Individualized treatment of breast cancer with chronic renal failure: A case report and review of literature

BACKGROUND Studies have shown that patients with chronic renal failure(CRF)are more likely to suffer from breast cancer and other malignant tumors.To our knowledge,CRF can reduce drug excretion,thereby increase drug exposure and lead to increased toxicity,which will limit drug treatment and lead to tumor progression.Currently,there are few successful reports on the combination of docetaxel,trastuzumab,and pertuzumab(THP)as a neoadjuvant treatment regimen for breast cancer patients with CRF.CASE SUMMARY We report a breast cancer(cT2N2M0,Her-2+/HR-)patient with CRF.It was a clinical stage IIIA tumor on the left breast.The patient had suffered from uremia for 2 years,and her heart function was normal.Based on the pathological type,molecular type,and clinical stage of breast cancer,and the patient’s renal function,the clinician analyzed the pharmacological and pharmacokinetic characteristics of the antitumor drugs after consulting the relevant literature,and prescribed the neoadjuvant regimen of THP(docetaxel 80 mg/m²,trastuzumab 8 mg/kg for the first dose,and 6 mg/kg for the maintenance dose with pertuzumab 840 mg for the first dose and 420 mg for the maintenance dose),once every 3 wk,for a total of 6 courses.The neoadjuvant treatment had a good effect,and the patient then underwent surgery which was uneventful.CONCLUSION CRF is not a contraindication for systemic treatment and surgery of breast cancer.The THP regimen without dose adjustment may be a safe and effective neoadjuvant treatment for HER-2 positive breast cancer patients with CRF.

Pharmacokinetic and pharmacodynamic considerations of antimicrobial drug therapy in cancer patients with kidney dysfunction

Patients with cancer have a high inherent risk of infectious complications.In addition,the incidence of acute and chronic kidney dysfunction rises in this population.Antiinfective drugs often require dosing modifications based on an estimate of kidney function,usually the glomerular filtration rate(GFR).However,there is still no preferential GFR formula to be used,and in acute kidney injury there is always a considerable time delay between true kidney function and estimated GFR.In most cases,the anti-infective therapy should start with an immediate and high loading dose.Pharmacokinetic as well as pharmacodynamic principles must be applied for further dose adjustment.Anti-infective drugs with time-dependent action should be given with the target of high trough concentrations(e.g.,beta lactam antibiotics,penems,vancomycin,antiviral drugs).Anti-infective drugs with concentration-dependent action should be given with the target of high peak concentrations(e.g.,aminoglycosides,daptomycin,colistin,quinolones).Our group created a pharmacokinetic database,called NEPharm,hat serves as a reference to obtain reliable dosing regimens of anti-infective drugs in kidney dysfunction as well as renal replacement therapy.To avoid the risk of either too low or too infrequent peak concentrations,we prefer the eliminated fraction rule for dose adjustment calculations.

A dual-targeted multifunctional nanoformulation for potential prevention and therapy of Alzheimer’s disease

Antioxidation and adjustable treatment strategies are critical for the effective treatment of Alzheimer’s disease(AD).Here,we design a dual-targeted Prussian blue nanoformulation(PTCN)that can cross the blood-brain barrier and target amyloid beta aggregates further exert antioxidant effects.An adjustable gradient dosing strategy with PTCN is used for the first time to design the preventive and therapeutic trials based on the severity of oxidative stress at different AD stages.The results show that PTCN could effectively ameliorate AD-related pathological processes,improve the cognitive decline,and rescue hippocampal atrophy of APP/PS1 mice in both preventive and therapeutic trials.Altogether,PTCN provided here is a successful combination of three traditional biomaterials with good biosafety,which has broad prospects for the early prevention,mild remission,and late treatment of AD,and is expected to be developed into personalized therapeutic drugs and healthcare products for clinical AD in the future.