Predicting Severe Haematological Toxicity in Gastrointestinal Cancer Patients Undergoing 5-FU-Based Chemotherapy: A Bayesian Network Approach.

PURPOSE: Severe toxicity is reported in about 30% of gastrointestinal cancer patients receiving 5-Fluorouracil (5-FU)-based chemotherapy. To date, limited tools exist to identify at risk patients in this setting. The objective of this study was to address this need by designing a predictive model using a Bayesian network, a probabilistic graphical model offering robust, explainable predictions. METHODS: We utilized a dataset of 267 gastrointestinal cancer patients, conducting preprocessing, and splitting it into TRAIN and TEST sets (80%:20% ratio). The RandomForest algorithm assessed variable importance based on MeanDecreaseGini coefficient. The bnlearn R library helped design a Bayesian network model using a 10-fold cross-validation on the TRAIN set and the aic-cg method for network structure optimization. The model's performance was gauged based on accuracy, sensitivity, and specificity, using cross-validation on the TRAIN set and independent validation on the TEST set. RESULTS: The model demonstrated satisfactory performance with an average accuracy of 0.85 (±0.05) and 0.80 on TRAIN and TEST datasets, respectively. The sensitivity and specificity were 0.82 (±0.14) and 0.87 (±0.07) for the TRAIN dataset, and 0.71 and 0.83 for the TEST dataset, respectively. A user-friendly tool was developed for clinical implementation. CONCLUSIONS: Despite several limitations, our Bayesian network model demonstrated a high level of accuracy in predicting the risk of developing severe haematological toxicity in gastrointestinal cancer patients receiving 5-FU-based chemotherapy. Future research should aim at model validation in larger cohorts of patients and different clinical settings.

Estudio observacional de la toxicidad con diferentes formulaciones de docetaxel en pacientes con cáncer de mama / Observational study of clinical toxicity with different formulations of docetaxel in breast cancer patients

OBJETIVO: Estudiar los excipientes e impurezas de los diferentes medicamentos comercializados de docetaxel y conocer la incidencia de los diversos eventos adversos derivados del uso de docetaxel y su repercusión clínica en pacientes con cáncer de mama en el contexto de adyuvancia o neoadyuvancia. MÉTODO: Estudio observacional, longitudinal, prospectivo y multicéntrico en 26 hospitales de Madrid, Cataluña, Andalucía y Comunidad Valenciana. Se caracterizaron las distintas formulaciones de docetaxel en cuanto a pH, cantidad de docetaxel e impurezas. Se evaluó la incidencia acumulada de eventos adversos de cualquier grado estratificados por tipo de medicamento, analizando las diferencias mediante el test de χ2.RESULTADOS: Se detectaron diferencias estadísticamente significativas entre las distintas formulaciones de docetaxel en cuanto a la incidencia acumulada por ciclo de: modificación de dosis, anemia, reacciones de hipersensibilidad y anafilaxia, neuropatía, toxicidad palmo-plantar y dermatológica, toxicidad ungueal y edema facial. La formulación con un menor contenido en impurezas presentó mejores resultados en modificación de dosis, visitas a urgencias, e incidencia de anemia y edema facial, pero peores en hospitalización, neutropenia febril, neuropatía motora y toxicidad palmo-plantar. CONCLUSIONES: Los resultados muestran diferencias en la incidencia de los eventos adversos de los distintos medicamentos con docetaxel comercializados en nuestro país, con diferencias significativas entre ellos en algunas de las variables estudiadas. No se ha podido identificar un medicamento con un mejor perfil de toxicidad. Tampoco se ha podido establecer su relación con respecto a la composición de excipientes e impurezas

OBJECTIVE: To analyze the excipients and impurities contained in the various docetaxel products available on the market and find out whether they may be responsible for any of the different adverse events associated with the use of docetaxel in patients with breast cancer receiving adjuvant or neoadjuvant treatment. METHOD: This is a prospective, multicenter, longitudinal observational, study carried in 26 hospitals in Madrid, Catalonia, Andalusia, and the Valencia Region. The different docetaxel formulations were characterized in terms of their pH, amount of the active ingredient and impurities. The cumulative incidence of adverse events of any grade was evaluated. Adverse events were stratified by drug type and differences were analyzed by means of a chi-square test. RESULTS: Statistically significant differences were found between the different docetaxel formulations in the cumulative per-cycle incidence of: dosage change, anemia, hypersensitivity reactions and anaphylaxis, neuropathy, palmoplantar and dermal toxicity, ungual toxicity and facia edema. The formulation with the lowest content of impurities showed better results in terms of change of dosage, visits to the emergency room and incidence of anemia and facial edema. However, it was associated with poorer results regarding hospitalization, febrile neutropenia, motor neuropathy and palmoplantar toxicity. CONCLUSIONS: The results of the study showed differences in the incidence of adverse events of the different docetaxel products available in Spain. Such differences were statistically significant for some of the variables analyzed. The study was not able to determine which of the products offered the best toxicity profile. Nor was it possible to establish a correlation with respect to the composition of excipients or the content of impurities

Observational study of clinical toxicity with different formulations of docetaxel in breast cancer patients.

OBJECTIVE: To analyze the excipients and impurities contained in the various docetaxel products available on the market and find out  whether they may be responsible for any of the different adverse events  associated with the use of docetaxel in patients with breast cancer  receiving adjuvant or neoadjuvant treatment. METHOD: This is a prospective, multicenter, longitudinal observational, study carried in 26 hospitals in Madrid, Catalonia, Andalusia, and the Valencia Region. The different docetaxel formulations were  characterized in terms of their pH, amount of the active ingredient and  impurities. The cumulative incidence of adverse events of any grade was  evaluated. Adverse events were stratified by drug type and differences  were analyzed by means of a chi-square test. RESULTS: Statistically significant differences were found between the different docetaxel formulations in the cumulative per-cycle incidence of: dosage change, anemia, hypersensitivity reactions and  anaphylaxis, neuropathy, palmoplantar and dermal toxicity, ungual toxicity  and facial edema. The formulation with the lowest content of impurities  showed better results in terms of change of dosage, visits to the  emergency room and incidence of anemia and facial edema. However, it  was associated with poorer results regarding hospitalization, febrile  neutropenia, motor neuropathy and palmoplantar toxicity. CONCLUSIONS: The results of the study showed differences in the incidence of adverse events of the different docetaxel products available in  Spain. Such differences were statistically significant for some of the  variables analyzed. The study was not able to determine which of the  products offered the best toxicity profile. Nor was it possible to establish a  correlation with respect to the composition of excipients or the content of  impurities.

Objetivo: Estudiar los excipientes e impurezas de los diferentes  medicamentos comercializados de docetaxel y conocer la incidencia de  los diversos eventos adversos derivados del uso de docetaxel y su  repercusión clínica en pacientes con cáncer de mama en el contexto de  adyuvancia o neoadyuvancia.Método: Estudio observacional, longitudinal, prospectivo y multicéntrico en 26 hospitales de Madrid, Cataluña, Andalucía y  Comunidad Valenciana. Se caracterizaron las distintas formulaciones de  docetaxel en cuanto a pH, cantidad de docetaxel e impurezas. Se evaluó  la incidencia acumulada de eventos adversos de cualquier grado  estratificados por tipo de medicamento, analizando las diferencias  mediante el test de χ2.Resultados: Se detectaron diferencias estadísticamente significativas entre las distintas formulaciones de docetaxel en cuanto a  la incidencia acumulada por ciclo de: modificación de dosis, anemia,  reacciones de hipersensibilidad y anafilaxia, neuropatía, toxicidad palmo- plantar y dermatológica, toxicidad ungueal y edema facial. La  formulación con un menor contenido en impurezas presentó mejores  resultados en modificación de dosis, visitas a urgencias, e incidencia de  anemia y edema facial, pero peores en hospitalización, neutropenia  febril, neuropatía motora y toxicidad palmo-plantar.Conclusiones: Los resultados muestran diferencias en la incidencia de  los eventos adversos de los distintos medicamentos con docetaxel comercializados en nuestro país, con diferencias significativas  entre ellos en algunas de las variables estudiadas. No se ha podido  identificar un medicamento con un mejor perfil de toxicidad. Tampoco se  ha podido establecer su relación con respecto a la composición de  excipientes e impurezas.

Evaluation of a non-parametric modelling for meropenem in critically ill patients using Monte Carlo simulation.

PURPOSE: In critically ill patients treated with meropenem, the proposed pharmacokinetics/pharmacodynamics (PK/PD) efficacy index is to keep the free drug concentration 4-5 times above the minimum inhibitory concentration (MIC) of the germ isolated, for 100% of the interval regimen. The objectives were to design a population pharmacokinetics model for meropenem in critically ill patients and to evaluate different dosage schemes that achieve the optimal PK/PD objectives. METHODS: This retrospective, observational, single-centre study included 80 critically ill patients (154 samples) treated with meropenem between May 2011 and December 2017. Patient data, concentrations, treatment and bacteriological variables were collected from electronic medical records. Total and free concentrations of meropenem were modelled in Pmetrics. Monte Carlo simulations were performed to assess the probability of achieving the PK/PD target for different dosage regimens. For patients with available data, the number of patients with a free concentration 4 times higher or lower than the observed MIC for the P. aeruginosa and E. coli was investigated. RESULTS: A one-compartment model with first-order elimination adequately described serum total and free meropenem concentrations. The only variable that significantly influenced the elimination constant of meropenem was the creatinine clearance (CLcr) calculated using the CKD-EPI formula. The highest probability of achieving the pharmacodynamic objective was with 3-h infusion dosage regimens. Sixty percent and 89% of patients attained a free drug concentration 4 times above the MIC for P. aeruginosa and E. coli respectively. CONCLUSIONS: This study proposed different dosing regimens depending on renal clearance strata and the MIC of the germ targeted.

Reality of the emetogenic level of irinotecan.

PURPOSE: To assess the emetogenic potential of different chemotherapy (CT) regimens in daily clinical practice in an outpatient setting. To optimize antiemetic prophylaxis if necessary METHODS: Prospective and retrospective review of the emetogenic potential of CT regimens used in adult patients in an outpatient setting RESULTS: We assess the chemotherapy-induced nausea and vomiting (CINV) of 50 different CT regimens used on 157 different patients in an outpatient setting. We found that the CT usually classified as highly emetogenic, including cisplatin and anthracycline-cyclophosphamide combination, had the higher incidence of CINV (37.5 and 54.4% respectively). The antineoplastic drugs usually considered to be moderately emetogenic had, as expected, lower rates of emesis with the exception of irinotecan, which presented a pattern of nausea and/or vomiting (NV) similar to the highly emetogenic CT with a global incidence of 48.5%. The appearance of emetic symptoms had impact on quality of life in 70% of the patients, with nausea being the main emetic symptom. CONCLUSION: Antiemetic prophylaxis for highly emetogenic CT could be improve. Irinotecan CT regimens have a high emetogenic potential more than moderate and require more intensive antiemetic prophylaxis too.

Determination of docetaxel and Paclitaxel in human plasma by high-performance liquid chromatography: validation and application to clinical pharmacokinetic studies.

Taxanes, docetaxel and paclitaxel, represent important antineoplastic agents with broad spectra of antitumor activity. The authors developed and validated a high-performance liquid chromatography method with ultraviolet detection for quantifying both taxanes in human plasma. The assay uses liquid-liquid extraction as sample treatment and an isocratic mobile phase and reversed-phase chromatography to determine docetaxel with paclitaxel as internal standard and vice versa. The lower limit of quantification was 0.015 mg/L. The assay had good recovery (87.96+/-14.05 and 90.57+/-9.63 for docetaxel and paclitaxel respectively) and precision: the within-day and between-days relative standard deviation of the mean for docetaxel (0.015-3 mg/L) and paclitaxel was always <10%. The method presented has been fully validated following the U.S. Food and Drug Administration requirements and has been successfully applied for the pharmacokinetic investigation of docetaxel or paclitaxel.