Adjuvant therapy of melanoma with interferon‐alpha‐2b is associated with mania and bipolar syndromes

Greenberg, Donna; Jonasch, Eric; Gadd, Michele A.; Ryan, Bonita F.; Everett, James R.; Sober, Arthur J.; Mihm, Martin A.; Tanabe, Kenneth K.; Haluska, Frank G.

doi:10.1002/1097-0142(20000715)89:2<356::aid-cncr21>3.3.co;2-q

Cited by 10 publications

(10 citation statements)

References 12 publications

(15 reference statements)

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“…A significant minority of patients on IFN therapy becomes depressed, in some cases leading to suicide. There are also several reports of mania in patients on IFN [135][136][137][138]. Mood disorders can occur in patients without predisposing factors or past history of psychiatric problems.…”

Section: Mood Disordersmentioning

confidence: 99%

Interferon in Oncological Practice: Review of Interferon Biology, Clinical Applications, and Toxicities

2001

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For the past 40 years, various forms of interferon (IFN) have been evaluated as therapy in a number of malignant and non-malignant diseases. With the advent of gene cloning, large quantities of pure IFN became available for clinical study. This paper reviews the biology, pharmacology, and clinical applications of IFN formulations most commonly used in oncology. It then reviews the most common side effects seen in patients treated with IFN, and makes recommendations for the management of IFN-induced toxicity.The major oncological indications for IFN include melanoma, renal cell carcinoma, AIDS-related Kaposi's sarcoma, follicular lymphoma, hairy cell leukemia, and chronic myelogenous leukemia. Unfortunately, IFN therapy is associated with significant toxicity, which can be divided into constitutional, neuropsychiatric, hematologic, and hepatic effects. These toxicities have a major impact on the patient's quality of life, and on the physician's ability to optimally treat the patient. Careful attention to all aspects of patient care can result in improved tolerability of this difficult but promising therapy. Conclusion: a better understanding of IFN biology, indications, side effect profiles, and toxicity management will aid in optimizing its use in the treatment of patients with cancer. The Oncologist 2001;6:34-55

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Section: Mood Disordersmentioning

confidence: 99%

Interferon in Oncological Practice: Review of Interferon Biology, Clinical Applications, and Toxicities

2001

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“…The most common drug-related adverse effects are chronic fatigue, myelosuppression, elevated liver enzymes, and neurologic symptoms. Depression or other psychiatric symptoms may also affect quality of life and may further contribute to poor adherence to the regimen 9–11. Dose modifications are often required, although delivery of 80% or more of the scheduled dose can still be achieved in most patients 7.…”

Section: Introductionmentioning

confidence: 99%

Health Management Program: Factors Influencing Completion of Therapy with High-Dose Interferon Alfa-2b for High-Risk Melanoma

et al. 2008

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The goal of the 1-year observational, multicentre, open-label study reported here was to identify factors influencing adherence to high-dose interferon alfa-2b adjuvant therapy in patients at high risk of recurrence following surgical excision of malignant melanoma. The study was carried out in 23 tertiarycare centres across Canada.The 225 patients enrolled in the study all had malignant melanoma that was surgically excised and that required adjuvant treatment with interferon alfa-2b. Of these patients, 64% were men. Mean age was 51.7 years. All patients received interferon alfa-2b treatment during a 4-week induction phase (20 MU/m 2 intravenously 5 days per week) followed by a 48-week maintenance phase (10 MU/m 2 subcutaneously 3 days per week).Oncology nurses reviewed side-effect management with the patients before the induction and maintenance phases. Patients were provided with daily diaries, comprehensive educational materials, and ongoing nursing support. Data on side effects and discontinuations were obtained from patient interviews and diaries.The main outcome measurements were related to treatment discontinuation: rate, timing, reason, and prevention. Of the 225 patients, 75 (33.3%) discontinued interferon during the induction phase, and 58 (25.8%) discontinued during the maintenance phase. The main reasons for discontinuation were adverse events (58%) and disease progression (26%). Patients with a daily fluid intake greater than 1.5 L were more likely to complete therapy than were those with an intake less than 1.5 L (64% vs. 36%, p < 0.0001).Of 225 patients enrolled in the interferon alfa-2b health management program, 41% completed the 1-year treatment course. Higher fluid intake (>1.5 L daily) was associated with increased adherence to therapy. KEY WORDSMelanoma, interferon alfa-2b, clinical trial, adherence

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“…Several authors [68][69][70] suggest caution when SSRI are given during IFN treatment. The development of manic symptoms has been described in some patients undergoing SSRI treatment during IFN therapy for HCV.…”

Section: Impact Of Ssri In the Pharmacological Treatment Of Hcv Patiementioning

confidence: 99%

Serotonin and its implication in the side‐effects of interferon‐based treatment of patients with chronic viral hepatitis: Pharmacological interventions

Stasi

Rosselli

Zignego

et al. 2013

Hepatology Research

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Depression is a frequent side-effect of interferon-based treatment of patients with chronic viral hepatitis, that may lead to reduction or discontinuation of treatment. Clinical trials data showed the importance of therapy of psychiatric disorders for a successful antiviral treatment. Emerging evidence suggests that interferon may cause depression affecting serotonin synthesis via increased activity of indoleamine 2,3-dioxygenase. Serotonin reuptake inhibitors significantly improve mood disorders, but the use of these drugs requires caution because some studies reported the emergence of mania in patients treated for depression during antiviral therapy. Therefore, this review will examine and discuss the putative role of serotonin and its metabolism in the development of depression during antiviral therapy, focusing on pharmacological interventions to reduce side-effects.

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Adjuvant therapy of melanoma with interferon‐alpha‐2b is associated with mania and bipolar syndromes

Cited by 10 publications

References 12 publications

Interferon in Oncological Practice: Review of Interferon Biology, Clinical Applications, and Toxicities

Interferon in Oncological Practice: Review of Interferon Biology, Clinical Applications, and Toxicities

Health Management Program: Factors Influencing Completion of Therapy with High-Dose Interferon Alfa-2b for High-Risk Melanoma

Serotonin and its implication in the side‐effects of interferon‐based treatment of patients with chronic viral hepatitis: Pharmacological interventions

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