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Aapro M.S.,Institute Multidisciplinaire dOncologie
Targeted Oncology | Year: 2012

Until recently, prescribers had to deal with generics, considered to be simple molecules that are easy to copy. But as discussed in this paper, the biodisponibility of generics remains a source of uncertainty. And now there are biosimilars, limited for the time being in the cancer setting to granulocyte-colony stimulating factors (G-CSFs) and epoetins. Soon there will be biosimilar monoclonal antibodies with anticancer activity. Prescribers will ask, as they did for generics, if such drugs have the same activity as originators, if their safety profile is the same, if quality of the production process is guaranteed. Prescribers will want to know if their patients are indeed receiving the prescribed product, and not another. Finally prescribers will want to check that the lower cost of biosimilars will allow them to adhere to international guidelines. This should benefit patients and the community. © 2011 Springer-Verlag. Source


Aapro M.,Institute Multidisciplinaire dOncologie | Launay-Vacher V.,Service Icar
Cancer Treatment Reviews | Year: 2012

Monitoring renal function in patients with solid tumors and hematologic malignancies is vital to the safe administration of therapeutic agents. Renal impairment is frequent in elderly patients (i.e., age≥65) with cancer, despite normal serum creatinine levels in most patients. Because serum creatinine levels do not accurately reflect clearance rates, renal function should be estimated by calculation (either Cockcroft-Gault or abbreviated Modification of Diet in Renal Disease [aMDRD] equations) or by measuring creatinine clearance using a 24-h urine collection. Additionally, patients with cancer often have preexisting comorbidities or other risk factors that increase the probability of renal impairment before receiving potentially nephrotoxic therapies. Patient age, preexisting renal dysfunction, and chronic comorbidities (e.g., diabetes, kidney disease, hypertension, and cardiac insufficiency) all contribute to the risk of renal impairment. Furthermore, both cancer and its therapies may lead to renal impairment. A number of cancer therapy agents are nephrotoxic, including chemotherapy agents, molecular targeted agents, pain management agents, radiopharmaceuticals, contrast agents used in radiology, and antiresorptive agents, and contrast agents used in radiology are nephrotoxic as well. Undetected decreases in clearance rates by the kidneys can greatly increase exposure to treatment agents, possibly decreasing the safety of treatment and exacerbating renal impairment. In conclusion, all cancer patients, not only those receiving potentially nephrotoxic agents, require renal monitoring. © 2011 Elsevier Ltd. Source


Aapro M.S.,Institute Multidisciplinaire dOncologie
Oncologie | Year: 2011

Until recently the prescriber had to deal with generics, considered to be simple molecules which are easy to copy. But as discussed in this paper, the biodisponibility of generics remains a source of uncertainty. And now arrive biosimilars, limited for the time being in the cancer setting to granulocyte-colony stimulating factors (G-CSFs) and epoetins. Soon there will be biosimilar monoclonal antibodies with anticancer activity. The prescriber will ask, as for generics, if such drugs have the same activity as originators, if their safety profile is the same, if quality of the production process is guaranteed. The prescriber will want to know if the patient is indeed receiving the prescribed product, and not another. Finally the prescriber will want to check that the lower cost of biosimilars will allow to adhere to international guidelines. This should benefit patients and the community. © 2011 Springer Verlag France. Source


Aapro M.S.,Institute Multidisciplinaire dOncologie
Cancer Investigation | Year: 2010

The use of endocrine therapy in breast cancer represents one of the earliest molecular targeting strategies used in cancer treatment. Tamoxifen, a selective estrogen-receptor (ER) modulator, has been the standard of care for women with receptor-positive breast cancer for the last 30 years. Tamoxifen suppresses the estrogen-dependent growth of breast cancer cells by specifically targeting the ER. Because of estrogenic effects, tamoxifen does not increase the risk of osteoporosis, but it can lead to endometrial cancer and thromboembolism. The third-generation aromatase inhibitors (AIs) exert their tumor antiproliferative action by targeting an enzyme critical for estrogen biosynthesis. The AIs thus have a different mechanism of action than tamoxifen, and a different safety profile. The majority of adverse events (AEs) related to the AIs are mild to moderate. Most of these AEs are common to menopause and are predictable and manageable. This review looks at AI-associated side effects and current clinical management strategies, with a particular emphasis on managing bone health. Compliance with long-term therapy, strategies to improve adherence, and considerations in elderly patients with hormone-responsive breast cancer are also discussed. Copyright © 2010 Informa Healthcare USA, Inc. Source


Hadji P.,University of Marburg | Aapro M.,Institute Multidisciplinaire dOncologie | Costa L.,Institute Medicina Molecular | Gnant M.,Medical University of Vienna
Cancer Treatment Reviews | Year: 2012

Antiresorptive therapies are the standard of care for maintaining bone health in patients with advanced cancers involving bone. In the absence of antiresorptive therapies, many patients with bone metastases from solid tumors will experience potentially debilitating skeletal-related events. Furthermore, older age is associated with decreased bone integrity both in female and male patients and also with increased risk for malignancies, such as breast and prostate cancer, which have a high risk of metastasis to bone. Although antiresorptive therapies are generally well tolerated, there have been reports of associated serious adverse events. Hypocalcemia, osteonecrosis of the jaw, renal events, and acute-phase reactions have been reported in patients with cancer receiving all types of antiresorptive therapies. Because the clinical indications of antiresorptive agents continue to expand, and new options are becoming available, it is important for clinicians to recognize adverse events so that they may be prevented or properly treated and managed. Moreover, the risk-benefit profiles of those agents must be considered on a per-patient basis. © 2012 Elsevier Ltd. Source

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