Targeted anti-cytokine therapy involves the use of an agent, such as a monoclonal antibody, that inhibits physiologic actions of the cytokine. Therapy reviewed here involved the use of an antibody to tumor necrosis factor, which has been used in a variety of inflammatory diseases, such as Crohn’s disease and arthritis. Use of this therapy was evaluated in patients with cancer for the management of fatigue.
Monk, J.P., Phillips, G., Waite, R., Kuhn, J., Schaaf, L.J., Otterson, G.A., . . . Villalona-Calero, M.A. (2006). Assessment of tumor necrosis factor alpha blockade as an intervention to improve tolerability of dose-intensive chemotherapy in cancer patients. Journal of Clinical Oncology, 24, 1852–1859.
N = 28
MEDIAN AGE = 56 years
AGE RANGE = 25–83 years
MALES = 17
KEY DISEASE CHARACTERISTICS: Most had received previous chemotherapy and/or radiotherapy and had multiple disease sites. The most common disease site was non-small-cell lung.
EXCLUSION CRITERIA: Patients were excluded if they were scheduled for major surgery, radiotherapy, or chemotherapy within 28 days of study entry or had brain metastases, serious infections, or psychiatric disorders that would interfere with consent or follow-up; pre-existing moderate-to-severe peripheral neuropathy; or cardiac disease. Pregnant or lactating women also were excluded.
Patients randomly were selected to receive etanercept/docetaxel. Less fatigue was self-reported in comparison to patients who received docetaxel only (p < 0.001). The FSI Interference score of Cohort A was significantly greater than the score of Cohort B (p < 0.001). Patients receiving additional cycles for treatment (Cohorts B,C, and D) did not experience worsening fatigue.
Tookman, A. J., Jones, C. L., Dewitte, M., & Lodge, P. J. (2008). Fatigue in patients with advanced cancer: a pilot study of an intervention with infliximab. Supportive Care in Cancer, 16, 1131–1140.
In the original protocol, infliximab was given as an intravenous infusion at 5 mg/kg over a two-hour period, followed by a two-hour observation period, at baseline and two, four, and every four weeks after that if improvement was demonstrated. After a patient suffered a serious infection following the week 2 infusion, the dosing regimen was amended to 5 mg/kg at week 0 and every four weeks after if improvement was observed. The first five patients were treated under the original protocol, and the next 12 were treated according to the amended protocol. Patient outcomes were evaluated at every time point.
Outpatient, daytime therapy clinics for specialist palliative care at the Marie Curie Hospice, United Kingdom
Patients were undergoing the palliative phase of care.
This was an open-label, pilot study.
Fatigue Severity Scale (FSS)
The infliximab intervention did not show an overall improvement of fatigue in patients. However, a small cohort of six patients showed an improvement in FSS scores over time with repeated infliximab infusions, although this difference did not reach statistical significance. The six patients shared a similar profile of NSCLC that was progressive through chemotherapy and received the amended protocol treatment.