Antioxidant activity of simvastatin prevents ifosfamide-induced nephrotoxicity

Ifosfamide is an anticancer agent used largely in treatment of solid tumors. The mainstay dose-limiting toxicity of ifosfamide is nephrotoxicity. This is largely believde to be a result of ifosfamide-induced oxidative stress. In this study, we investigated the antioxidant activity of simvastatin and the possible protective role of simvastatin against ifosfamide induced nephrotoxicity. Thirty Sprague-Dawely rats were divided into five groups and given orally different drug combinations. Group I and II were regarded as control groups and received 0.1% DMSO and normal saline, respectively. Group III received ifosfamide at 50mg/kg, group IV received simvastatin at 0.3mg/kg and group V received both ifosfamide and simvastatin. All animals were decapitated 2 days after the last ifosfamide administration. Findings revealed that ifosfamide induced nephrotoxicity as indicated by a significant increase in plasma creatinine and lipid per oxidation. This increase was significantly inhibited in animals pretreated with simvastatin. Histopathological observations were in correlation with the biochemical parameters in that simvastatin minimized ifosfamide-induced renal tubular damage. The above results promote a future use of simvastatin in combination with ifosfamide in treatment of cancer patients to indicated that simvastatin protectics against ifosfamide-induced nephrotoxicity in terms of oxidative stress and might be given in combination

Avaliação da expressão imunoistoquímica de proteínas da via de sinalização mediada por TGFβ como preditores de resposta à quimioterapia pré-operatória em adultos portadores de sarcoma de partes moles de alto grau em extremidades / Protein expression evaluation of protein of genes belonging to the TGFβ pathway as predictors of response to preoperative chemotherapy with doxorubicin and ifosfamide in adult patients with high grade soft tissue sarcomas located in extremities

Introdução: Sarcomas de partes moles (SPM) constituem um grupo de neoplasias raras de comportamentos distintos. O tratamento para os tumores de alto grau, não passiveis de ressecção adequada, é feito por cirurgia, radioterapia (RT) e quimioterapia (QT). Apesar disso, 50% dos pacientes com tumores localizados ao diagnóstico morrem da doença metastática. A QT pré-operatória para o tratamento de tumores localizados, apesar de não ser considerada como padrão, é uma opção promissora. A escassez de preditores biológicos de resposta, e achados de que a superexpressão de genes pertencentes à via mediada por TGFβ estaria relacionada à resistência à QT nos levaram à tentativa de estabelecer a relação entre a expressão de FST, SMAD4, TGFβ e Id com resposta patológica. Objetivos: Avaliar por imunoistoquímica (IQ) a expressão das proteínas produzidas a partir dos genes TGFB, FST, Id1 e SMAD4 da via mediada por TGFβ, correlacionando com a resposta patológica; expandir os resultados clínicos do esquema de QT pré-operatória com doxorrubicina e ifosfamida em vigência no Hospital A.C. Camargo; determinar as taxas de toxicidade e avaliar um método de análise patológica que quantifique a percentagem de células tumorais viáveis em peça operatória. Pacientes e Métodos: 42 pacientes com SPM de alto grau localizados em extremidades, tratados com doxorrubicina e ifosfamida pré-operatória, foram observados de forma prospectiva, desde janeiro de 2005 a agosto de 2012. Amostras das biópsias e das peças operatórias foram obtidas e submetidas à pesquisa da expressão das proteínas já referidas por IQ. Resultados: A expressão das proteínas estudadas não teve correlação estatisticamente significativa com a resposta patológica...

Backgraund: Soft Tissue Sarcomas (STS) are rare neoplasms with many histological subtypes, behaviors and response to different treatments. The treatment of these tumors involves surgery, radiation and chemotherapy. Despite that 50% of patients with localized tumors will develop metastatic disease. Preoperative chemotherapy (CT) although not standard is considered a promising therapeutic option. The lack of biological predictors of response, led us to study the relationship between the expression of FST, SMAD4, TGFβ and Id (TGFβ superfamily genes) in patients submitted to preoperative CT. Objectives: To evaluate the protein expression. Produced by genes belonging to the TGFβ pathway by IH and correlate it with pathologic response; expand the preliminary results of a previous phase II trial testing a schedule of preoperative CT with doxorubicin and ifosfamide in Hospital A.C. Camargo; determine the rate of toxicity and evaluate a method of assessing pathological analysis that quantifies the percentage of viable tumor cells in surgical specimens. Patients and Methods: 42 patients with high grade STS located in extremities treated with preoperative doxorubicin and ifosfamide CT were observed prospectively, on a non controlled fashion since January 2005 to august 2012. Biopsies and surgical specimens were obtained to enable the analysis of TGFβ, FST, SMAD4 and Id protein expressional by immunohistochemistry (IH). Results: The expression of the proteins studied had no significant association with pathological response. The objective response rates of the primary tumor were 17.5% for clinical response and 15% for pathologic complete response. Only 7.5% patients had a limb amputated. The rate of surgical contraindication was 4.7%. Grade 3-4 toxicity occurred in 45.2% of cases. Conclusion: The method of pathological response analysis was considered easily applicable. TGFβ-mediated pathway proteins studied did not correlate with pathological response...

Acute renal toxicity of 2 conditioning regimens in patients undergoing autologous peripheral blood stem-cell transplantation. Total body irradiation-cyclophosphamide versus ifosfamide, carboplatin, etoposide

To compare acute renal toxicity of 2 conditioning regimens of total body irradiation/cyclophosphamide TBI-Cy and Ifosfamide, Carboplatin, and Etoposide ICE. Between August 1996 and February 2004, patients treated with autologous peripheral stem cell transplantation in the Department of Medical and Radiation Oncology, Gulhane Military Medical School, Ankara, Turkey with 2 different conditioning regimens was comparatively analyzed for acute renal toxicity in the early post-transplant period. Forty-seven patients received ICE regimen with 12 g/m2; 1.2 g/m2; and 1.2 g/m2 divided to 6 consecutive days, whereas 21 patients received 12 Gy TBI 6 fractions twice daily in 3 consecutive days and 60 mg/m2/day cyclophosphamide for 2 days. Sixty-eight patients were evaluated in this study. There was no significant difference in baseline renal function between patients in the ICE and TBI-Cy groups. Eleven patients developed nephrotoxicity 23.4% in the ICE group while one patient 4.8% in the TBI-Cy group developed nephrotoxicity p=0.06. Five out of 11 patients developing nephrotoxicity in ICE group required hemodialysis and subsequently 4 8.5% of them died. In contrast, one patient 4.8% died due to nephrotoxicity despite hemodialysis in the TBI-Cy arm. This study reveals that the TBI-Cy conditioning regimen seems no more nephrotoxic than an ICE regimen particularly in patients who had used cisplatin prior to transplantation

Simposio. Avances recientes con ifosfamida/mesna en el tratamiento de tumores sólidos malignos: etopósido, platino, ifosfamida y dexametasona como tratamiento de rescate en los linfomas no Hodgkin / Symposium on recent advances with ifosfamide/Mesna in the treatment of malignant solid tumors

Existen grandes avances en el manejo de los linfomas; desafortunadamente un porcentaje variable de casos recaerán a regímenes de primera línea. Se informan los resultados preliminares de 17 pacientes con diagnóstico de linfoma de Hodgkin refractarios a manejo de primera línea o refractarios. El esquema utilizado fue cada 3-4 semanas: combinación de etopósido 100 mg/m² por tres días, platino 100 mg/m² e ifosfamida 5g/m² fraccionados en tres días, mesna al 20 por ciento de la dosis diaria de ifosfamida por tres dosis; y dexametasona de 20 a 40 mg cada 24 horas por tres días. Trece de los 17 pacientes fueron evaluables para eficacia (dos aún en tratamiento; los otros dos abandonaron la terapia) y 16 fueron evaluables para toxicidad en 74 ciclos administrados. Se obtuvieron 11 respuestas totales (84 por ciento): seis respuestas (46 por ciento) Äcon supervivencia libre de enfermedad mínima de dos meses y máxima de 11 mesesÄ y cinco respuestas parciales (38 por ciento). La toxicidad más frecuente y grave fue neutropenia grado 4 (20 por ciento) con dos muertos por septicemia y plaquetopenia grado 4 (7 por ciento). El resto de los efectos tóxicos fueron leves y reversibles. No se observó toxicidad vasical. Concluimos que el esquema utilizado es efectivo, pero conlleva toxicidad grave en una cuarta parte de los ciclos. Consideramos que es conveniente incluir factores estimulantes de colonias en este tratamiento