Beginning Of Chemotherapy Research Articles

Prognostic role of the updated Kiel classification in canine high-grade T-cell lymphomas.

The aim of this study was to determine and describe the prognostic role of the morphological subtype determined according to the updated Kiel classification in dogs with high-grade T-cell lymphomas (HGTCLs) depending on the treatment applied. The HGTCLs were classified into three subtypes according to the updated Kiel classification: pleomorphic mixed (PM), lymphoblastic lymphoma/acute lymphoblastic leukaemia and plasmacytoid (P). The treatment was divided into a palliative therapy (PlT) group and a chemotherapy (ChT) group. The study was conducted between 2009 and 2017, and it enrolled 58 dogs in which cytomorphological and immunocytochemistry diagnoses were HGTCL. Overall survival (OS) was significantly longer in the ChT group (median OS-4 months, interquartile range [IQR] from 2 to 8 months) than in the PlT group (median OS-6 weeks, IQR from 1 week to 3 months). In the PlT group, PM subtype and glucocorticosteroids (GCSs) treatment proved significantly and independently linked to longer OS and approximately three-fold lower risk of death during the study period (adjusted hazard ratio [HRadj] = 0.26, confidence interval [CI] 95%: 0.08-0.81; p = 0.020 and HRadj = 0.30, CI 95%: 0.11-0.77; p = 0.013, respectively), although due to small group size, precision of estimations was poor (wide CI 95%). In the ChT group, >7 days elapsing between diagnosis and the beginning of chemotherapy and GCS treatment prior to chemotherapy were significantly associated with lower chance of complete remission (CR; p = 0.034 for both); GCS treatment prior to chemotherapy was significantly associated with shorter OS (p = 0.016); chemotherapy based on the modified CHOP protocol was significantly associated with higher chance of CR (p = 0.034) and longer OS (p = 0.039); and CR was significantly linked to longer OS (p = 0.001). The morphological subtype of HGTCL has some prognostic value in dogs treated palliatively (with PM subtype associated with longer OS than P subtype); however, this effect is no longer visible when a dog is treated with chemotherapy.

Abstract PO4-06-03: A comparative study between RECIST 1.1 using MRI and PERCIST 1.0 using PET/CT to evaluate the response in patients of carcinoma breast receiving neoadjuvant chemotherapy

Abstract Introduction: Breast cancer is the most common cancer in women leading to the major public health problem with an estimated new cases of 2,261,419 (11.7%). Depending upon the stage at presentation, the primary modalities vary. Presently, the primary option for HER2-positive, Triple negative cancers of size more than 2cm or nodal involvement and locally advanced breast cancer is neoadjuvant chemotherapy (NACT). Accurate assessment of the tumor response and residual cancer after undergoing NACT is considered crucial for reducing the number of local recurrence cases and to predict the prognosis as patients who achieve pathological complete response (pCR) after NACT have a longer disease free period and better overall survival as compared to non-responders. In our study we have compared the two commonly used criteria i.e. RECIST 1.0 and PERCIST 1.0. Methodology: 70 patients diagnosed with breast cancer requiring neoadjuvant chemotherapy were recruited in the study conducted in the department of surgical disciplines, AIIMS Delhi from January 2021 to December 2022. Each patient underwent a contrast enhanced MRI breast and whole body FDG PET/CT at the beginning of chemotherapy and after completion of chemotherapy within a stipuated time of two to three weeks. For RECIST 1.1 criteria, response assessment was done using MRI and PERCIST used PET/CT. The response was compared with the gold standard histopathological size. Results: Concordance between the RECIST 1.1 and PERCIST 1.0 response classifications was seen in 27 (39.1%) cases, while discordance was seen in 42 (60.8%). A significant difference was observed between RECIST 1.1 and PERCIST 1.0 (k=0.1309, p< 0.0001) for response classification. Tumor response was upgraded in 32 and downgraded in 2 patients using PERCIST 1.0 as compared to RECIST 1.1. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy to predict pCR along with comparison among different molecular subtypes is shown in the table below. Conclusion: RECIST 1.1 showed high specificity, PPV and accuracy in predicting pathological complete response but tends to underestimate it whereas PERCIST 1.0 showed higher sensitivity with a tendency to overestimate. RECIST 1.1 had a high level of specificity and NPV as compared to the PERCIST 1.0, which showed a high level of sensitivity and PPV. Thus, they act as complementary modalities for predicting pathological complete response. The accuracy to predict pCR was higher for the triple-negative phenotype and Her2 neu enriched with PERCIST 1.0 as compared to RECIST 1.1, while that of PERCIST 1.0 was lower for luminal type. Table. Comparison of RECIST 1.1 and PERCIST 1.0. Citation Format: Anita Dhar, Kanika Sharma. A comparative study between RECIST 1.1 using MRI and PERCIST 1.0 using PET/CT to evaluate the response in patients of carcinoma breast receiving neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-06-03.

Alterations of Nutritional Status in Children and Adolescents with Acute Lymphoblastic Leukemia.

Malnutrition is often observed in pediatric cancer patients and has been recognized as a risk factor for relapse and survival. Maintaining an appropriate nutritional status during anticancer treatment has, therefore, been more and more frequently perceived as an additional requirement for optimal therapy outcomes. The aim of our study was to establish alterations of nutritional status in 26 children and adolescents treated for acute lymphoblastic leukemia (ALL) at the Children's Hospital in Zagreb, Croatia, between 2016 and 2021, by using anthropometric measures and serum albumin levels. The majority of patients (53.8% female, median 4 years, 52.2% intermediate-risk leukemia group) had normal weight at the beginning of chemotherapy. The percentage of overweight/obese patients increased from 4.2% at diagnosis to 37.5% at the end of intensive therapy. Apart from a significant increase in body weight (BW) and body mass index (BMI) for age, a notable decline in body height/body length (BH/BL) for age in the observed period was recorded, especially in high-risk leukemia patients. The alterations in serum albumin values were not significant, nor was their correlation with BMI. Dietary consultation was offered to all patients, while children with a decline in BMI and BH/BL received additional nutritional support.

Prospective observational study of zinc deficiency symptoms during first-line chemotherapy for gastric and colorectal cancer.

Zinc deficiency during long-term chemotherapy and its related symptoms, including skin rash, taste disorders, and oral mucositis, have not been sufficiently investigated. This prospective observational study enrolled patients with gastric and colorectal cancer who underwent standard first-line chemotherapy. According to the Practice Guidelines for Zinc Deficiency, zinc deficiency is defined as a serum level of <60 µg/dL. Serum zinc levels were measured before and after (1, 3, and 6 months) chemotherapy, and symptoms were assessed using the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events version 1.0. Repeated measures were analyzed using a generalized linear mixed model. Of the 61 enrolled patients, 48 who underwent standard first-line chemotherapy with fluoropyrimidine plus oxaliplatin were analyzed. Zinc deficiency was observed in 18 patients (38%) before chemotherapy. The least-squares means of serum zinc levels significantly decreased at 3 and 6 months of chemotherapy in 30 patients without zinc deficiency at the start of chemotherapy (both P<0.01) but not in 18 with zinc deficiency at the beginning. Changes in serum zinc levels during chemotherapy negatively correlated with changes in taste, rash, and itching (all P<0.04) in patients without zinc deficiency before treatment initiation. Serum zinc levels decreased during chemotherapy in zinc-non-deficient patients at the beginning of chemotherapy and correlated with taste changes, skin rash, and itching. Therefore, investigating whether zinc supplementation ameliorates these symptoms is necessary.

Non-pegylated liposomal doxorubicin in older adjuvant early breast cancer patients: cardiac safety analysis and final results of the COLTONE study

AimsTo explore the cardiac safety of adjuvant Non-Pegylated Liposomal Doxorubicin (NPL-DOX) plus Cyclophosphamide (CTX) followed by weekly Paclitaxel, in elderly women (≥ 65 years) with high-risk breast cancer. Previously, we described no symptomatic cardiac events within the first 12 months from starting treatment. We now reported the updated results after a median follow-up 76 months.MethodsThe cardiac activity was evaluated with left ventricular ejection fraction (LVEF) echocardiograms assessments, before starting chemotherapy and every 6 months, until 30 months from baseline, then yearly for at least 5 years.ResultsForty-seven women were recruited by two Units of Medical Oncology (Ethics Committee authorization CESM-AOUP, 3203/2011; EudraCT identification number: 2010-024067-41, for Pisa and Pontedera Hospitals). An episode of grade 3 CHF (NCI-CTCAE, version 3.0) occurred after 18 months the beginning of chemotherapy. The echocardiograms assessments were performed comparing the LVEF values of each patient evaluated at fixed period of time, compared to baseline. We observed a slight changed in terms of mean values at 48, 60, 72 and 84 months. At these time points, a statistically significant reduction of − 3.2%, − 4.6%, − 6.4% and − 7.1%, respectively, was observed. However, LVEF remained above 50% without translation in any relevant clinical signs. No other cardiac significant episodes were reported. To this analysis, in 13 patients (28%) occurred disease relapse and, of them, 11 (23%) died due to metastatic disease. Eight patients died of cancer-unrelated causes.ConclusionsThe combination including NPL-DOX in elderly patients revealed low rate of cardiac toxic effects. Comparative trials are encouraged.

Prognostic and predictive significance of CA-125 elimination rate constant K (KELIM) in ovarian cancer patients treated with neoadjuvant chemotherapy in a real-world setting.

e17594 Background: CA-125 ELIMination Rate Constant K (KELIM) is considered a marker of chemosensitivity in ovarian cancer patients and its prognostic and predictive significance in Neo-adjuvant Chemotherapy (NACT) treated patients has been established through prospective trials. Limited data exist regarding the feasibility of its application in the real-world setting. Under this perspective, we undertook a retrospective study of the predictive and prognostic significance of KELIM in ovarian cancer patients treated with NACT in our institution. Methods: Medical records of women with aEOC treated with NACT at Alexandra Hospital from 2010 to 2019 were retrospectively identified. Clinicopathological data, treatment and survival data were analysed. Modeled CA-125 KELIM score was calculated from the available online tool ( https://www.biomarker-kinetics.org/CA-125-neo ). Kaplan-Meier Survival curves were generated using SPSS; survival differences were estimated using the long-rank test. Results: 99 patients treated with 3-4 cycles of NACT with Paclitaxel and Carboplatin with available at least three CA125 measurements within 100 days from the beginning of chemotherapy were included. Median age was 66.6 years (25th-75th percentile was 59.8 and 74.5 years respectively) and median numbers of CA125 measurements were 3. KELIM score &lt; 1 (unfavorable) had 56 patients (56.6%) while score ≥1 had 43 patients (43.4%). All patients had high grade serous histology and 72 patients were treated with debulking surgery (72.8%). BRCA1/2 mutation status was known in 66 patients, among them 18 patients (27.3%) were positive for the presence of BRCA1/2 mutations. Favorable KELIM score was predictive of both increased PFS [mPFS 16.6 months (95% CI 12.6-20.5) in favorable group vs 11.9 months (95% CI 10.6-13.4) in unfavorable, p &lt; 0.001] and OS [mOS 44.7 months (95% CI 40.2-49.1) in favorable group vs 27.2 months (95% CI 18.5-35.9) in unfavorable, p = 0.013]. Predictive and prognostic significance of KELIM was retained in multivariate analysis when other prognostic parameters as age, ECOG-PS, quality of debulking surgery were taken into account. Bevacizumab administration post NACT increased statistical significantly both PFS and OS only in patients with unfavorable KELIM score. There was no statistical correlation between favorable KELIM score and presence of BRCA1/2 mutations, however our analysis is limited by the small number of patients. Conclusions: KELIM score can be easily applied in common clinical practice of ovarian cancer patients treated with NACT and provide valuable prognostic and predictive information. Despite in our analysis no correlation with presence of BRCA1/2 mutations was found further investigation is warranted, since PARP inhibitors constitute the established maintenance treatment in the frontline setting.

Early and late onset cardiotoxicity following anthracycline-based chemotherapy in breast cancer patients: Incidence and predictors

IntroductionCardiotoxicity represents a major limitation for the use of anthracyclines or trastuzumab in breast cancer patients. Data on longitudinal studies about early and late onset cardiotoxicity in this group of patients is scarce. The objective of the present study was to assess predictors of early and late onset cardiotoxicity in patients with breast cancer treated with A. Methods100 consecutive patients receiving anthracycline-based chemotherapy (CHT) to treat breast cancer were included in this prospective study. All patients underwent evaluation at baseline, at the end of CHT, 3 months after the end of CHT and 1 and 4 years after the beginning of CHT. Clinical data, systolic and diastolic echo parameters and cardiac biomarkers including high sensitivity Troponin T (TnT), N-terminal pro-brain natriuretic peptide (NT-proBNP) and Heart-type fatty acid binding protein (H-FABP) were assessed. ResultsMean doxorubicin dose was 243 mg/m2. Mean follow-up was 51.8 ± 8.2 months. At one-year incidence of anthracycline related-cardiotoxicity (AR-CT) was 4% and at the end of follow-up was 18% (15 patients asymptomatic left ventricular systolic dysfunction, 1 patients heart failure and 2 patients a sudden cardiac death). Forty-nine patients developed diastolic dysfunction (DD) during first year. In the univariate analysis DD during first year was the only parameter associated with AR-CT (Table 1). In the logistic regression model DD was independently related with the development of AR-CT, with an odds ratio value of 7.5 (95% CI 1.59–35.3). ConclusionsIncidence of late-onset cardiotoxicity is high but mostly subclinical. Diastolic dysfunction early after chemotherapy is a strong predictor of anthracycline cardiotoxicity.

Abstract P4-03-41: Prospective observational study of breast cancer patients during the cycle of chemotherapy with taxanes: evaluation of the incidence and prevalence of peripheral neuropathy

Abstract OBJECTIVE: To evaluate the prevalence of sensitivity changes in patients during the cycle of chemotherapy with taxanes and the impacts on quality of life. DESIGN: A prospective, observational, Approved study was conducted at the Oncomastology outpatient clinic of Hospital São Paulo- Unifesp, in the period from November 2018 to February 2022, where 102 women with breast cancer were selected and 79 patients who underwent chemotherapy with paclitaxel were included. METHODS: Collection of demographic and clinical information. Used stesiometer that assessed sensitivity in dermatos and myotomes in the following body regions: arms, hands, legs and feet. FACT/GOG-Ntx Questionnaire analyzed the quality of life and chemotherapy-induced peripheral neuropathy of the patients before starting chemotherapy. All participants were informed and signed an informed consent form. RESULTS: The mean age was 49 years, mean BMI was 27.95Kg/m2, NICC (Invasive Carcinoma not special) represented 89.9% of the sample, 88.6% had Neoadjuvant Chemotherapy, regarding the size of the tumor 45.6% presented from 2 to 5 cm, of the pre existing diseases Diabetes mellitus 15.2% and Systemic Arterial Hypertension 30.4%. The initial moment in relation to sensitivity alterations, of the arm regions presented (right C6 (HC 1.05-1.23) left C6 (HC 1.05- 1.23), and legs (right L5 (HC 1.14 -1.55) left L5 (HC1.22 - 1.52) and right S1 (HC 1.21-1.47) left S1 (HC 1.21-1.48). The conversion of the Estesiometer colors into numbers followed as follows, Green (1.0): normal sensitivity, Blue (2.0): decreased sensitivity. The FACT/Taxane (TOI) quality of life Questionnaire (30 items) its scores 0-120,(average 91.44 points) demonstrates in its response impairment in more than 80 % in the quality of life in the domains. Physical Well-Being-PWB (0-28 points) (mean 20.28/HC 18.88-21.66), Functional Well-Being-FWB (0-28 points) (mean16.00/HC14.22-17.22) and in the specific questions about chemotherapy-induced peripheral neuropathy (CPIN), TaxS (0-64 points) (mean 55.16/HC 52.74-57.26) reduced scores. CONCLUSION: It is concluded that mean age, overweight, tumors between 02 and 05 cm were the most prevalent among patients diagnosed with breast cancer. At the beginning of chemotherapy containing paclitaxel, sensitivity changes were not present characterizing arthralgia, myalgia and the hand-foot syndrome (CPIN). The quality of life evaluated by FACIT/Taxane, showed a reduction of 80% in the scores of the domains Physical Well-Being-PWB, Functional Well-Being-FWB and general quality of life, that is, the quality of life of patients from the time of diagnosis is already very compromised. Key words: Breast neoplasm, adjuvant drug treatment, chemotherapy, quality of life. Number of Opinion: 2.351.174 DATA OF THE OPINION, CEP Number: 0934/2017 of the ethics in research committee. Registered in Clinical Trials on 12/12/2017, protocol number -NCT 03373032. Table 1: Results of the sensitivity of dermatos and myths (monofilaments) undergoing chemotherapy cycles with paclitaxel (eyes closed) Legend: Analysis of quantitative frequencies, Mean, Standard Deviation and Confidence Interval, Percentage (%) and Absolute number. Citation Format: Roberta P. Costa Luz, Carmen S. Alliz, Samantha K. Lopes de Almeida Rizzi, Cinira Haddad, Christiano Bittencourt Machado, Afonso Nazário, Gil Facina. Prospective observational study of breast cancer patients during the cycle of chemotherapy with taxanes: evaluation of the incidence and prevalence of peripheral neuropathy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-41.

Trajectories of cancer-specific stress in cancer patients: a latent growth mixture analysis.

This study aimed to examine trajectories of cancer specific stress (CSS) over the course of a year, starting at the beginning of chemotherapy, and identify psychosocial factors that predicted trajectory class membership. Growth Mixture Modeling was used to identify distinct trajectories of CSS. Multinomial regression examined potential psychosocial predictors of trajectory membership. In the 4-class solution, all four trajectories demonstrated a decrease in CSS over the year but with differing intercepts and magnitudes of slopes. These were characterized as recovery, resilience, chronic, and severely chronic. The recovery group reported significantly higher insomnia scores than the resilient group. The chronic group reported significantly higher insomnia, higher depression, lower social support, and lower optimism than the resilient group. The chronic group reported significantly lower social support and higher depression than the recovery group. The findings provide information about psychosocial risk factors for CSS that can be screened for early intervention following diagnosis.

Oxidative Stress and Pyroptosis in Doxorubicin-Induced Heart Failure and Atrial Fibrillation.

Patients undergoing doxorubicin (Dox) chemotherapy often develop new-onset atrial fibrillation and heart failure. Recent studies indicate that the TLR4/MyD88/NLRP3 pyroptosis signaling pathway plays a key role in the occurrence and development of cancer, heart failure, and atherosclerosis. However, few studies investigated the role of oxidative stress and pyroptosis in doxorubicin-induced heart failure and new-onset atrial fibrillation. In this study, we recruited 84 healthy subjects, 112 patients undergoing Dox chemotherapy showing heart failure (HF), and 62 patients undergoing Dox treatment who manifested atrial fibrillation (AF). The mRNA and protein levels of TLR4 expression, several downstream pyroptosis-associated proteins (cleaved caspase-1, NLRP3, GSDMD-N, and HMGB-1), serum inflammatory factors, and oxidative stress were detected at the beginning of chemotherapy and after 3 months of Dox chemotherapy. Oxidative stress and downstream pyroptosis-associated proteins tended to increase in the Dox-baseline group to the Dox-HF group. However, virtually no change in the expression of either oxidative stress or pyroptosis-associated proteins was detected in patients after three months of Dox chemotherapy compared with those at baseline. This study suggests that the prolonged oxidative stress and high levels of pyroptosis-associated proteins contribute to cardiac systolic dysfunction, suggesting TLR4 as a novel biomarker and a potential treatment target for doxorubicin-induced heart failure.

Diabetes is associated with high risk of severe adverse events during chemotherapy for cancer patients: A single-center study.

Diabetes mellitus (DM) is a common comorbidity among cancer patients, but its impact on chemotherapy tolerance has not been widely studied. We aimed to compare the occurrence of severe grade 3/4 adverse events (G3/4 AEs) within 90 days of starting chemotherapy between patients with and without diabetes. We conducted a retrospective single-center study in Lille University Hospital Oncology Department, France. Patients who received the first cycle of chemotherapy for gastrointestinal, gynecological or cancer of unknown primary source between 1 May 2013 and 1 May 2016, were included. Overall, 609 patients were enrolled: 490 patients without diabetes (80.5%) and 119 patients with diabetes (19.5%). Within 90 days of starting chemotherapy, patients with diabetes had a significantly higher occurrence of AEs G3/4 compared to those with no diabetes (multivariate odds ratio [OR]: 1.57 [1.02-2.42], P=.04). More frequent G3/4 AEs in patients with diabetes were infection (26%), hematological disorders (13%), endocrine disorders (13%) and deterioration of the general condition (13%). In the year following the beginning of chemotherapy, patients with diabetes were twice as likely to be hospitalized as those without diabetes (univariate OR: 2.1 [1.40-3.15], P=.0003). After multivariate adjustment, diabetes was no longer significantly associated with the risk of hospitalization (P=.051). There were no differences between patients with and without diabetes regarding dose reduction and chemotherapy treatment delays (P=.61 and P=.30, respectively). Our study suggests the need for better consideration of DM in the personalized care plan to improve chemotherapy tolerance and quality of life of patients with DM.

Exploring Patients' Understanding of Chemotherapy-Induced Peripheral Neuropathy.

Little quantitative evidence exists surrounding patients' level of understanding of chemotherapy-induced peripheral neuropathy (CIPN) symptoms (numbness, tingling, pain in the hands/feet) and consequences (e.g., negatively affect physical functioning or chemotherapy dosing) at the beginning of chemotherapy. The purpose of this cross-sectional, secondary analysis was to describe CIPN knowledge and education patterns among adults early in a course of neurotoxic chemotherapy for the treatment of cancer (< three infusions). Following consent, participants completed an electronic questionnaire about their perceptions of CIPN symptoms, incidence, and education. Participants (N = 92) were mainly female (76%), white (91%), and diagnosed with breast (46%) or gastrointestinal (40%) cancers. Most participants without CIPN (n = 48) did not expect to develop CIPN (45%) or were unaware of CIPN as a side-effect (30%). Furthermore, 71% of participants without CIPN (n = 31) estimated CIPN to occur in ≤ 30% of patients receiving neurotoxic chemotherapy. Overall, participants learned about CIPN from their doctor or nurse prior to beginning chemotherapy (90%). Clinicians delivered education about CIPN symptoms (75%), but less frequently delivered education about CIPN management (14%), or the impact of CIPN on the ability to continue chemotherapy (16%) or physical functioning (24%). Finally, participants reported that a discussion with their doctor/nurse would be the best way to learn about CIPN (92%). Results revealed that participants without CIPN were largely unaware of the adverse consequences or incidence of CIPN during treatment. Further research is needed to investigate optimal methods to promote patient-clinician communication about CIPN during chemotherapy to enhance patients' retention of CIPN information and activation in their care.

Ovarian mucinous borderline tumor with anaplastic carcinomatous nodules in adolescents

Bilateral ovarian epithelial neoplasms in adolescents are rare. Moreover, borderline mucinous neoplasms with local intraepithelial carcinoma with anaplastic carcinoma are even more infrequent. Herein, we presented a single case (a 17-year-old female) with regular menstrual cycles and stomach pain when eating who was diagnosed with a left ovarian tumor accompanied by mural nodules. The right ovarian cyst, the left ovary, and the fallopian tube were removed by surgery. Intraoperative diagnosis suggested a bilateral ovarian tumor with mural nodules, which include three different pathological types: sarcomatoid transformation, anaplastic carcinoma, and sarcoma. Paclitaxel combined with carboplatin was given for 6 cycles after an operation, and gonadotropin-releasing hormone agonist (GnRHa) was given at the beginning of chemotherapy for 3 cycles for ovarian function protection. Regular follow-up (the last follow-up was performed 48 months after the operation) of gynecological ultrasound and tumor indicators did not indicate recurrence. In clinical practice, it is necessary to pay attention to the symptoms such as abdominal pain in adolescent females. Routine non-invasive pelvic ultrasound is recommended to fully evaluate the nature of the tumor before surgery, and decide the operation mode. Also, intraoperative frozen pathology of the tissue should be performed as soon as possible.

Cancer, Phase Angle and Sarcopenia: The Role of Diet in Connection with Lung Cancer Prognosis.

Lung cancer is the most common cause of cancer death and is associated with malnutrition and sarcopenia. The detection of sarcopenia and conduction of simple body composition measurements, such as the phase angle (PhA) deriving from bioelectrical impedance analysis (BIA), can help to early identify, monitor, prevent and treat malnutrition. The present review aims to clarify the relationship between PhA and sarcopenia with the pathophysiology, clinical outcomes, and therapeutic aspects of lung cancer. PhA and sarcopenia are connected to lung cancer prognosis through various mechanisms including inflammation and oxidative stress, although more research is needed to identify the critical thresholds for increased mortality risk. Moreover, emphasis is given on the role of dietary interventions (oral nutritional supplementation, and dietary counseling) to manage sarcopenia and related variables in patients with lung cancer. Oral nutritional supplements and/or those containing n - 3 polyunsaturated fatty acids may have a positive effect on physical strength measures and muscle mass if administered at the beginning of chemotherapy. Data on sole dietary counseling or multimodal interventions are less promising so far. In the future, sophisticated body composition phenotypes deriving from the described methods along with artificial intelligence techniques could be used to design personalized nutrition interventions and timely treat these patients.

Impact of Resilience on Psychological Well-Being In Breast Cancer Patients Undergoing Chemotherapy

Background: The most commonly used therapy for breast cancer is chemotherapy. Chemotherapy has physical and psychological side effects that affect the psychological well-being of the patient. Resilience plays an important role in changing psychological well-being. Cancer patients who have low levels of resilience will show negative psychological well-being and vice versa. However, the condition of cancer patients undergoing chemotherapy is not yet known whether resilience can change psychological well-being so that they can adapt to the stressors of chemotherapy. Purpose: This study aims to analyze the relationship between resilience and psychological well-being of breast cancer patients undergoing chemotherapy. Methods: This study was conducted using an observational analytic method with a cross-sectional approach. The population in this study were breast cancer patients who underwent chemotherapy sessions 2-6 at one of the hospitals in Malang, Indonesia. A sample of 62 people was obtained by using a stratified random sampling technique based on the chemotherapy sessions the patient underwent. Data Collection used the Connor-Davidson Resilience Scale questionnaire. Data analysis procedures were carried out in univariate and bivariate ways (lambda correlation test). Results: The Univariate analysis showed that the lowest resilience was experienced by respondents who underwent the second chemotherapy session and the bivariate analysis showed that there was a positive correlation between resilience and psychological well-being with p=0.039 and r=0.267. This means that the higher a person’s resilience, the greater the chance of having positive psychological well-being. Conclusion: This study shows that the higher the resilience, the greater the probability of experiencing positive psychological well-being. While the higher the resilience, the more likely it is to experience positive psychological well-being. It is recommended that patients who will undergo chemotherapy are given education related to therapy so that low resilience is not experienced at the beginning of chemotherapy.

Second cancer after adjuvant chemotherapy in patients with colon cancer.

86 Background: Adjuvant chemotherapeutic treatment of UICC-stage III/IV colon cancer with fluorouracil, leucovorin and oxaliplatin (FOLFOX) is widely accepted as the current standard after R0-resection. However, with continuous improvement of patients´ survival and life expectancy, long-term side effects of chemotherapy such as second cancer development are becoming increasingly important. Methods: We performed a retrospective analysis of clinical data derived from the population-based cancer registry at the Regensburg Tumor Center, Germany. Patients who were diagnosed with colon cancer UICC stage III and IV between 2002 and 2018 and underwent R0 surgical resection of primary tumor were included for the study. Second cancer was as defined new tumor occurrence at least 6 months after beginning of chemotherapy and in another localization compared to primary tumor. Second cancer rate was compared between patients with and patients without adjuvant chemotherapy. Results: Data of totally 2,856 Patients with UICC-stage III/IV colon cancer were analyzed, 1,520 (53.2%) of whom received adjuvant chemotherapy. Overall, 223 (7.8%) patients developed a subsequent second cancer. Most frequent second cancers were prostate cancer (18.4%), colon cancer (16.1%), breast cancers (8.1%), lung cancer (8.1%), rectal cancer (4.9%) and uterine cancer (4.9%). However, patients treated with adjuvant chemotherapy did not have a significantly increased risk for second cancer development compared to patients without adjuvant chemotherapy (Table). Interestingly, our data suggest a significantly decreased second cancer rate in patients treated with FOLFOX compared to FUFOL for adjuvant treatment. Conclusions: Second cancer development was not increased after adjuvant chemotherapy for UICC-stage III/IV colon cancer, which is a novel aspect in the ongoing discussions on reduction of adjuvant treatment to 3 months or treatment of lymph node negative patients. Primary tumor (N) Second tumor (N) Second tumor (%) Cumulative rate 60 months (%) Log-Rank p Chemotherapy Yes 1520 145 9.5% 8.8% No 1336 78 5.8% 9.0% 0.685 Total 2856 223 7.8% 8.9%

Case of Geotrichum capitatum septicemia successfully resolved by the use of liposomal amphotericin B in a patient with acute myeloid leukemia

Background: Geotrichum capitatum infection is a rare condition and it has only been reported in immune-compromised patients. The prognosis is poor, with a mortality rate between 50-90%. Case presentation: Here we report a case of Geotrichum capitatum septicemia in a neutropenic patient undergoing induction chemotherapy for acute myeloblastic leukemia. At day +24 from the beginning of chemotherapy, the patient’s blood cultures were positive for Geotrichum capitatum. When we received the antimicogram a therapy with liposomal amphotericin B (3 mg/kg/day) was started. After 15 days of antifungal treatment, the patient’s clinical condition had dramatically improved and at the twenty-first day of antifungal treatment the blood culture was negative for Geotrichum capitatum. On day +47 from the start of induction, the patient died in hematological remission of AML due to sudden death. An autopsy was not performed. Conclusion: This clinical case highlights the emergence of Geotrichum capitatum as an opportunistic fungus in Italian leukemia patients. Moreover, our case report shows how liposomal amphotericin B could represent an effective therapeutic approach for these infections. Further studies are needed to shed more light on these rare fungal infections, in order to define the best therapeutic approach towards invasive geotrichosis. Keywords: geotrichum capitatum; fungemia; neutropenia; acute myeloid leukemia.

Prospective assessment of psychopathological symptoms and their relation to demographic factors in primary caregivers of cancer patients throughout chemotherapy.

The present study aims to investigate the course of psychological symptoms through chemotherapy in a sample of primary caregivers of patients with cancer and to examine all possible correlations between psychological distress and demographic characteristics. In this prospective study, 112 primary family caregivers of cancer patients were evaluated. Symptom checklist 90 revised (SCL-90-R) was administered to assess their pathological symptoms, the Hospital Anxiety and Depression Scale (HADS) to assess depression and anxiety. There was an evaluation at the beginning of chemotherapy and a second at the end of the patients' intravenous chemotherapy treatment (EOT). A total of 112 primary caregivers were initially enrolled in the study, and 99 (88.4%) completed it. Caregivers' psychopathology was low to moderate at both points of time (baseline and EOT). However, a considerable decrease in the Global Severity Index (GSI) emerged over time. At EOT, participants reported statistically significant decreases in five aspects of SCL 90, namely Depression, phobic anxiety, obsessive-compulsive symptoms, somatization, and psychoticism. A notable finding was that female caregivers were significantly more distressed, especially when providing care to a male recipient.

Assessing the Impact of Prophylactic Anidulafungin during Remission Induction of Acute Myeloid Leukemia - a Propensity-Score Matching Analysis

Introduction: Invasive fungal disease (IFD) accounts for substantial morbidity during the treatment of acute myeloid leukemia (AML) in adults. Antifungal prophylaxis (AP) is needed during intensive chemotherapy, and posaconazole has recently emerged as a drug of choice for this purpose. In our setting, alternative strategies such as no upfront prophylaxis, fluconazole, or echinocandins have been used during the remission induction, as posaconazole is not available. While few reports have pointed to micafungin as an option for this aim, studies addressing the use of anidulafungin in AML are lacking. In this study, we aimed to examine the impact of prophylactic anidulafungin during intensive AML remission induction.Methods: This retrospective cohort encompassing newly diagnosed AML adult patients (pts) treated at Instituto do Cancer do Estado de Sao Paulo, Brazil, between June 2011 and June 2020. We used a slight modification of European LeukemiaNet 2010 classification previously published by our group - Adapted Genetic Risk (AGR) (Silveira et al., 2020). Over these years, local policies regarding AP changed. All patients received the “7+3” regimen and were divided into three groups: pts who did not receive any AP and pts who received fluconazole (15-400 mg/day) or anidulafungin (100 mg/day) as AP. Local recommendations for IFD treatment were followed, and they also changed over time. The primary endpoint was IFD rate during the first 60 days from the beginning of chemotherapy, following the recommendation of EORTC/MSG. Multivariable analysis (MVA) was performed by logistic regression. Aiming to equalize subgroups for IFD risk factors, a propensity-score matching was performed using the nearest neighbor method.Results: Overall, 204 pts were included, with a median age of 54 years (range,17-74). The main baseline features of this cohort are summarized in Table 1. Regarding AP, 108 pts received anidulafungin, 82 pts did not receive AP, and 14 pts received fluconazole. The incidence of IFI was 26.6% (95% CI 20.8-33.3), classified as possible, probable, and proven in 65.5%, 1.8%, and 32.7%, respectively. Regarding the fungus specimen, Aspergillus sp. responded for most cases (60%), followed by Fusarium sp. (23%), Candida sp. (11%), and Zygomycetes (4%). Complete response was documented at the end of induction in 49%, with the remaining patients being either refractory (27%) or not available (24%). The 60-day mortality was 25.8%. MVA showed that lower neutrophil counts at the AML diagnosis are associated with IFD during induction (OR=2.8, 95% CI 1.3-6.2), whereas age, genetic classification, and lymphocyte counts were not. Comparing the three abovementioned groups (AP: none, anidulafungin, or fluconazole), significant differences could be seen in AGR and anthracycline doses (Table 2). To analyze the impact of anidulafungin in comparison with ‘no AP’, a post-matched cohort with 164 subjects was created, matching for neutrophil and lymphocyte counts and AGR. The use of anidulafungin was not significantly related to less IFD during induction (OR=0.7, 95% CI 0.3-1.6), while neutrophil counts remained significant. Few subjects received fluconazole as AP, and it also was not related to less IFD (p=0.35). At the end of induction, complete response status did not relate to IFD during this period (p=1). Treatment for IFD with amphotericin B and voriconazole was given for 60.2% and 13.1% during induction, respectively. Patients under prophylactic anidulafungin received less amphotericin B (p<0.001) but not voriconazole (p=0.49). Fusarium sp. cases that occurred during induction (n=12) received mostly prophylactic fluconazole (42%), which was statistically relevant in comparison to other AP (p<0.001). Among these 12 cases, no favorable genetic risk was found. The occurrence of IFD during induction did not correlate with early mortality (HR=0.97, 95% CI 0.5-1.8) in our cohort.Conclusion: To our knowledge, this is the first study addressing the role of anidulafungin during AML induction. Here, the use of AP did not decrease IFD incidence within this phase. Our results point to the fact that the fungistatic activity of echinocandins in molds might be suboptimal for immunocompromised pts. Furthermore, these results strengthen the role of posaconazole in this setting, especially for baseline neutropenic patients or higher risk subsets, such as primary refractory cases. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Multifunctional, TNF-α and IFN-γ-Secreting CD4 and CD8 T Cells and CD8High T Cells Are Associated With the Cure of Human Visceral Leishmaniasis.

Visceral leishmaniasis (VL) is a chronic and often fatal disease caused by protozoans of the genus Leishmania that affects millions of people worldwide. Patients with symptomatic VL have an impaired anti-Leishmania-specific CD4+ T-cell response, which is reversed after clinical cure. In contrast, the quality of the CD4+ and CD8+ T-cell responses involved in resistance and/or cure of VL relies on the capability of these cells to activate polyfunctional and memory responses, which are associated with the simultaneous production of three cytokines: IFN-γ, IL-2, and TNF-α. Models for the development of CD4 and CD8 T-cell quality in memory and protection to leishmaniasis have been described previously. We aimed to assess the functionality of the T cells involved in the recovery of the immune suppression throughout the VL treatment. Therefore, we cultured peripheral blood mononuclear cells (PBMCs) from VL patients and healthy controls in vitro with soluble Leishmania antigen (SLA). Cell surface markers and intracellular cytokine production were determined on days 7, 14, 21, 30, 60, 90, and 180 after the beginning of chemotherapy. We observed that the frequencies of CD4+TNF-α+IFN-γ+ and the multifunctional CD4+IL-2+TNF-α+IFN-γ+, together with CD4+TNF-α+ and CD4+IFN-γ+ T cells, increased throughout and at the end of the treatment, respectively. In addition, enhanced frequencies of CD8+IL-2+TNF-α+IFN-γ+ and CD8+TNF-α+IFN-γ T cells were also relevant in the healing process. Noteworthy, the frequencies of the CD4+ and CD8 central-memory T cells, which produce IL-2, TNF-α, and IFN-γ and ensure the memory response against parasite reinfection, are significantly enhanced in cured patients. In addition, the subset of the non-functional CD8Low population is predominant in VL untreated patients and decreases along the chemotherapy treatment. In contrast, a CD8High subset increased towards the cure. Furthermore, the cure due to treatment with meglumine antimoniate or with liposomal amphotericin B was associated with the recovery of the T-cell immune responses. We described the evolution and participation of functional T cells during the treatment of patients with VL. Our results disclosed that the clinical improvement of patients is significantly associated with the participation of the CD4+ and CD8+ cytokine-secreting T cells.