Influence of hyperglycemia on toxicity in older patients receiving chemotherapy

Abstract

19579 Background: Few data are available concerning how glycemic control can affect outcomes in cancer patients (pts) treated with chemotherapy (CHT), particularly with those regimens that are more likely to cause increases in glycemia. Methods: Charts of non-Hodgkin lymphoma (NHL) and prostate cancer (PC) pts treated at Moffitt Cancer Center from January 1999 to September 2006 were reviewed, and pts who received Cyclophosphamide, Doxorubicin, Vincristine, Prednisone and Rituximab or Docetaxel-based CHT plus steroids were eligible. Demographics, vitals, comorbidity, biochemicals including baseline and average glucose level during chemotherapy, G4 hematological (HemT) and G3-G4 non hematological toxicity (NHemT), progression and death dates were recorded. Upper Limits of Normal for glycemia were set at 100 (fasting) and 140 mg/dL (post-prandial). Results: Three hundred forty-nine pts were eligible (NHL/PC: 62/187). Pts’ characteristics are outlined in Table I . Thirty-three pts in the NHL group and 48 pts in the PC group had received previous chemotherapy. G4 HemT was experienced by 76 (47%) NHL and 9 (5%) PC pts. 79 NHL and 86 PC pts had G3-G4 NHemT: neuropathy (25.3%), fever (not neutropenic, 18.9%), fatigue (15.2%), for NHL and fatigue (22.1%), thrombosis (11.6%) and diarrhea (9.3%) for PC. For NHL pts, G3–4 NHemT was associated with baseline hyperglycemia (p=0.0384, Wilcoxon Rank-Sum test) as well as with average glycemia during CHT (p=0.0048), while there was no significant correlation for HemT. For PC pts, a positive correlation was found between baseline hyperglycemia and G4 HemT (p=0.0241), while correlations between average glycemia during CHT and G4 HemT and between both baseline and average glycemia with NHemT were not significant. Conclusions: In NHL pts receiving CHT, often with a curative intent, hyperglycemia entails greater toxicity. Prospective studies are needed in order to assess whether a better glycemic control can improve the toxicity rate and the outcomes in elderly patients receiving chemotherapy. [Table: see text] [Table: see text]