Taste and smell abnormalities (TSA) in patients with newly diagnosed malignant gliomas (MG) treated with combined modality therapy (CMT).

Abstract

e19646 Background: TSA are common complications of cancer therapy which may lead to impaired nutrition and diminished quality of life. We performed a pilot clinical trial to characterize the frequency, intensity and time course of TSA in patients with MG receiving standard radiation (RT) with concurrent and adjuvant temozolomide (TEM). We also utilized serial salivary analyses to explore the relationship between TSA and lipid peroxidation in the oral cavity, a putative mechanism of metallic taste in other model systems. Methods: Eligible patients completed a validated TSA questionnaire prior to CMT and then again at 3, 6 (completion of RT), 10, 18 and 30 weeks. This tool provided a total chemosensory complaint score (CSCS) with a scale of 0 (normal) to 16 (maximally impaired). Paired samples of saliva were collected at each timepoint following an oral rinse with both a weak ferrous and a control solution. The salivary concentration of lipid peroxidation byproducts was determined using standard colorimetric techniques (TBAR analysis). Results: 17/22 enrolled patients had at least baseline and 6 week CSCS data and were eligible for analysis: Sex - 10M/7F, median age - 58 (range 19-78), Path - 10 GBM, 1 AA, 1 AO, 3 LGO, 1 LGA, 1 LGOA. All analyzed patients completed RT (54-60 Gy), 15/17 completed concurrent TEM, 8/17 completed 6 adjuvant cycles of TEM, and 2 also received investigational agents. Analysis of serial CSCS segregated patients into 3 distinct groups. Group 1 (5 pts)- no TSA at baseline or during CMT; Group 2 (8 pts) – no TSA at baseline but developed TSA during CMT; Group 3 (4 pts)– TSA present at baseline and persisted during CMT. TSA developed within 6 weeks in 7/8 pts in Group 2 and TSA persisted in all Group 2 and 3 pts tested thus far at 18 weeks (5/12). When compared with Group 1, Group 2 pts were more likely to have GBM (7/8 vs 1/5, p=.032) and to have temporal lobe lesions (4/8 vs 0/5, p=.105). No clear correlation was seen between CSCS and the concentration of salivary lipid peroxidation byproducts. Conclusions: TSA can occur in newly diagnosed patients with MG or develop during CMT. These changes develop rapidly during treatment and typically persist for months following the completion of radiation.