RESUMO
We present a novel approach to a personalized therapeutic concept for solid tumors. We illustrate this on a rare childhood tumor for which only a generalized treatment concept exists using carbonic anhydrase IX and aquaporin 1 inhibitors. The use of microcalorimetry as a refined in vitro method for evaluation of drug susceptibility in organotypic slice culture has not previously been established. Rapid microcalorimetric drug response assessment can refine a general treatment concept when it is applied in cases in which tumors do not respond to conventional chemo-radiation treatment. For solid tumors, which do not respond to classical treatment, and especially for rare tumors without an established protocol rapid microcalorimetric drug response testing presents an elegant novel approach to test alternative therapeutic approaches. While improved treatment concepts have led to improved outcome over the past decades, the prognosis of high risk disease is still poor and rethinking of clinical trial design is necessary. A small patient population combined with the necessity to assess experimental therapies for rare solid tumors rather at the time of diagnosis than in relapsed or refractory patients provides great challenges. The possibility to rapidly compare established protocols with innovative therapeutics presents an elegant novel approach to refine and personalize treatment.
Assuntos
Antineoplásicos/uso terapêutico , Aquaporina 1/antagonistas & inibidores , Anidrase Carbônica IX/antagonistas & inibidores , Inibidores da Anidrase Carbônica/uso terapêutico , Neoplasias/tratamento farmacológico , Medicina de Precisão , Fatores Etários , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Biomarcadores Tumorais , Biópsia , Calorimetria , Inibidores da Anidrase Carbônica/administração & dosagem , Inibidores da Anidrase Carbônica/efeitos adversos , Criança , Humanos , Imageamento por Ressonância Magnética/métodos , Terapia de Alvo Molecular , Estadiamento de Neoplasias , Neoplasias/diagnóstico , Neoplasias/metabolismo , Medicina de Precisão/métodosAssuntos
Inibidores da Anidrase Carbônica/administração & dosagem , Diclorofenamida/administração & dosagem , Paralisia Periódica Hipopotassêmica/tratamento farmacológico , Paralisia Periódica Hiperpotassêmica/tratamento farmacológico , Inibidores da Anidrase Carbônica/efeitos adversos , Inibidores da Anidrase Carbônica/economia , Diclorofenamida/efeitos adversos , Diclorofenamida/economia , Esquema de Medicação , Custos de Medicamentos , Interações Medicamentosas , Humanos , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisia Periódica Hipopotassêmica/fisiopatologia , Paralisia Periódica Hiperpotassêmica/diagnóstico , Paralisia Periódica Hiperpotassêmica/fisiopatologia , Resultado do TratamentoRESUMO
OBJECTIVE: Carbonic anhydrase (CA) inhibitors topiramate and zonisamide can induce metabolic acidosis in some patients. Our aims were to assess the prevalence and severity of this acidosis and to determine its predictors. METHODS: For 70 patients established on treatment with topiramate (n=55) or zonisamide (n=14) or both (n=1), we measured electrolytes, and genotyped single nucleotide polymorphisms (SNPs) in the main renal CA isoenzymes (II, IV and XII). RESULTS: Twenty-six percent of patients had a metabolic acidosis (serum bicarbonate <20 mmol/l). The mean serum bicarbonate of patients taking topiramate was significantly lower than those taking zonisamide (P=0.002). We found no association between serum bicarbonate and the dose of drug or the duration of treatment. Serum bicarbonate levels were associated with the CA type XII SNPs rs2306719 (P=0.006 by one-way analysis of variance) and rs4984241 (P=0.015), but this association was not strong enough to survive correction for multiple testing. CONCLUSION: The development of acidosis with topiramate and zonisamide is not determined by drug dose or by treatment duration, but may be influenced by polymorphisms in the gene for CA type XII. The aforementioned SNPs lie 9.8 kb apart in intron 1 of the CA type XII gene, and deserve further study in a larger cohort of patients.
Assuntos
Acidose Tubular Renal/epidemiologia , Acidose Tubular Renal/genética , Inibidores da Anidrase Carbônica/efeitos adversos , Anidrases Carbônicas/genética , Epilepsia/tratamento farmacológico , Frutose/análogos & derivados , Isoxazóis/efeitos adversos , Equilíbrio Ácido-Base/efeitos dos fármacos , Acidose Tubular Renal/induzido quimicamente , Adulto , Idoso , Inibidores da Anidrase Carbônica/uso terapêutico , Feminino , Frutose/efeitos adversos , Frutose/uso terapêutico , Estudo de Associação Genômica Ampla , Humanos , Isoxazóis/uso terapêutico , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Prevalência , Índice de Gravidade de Doença , Topiramato , Adulto Jovem , ZonisamidaRESUMO
This set of Viewpoints articles examines the merits of beta-blockers versus other medications as the primary drug treatment for glaucoma. Ophthalmologists must balance issues such as efficacy, compliance, cost, and side effects when deciding on the appropriate medication to prescribe. Dr. Stamper stresses the advantages of tailoring the choice of medication to the needs of the individual patient. Drs. Wigginton and Higginbotham review the benefits of beta-blockers and present some of the disadvantages of the non-beta-blocker class of medications.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Glaucoma/tratamento farmacológico , Agonistas alfa-Adrenérgicos/efeitos adversos , Agonistas alfa-Adrenérgicos/economia , Agonistas alfa-Adrenérgicos/uso terapêutico , Antagonistas Adrenérgicos beta/efeitos adversos , Antagonistas Adrenérgicos beta/economia , Inibidores da Anidrase Carbônica/efeitos adversos , Inibidores da Anidrase Carbônica/economia , Inibidores da Anidrase Carbônica/uso terapêutico , Custos de Medicamentos , Humanos , Soluções Oftálmicas/uso terapêutico , Cooperação do Paciente , Prostaglandinas/efeitos adversos , Prostaglandinas/economia , Prostaglandinas/uso terapêuticoRESUMO
All antiglaucoma drugs are able to lower intraocular pressure (IOP) to variable degrees. However, all of them can possibly produce ocular and/or systemic adverse effects, some of which are not acceptable. Therefore, the drug or the combination of drugs which is efficacious enough to achieve the target IOP and have no or negligible adverse effects should be identified for each glaucoma patient, considering their ocular (e.g. the stage of glaucomatous damage, refraction) and systemic (e.g. age, cardiovascular disease) conditions.