losartan-potassium and Pancreatic-Neoplasms

Results of treatment of 39 patients, to whom pancreatoduodenal resection was performed for periampullar zone tumour, were analyzed. Anemia, revealed before the operation, had constituted the factor, which trustworthily increased the postoperative complications occurrence risk. Therapeutic course, using recombinant erythropoietins, was conducted for correction of anemia in 7 patients. This had promoted the hemoglobin level raising, the risk of postoperative complications occurrence lowering, but did not influence the intraoperative blood loss severity and perioperative hemotransfusion volume.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Anemia; Bile Duct Neoplasms; Digestive System Neoplasms; Drug Administration Schedule; Duodenal Neoplasms; Epoetin Alfa; Erythropoietin; Female; Humans; Male; Middle Aged; Pancreatic Neoplasms; Pancreaticoduodenectomy; Postoperative Complications; Recombinant Proteins; Risk Factors; Treatment Outcome

Preoperative treatment with 600 U/kg of recombinant human erythropoietin (r-HuEPO) effectively increases erythropoiesis in cancer patients. The aim of this study was to evaluate the erythropoietic response after different doses of r-HuEPO in order to find the minimum effective dose.. Twenty anemic sideropenic patients (hemoglobin

Topics: Adenocarcinoma; Aged; Anemia; Colorectal Neoplasms; Dose-Response Relationship, Drug; Erythropoiesis; Erythropoietin; Female; Humans; Male; Middle Aged; Pancreatic Neoplasms; Preoperative Care; Prospective Studies; Recombinant Proteins; Stomach Neoplasms

The refusal of blood transfusions compels surgeons to face ethical and clinical issues. A single-institution experience with a dedicated perioperative blood management protocol was reviewed to assess feasibility and short-term outcomes of true bloodless pancreatic surgery.. The institutional database was reviewed to identify patients who refused transfusion and were scheduled for elective pancreatic surgery from 2010 through 2018. A protocol to optimize the hemoglobin values by administration of drugs stimulating erythropoiesis was systematically used.. Perioperative outcomes of 32 Jehovah's Witnesses patients were included. Median age was 67 years (range, 31-77). Nineteen (59.4%) patients were treated with preoperative erythropoietin. Twenty-four (75%) patients underwent pylorus-preserving pancreaticoduodenectomy, 4 (12.5%) distal pancreatectomy (DP) with splenectomy, 3 (9.4%) spleen-preserving DP, and 1 (3.1%) total pancreatectomy. Median estimated blood loss and surgical duration were 400 mL (range, 100-1000) and 470 min (range, 290-595), respectively. Median preoperative hemoglobin was 13.9 g/dL (range, 11.7-15.8) while median postoperative nadir hemoglobin was 10.5 g/dL (range, 7.1-14.1). The most common histological diagnosis (n = 15, 46.9%) was pancreatic ductal adenocarcinoma. Clavien-Dindo grade I-II complications occurred in fourteen (43.8%) patients while one (3.1%) patient had a Clavien-Dindo grade IIIa complication wich was an abdominal collection that required percutaneous drainage. Six (18.8%) patients presented biochemical leak or postoperative pancreatic fistula grade B. Median hospital stay was 16 days (range, 8-54) with no patient requiring transfusion or re-operation and no 90-day mortality.. A multidisciplinary approach and specific perioperative management allowed performing pancreatic resections in patients who refused transfusion with good short-term outcomes.

Topics: Adult; Aged; Blood Loss, Surgical; Blood Transfusion; Bloodless Medical and Surgical Procedures; Carcinoma, Pancreatic Ductal; Erythropoietin; Feasibility Studies; Female; Hemoglobins; Humans; Jehovah's Witnesses; Length of Stay; Male; Middle Aged; Pancreatectomy; Pancreatic Neoplasms; Pancreaticoduodenectomy; Perioperative Care; Postoperative Complications; Splenectomy; Treatment Outcome; Treatment Refusal

Topics: Abdominal Neoplasms; Adolescent; Adult; Basic Helix-Loop-Helix Transcription Factors; Child; DNA Mutational Analysis; Erythropoietin; Exudates and Transudates; Female; Fibrosis; Fluorescein Angiography; Humans; Male; Optic Disk; Pancreatic Neoplasms; Paraganglioma; Polycythemia; Retinal Neovascularization; Somatostatinoma

Erythropoietin (Epo) administration has been reported to have tumor-promoting effects in anemic cancer patients. We investigated the prognostic impact of endogenous Epo in patients with pancreatic ductal adenocarcinoma (PDAC).. The clinico-pathological relevance of hemoglobin (Hb, n = 150), serum Epo (sEpo, n = 87) and tissue expression of Epo/Epo receptor (EpoR, n = 104) was analyzed in patients with PDAC. Epo/EpoR expression, signaling, growth, invasion and chemoresistance were studied in Epo-exposed PDAC cell lines.. Compared to donors, median preoperative Hb levels were reduced by 15% in both chronic pancreatitis (CP, p<0.05) and PDAC (p<0.001), reaching anemic grade in one third of patients. While inversely correlating to Hb (r = -0.46), 95% of sEPO values lay within the normal range. The individual levels of compensation were adequate in CP (observed to predicted ratio, O/P = 0.99) but not in PDAC (O/P = 0.85). Strikingly, lower sEPO values yielding inadequate Epo responses were prominent in non-metastatic M0-patients, whereas these parameters were restored in metastatic M1-group (8 vs. 13 mU/mL; O/P = 0.82 vs. 0.96; p<0.01)--although Hb levels and the prevalence of anemia were comparable. Higher sEpo values (upper quartile ≥ 16 mU/ml) were not significantly different in M0 (20%) and M1 (30%) groups, but were an independent prognostic factor for shorter survival (HR 2.20, 10 vs. 17 months, p<0.05). The pattern of Epo expression in pancreas and liver suggested ectopic release of Epo by capillaries/vasa vasorum and hepatocytes, regulated by but not emanating from tumor cells. Epo could initiate PI3K/Akt signaling via EpoR in PDAC cells but failed to alter their functions, probably due to co-expression of the soluble EpoR isoform, known to antagonize Epo.. Higher sEPO levels counteract anemia but worsen outcome in PDAC patients. Further trials are required to clarify how overcoming a sEPO threshold ≥16 mU/ml by endogenous or exogenous means may predispose to or promote metastatic progression.

Topics: Adult; Aged; Autoantibodies; Base Sequence; Blotting, Western; Carcinoma, Pancreatic Ductal; DNA Primers; Erythropoietin; Female; Flow Cytometry; Humans; Immunohistochemistry; Immunoprecipitation; Male; Middle Aged; Pancreatic Neoplasms; Prognosis; Real-Time Polymerase Chain Reaction; Receptors, Erythropoietin; RNA, Messenger

Topics: Aged; Anemia; Antimetabolites, Antineoplastic; Chronic Disease; Deoxycytidine; Erythropoietin; Gemcitabine; Hemolytic-Uremic Syndrome; Humans; Liver Neoplasms; Male; Pancreatic Neoplasms; Treatment Failure

Risk factors for cancer-associated VTE include certain cancer types (e.g. pancreatic adenocarcinoma), chemotherapy, and the use of erythropoiesis-stimulating agents, central venous catheters, and surgery. We studied the risk factors for cancer-associated VTE in our institution.. Retrospective analysis of patients with solid cancers treated with chemotherapy at King Khalid University Hospital from 2000 to 2010.. We assessed risk factors responsible for VTE, including performance status, age, chemotherapy, use of erythropoietin (EPO), stage of disease and use of a central venous catheter. Patients with other co-morbidities such as diabetes were excluded.. Forty of 306 patients were identified as having VTE, including 111 males and 195 females with a median age of 38 years (range, 13-18 years). Thirty-nine patients had proximal deep vein thrombosis (DVT) and, 4 had pulmonary embolism with no evidence of DVT. Of the 43 patients, 40 patients had stage III or IV at the time of VTE. Thirty patients were taking erythropoietin (40 000 units/ week); 25 had a hemoglobin level higher than 12 g/L. All patients were treated with low molecular weight (LMW) heparin and maintained on LMW heparin or warfarin for minimum of 6 months.. VTE imposes a great risk to life in cancer patients. Risk factors include age more than 40 years, advanced cancer stage, chemotherapy, use of EPO for anemia and underuse of DVT prophylaxis.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anemia; Anticoagulants; Catheterization, Central Venous; Erythropoietin; Female; Hemoglobins; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Neoplasm Staging; Pancreatic Neoplasms; Retrospective Studies; Risk Factors; Venous Thromboembolism; Warfarin; Young Adult

Erythropoietin (EPO) regulates the proliferation and differentiation of erythroid cells by binding to its specific transmembrane receptor EPOR. Recent studies, however, have shown that the EPOR is additionally present in various cancer cells and EPO induces the proliferation of these cells, suggesting a different function for EPO other than erythropoiesis. Therefore, the purpose of the present study was to examine EPOR expression and the role of EPO in the proliferation and signaling cascades involved in this process, using the rat pancreatic tumor cell line AR42J. Our results showed that AR42J cells expressed EPOR, and EPO significantly enhanced their proliferation. Cell cycle analysis of EPO-treated cells indicated an increased percentage of cells in the S phase, whereas cell numbers in G0/G1 phase were significantly reduced. Phosphorylation of extracellular regulatory kinase 1/2 (ERK1/2) and c-Jun NH(2) terminal kinase 1/2 (JNK1/2) was rapidly stimulated and sustained after EPO addition. Treatment of cells with mitogen-activated protein/ERK kinase (MEK) inhibitor PD98059 or JNK inhibitor SP600125 significantly inhibited EPO-enhanced proliferation and also increased the fraction of cells in G0/G1 phase. Furthermore, the inhibition of JNK using small interference RNA (siRNA) suppressed EPO-enhanced proliferation of AR42J cells. Taken together, our results indicate that AR42J cells express EPOR and that the activation of both ERK1/2 and JNK1/2 by EPO is essential in regulating proliferation and the cell cycle. Thus both appear to play a key role in EPO-enhanced proliferation and suggest that the presence of both is required for EPO-mediated proliferation of AR42J cells.

Topics: Animals; Antibodies; Cell Cycle; Cell Line, Tumor; Cell Proliferation; Erythropoietin; ets-Domain Protein Elk-1; Extracellular Signal-Regulated MAP Kinases; JNK Mitogen-Activated Protein Kinases; Kinetics; Mitogen-Activated Protein Kinase 1; Mitogen-Activated Protein Kinase 3; Mitogen-Activated Protein Kinase 8; Mitogen-Activated Protein Kinase 9; Pancreatic Neoplasms; Phosphorylation; Protein Kinase Inhibitors; Rats; Receptors, Erythropoietin; RNA, Small Interfering; Signal Transduction; Transfection

To assess recent developments in the use of transfusions.. Data from hospital-based sources were condensed in a single spread sheet covering 1611 transfusions of a total of 881 patients together with data on 25,264 treatment sessions in 6137 patients within a time period between 1 August 2001 and 31 July 2004.. Our audit showed an increase in transfusions of 25% in 3 years. This was accompanied by an increased threshold for transfusions, as shown by a significant rise in mean haemoglobin trigger levels from 8.53 to 8.86 g/dl (P<0.001) as well as an increase in treatment sessions and patient numbers - especially for chemotherapy or combinations of chemotherapy and radiotherapy. The highest transfusion rates and also the greatest increments occurred in patients with carcinoma of the ovary, lung and pancreas. Within these groups, treatment regimens as well as treatment lines were additional predictive factors.. This audit gives a detailed view on rising trends in transfusion requirements and, in light of anticipated restrictions on resources, it identifies high-risk areas, where the use of alternatives, such as erythropoietin, could be considered.

Topics: Anemia; Antineoplastic Combined Chemotherapy Protocols; Blood Transfusion; Breast Neoplasms; Cost-Benefit Analysis; Database Management Systems; England; Erythropoietin; Female; Health Services Needs and Demand; Hemoglobins; Hospitals, University; Humans; Lung Neoplasms; Male; Medical Audit; Medical Oncology; Ovarian Neoplasms; Pancreatic Neoplasms; Radiation Oncology; Utilization Review

Topics: Carcinoid Tumor; Erythropoietin; Female; Hormones, Ectopic; Humans; Liver Neoplasms; Middle Aged; Pancreatic Neoplasms; Paraneoplastic Endocrine Syndromes; Polycythemia

Topics: Adult; Blood Transfusion; Christianity; Erythropoietin; Humans; Injections, Intravenous; Intraoperative Period; Iron; Male; Middle Aged; Pancreatic Neoplasms; Recombinant Proteins

Topics: Adenocarcinoma; Carcinoma, Pancreatic Ductal; DNA, Complementary; Erythropoietin; Humans; Immunohistochemistry; Male; Middle Aged; Pancreatic Neoplasms; RNA, Messenger

Topics: Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Erythropoietin; Gonadotropins, Pituitary; Growth Hormone; Humans; Insulin; Insulin Secretion; Liver Neoplasms; Lung Neoplasms; Malignant Carcinoid Syndrome; Melanocyte-Stimulating Hormones; Pancreatic Neoplasms; Paraneoplastic Endocrine Syndromes; Prolactin; Serotonin; Thymus Neoplasms; Vasopressins