warfarin and Carcinoma--Non-Small-Cell-Lung

Trapeziometacarpal osteoarthritis is associated with more pain and restrictions than other hand osteoarthritis due to the functional importance of the thumb. While the effectiveness of surgical and pharmacological interventions has been widely examined, there is a lack of specific evidence about conservative non-pharmacological trapeziometacarpal osteoarthritis therapies. The objective of this systematic review was to provide evidence-based knowledge on the effectiveness of physiotherapy and occupational therapy on pain, function and quality of life.. A literature search of Medline, CINAHL, PEDro, OTseeker, EMB Dare Cochrane Database of Systematic Reviews and Cochrane CENTRAL was performed. Randomized and quasi-randomized controlled trials and corresponding systematic reviews, observational studies, pragmatic studies and case-control studies were included. The risk of bias was assessed.. Physical and occupational therapy-related interventions, especially multimodal interventions, seem to be effective to treat pain in patients with trapeziometacarpal osteoarthritis. Pre-fabricated neoprene splints and custom-made thermoplastic splints may reduce pain equally. Single interventions seem not to be effective. Significant evidence for effectiveness on function and quality of life could not be found.. The sole Na. The SUV. Genetic variants of

Topics: AC133 Antigen; Acenaphthenes; Acer; Acrosome Reaction; Adult; Agaricales; Aged; Aged, 80 and over; Animals; Animals, Zoo; Anti-Bacterial Agents; Anticoagulants; Antifungal Agents; Antimanic Agents; Antioxidants; Aortic Valve; Area Under Curve; ATP Binding Cassette Transporter, Subfamily G, Member 2; Bacillus; Bacterial Toxins; Bacterial Typing Techniques; Base Composition; Beauveria; Binge Drinking; Biomarkers; Bipolar Disorder; Blood Coagulation; Blotting, Western; Brachytherapy; Calcium Channels, L-Type; Carcinoma, Non-Small-Cell Lung; Cell Cycle; Cell Line, Tumor; Cell Proliferation; Cell Survival; Cell Transformation, Neoplastic; Cell Wall; Cells, Cultured; Ceramics; Chi-Square Distribution; China; Chlorophyll; Chlorophyta; Chloroplasts; Cholesterol, HDL; Chromatography, High Pressure Liquid; Chromobacterium; Clostridium perfringens; Clozapine; Constriction, Pathologic; Coronary Artery Bypass; Corticotropin-Releasing Hormone; Cross-Sectional Studies; Cytochrome P-450 CYP2C9; Dental Porcelain; Dental Restoration Failure; Dental Stress Analysis; Designer Drugs; Diaminopimelic Acid; DNA Fingerprinting; DNA, Bacterial; Dose-Response Relationship, Drug; Dose-Response Relationship, Radiation; Drug Dosage Calculations; Drug Evaluation, Preclinical; Drug Resistance, Bacterial; Elasticity Imaging Techniques; Epsilonproteobacteria; Equipment Design; Ericaceae; Excitatory Amino Acid Antagonists; False Negative Reactions; Fatty Acids; Female; Food Analysis; Fresh Water; Gene Expression Regulation, Neoplastic; Glutathione; Graft Occlusion, Vascular; Heart Valve Prosthesis Implantation; Heart Ventricles; HEK293 Cells; Hemolymph; Humans; Hyaluronan Receptors; Hydrogen Peroxide; Hydrothermal Vents; Indoles; Inflammation Mediators; Inhibitory Concentration 50; Insecta; International Normalized Ratio; Isotope Labeling; Itraconazole; Kidney; Kinetics; Kruppel-Like Factor 4; Kruppel-Like Transcription Factors; Lamotrigine; Lanthanoid Series Elements; Limit of Detection; Linear Models; Lipid Peroxidation; Liver; Liver Cirrhosis; Logistic Models; Lung Neoplasms; Lymph Node Excision; Lymphatic Metastasis; Male; Malondialdehyde; Mediastinum; Metronidazole; Mice; Mice, Nude; Mice, Transgenic; Microbial Sensitivity Tests; Microscopy, Fluorescence; Middle Aged; Monocytes; Monomeric GTP-Binding Proteins; Multivariate Analysis; Myocytes, Cardiac; Neoplasm Staging; Neoplastic Stem Cells; Neural Pathways; Nitrates; Nucleic Acid Hybridization; Octamer Transcription Factor-3; Odds Ratio; Oxidation-Reduction; Oxidative Stress; Peptidoglycan; Phantoms, Imaging; Pharmacogenetics; Pharmacogenomic Variants; Phenotype; Phospholipids; Photolysis; Photosynthesis; Phylogeny; Plant Extracts; Polychaeta; Polymerase Chain Reaction; Polymorphism, Single Nucleotide; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Preoperative Care; Prostatic Neoplasms; Pseudomonas aeruginosa; Pyrimidines; Pyrroles; Quorum Sensing; Radiology, Interventional; Radiopharmaceuticals; Radiotherapy Dosage; Rats; Rats, Sprague-Dawley; Receptors, Corticotropin-Releasing Hormone; Reference Values; Regression Analysis; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction; Rhizosphere; Risk Factors; RNA, Ribosomal, 16S; ROC Curve; Rutin; Saphenous Vein; Seawater; Selenium; Semen Preservation; Sensitivity and Specificity; Septal Nuclei; Sequence Analysis, DNA; Serum Albumin; Serum Albumin, Human; Shear Strength; Sodium Pertechnetate Tc 99m; Sodium-Hydrogen Exchangers; Soil Microbiology; SOXB1 Transcription Factors; Spain; Species Specificity; Sperm Motility; Spermatozoa; Spheroids, Cellular; Spores, Fungal; Stroke; Superoxide Dismutase; Swine; Tandem Mass Spectrometry; Technetium Compounds; Technetium Tc 99m Exametazime; Technetium Tc 99m Sestamibi; Temperature; Thiosulfates; Thrombosis; Thyroid Neoplasms; Transducers; Transfection; Transplantation, Heterologous; Treatment Outcome; Triazines; Tumor Burden; Urocortins; Uterine Cervical Neoplasms; Vacuoles; Valproic Acid; Ventral Tegmental Area; Vitamin K 2; Vitamin K Epoxide Reductases; Warfarin; Water Microbiology; Young Adult

Activation of coagulation and of the fibrinolytic system has been identified in small cell and non-small cell cancers respectively. For the clinician this poses the diagnostic problem of a thrombosis, which is most often venous with or without pulmonary emboli, complicating the evolution of an already diagnosed cancer. The inverse is that these features may reveal an underlying neoplasm and amongst the most common of these would be bronchopulmonary cancer. Numerous laboratory studies have shown the existence of a state of hyper-coagulability, with disseminated intra-vascular coagulation, which is more or less compensated and is the more marked, the more advanced the cancer is. One should not fail to recognise that this state of hyper-coagulability may be aggravated by certain cytotoxic drugs. At the level of the tumour itself, there seems to be interactions between the cancer cells and the coagulation and fibrinolytic system: these interactions are very different according to the histological type as to whether they are small cell or non-small cell bronchopulmonary cancers.

Topics: Anticoagulants; Antineoplastic Agents; Blood Coagulation; Blood Coagulation Disorders; Bronchial Neoplasms; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Disseminated Intravascular Coagulation; Female; Fibrinolysis; Humans; Lung Neoplasms; Male; Middle Aged; Randomized Controlled Trials as Topic; Thromboembolism; Thrombosis; Warfarin

Ceritinib is an ALK receptor tyrosine kinase inhibitor approved as first- and second-line treatment in adult patients with ALK + metastatic non-small cell lung cancer (NSCLC). The study investigated the drug-drug interaction (DDI) potential of ceritinib when coadministered with midazolam and warfarin as probe substrates for CYP3A and CYP2C9 activity, respectively.. This was a phase I, multicenter, open-label, single sequence, crossover DDI study in 33 adult patients with ALK + NSCLC or other advanced tumors. A single dose of a cocktail consisting of midazolam and warfarin was administered with and without concomitant administration of ceritinib. The primary objective was to evaluate the pharmacokinetics of midazolam and warfarin. Secondary objectives included pharmacokinetics, safety, tolerability, overall response rate (ORR), and duration of response (DOR) of ceritinib 750 mg once daily.. Ceritinib inhibited CYP3A-mediated metabolism of midazolam, resulting in a markedly increased AUC (geometric mean ratio [90% confidence interval]) by 5.4-fold (4.6, 6.3). Ceritinib also led to an increase in the AUC of S-warfarin by 54% (36%, 75%). The pharmacokinetics and safety profile of ceritinib in this study are consistent with previous reports and no new safety signals were reported. Among the 19 patients with NSCLC, efficacy (ORR: 42.1% and DCR: 63.2%) was similar to that reported previously in studies of pretreated patients with ALK + NSCLC.. Ceritinib is a strong CYP3A inhibitor and a weak CYP2C9 inhibitor. These findings should be reflected as actionable clinical recommendations in the prescribing information for ceritinib with regards to concomitant medications whose pharmacokinetics may be altered by ceritinib.

Topics: Adult; Aged; Anaplastic Lymphoma Kinase; Carcinoma, Non-Small-Cell Lung; Cross-Over Studies; Cytochrome P-450 CYP2C9; Cytochrome P-450 CYP3A; Drug Interactions; Female; Humans; Lung Neoplasms; Male; Midazolam; Middle Aged; Pyrimidines; Sulfones; Warfarin; Young Adult

This report describes the case of a 66-year-old man with non-small cell lung cancer and venous thromboembolism (VTE). Unfractionated heparin (UFH) was initially used to control VTE before chemotherapy. However, switching UFH to warfarin or edoxaban, a novel oral anticoagulant (NOAC), failed. Chemotherapy was then administered to control the tumor which was thought to have been the main cause of VTE, which had been treated by UFH. After tumor shrinkage was achieved by chemotherapy, we were able to successfully switch from UFH to edoxaban. Controlling the tumor size and activity enabled the use of edoxaban as maintenance therapy for VTE.

Topics: Aged; Anticoagulants; Carcinoma, Non-Small-Cell Lung; Heparin; Humans; Lung Neoplasms; Male; Pyridines; Thiazoles; Tumor Burden; Venous Thromboembolism; Warfarin

A 65-year-old man was diagnosed with advanced non-small, non-squamous lung cancer. He was treated with chemotherapy containing bevacizumab as well as cisplatin and pemetrexed. After 2 courses of treatment, computed tomography revealed that his abdominal aortic artery was almost occluded by a thrombus; however, he had no ischemic symptoms. Heparin infusion and warfarin reduced the size of the arterial thrombus and the patient was subsequently treated with chemotherapy without bevacizumab. No thrombotic events occurred during the subsequent treatment. We later noticed a small organized abdominal arterial clot and calcification on a computed tomography scan taken before bevacizumab treatment. Atherosclerotic changes should be evaluated before the administration of bevacizumab.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Aortic Diseases; Bevacizumab; Carcinoma, Non-Small-Cell Lung; Cisplatin; Heparin; Humans; Lung Neoplasms; Male; Pemetrexed; Thrombosis; Treatment Outcome; Warfarin

We report a case of increased prothrombin time-international normalized ratio (PT-INR) when crizotinib and warfarin were co-administered. A 74-year-old Japanese woman presented to the hospital with dyspnea, and was diagnosed with anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer (NSCLC). Three years after surgical resection of the tumor, the patient started crizotinib because of the recurrence of NSCLC. She received 2 mg/day warfarin due to a medical history of cerebral infarction and chronic atrial fibrillation. Before crizotinib initiation, the patient's PT-INR was 2.60. After 7 days of daily doses of crizotinib, the patient's PT-INR increased to 3.65. This case report provides the first evidence of a drug interaction between crizotinib and warfarin.

Topics: Aged; Anticoagulants; Carcinoma, Non-Small-Cell Lung; Crizotinib; Drug Interactions; Drug Therapy, Combination; Female; Humans; International Normalized Ratio; Lung Neoplasms; Neoplasm Recurrence, Local; Protein Kinase Inhibitors; Prothrombin Time; Pyrazoles; Pyridines; Warfarin

Cisplatin-based therapy is associated with various toxicities, including renal failure and neuropathy. However, acute arterial thrombosis is also a possible toxic effect of cisplatin, one that has been documented in a few cases worldwide. Here we present a rare case of ascending aortic thrombosis occurring 9 days after cisplatin-based chemotherapy in a 74-year-old male who was diagnosed with malignant pleural effusion suggestive of non-small cell lung cancer. The patient did not have any predisposing factor for the occurrence of an aortic thrombus before cisplatin-based chemotherapy. Thus, we suggest that the hypercoagulable state occurred secondary to cisplatin-based chemotherapy and was additive to the malignancy itself, causing aortic thrombosis. The patient was treated successfully with low-molecular-weight heparin and warfarin.

Topics: Aged; Anticoagulants; Aorta; Carcinoma, Non-Small-Cell Lung; Cisplatin; Heparin; Humans; Lung Neoplasms; Male; Pleural Effusion, Malignant; Thrombosis; Warfarin

The case of a patient who developed elevated International Normalized Ratio (INR) values after concomitant administration of warfarin and erlotinib is reported.. A 47-year-old Caucasian man with a history of atrial fibrillation, anxiety, and a 40-pack-year smoking history was diagnosed with advanced, moderately differentiated adenocarcinoma of the lung. Soon after being diagnosed with non-small-cell lung cancer, warfarin was initiated for the treatment of a venous thromboembolism. The patient's warfarin dosage was adjusted to reach a target INR of 2-3. His INR was relatively stable (2.1-3.2) for at least eight weeks before erlotinib was added to the chemotherapy regimen. The patient developed a well-disseminated rash and diarrhea soon after starting erlotinib. Seven days after the initiation of erlotinib therapy, the patient's INR value increased from 2.8 to 5.3, with no concurrent changes in warfarin dosage, other medications, or diet. After withholding two doses of warfarin, the patient's INR value increased to 9.1, and the patient developed an elbow hematoma. His anticoagulation was rapidly reversed with the administration of subcutaneous phytonadione. The patient elected to discontinue erlotinib nine days after its initiation. The next day, his INR value was 2.4. The patient returned to the hematology-oncology clinic for follow-up two days later, where his INR was found to be 0.9.. Concomitant administration of erlotinib and warfarin resulted in an increase in INR values in a 47-year-old man with advanced lung cancer.

Topics: Adenocarcinoma; Anticoagulants; Carcinoma, Non-Small-Cell Lung; Drug Interactions; Drug Therapy, Combination; Erlotinib Hydrochloride; Humans; International Normalized Ratio; Lung Neoplasms; Male; Middle Aged; Quinazolines; Thromboembolism; Warfarin

Topics: Aged; Anticoagulants; Carcinoma, Non-Small-Cell Lung; Cardiac Tamponade; Female; Humans; Pericardial Effusion; Warfarin

Despite the literature indicating adverse interactions between warfarin and cytotoxic agents, whether such an interaction occurs when warfarin and gefitinib are used concomitantly is unknown. We analyzed the prevalence of the concomitant use of warfarin and gefitinib, and the incidence of prothrombin time-international normalized ratio (PT-INR) alterations or adverse interactions in concomitant users of warfarin and gefitinib.. We conducted a retrospective study of patients with non-small cell lung cancer treated at the Kitasato University Hospital who received concomitant warfarin and gefitinib between September 2002 and January 2007. Medical information, including the indication for warfarin use, warfarin dosing and dosing changes, and exposure to gefitinib were collected from computerized databases and medical records.. Twelve (4.1%) of 296 patients treated with gefitinib received warfarin. PT-INR elevation occurred in 6 patients (50.0%). Two (16.7%) of the 12 patients had liver metastases. Liver dysfunction was associated with PT-INR elevation (P = 0.0100).. As there is a possibility of PT-INR abnormalities occurring during the concomitant use of gefitinib and warfarin, clinicians should be aware of this interaction. Because of the potentially severe consequences of this interaction, close monitoring of PT-INR and warfarin dose adjustment are recommended for patients receiving warfarin and gefitinib, especially during the first 2 weeks in the beginning of warfarin therapy.

Topics: Aged; Anticoagulants; Antineoplastic Agents; Blood Coagulation; Carcinoma, Non-Small-Cell Lung; Drug Interactions; Female; Gefitinib; Humans; International Normalized Ratio; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Protein Kinase Inhibitors; Prothrombin Time; Quinazolines; Retrospective Studies; Time Factors; Warfarin

The anticoagulant warfarin can produce a skin necrosis that is clinically indistinguishable from the skin necrosis caused by purpura fulminans associated with disseminated intravascular coagulation (DIC) and heparin-induced thrombocytopenia (HIT). The similar clinical and histologic findings observed in each of these skin necroses create a challenge for diagnosis and eventual treatment. The authors report a patient with significant risk factors for warfarin-induced skin necrosis, DIC, and HIT presenting with painful, purpuric patches beginning on her feet and extending proximally before becoming hemorrhagic bullae on her lower extremities.

Topics: Aged; Anticoagulants; Biopsy; Carcinoma, Non-Small-Cell Lung; Diagnosis, Differential; Disseminated Intravascular Coagulation; Fatal Outcome; Female; Humans; IgA Vasculitis; Lung Neoplasms; Mediastinal Neoplasms; Necrosis; Pulmonary Embolism; Warfarin

Gefitinib is a synthetic, oral anilinoquinazoline specifically designed to inhibit the epidermal growth factor receptor tyrosine kinase, and is the first targeted drug to demonstrate reproducible activity in non-small cell lung cancer patients who do not respond to platinum-based chemotherapy. In this report, we present two cases of an interaction between gefitinib and warfarin which has not been reported previously. Because of the potentially serious consequences of this interaction, close monitoring of the International Normalized Ratio and warfarin dosage adjustment are recommended for patients receiving warfarin together with gefitinib.

Topics: Aged; Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Drug Administration Schedule; Drug Interactions; Drug Synergism; ErbB Receptors; Female; Gefitinib; Humans; Lung Neoplasms; Middle Aged; Protein Kinase Inhibitors; Quinazolines; Thrombosis; Warfarin

One of the standard treatments for cancer-associated thrombosis has been initial therapy with unfractionated heparin (UFH) followed by long-term therapy with an oral anticoagulant (i.e., warfarin). However, characteristics associated with these two agents may make them suboptimal for many cancer patients. This article will explore some of the considerations and limitations when using UFH and warfarin in the cancer population and will also utilize case studies to emphasize the importance of individualized care.. UFH is an effective anticoagulant when doses are adjusted to maintain the activated partial thromboplastin time (aPTT) within a specified therapeutic range. However, due to the complex pharmacokinetics of this agent, patients must undergo frequent monitoring to maintain a therapeutic aPTT. In addition, UFH can be associated with serious adverse events including osteoporosis, heparin-induced thrombocytopenia, and bleeding. Similar to UFH, warfarin requires frequent monitoring and dose adjustments to maintain the International Normalized Ratio (INR) within the therapeutic range of 2.0 to 3.0. Warfarin also has numerous drug-herbal, drug-food, and drug-drug interactions, including interactions with many commonly used anti-tumor therapies. Complications related to UFH and warfarin in the treatment of cancer-associated thrombosis have gradually been minimized with the increased use of low molecular weight heparins (LMWHs), which are associated with reduced incidence of bleeding, heparin-induced thrombocytopenia, and drug interactions. In addition, LMWHs allow for convenient daily dosing without requiring routine monitoring and the option of home therapy.. When deciding on the optimal anticoagulant strategy, pharmacists must take into account the unique characteristics and needs of each individual patient as well as the specifics of the various anticoagulant therapies. Future strategies for the initial and long-term treatment of cancer-associated thrombosis may increasingly incorporate LMWHs because of factors related to safety and convenience.

Topics: Anticoagulants; Bone Neoplasms; Breast Neoplasms; Carcinoma, Non-Small-Cell Lung; Fatigue; Female; Heparin; Heparin, Low-Molecular-Weight; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasms; Thrombosis; Warfarin

The effect on long-term survival of immunomodulation adjuvant to various cytotoxic chemotherapy regimens in non-small cell lung cancer (NSCLC) was evaluated in 669 patients followed up between 1974 and 1987. Four hundred seventeen patients were treated only by cytotoxic chemotherapy and served as controls. Two hundred fifty-two patients received warfarin (W), levamisole (L) and tranexamic acid (T) for adjuvant immunomodulation. These drugs, especially when given in combination (W + L + T), led to a significant (p less than 0.05) enhancement of survival in patients with advanced NSCLC, independent of the cytotoxic regimen used.

Topics: Adjuvants, Immunologic; Carcinoma, Non-Small-Cell Lung; Combined Modality Therapy; Female; Humans; Levamisole; Lung Neoplasms; Male; Middle Aged; Tranexamic Acid; Warfarin