A Multi-disciplinary Approach to the Prevention and Management of Cancer-Related Toxicities

A special issue of Current Oncology (ISSN 1718-7729).

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 8062

Special Issue Editor


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Guest Editor
Department of Pediatrics and Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
Interests: acute and chronic kidney disease, and hypertension in hematopoietic cell transplant (HSCT) and cancer patients; thrombotic microangiopathy; the role of the immune system in kidney injury in HSCT patients

Special Issue Information

Dear Colleagues,

Cancer is the second leading cause of death in the pediatric population, with leukemia and brain tumors being the two most common malignancies. Recent treatment advances have led to significant improvements in survival. However, the severity of the underlying malignancy and the use of increasingly aggressive therapeutic regimens can cause organ toxicity with both short-term and long-term consequences. Close collaboration between nephrologists, oncologists, pharmacists, dieticians, endocrinologists, transplant providers, intensivists, and infectious disease experts is critical to maximize outcomes for these complicated patients. Though my interest and expertise is in kidney injury after cancer and HSCT and our understanding of the mechanisms of kidney injury has allowed the field of onconephrology to grow, continued research in this area and other organ toxicities including, lung, heart, endocrine, reproductive, brain, and gastrointestinal will hopefully further improve outcomes for patients in the future. As more patients are surviving longer, multidisciplinary survivorship clinics are increasingly following those treated for cancer or having received a HSCT.

For this special edition of Current Oncology, the goal is to describe the treatment-related toxicity of cancer therapy and newer immunotherapies and approaches to management with an emphasis on prevention of both short and long-term complications with an understanding that the toxicity in one organ does not occur in isolation. This edition will hopefully serve as a reference for oncologists and primary providers to effectively manage and monitor survivors and to support the creation of multidisciplinary survivorship clinics at institutions so that comprehensive care can be delivered in one clinic. We need a more holistic approach to the care of patients with cancer that starts at the time of diagnosis.

Prof. Dr. Sangeeta R. Hingorani
Guest Editor

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Keywords

  • organ toxicity
  • short and long-term outcomes
  • prevention
  • management
  • monitoring
  • epidemiology
  • multidisciplinary

Published Papers (3 papers)

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Review

21 pages, 717 KiB  
Review
Management and Prevention of Cellular-Therapy-Related Toxicity: Early and Late Complications
by Simon R. Mucha and Prabalini Rajendram
Curr. Oncol. 2023, 30(5), 5003-5023; https://doi.org/10.3390/curroncol30050378 - 15 May 2023
Cited by 3 | Viewed by 2751
Abstract
Chimeric Antigen Receptor T (CAR-T) cell therapy has dramatically changed prognosis and treatment of relapsed and refractory hematologic malignancies. Currently the 6 FDA approved products target various surface antigens. While CAR-T therapy achieves good response, life-threatening toxicities have been reported. Mechanistically, can be [...] Read more.
Chimeric Antigen Receptor T (CAR-T) cell therapy has dramatically changed prognosis and treatment of relapsed and refractory hematologic malignancies. Currently the 6 FDA approved products target various surface antigens. While CAR-T therapy achieves good response, life-threatening toxicities have been reported. Mechanistically, can be divided into two categories: (1) toxicities related to T-cell activation and release of high levels of cytokines: or (2) toxicities resulting from interaction between CAR and CAR targeted antigen expressed on non-malignant cells (i.e., on-target, off-tumor effects). Variations in conditioning therapies, co-stimulatory domains, CAR T-cell dose and anti-cytokine administration, pose a challenge in distinguishing cytokine mediated related toxicities from on-target, off-tumor toxicities. Timing, frequency, severity, as well as optimal management of CAR T-cell-related toxicities vary significantly between products and are likely to change as newer therapies become available. Currently the FDA approved CARs are targeted towards the B-cell malignancies however the future holds promise of expanding the target to solid tumor malignancies. Further highlighting the importance of early recognition and intervention for early and late onset CAR-T related toxicity. This contemporary review aims to describe presentation, grading and management of commonly encountered toxicities, short- and long-term complications, discuss preventive strategies and resource utilization. Full article
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15 pages, 841 KiB  
Review
Kidney Injury in Children after Hematopoietic Stem Cell Transplant
by Vinson James, Joseph Angelo and Lama Elbahlawan
Curr. Oncol. 2023, 30(3), 3329-3343; https://doi.org/10.3390/curroncol30030253 - 13 Mar 2023
Cited by 1 | Viewed by 2225
Abstract
Hematopoietic cell transplant (HCT), used for treatment of many malignant and non-malignant pediatric diseases, is associated with serious complications, limiting this therapy’s benefit. Acute kidney injury (AKI), seen often after HCT, can occur at different stages of the transplant process and contributes to [...] Read more.
Hematopoietic cell transplant (HCT), used for treatment of many malignant and non-malignant pediatric diseases, is associated with serious complications, limiting this therapy’s benefit. Acute kidney injury (AKI), seen often after HCT, can occur at different stages of the transplant process and contributes to morbidity and mortality after HCT. The etiology of AKI is often multifactorial, including kidney hypoperfusion, nephrotoxicity from immunosuppressive and antimicrobial agents, and other transplant-related complications such as transplant-associated thrombotic microangiopathy and sinusoidal obstructive syndrome. Early recognition of AKI is crucial to prevent further AKI and associated complications. Initial management includes identifying the etiology of AKI, preventing further kidney hypoperfusion, adjusting nephrotoxic medications, and preventing fluid overload. Some patients will require further support with kidney replacement therapy to manage fluid overload and AKI. Biomarkers of AKI, such as neutrophil gelatinase-associated lipocalin can aid in detecting AKI before a rise in serum creatinine, allowing earlier intervention. Long-term kidney dysfunction is also prominent in this population. Therefore, long-term follow-up and monitoring of renal function (glomerular filtration rate, microalbuminuria) is required along with management of hypertension, which can contribute to chronic kidney disease. Full article
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16 pages, 834 KiB  
Review
Everything You Always Wanted to Know about Sarcopenia but Were Afraid to Ask: A Quick Guide for Radiation Oncologists (impAct oF saRcopeniA In raDiotherapy: The AFRAID Project)
by Federica Medici, Stefania Rizzo, Milly Buwenge, Alessandra Arcelli, Martina Ferioli, Gabriella Macchia, Francesco Deodato, Savino Cilla, Pierandrea De Iaco, Anna Myriam Perrone, Silvia Strolin, Lidia Strigari, Gloria Ravegnini, Alberto Bazzocchi and Alessio G. Morganti
Curr. Oncol. 2022, 29(11), 8513-8528; https://doi.org/10.3390/curroncol29110671 - 08 Nov 2022
Cited by 4 | Viewed by 2466
Abstract
Sarcopenia (SP) is a syndrome characterized by age-associated loss of skeletal muscle mass and function. SP worsens both acute and late radiation-induced toxicity, prognosis, and quality of life. Myosteatosis is a pathological infiltration of muscle tissue by adipose tissue which often precedes SP [...] Read more.
Sarcopenia (SP) is a syndrome characterized by age-associated loss of skeletal muscle mass and function. SP worsens both acute and late radiation-induced toxicity, prognosis, and quality of life. Myosteatosis is a pathological infiltration of muscle tissue by adipose tissue which often precedes SP and has a proven correlation with prognosis in cancer patients. Sarcopenic obesity is considered a “hidden form” of SP (due to large fat mass) and is independently related to higher mortality and worse complications after surgery and systemic treatments with worse prognostic impact compared to SP alone. The evaluation of SP is commonly based on CT images at the level of the middle of the third lumbar vertebra. On this scan, all muscle structures are contoured and then the outlined surface area is calculated. Several studies reported a negative impact of SP on overall survival in patients undergoing RT for tumors of the head and neck, esophagus, rectum, pancreas, cervix, and lung. Furthermore, several appetite-reducing side effects of RT, along with more complex radiation-induced mechanisms, can lead to SP through, but not limited to, reduced nutrition. In particular, in pediatric patients, total body irradiation was associated with the onset of SP and other changes in body composition leading to an increased risk of cardiometabolic morbidity in surviving adults. Finally, some preliminary studies showed the possibility of effectively treating SP and preventing the worsening of SP during RT. Future studies should be able to provide information on how to prevent and manage SP before, during, or after RT, in both adult and pediatric patients. Full article
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