomatic multiple myeloma (MM) on an outpatient basis has been well established in the USA and Canada, whereas in Germany and Western Europe an inpatient setting is the current standard. We report on a German single-centre program to offer the procedure on an outpatient basis to selected patients. METHODS: Major requirements included: patients had to have family and/or other caregivers, had to be able to reach the hospital within 45 min and have an ECOG performance

Moving Beyond G-CSF Mobilization-Learning From a 15-Year Experience of Different Stem Cell Mobilization Regimens in Multiple Myeloma.

BackgroundStem-cell mobilization in multiple myeloma is usually done with G-CSF with or without Cyclophosphamide (Cy) based chemotherapy/Plerixafor. Pre-clinical data suggest the role of proteasome inhibitors in mobilization. We previously reported that Bortezomib (Bort) when added to a Cy-based regimen had a better stem-cell yield. Consequent to favorable results with Bort + Cy-G-CSF, we used Bortezomib with G-CSF too. Hence, four different mobilization regimens were used-Bort + G-CSF (Group-1); G-CSF + Plerixafor (Group-2); Bort - Cy-G-CSF (Group-3); Cy + G-CSF (Group-4). We report here our

Maintenance Strategies Post-Autologous Stem Cell Transplantation for Newly Diagnosed Multiple Myeloma.

Multiple myeloma, the second most common hematological malignancy worldwide, has demonstrated dramatic improvements in outcome in the last decade. In newly diagnosed patients, induction chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard of care. After ASCT, the majority of patients experience disease remission but, despite recent therapeutic developments, most will eventually relapse. In this review we consider clinical aspects of maintenance therapies that can be used post-ASCT to prolong remission duration. We discuss the evidence for the effectiveness of ea

Управление неблагоприятными событиями, связанными с комбинациями на основе помалидомида у пациентов с повторной/редактируемой множественной миеломой.

Многоагентные режимы с иммуномодуляционными (IMID) агентами, такими, как палидомид, линалидомид и помалидомид, стали предпочтительным стандартом лечения пациентов с множественной миеломой (MM), что позволило улучшить показатели выживания. В настоящее время существуют three Агенты IMID, утвержденные для лечения MM: талидомид, линалидомид и помалидомид. Леналидомид обычно используется для лечения пациентов с недавно поставленным диагнозом MM, а также для лечения после пересадки стволовых клеток или после рецидива заболевания. Помалидомид, в центре внимания которого находится данный обзор, утверж

Phase 1 study of selinexor plus carfilzomib and dexamethasone for the treatment of relapsed/refractory multiple myeloma.

Selinexor, an oral Selective Inhibitor of Nuclear Export, targets Exportin 1 (XPO1, also termed CRM1). Non-clinical studies support combining selinexor with proteasome inhibitors (PIs) and corticosteroids to overcome resistance in relapsed/refractory multiple myeloma (RRMM). We conducted a phase I dose-escalation trial of twice-weekly selinexor in combination with carfilzomib and dexamethasone (SKd) to determine maximum tolerated dose in patients with RRMM (N = 21), with an expansion cohort to assess activity in carfilzomib-refractory disease and identify a recommended phase II dose (RP2D). Du

Preclinical evaluation of the novel, orally bioavailable Selective Inhibitor of Nuclear Export (SINE) KPT-335 in spontaneous canine cancer: results of a phase I study.

BackgroundThe purpose of this study was to evaluate the activity of Selective Inhibitors of Nuclear Export (SINE) compounds that inhibit the function of the nuclear export protein Exportin 1 (XPO1/CRM1) against canine tumor cell lines and perform a Phase I clinical trial of KPT-335 in dogs with spontaneous cancer to provide a preliminary assessment of biologic activity and tolerability.Methods and findingsCanine tumor cell lines derived from non-Hodgkin lymphoma (NHL), mast cell tumor, melanoma and osteosarcoma exhibited growth inhibition and apoptosis in response to nanomolar concentrations o