Dynamics of neutrophil and C‐reactive protein reflect the clinical course of pyrexia during combination therapy with dabrafenib and trametinib

Autor: Chisato Yamashita, Yasuhiro Fujisawa, Megumi Kato, Jiro Uehara, Koji Yoshino, Takuya Maeda, Kojiro Nagai, Azusa Hiura, Satoe Oaku
Rok vydání: 2019
Předmět:
Male
Skin Neoplasms
Time Factors
Neutrophils
Administration
Oral
Gastroenterology
Leukocyte Count
030207 dermatology & venereal diseases
0302 clinical medicine
Antineoplastic Combined Chemotherapy Protocols
Oximes
Melanoma
Trametinib
biology
Imidazoles
General Medicine
Drug holiday
Middle Aged
C-Reactive Protein
Treatment Outcome
030220 oncology & carcinogenesis
Absolute neutrophil count
Female
medicine.drug
Adult
medicine.medical_specialty
Fever
Combination therapy
Pyridones
Prednisolone
Pyrimidinones
Dermatology
complex mixtures
Young Adult
03 medical and health sciences
Internal medicine
parasitic diseases
medicine
Humans
Adverse effect
Aged
Retrospective Studies
business.industry
C-reactive protein
Dabrafenib
bacterial infections and mycoses
Concomitant
biology.protein
Feasibility Studies
business
Biomarkers
Zdroj: The Journal of Dermatology. 46:716-719
ISSN: 1346-8138
0385-2407
DOI: 10.1111/1346-8138.14949
Popis: Pyrexia is the most common adverse event in patients with melanoma or other solid organ malignancies that are treated with the combination of dabrafenib and trametinib (combi-DT). Given the expanded indication for combi-DT, management of pyrexia is a high priority. No previous case series has revealed which blood markers reflect the course of pyrexia and there is no consensus on the management strategy for pyrexia. The current case series study describes the utility of neutrophil count (NC), neutrophil ratio (NR) and C-reactive protein (CRP) in 11 patients with metastatic melanoma and BRAF V600 mutations who experienced pyrexia during combi-DT in our department. We also described the clinical course of pyrexia episodes that were managed with the concomitant use of oral prednisolone and immediate withdrawal of combi-DT. Consequently, the analysis of 37 pyrexia episodes in 11 patients showed that the differences in NC, NR and CRP at the onset of pyrexia were significantly different from those at pyretolysis (P = 0.01, 0.006 and 0.03, respectively). Additionally, in the 24 pyrexia episodes treated with the concomitant use of oral prednisolone and the immediate withdrawal of combi-DT, the mean duration of pyrexia and the mean time to restart combi-DT were 3 and 6 days, respectively. Therefore, the blood markers that reflect the course of pyrexia during combi-DT may be helpful for the appropriate management of pyrexia; also, our management strategy for pyrexia successfully reduced the duration of pyrexia and did not require a long-term drug holiday. Further large-scale studies are required to verify our results.
Databáze: OpenAIRE
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