Capecitabina: Formulação Magistral

Topical aloe vera for the treatment of cetuximab-related acneiform rash in colorectal cancer: A case report

Mustafa Gu¨rbu¨z, Faculty of Medicine, Department of Medical Oncology, Ankara University, Ankara TR06100, Turkey. 

Email: drgurbuz123@gmail.com

Abstract

 

Introduction: Colorectal cancer is one of the most common cancers in the world. Cetuximab is an epidermal growth factor receptor (EGFR) inhibitor which provides survival benefit when combined with chemotherapy in RAS wild type metastatic colorectal cancer. Cutaneous toxicities associated with cetuximab have a significant impact on patient quality of life, treatment continuation and healthcare resource utilization. 

Case report: A 60-year-old male patient presented with fatigue, weight loss and abdominal pain. Two closely located malignant polypoid lesions were detected in the sigmoid colon, and pathological examination revealed colonic adenocarcinoma.

Management and outcome: Thorax, abdominal and pelvic computed tomography showed metastases. FOLFOX chemotherapy and cetuximab were started. The patient developed acneiform rash firstly in his face, although prophylactic vitamin K1 0.1% containing cream was given. He was given mild potency topical corticosteroid and doxycycline. The lesions progressed to his front and back body. He did not want to use topical vitamin K1 cream, topical steroid and doxycycline tablets. Instead, he wanted to use aloe vera extract which he produced from the leaves of the plant. Patient’s lesions were regressed significantly.

Discussion: The most common and earliest skin toxicity is acneiform rash which affects 60 to 80% of the patients. In this case, cetuximab-related severe acneiform rash was effectively treated by topical aloe vera. Topical aloe vera may be used in the management of cetuximab-related cutaneous toxicities without any side effect. Here, we have presented a case of cetuximab-related acneiform rash which regressed by topical aloe vera. Skin lesions on the body, face and neck are common side effects of cetuximab. These side effects generally occur in the second week of the treatment and regress when the treatment is discontinued.11 The common cutaneous toxicities include xerosis (dry skin), fissures, pruritus, eczema, skin infections and urticaria; nail conditions such as paronychia (suppurative inflammation around the nails) and hair-growth abnormalities, including trichomegaly. The most common and earliest skin toxicity is acneiform rash which affects 60 to 80% of the patients.8 Our patient developed acneiform rash at first week and progressed to maximum level at second week (Naranjo score: 7).

Conclusion In this case, cetuximab-related severe acneiform rash was effectively treated by topical aloe vera. Because it is crucial to give cetuximab without any dose modification and treatment delay, topical aloe vera may be used in the management of cetuximab-related cutaneous toxicities without any side effect. Prospective controlled studies may be designed to test this beneficial effect.

Keywords Colorectal cancer, cetuximab, aloe vera

J Oncol Pharm Practice

Mucosite: formulação magistral.

Anfotericina B: Diferenças nas apresentações do produto.

Tabela informativa da administração de medicamentos pela via subcutânea direta ou contínua

Serviço de Farmácia. Hospital Universitário Antonio Pedro - Niterói (RJ), Brasil 

Objetivo: Elaborar uma tabela de medicamentos que podem ser utilizados via SC. A ANVISA não definiu estas informações nas bulas dos medicamentos. Existem diversos medicamentos que podem ser administrados pela via subcutânea, mas ainda é necessária a realização de novos estudos para avaliar a segurança e a efetividade de outros grupos farmacológicos e assegurar uma prática baseada em evidência. A administração de medicações via SC tem duas denominações: administração intermitente (intermittent SC injection-ISCI) e contínua (continuous SC injectionCSCI). A administração de grande volume de fluidos é denominada hipodermóclise (HDC). 

Métodos: Realizou-se em maio de 2018, busca em sites especializados de hospitais universitários e para os seguintes descritores: hipodermóclise, médicaments administrés régulièrement par voie sous-cutanée, subcutânea, soins palliatifs par voie sous-cutanée. 

Resultados: Registrados na Suiça, Inglaterra, França, Alemanha uso via subcutânea: Alfentanila, Amicacina, Atropina, Buprenorfina, Ceftriaxona, Clonazepam, Dexametasona, Fenobarbital, Fentanila, Haloperidol, Hidromorfona, Hioscina, Ketamina, Ketorolaco, Levomepromazina, Meperidina, Metadona, Metoclopramida, Midazolam, Morfina, Octreotida, Ondansetrona, Oxicodona, Papaverina, Petidina, Prometazina, Ranitidina, Tramadol. Registrados na Suiça para uso via subcutânea: Alfainterferona, Atropina, Butilescopolamina, Clonidina, Citarabina, Dexferroxamina, Dexametasona, Efedrina, Epinefrina, Filgrastim, Glucagon, Imunoglobulina, Lenograstim, Metadona, Metilergometrina, Morfina, Nalbufina, Naloxona, Neostigmina, Octreotida, Petidina, Salbutamol, Tramadol, Vitamina B6, Vitamina B12. Relatos na literatura uso SC: Alentuzumabe, Alfentanila, Amicacina, Buprenorfina, Cefepima, Ceftriaxona, Clodronato, Clonazepam, Clorazepato, Desmopressina, Diclofenaco, Ertapenem, Esomeprazol, Fenobarbital, Fitomenadiona, Fentanila, Fludarabina, Furosemida, Granisetrona, Haloperidol, Hidromorfona, Ketamina, Ketorolaco, Levomepromazina, Mesna, Metotrexato, Metilprednisolona, Metoclopramida, Omeprazol, Ondansetrona, Ranitidina, Sufentanila, Teicoplanina, Tobramicina. 

Conclusão: A administração de medicamentos e soluções pela via subcutânea é uma alternativa segura e eficaz.

Revista Brasileira de Terapia Intensiva. Suplemento I. 2018. Resumos dos trabalhos científicos apresentados no XXIII CONGRESSO BRASILEIRO DE MEDICINA INTENSIVA. São Paulo. 2018.

Experiencia de uso de brentuximab vedotina en monoterapia o en combinación con bendamustina en linfoma de Hodgkin y linfoma anaplásico de células grandes

Conesa Nicolás E, Martínez Penella M, Gutiérrez-Meca Maestre MD, Mira Sirvent MC

Servicio de Farmacia. Hospital General Universitario Santa Lucía. Cartagena. Murcia (España) Elena Conesa Nicolás – Hospital General Universitario Santa Lucía (Servicio de Farmacia) – C/Mezquita, s/n – 30202 Cartagena. Murcia (España) elenalbs@hotmail.com

RESUMEN

Objetivo: Analizar el uso de brentuximab vedotina (BV) en monoterapia o en combinación con bendamustina en el tratamiento de linfoma Hodgkin (LH) y linfoma anaplásico de células grandes (LACG) en recaída o refractario. Métodos: Estudio retrospectivo y multicéntrico de los pacientes con LH o LACG en recaída o refractarios tratados con BV hasta febrero de 2019. Se analizaron variables demográficas, de la patología (clínicas y analíticas), respuesta y efectos adversos (EA). Resultados: Se incluyeron 16 pacientes en dos grupos. Grupo 1 (BV en monoterapia, 10 pacientes): 6 hombres, 57,5 años (rango: 44-72). 7 pacientes presentaban LH y 3 LACG. Tras 4 ciclos, se obtuvieron 6 respuestas parciales (RP), 3 respuestas completas (RC) y un paciente refractario. Tasa respuesta objetiva (TRO) 90%. 5 pacientes en RP progresaron siendo la supervivencia libre de progresión (SLP) 4 meses (IC 95% 2,55-4,27). Un paciente en RC fue sometido a trasplante autólogo de progenitores hematopoyéticos (TAPH) y recibió BV en mantenimiento. Grupo 2 (en combinación con bendamustina, 6 pacientes): 4 hombres, 42 años (rango: 18-74). Tras 4 ciclos se obtuvieron 2 RP, 3 RC y 1 paciente refractario. TRO 83,33%. 1 paciente en RP progresó (SLP 3 meses). Los pacientes en RC pudieron beneficiarse de TAPH y mantenimiento con BV. En ambos grupos los EA principales fueron neuropatía (grado 3 en 2 pacientes) y alteraciones digestivas. Conclusiones: BV presenta buena actividad en monoterapia, logrando TRO elevadas. La combinación con bendamustina ha permitido aumentar la eficacia logrando respuestas más duraderas y nos ha permitido ofertar TAPH a pacientes no candidatos previamente. Se han reportado EA manejándose adecuadamente. Son necesarios más estudios para posicionar BV en la práctica clínica habitual.

Palabras clave: Brentuximab vedotina, bendamustina, linfoma de Hodgkin, linfoma anaplásico de células grandes, efectividad, seguridad.

Experience of use of brentuximab vedotin in monotherapy or combination with bendamustin in Hodgkin lymphoma and anaplastic large cell lymphoma

SUMMARY

Objective: To analyze the use of brentuximab vedotin (BV) in monotherapy or in combination with bendamustine in the treatment of relapsed or refractory Hodgkin’s lymphoma (HL) and anaplastic large cell lymphoma (ALCL). Methods: Retrospective and multicenter study of patients with relapsed or refractory HL or ALCL treated with BV until February 2019. Demographic, pathological (clinical and analytical), response and toxicity variables were analyzed. Results: Sixteen patients were included in two groups. Group 1 (BV in monotherapy, 10 patients): 6 men, 57.5 years (range: 44-72). 7 patients presented HL and 3 ALCL. After 4 cycles, 6 partial responses (PR), 3 complete responses (CR) and one refractory patient were obtained. Objective response rate (ORR) 90%. 5 patients in PR progressed being progression-free survival (PFS) 4 months (95% CI 2.55-4.27). A patient in CR was submitted to autologous stem cell transplantation (ASCT) and received BV in maintenance. Group 2 (in combination with bendamustine, 6 patients): 4 men, 42 years (range: 18-74). After 4 cycles, 2 PR, 3 CR and 1 refractory patient were obtained. ORR 83.33%. 1 patient in PR progressed (PFS 3 months). The patients in CR could benefit from ASCT and maintenance with BV. In both groups, the main adverse effects (AE) were neuropathy (grade 3 in 2 patients) and digestive alterations. Conclusions: BV presents good activity in monotherapy, achieving high ORR. The combination with bendamustine has made it possible to increase efficiency by achieving more lasting responses and it has allowed us to offer ASCT to previously non-candidates. AE have been reported but they have been handled properly. Further studies are necessary to position BV in routine clinical practice.

Brentuximab vedotin, bendamustine, Hodgkin lymphoma, anaplastic large cell lymphoma, effectiveness, safety.

Rev. OFIL·ILAPHAR 2020 [first on line] / ORIGINAL / 1