{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:31:45Z","timestamp":1791304305703,"version":"4.3.1"},"reference-count":88,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"unspecified","delay-in-days":266,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CNS Spectr."],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:p>Clozapine is the gold standard for treatment-resistant schizophrenia. In the setting of malignancy with concurrent anti-cancer agent use, clozapine use may be of increased concern. Clozapine cessation holds its own risks. This study aims to systematically review all cases of concurrent pharmacotherapy with clozapine and anti-cancer agents and analyze the psychiatric and physical health outcomes. PubMed, EMBASE, CINAHL, and PsycINFO databases were searched from inception to February 2025. Descriptive statistics and narrative analysis of the included cases occurred. There were 53 cases of clozapine use with anti-cancer agents, with a male to female ratio of 1.7:1 and a mean age of 45.0\u00a0years. In 30 cases, clozapine was continued without interruption, and in additional 16 cases, clozapine was recommenced after a period of interruption. In cases with clozapine interruption or discontinuation, 90% noted significant deterioration in mental state despite alternative antipsychotic treatments. There were 34 cases of neutropenia, mostly (94%) in the setting of cytotoxic chemotherapy, with low rates of neutropenic complications. The successful continuation of clozapine with anti-cancer agents can occur, although risk-benefit analysis taking into account individual, clozapine, psychiatric, and physical health factors is required. Consideration of prophylactic neutropenia protective measures should form part of the discussion with the individual and their family.<\/jats:p>","DOI":"10.1017\/s1092852925100576","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T07:51:56Z","timestamp":1758700316000},"source":"Crossref","is-referenced-by-count":4,"title":["Clozapine and anti-cancer agents: a systematic literature review of case reports"],"prefix":"10.1017","volume":"30","author":[{"given":"Amity","family":"Honor","sequence":"first","affiliation":[{"name":"The University of Queensland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Parmenter","sequence":"additional","affiliation":[{"name":"Royal Brisbane and Women\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney","family":"Marsh","sequence":"additional","affiliation":[{"name":"Royal Brisbane and Women\u2019s Hospital"},{"name":"The University of Queensland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Siskind","sequence":"additional","affiliation":[{"name":"The University of Queensland"},{"name":"Metro South Addiction and Mental Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0805-1182","authenticated-orcid":false,"given":"Nicola","family":"Warren","sequence":"additional","affiliation":[{"name":"The University of Queensland"},{"name":"Metro South Addiction and Mental Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"S1092852925100576_r7","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-199710000-00010"},{"key":"S1092852925100576_r15","doi-asserted-by":"publisher","DOI":"10.1038\/nrd3003"},{"key":"S1092852925100576_r50","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2016.0100"},{"key":"S1092852925100576_r39","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0000000000001900"},{"key":"S1092852925100576_r72","doi-asserted-by":"publisher","DOI":"10.1093\/jscr\/rjad105"},{"key":"S1092852925100576_r33","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1176\/ajp.150.10.1562","article-title":"Clozapine, cancer, and schizophrenia","volume":"150","author":"Avnon","year":"1993","journal-title":"Am J Psychiatry."},{"key":"S1092852925100576_r24","doi-asserted-by":"publisher","DOI":"10.1017\/S204579602000044X"},{"key":"S1092852925100576_r19","doi-asserted-by":"publisher","DOI":"10.1177\/20451253211032053"},{"key":"S1092852925100576_r36","doi-asserted-by":"publisher","DOI":"10.1002\/pon.3779"},{"key":"S1092852925100576_r58","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S49028"},{"key":"S1092852925100576_r80","doi-asserted-by":"publisher","DOI":"10.1093\/oncolo\/oyac074"},{"key":"S1092852925100576_r68","doi-asserted-by":"publisher","DOI":"10.1002\/pon.5152"},{"key":"S1092852925100576_r78","first-page":"77","article-title":"Clozapine and chemotherapy in a patient with end-stage Merkel cell carcinoma","volume":"64","author":"Yoong","year":"2023","journal-title":"Australas J Dermatol."},{"key":"S1092852925100576_r57","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.941746"},{"key":"S1092852925100576_r41","doi-asserted-by":"publisher","DOI":"10.1016\/j.psym.2015.02.005"},{"key":"S1092852925100576_r52","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2020.10.010"},{"key":"S1092852925100576_r74","first-page":"S31","article-title":"The antipsychotic property of neoadjuvant chemotherapy regime 5-flourouracil, epidoxorubicin and cyclophosphomide (FEC) in a patient with treatment resistant schizophrenia: a case study","volume":"56","author":"Francis","year":"2019","journal-title":"Eur Psychiatry."},{"key":"S1092852925100576_r49","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1267"},{"key":"S1092852925100576_r12","doi-asserted-by":"publisher","DOI":"10.1177\/0004867412438871"},{"key":"S1092852925100576_r67","doi-asserted-by":"publisher","DOI":"10.1177\/02698811241262767"},{"key":"S1092852925100576_r13","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1007\/s00213-020-05746-y","article-title":"A systematic review and meta-analysis of the association between clozapine and norclozapine serum levels and peripheral adverse drug reactions","volume":"238","author":"Honarparvar","year":"2021","journal-title":"Psychopharmacology (Berl)"},{"key":"S1092852925100576_r31","first-page":"2127","article-title":"Methodological quality of case series studies: an introduction to the JBI critical appraisal tool","volume":"18","author":"Munn","year":"2020","journal-title":"JBI Evid Synth."},{"key":"S1092852925100576_r4","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.60.1.82"},{"key":"S1092852925100576_r6","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbu120"},{"key":"S1092852925100576_r76","first-page":"451","article-title":"Long-term clozapine use is a risk factor for neutropenia in the post-engraftment phase after allogeneic hematopoietic stem cell transplantation","volume":"57","author":"Langebrake","year":"2022","journal-title":"Bone Marrow Transplant."},{"key":"S1092852925100576_r23","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(22)00044-X"},{"key":"S1092852925100576_r18","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2017.03.045"},{"key":"S1092852925100576_r46","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5545.130507"},{"key":"S1092852925100576_r34","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajp.2018.05.023"},{"key":"S1092852925100576_r54","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajp.2024.104041"},{"key":"S1092852925100576_r55","first-page":"831","article-title":"Clozapine and chemotherapy","volume":"45","author":"McKenna","year":"1994","journal-title":"Hosp Community Psychiatry."},{"key":"S1092852925100576_r87","doi-asserted-by":"publisher","DOI":"10.1017\/S109285292300202X"},{"key":"S1092852925100576_r86","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbq019"},{"key":"S1092852925100576_r56","doi-asserted-by":"publisher","DOI":"10.1002\/pon.3744"},{"key":"S1092852925100576_r42","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2019.09.007"},{"key":"S1092852925100576_r5","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12989"},{"key":"S1092852925100576_r77","first-page":"42","article-title":"Managing schizophrenia in a patient with cancer: a fine balance","volume":"16","author":"Riddle","year":"2017","journal-title":"Curr Psychiatry."},{"key":"S1092852925100576_r8","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(23)00343-7"},{"key":"S1092852925100576_r9","doi-asserted-by":"publisher","DOI":"10.1080\/14740338.2024.2362796"},{"key":"S1092852925100576_r73","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.178.6.576-a"},{"key":"S1092852925100576_r44","doi-asserted-by":"publisher","DOI":"10.1016\/j.psym.2014.05.007"},{"key":"S1092852925100576_r43","doi-asserted-by":"publisher","DOI":"10.3371\/CSRP.MCTF.071317"},{"key":"S1092852925100576_r10","doi-asserted-by":"publisher","DOI":"10.1177\/0004867419898760"},{"key":"S1092852925100576_r22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2006.00850.x"},{"key":"S1092852925100576_r11","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbae065"},{"key":"S1092852925100576_r28","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"S1092852925100576_r16","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-199512030-00003"},{"key":"S1092852925100576_r32","doi-asserted-by":"publisher","DOI":"10.2174\/1570159X22666231128101725"},{"key":"S1092852925100576_r63","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2007.06122021"},{"key":"S1092852925100576_r75","first-page":"237","article-title":"Clozapine and chemotherapy","volume":"7","author":"H","year":"1995","journal-title":"J Drug Develop Clin Pract"},{"key":"S1092852925100576_r84","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2013.12.006"},{"key":"S1092852925100576_r62","doi-asserted-by":"crossref","first-page":"462","DOI":"10.4103\/0019-5545.196711","article-title":"Use of clozapine alongside chemotherapy in a treatment-resistant bipolar disorder patient with ovarian carcinoma: a case report and brief review","volume":"58","author":"Pakhre","year":"2016","journal-title":"Indian J Psychiatry"},{"key":"S1092852925100576_r3","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12700"},{"key":"S1092852925100576_r40","doi-asserted-by":"publisher","DOI":"10.1192\/pb.bp.114.048306"},{"key":"S1092852925100576_r59","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0000000000000970"},{"key":"S1092852925100576_r38","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2020-238377"},{"key":"S1092852925100576_r25","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.116.195776"},{"key":"S1092852925100576_r21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2008.01163.x"},{"key":"S1092852925100576_r48","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2008.05.017"},{"key":"S1092852925100576_r37","doi-asserted-by":"publisher","DOI":"10.1177\/1179573519832014"},{"key":"S1092852925100576_r71","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.168.2.217"},{"key":"S1092852925100576_r2","first-page":"892","article-title":"Effects of six months of clozapine treatment on the quality of life of chronic schizophrenic patients","volume":"41","author":"Meltzer","year":"1990","journal-title":"Hosp Community Psychiatry"},{"key":"S1092852925100576_r69","doi-asserted-by":"publisher","DOI":"10.1177\/2045125314553610"},{"key":"S1092852925100576_r70","first-page":"673","article-title":"Chemotherapie bij gebruik van clozapine; een verhoogde kans op agranulocytose? [Chemotherapy during clozapine treatment. Increased risk of agranulocytosis?]","volume":"50","author":"van Gool","year":"2008","journal-title":"Tijdschr Psychiatr."},{"key":"S1092852925100576_r81","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20983"},{"key":"S1092852925100576_r27","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.13285"},{"key":"S1092852925100576_r64","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.161.1.175"},{"key":"S1092852925100576_r83","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.200"},{"key":"S1092852925100576_r88","doi-asserted-by":"publisher","DOI":"10.5498\/wjp.v11.i8.429"},{"key":"S1092852925100576_r17","doi-asserted-by":"publisher","DOI":"10.1177\/02698811241241394"},{"key":"S1092852925100576_r35","first-page":"59","article-title":"Clozapine and full-dose concomitant chemoradiation therapy in a schizophrenic patient with nasopharyngeal cancer","volume":"88","author":"Bareggi","year":"2002","journal-title":"Tumori."},{"key":"S1092852925100576_r51","doi-asserted-by":"publisher","DOI":"10.1002\/pon.3209"},{"key":"S1092852925100576_r53","doi-asserted-by":"publisher","DOI":"10.1176\/jnp.2010.22.4.451.e4"},{"key":"S1092852925100576_r85","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0000000000000715"},{"key":"S1092852925100576_r1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.115.177261"},{"key":"S1092852925100576_r65","first-page":"419","article-title":"Clozapine, cancer chemotherapy and neutropenia\u2014dilemmas in management","volume":"25","author":"Sankaranarayanan","year":"2013","journal-title":"Psychiatr Danub."},{"key":"S1092852925100576_r14","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2017.11.005"},{"key":"S1092852925100576_r60","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-016-0268-7"},{"key":"S1092852925100576_r26","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(24)00091-9"},{"key":"S1092852925100576_r29","unstructured":"29. Ltd AMHP, ed. Australian Medicines Handbook (online). https:\/\/amhonline.amh.net.au\/. Accessed February 10, 2025."},{"key":"S1092852925100576_r47","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0000000000001651"},{"key":"S1092852925100576_r66","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajoc.2023.101851"},{"key":"S1092852925100576_r79","doi-asserted-by":"publisher","DOI":"10.12788\/cp.0254"},{"key":"S1092852925100576_r82","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2014.001492"},{"key":"S1092852925100576_r30","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l6890"},{"key":"S1092852925100576_r45","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2012.06.007"},{"key":"S1092852925100576_r61","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaclp.2023.08.003"},{"key":"S1092852925100576_r20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2006.00787.x"}],"container-title":["CNS Spectrums"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1092852925100576","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T16:19:32Z","timestamp":1759853972000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1092852925100576\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":88,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025]]}},"alternative-id":["S1092852925100576"],"URL":"https:\/\/doi.org\/10.1017\/s1092852925100576","relation":{},"ISSN":["1092-8529","2165-6509"],"issn-type":[{"value":"1092-8529","type":"print"},{"value":"2165-6509","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025]]},"article-number":"e76"}}