Oral targeted therapy dose adaptation in older patients with cancer: A real-life French cohort.

INTRODUCTION: Oral targeted therapies (OTTs) are widely used for cancer management. However, there is no consensus on OTT dose adaptation in older patients with cancer. METHODS: This noninterventional, retrospective study was a real-life assessment of dose adaptation for six OTTs (afatinib, everolimus, palbociclib, pazopanib, sorafenib and sunitinib), at baseline and during treatment, and the reasons for the changes, in ≥70-year-old patients treated between February 2016 and August 2019. Data were compared with univariate models fitted with all variables. RESULTS: Among the 986 patients treated with OTT, the group of ≥70-year-old patients (n = 122) received afatinib (15.6%), everolimus (14.8%), palbociclib (50.8%), pazopanib (9.8%), sorafenib (5.8%) or sunitinib (3.2%). At baseline, the prescribed OTT dose was adapted (reduction) in 29% of ≥70-year-old patients (35/122). These 35 patients were significantly older (mean age 80 vs 74 years, P < .001), and more frequently had a performance status score ≥2 (P < .01) than the other patients (n = 87). In the standard dose group, higher toxicity grades (P = .18) and subsequent dose reduction (41% of patients, 36/87) tended to be more frequent compared with the baseline adapted dose group (26%, 9/35, P = .1). At the study end, 53% of patients in the whole cohort (65/122) were taking a lower dose than the recommended one. CONCLUSION: At OTT initiation, dose was adapted in 29% of older adults with cancer, rarely after a formal oncogeriatric evaluation (6.5% of all patients). In the absence of recommendations, clinical studies are needed to evaluate the efficacy and safety of baseline OTT dose reduction in older adults with cancer.

Wheat germ supplementation of a low vitamin E diet in rats affords effective antioxidant protection in tissues.

BACKGROUND: Oxidative stress is implicated in the etiology of many diseases, but most of clinical trials failed to demonstrate beneficial effects of antioxidant supplementation. METHODS: In the present experiment, we assessed the mean-term effect of wheat germ supplementation, as a dietary source of vitamin E, on antioxidant protection in rat. RESULTS: Feeding rats a 20% wheat germ diet significantly increased plasma and liver vitamin E levels, compared to the low vitamin E basal diet. Concurrently, wheat germ diet consumption strongly decreased the susceptibility of heart and liver lipids to oxidation, as well as the plasma. Wheat germ feeding did not change triglycerides (TG) nor total cholesterol concentrations in plasma or liver, resulting in higher vitamin E/TG ratio compared to controls. Similar results were found with a diet in which wheat germ oil provided the same amount of vitamin E. CONCLUSIONS: Wheat germ appears thus very effective to improve antioxidant defense status, especially in tissues, irrespective of modifications of lipids status.

The bioavailability of ferulic acid is governed primarily by the food matrix rather than its metabolism in intestine and liver in rats.

The physiologic importance of ferulic acid (FA), and notably its antioxidant properties, depends upon its availability for absorption and subsequent interaction with target tissues. Because FA is widely present in cereals, the aim of the present study was to investigate its intestinal and hepatic metabolism in rats by in situ intestinal perfusion model (from 10 to 50 nmol/min), and its bioavailability in supplemented diets (from 10 to 250 micromol/d) or in a complex cereal matrix, i.e., whole flours from Valoris (Triticum aestivum) or Duriac (T. durum) cultivars and bran or white flour from the Valoris cultivar. In perfused rat intestine, net FA absorption was proportional to the perfused dose (R2 = 0.997); once absorbed, FA was completely recovered as conjugated forms in plasma and bile secretion (representing 5-7% of the perfused dose). In rats fed FA-enriched semipurified diets, FA absorption was quite efficient because approximately 50% of the ingested dose was recovered in urine. This extensive elimination by kidneys limited FA accumulation in plasma (typically 1 micromol/L in rats fed 50 micromol FA/d). In contrast, in rats fed cereal diets providing 56-81 micromol FA/d, urine excretion was 90-95% lower than in rats fed FA-enriched semipurified diets, and plasma concentrations were approximately 0.2-0.3 micromol/L. Thus, the cereal matrix appears to severely limit FA bioavailability. This inherently low bioavailability of FA in cereals likely reflects FA association with the fiber fraction through cross-linking with arabinoxylans and lignins.