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Impact of serum caffeine monitoring on adverse effects and chemotherapeutic responses to caffeine-potentiated chemotherapy for osteosarcoma
Journal of Orthopaedic Science, 06/08/09

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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