Nivolumab-Induced Exocrine Pancreatic Insufficiency

Immunotherapy is increasingly gaining applicability for several malignancies. While the survival of several malignancies has dramatically improved, immune-related adverse events (irAEs) can occur and can cause severe damage to patients. Side effects such as colitis are well known nowadays; however, with increased use of immunotherapy, less common side effects should also be addressed. In this article, 2 patients that received nivolumab developed exocrine dysfunction of the pancreas. Endocrine dysfunction has been well known, but exocrine dysfunction is less often described. It is important to be aware of this side effect because it is possibly underdiagnosed. Symptoms often mimic symptoms of malignancy, chemotherapy side effects, or immune-related colitis. Although the exact mechanism is yet to be elaborated, dormant CD8+ T cells are likely to be involved. No known therapy is yet been proven to be effective. More knowledge and research about irAEs will lead to possible therapies that will be effective. Currently, high-dose prednisone is recommended based on expert opinion.

GENDER-SPECIFIC SIDE EFFECTS OF CHEMOTHERAPY IN PANCREATIC CANCER PATIENTS

Pancreatic carcinoma incidence showed a significant increase in men over the last few years and the prognosis remains poor. Patients are treated with different pharmacological plans with no evidence about gender-specific adverse effects. We aimed to investigate differences in the incidence of chemotherapy side effects in the treatment of pancreatic cancer, in order to provide insights toward a personalized assistance based in individual needs. The sample population is composed of 207 patients. Regression model highlighted the predictive role of female gender for alopecia, constipation, hand-foot syndrome and epigastric pain. Also considering single therapeutic schemes, gender differences have been reported. Moreover, evaluating the effect of age, a general reduced risk of toxicity has been reported in younger patients. In order to personalize chemotherapy and increase patients survival rate and life quality during the therapy, gender medicine and pharmacology studies are recommended.

Nutritional interventions based on dietary restriction and nutrient reductions for the prevention of doxorubicin chemotherapy side effects

BACKGROUND: Doxorubicin (DOX) is one of most used chemotherapeutic drugs, but it has important adverse effects. Nutrition has a critical role to prevent or minimize chemotherapy side effects. Caloric and nutrient restriction has been widely studied in different health fields showing extensive beneficial effects. Given the importance of these interventions, it is expected that some of them have benefits in patients under DOX chemotherap OBJECTIVE: This review aimed to compile published studies evaluating the effects of different dietary intetrventions based on restriction of calories or certain nutrients against DOX-induced damage and toxicity. RESULTS: Caloric restriction and partial reduction of fat have shown to reduce DOX cardiotoxicity correlating with a reduction of oxidative stress. Reduction of dietary fat was proved to act in the same sense at liver and kidney. Studies in relation to protein reduction is more elevated has focused only on kidneys and bone, and under certain circumstances, these interventions could increase susceptibility to DOX toxicity. CONCLUSIONS: The promising effects of restriction of dietary fat, protein and sodium on differerent organs have been supported by a greater number of studies among all the dietary interventions evaluated. Still, clinical studies are necessary to confirm the potential usefulness of these interventions.

Rutin: A Flavonoid as an Effective Sensitizer for Anticancer Therapy; Insights into Multifaceted Mechanisms and Applicability for Combination Therapy

Rutin is a unique antioxidant flavonoid that is mainly found in fruit, vegetables, cereals, and many other plant-based human diets. This review aims to highlight the in vitro anticancer properties of rutin including combination therapeutic strategies. Literature resources were gathered through PubMed, Scopus, Web of Science, and Google Scholar databases that cover the period of 1995–2021. Rutin is demonstrated to inhibit the proliferation of breast, colon, lung, and prostate cancers and other tumors. Furthermore, rutin alone or in combination with other therapeutic agents has been shown to regulate several signalling pathways involving the Ras/Raf and PI3K/Akt, MAPK, and TGF-β2/Smad2/3Akt/PTEN, etc., which are related to the processes of carcinogenesis and induction of apoptosis. The combination of rutin with other chemotherapy drugs may benefit on prevention of tumor cells by decreasing drug resistance and chemotherapy side effects. Moreover, rutin induces apoptosis synergistically with the therapeutic agent. More in vivo and clinical data are however needed to evaluate the true potential of rutin as an anticancer agent as an adjuvant. The present review highlights the effects of rutin which can be a promising candidate in combination with other antitumor drugs or alone for cancer treatment in vitro. Also, rutin can lead to decrease in drug resistance and chemotherapeutic side effects.

Rehabilitation in oncology

Current oncology and oncohematology treatment methods allow more patients to successfully survive the disease. However, afterwards, most survivors have to deal with a wide range of symptoms and side effects and need rehabilitation. Personalized rehabilitation programs for such patients employ various methods of physical medicine. Physical activity is an important component of the cancer patients' treatment and rehabilitation. It improves their functional health, specifically — physical performance, cognitive function, psychological health, and makes the quality of their lives better. Physical activity increases muscle strength, alleviates the radiation and chemotherapy side effects and relieves fatigue. Personalized exercise programs are employed to monitor patient's condition and exercise tolerance. Physical and cognitive rehabilitative interventions are performed simultaneously as part of interdisciplinary rehabilitative care, so this approach can have a synergistic effect. It is necessary to factor in contraindications when prescribing regular physical activity, exercise and other methods of rehabilitation, otherwise they can lead to clinical complications.

PERCEPTION OF CANCER PATIENTS ON CHEMOTHERAPY SIDE EFFECTS

Chemotherapy causes various side effects that can affect the patient's physical or non-physical condition. Patients' perceptions or ratings of these side effects vary. This study aimed to identify cancer patients' perceptions of the side effects of chemotherapy they are undergoing. The descriptive study was conducted on 84 samples, namely cancer patients aged 20 years who had undergone chemotherapy at least once before. Data collection using a questionnaire that has been tested for validity and reliability. Data analysis was carried out descriptively with frequency distribution. The results showed that the perception of the physical side effects of chemotherapy that was considered very disturbing by the patient (severe symptoms) was nausea (59.5%), feeling of weakness (36.9%), hair loss (35.7%), vomiting. (29.8%), loss of appetite (28.6%). %), weight loss (27.4%), insomnia and skin discoloration (19% each), headache (16.7%) and fever (15.5%). When the perception of non-physical side effects was fear of death, affecting work/household duties and feeling fear (15.5% each), feeling anxious about my life, and the presence of family members I have to take care (14.3% each). The most disturbing side effects of chemotherapy are physical problems. The health service is expected to increase interventions to minimize the side effects of chemotherapy.