Impact of serum caffeine monitoring on adverse effects and chemotherapeutic responses to caffeine-potentiated chemotherapy for osteosarcoma
Hayashi K et al. - In a trial to assess the use of monitoring and adjusting serum caffeine levels during caffeine-potentiated chemotherapy to reduce adverse effects it was concluded that monitoring and adjusting caffeine levels were achieved without apparent loss of chemotherapeutic efficacy. Methods- A method for rapidly determining caffeine concentration by high-performance liquid chromatography was utilized.
- The maximum caffeine concentration was predicted from the measured concentrations at 24 and 48 hr after the beginning of caffeine administration.
- Caffeine infusion rate was then modified accordingly to prevent the expected final concentration from exceeding 80 ?g/ml.
- The study involved 22 American Joint Committee on Cancer (AJCC) stage IIB high-grade osteosarcoma pts treated with caffeine-potentiated chemotherapy.
- 9 pts underwent monitoring of their serum caffeine levels (monitoring group), and the remaining 13 pts were not monitored (nonmonitoring group).
- Toxicities were graded according to the Japan Clinical Oncology Group Toxicity Criteria.
Results- Hematological toxic events were well tolerated in both groups.
- Grade 4 leukocyte toxicity events occurred in both groups.
- In the nonmonitoring group, grade 2 or higher toxicities included 5 elevated aspartate aminotransferase/alanine aminotransferase level events and 17 hyponatremia events vs 1 hyponatremia event in the monitoring group.
- Histological examination of excised tumor samples after preoperative chemotherapy revealed that chemotherapeutic efficacy in the monitoring group was as good as in the nonmonitoring group.
- Median follow-up period in all pts was 72 mos.
- Event-free survival was 76%, and overall survival was 100%.
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