Acute toxicity of neoadjuvant chemotherapy in oral cavity cancers: Can it be predicted?

Abstract

e17027 Background: Neoadjuvant chemotherapy administration is associated with significant amount of morbidity and around 2-3% mortality in the Western world protocol settings. In developing countries where malnourishment is prevalent, the same data might not apply. Methods: This analysis was performed on a database of patients undergoing NACT for oral cancers at our center from 2010- 2012. The toxicity was graded according to CTCAE version 4.02 scale. Descriptive analysis, univariate and multivariate analysis were performed to determine factors affecting toxicity. Results: There were 528 patients, the median age was 45 years (22-78 years). The regimens administered were TPF in 35 patients (6.6%) and taxane with platinum in the rest. At least one cycle of chemotherapy was taken at our center by 94.8% (494). The median number of cycles were 2. The any grade toxicity after 1st cycle of chemotherapy were vomiting, diarrhea, mucositis, fatigue, febrile neutropenia (FN), peripheral neuropathy, hyponatremia, hypokalemia, hperkalemia, transaminitis were in 41.3% (204), 43.9% (217), 44.3% (219), 47.2% (233), 7.2% (35), 3.0% (15), 33.8% (167), 14.4% (71), 4.9% (24) and 12.3% (61).Toxicity details of second cycle of chemotherapy were available for 390 patients. The any grade toxicity after 2nd cycle of chemotherapy were vomiting, diarrhea, mucositis, fatigue, febrile neutropenia, peripheral neuropathy, hyponatremia, hypokalemia, hyperkalemia, transaminitis were in 28.6% (113), 37.3% (108), 31.3% (124), 39.3% (116), 3.1 % (12), 3.2% (13), 19.7 % (74), 7.4% (30), 3.1% (12) and 4.9% (19). For diarrhoea, female sex, nutrition (BMI below 18.5 KG/m2) and use of 3 drug regimen were predictive. For development of mucositis only nutrition was predictive. Use of 3 drug regimen and overnourishment were predictive of FN. Use of 3 drug regimen and use of docetaxel were predictive for hyponatremia. On multivariate analysis for diarrhoea only nutrition was predictive (p=0.017), for FN both drug regimen (p=0.003) and over nutrition (p=0.035) were predictive and for hyponatremia only use of 3 drug regimen was significant (p=0.017). Conclusions: 3 drug regimen, malnourishment and use of docetaxel are important predictors of acute toxicity associated with NACT in oral cancers.