Programa de Engenharia Biomédica/UFRJ, Av. Horácio Macedo 2030, Centro de Tecnologia, COPPE/UFRJ, Bloco H, Sala 327, Cidade Universitária, Rio de Janeiro, Brazil.
Escola Nacional de Saúde Pública - FIOCRUZ, Rio de Janeiro, Brazil.
Support Care Cancer. 2020 Jan;28(1):395-403. doi: 10.1007/s00520-019-04841-x. Epub 2019 May 6.
Asthenia, myalgia, arthralgia, mucositis, abdominal pain, diarrhea, and neutropenia are adverse reactions commonly reported by women undergoing chemotherapy. Traditional approaches do not take into account the effect that chemotherapeutic changes and variable interactions can cause in adverse reactions. We aimed to identify the impact of the change of a chemotherapy protocol within the same treatment in profiles associated with adverse reactions.
A total of 166 women admitted to the Brazilian National Institute of Cancer (INCA) were followed. Polymorphisms, clinical variables, and FAC-D protocols (3 cycles of cyclophosphamide, 5-fluorouracil, and doxorubicin followed by 3 cycles of docetaxel) composed the set of independent variables analyzed. Reaction levels were recorded at the end of each chemotherapy cycle via interviews. Marginal models were fitted.
The results of marginal models for non-hematological reactions revealed that the docetaxel phase was associated with increased reaction levels compared with the FAC phase. In addition, the set of factors associated with the reactions changed in each protocol. The post-menopausal status was related to high levels of asthenia in docetaxel protocol whereas CYP2B6 polymorphism (rs3745274) was related to high levels in FAC protocol. Regarding the docetaxel phase, high levels of abdominal pain and mucositis were related to CBR3 gene (rs8133052) polymorphism and diabetes respectively.
The results suggest the need for monitoring non-hematological reactions during the docetaxel phase of FAC-D treatment. The factors related to more severe reactions depend on the chemotherapy protocol used.
乏力、肌痛、关节痛、黏膜炎、腹痛、腹泻和中性粒细胞减少是接受化疗的女性常见的不良反应。传统方法并未考虑化疗变化和可变相互作用可能对不良反应造成的影响。我们旨在确定同一治疗方案中化疗方案改变对不良反应相关特征的影响。
共随访了 166 名入组巴西国家癌症研究所（INCA）的女性。多态性、临床变量和 FAC-D 方案（3 个周期的环磷酰胺、5-氟尿嘧啶和多柔比星，随后是 3 个周期的多西他赛）构成了分析的独立变量集。通过访谈在每个化疗周期结束时记录反应水平。拟合边缘模型。
非血液学反应的边缘模型结果表明，与 FAC 阶段相比，多西他赛阶段与更高的反应水平相关。此外，与反应相关的因素集在每个方案中都发生了变化。绝经后状态与多西他赛方案中的乏力水平较高相关，而 CYP2B6 多态性（rs3745274）与 FAC 方案中的高水平相关。关于多西他赛阶段，高水平的腹痛和黏膜炎分别与 CBR3 基因（rs8133052）多态性和糖尿病相关。
结果表明，在 FAC-D 治疗的多西他赛阶段需要监测非血液学反应。更严重反应的相关因素取决于所使用的化疗方案。
