Perrault David, Chen Kellen, Nazerali Rahim, Wan Derrick
Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford University, Stanford, CA 94305, USA.
Division of Plastic and Reconstructive Medicine, Stanford University School of Medicine, Stanford University, Stanford, CA 94305, USA.
Ann Case Rep. 2024;9(3). doi: 10.29011/2574-7754.101844. Epub 2024 Jun 13.
Radiation therapy is used in over 60% of cancer patients and can lead to radiation dermatitis, radiation induced fibrosis, hyperpigmentation, telangiectasias, fat necrosis, and poor wound healing. Deferoxamine (DFO) is an iron-chelating agent that has been used systemically to treat iron overload conditions and more recently been studied to treat radiation fibrosis. Through iron chelation, DFO stabilizes hypoxia inducible factor-1α, driving downstream upregulation of angiogenic factors, and reduces formation of reactive oxygen species, thereby offering a potential therapy for radiation associated chronic wounds. The purpose of this work was to describe treatment of a refractory wound following radiation treatment that had failed conventional therapy.
The patient is a 71-year-old female with inflammatory breast cancer that developed a radiation related wound after mastectomy, chemotherapy, and radiation therapy. The wound did not show any signs of improvement with five months of wound care and risk factor modification. The patient was offered treatment with a topical Deferoxamine Intradermal Delivery Patch through the FDA single patient investigative new drug pathway.
After two weeks of treatment, the wound healed. Additionally, serum was collected at cessation of therapy and 5 weeks after, with both samples showing no significant systemically detectible level of the drug to be present. Subjectively the patient reported improvement in appearance and quality of the skin.
Topical deferoxamine is a promising therapy for radiation wounds. Although this report is limited to a single patient experience, we believe this work is important in describing the first in-human use of topical deferoxamine to heal a radiation therapy associated wound.
超过60%的癌症患者会接受放射治疗,这可能导致放射性皮炎、放射性纤维化、色素沉着、毛细血管扩张、脂肪坏死以及伤口愈合不良。去铁胺(DFO)是一种铁螯合剂,已被用于全身治疗铁过载情况,最近也被研究用于治疗放射性纤维化。通过铁螯合作用,DFO可稳定缺氧诱导因子-1α,促使血管生成因子的下游上调,并减少活性氧的形成,从而为放射性相关慢性伤口提供一种潜在的治疗方法。这项工作的目的是描述一例放疗后难治性伤口在常规治疗失败后的治疗情况。
患者为一名71岁女性,患有炎性乳腺癌,在乳房切除术、化疗和放疗后出现了与放疗相关的伤口。经过五个月的伤口护理和危险因素调整,伤口没有任何改善迹象。通过美国食品药品监督管理局(FDA)的单患者研究性新药途径,为该患者提供了外用去铁胺皮内给药贴片治疗。
治疗两周后,伤口愈合。此外,在治疗结束时和结束后5周采集血清,两个样本均显示未检测到有明显的全身可检测到的药物水平。患者主观报告皮肤外观和质量有所改善。
外用去铁胺是治疗放射性伤口的一种有前景的疗法。尽管本报告仅限于单一患者的经验,但我们认为这项工作对于描述外用去铁胺首次用于治疗与放射治疗相关伤口的人体应用情况具有重要意义。