Tolerability Of Chemotherapy Research Articles

Outcomes in older patients with metastatic epithelial ovarian cancer: Are we providing equitable care? (600)

Outcomes in older patients with metastatic epithelial ovarian cancer: Are we providing equitable care? (600)

Time to Neoadjuvant Chemotherapy Initiation Is not Associated With Survival in Pancreatic Cancer.

Not all patients with pancreatic adenocarcinoma (PDAC) tolerate multiagent neoadjuvant chemotherapy (NAC). We utilized institutional data and the National Cancer Database (NCDB) to investigate if time from diagnosis to NAC initiation is associated with survival. Patients who received NAC and underwent pancreatectomy at our institution (2010-2021) or within the NCDB (2010-2016) were identified. Time from diagnosis to NAC was grouped: <21, 21-35, and >35d. Recurrence-free (RFS) and overall survival (OS) was compared. At our institution, 122 patients received NAC before pancreatectomy (<21 d: n=36; 21-35 d: n=61; >35 d: n=25). Demographics, performance status, and anatomic resectability were similar. There was no difference in RFS (13.3 versus 12.4 versus 11.9mo) or OS (26.7 versus 25.8 versus 26.1mo) based on NAC timing. Patients who received FOLFIRINOX had an improvement in RFS (14.4 versus 12.2 versus 6.8mo, P=0.05) and OS (39.2 versus 21.4 versus 17.3mo, P=0.01) compared to gemcitabine with nab-paclitaxel or other regimens. Within the NCDB, 6713 patients were included (<21 d: n=2087; 21-35 d: n=2656; >35 d: n=1970). There was no difference in OS (21.6 versus 20.9 versus 22.2mo). Multiagent NAC was associated with improved OS compared to single-agent (22.6 versus 18.8mo, P<0.001). Delay in NAC initiation for PDAC is not associated with survival. Patient optimization could be considered with the goal of improving tolerance of multiagent chemotherapy.

Treatment Tolerance of Cetuximab versus Alternative Chemotherapy Agents in Non-Cisplatin Candidates with Head and Neck Cancer Receiving Concurrent Chemoradiotherapy

Introduction: Standard of care for radiosensitization in head and neck squamous cell carcinoma (HNSCC) is concurrent chemoradiotherapy (CCRT) with high-dose cisplatin. The optimal chemoradiation regimen for patients medically unfit for cisplatin is unclear. We compared our experience with concurrent cetuximab (CTX) versus other cytotoxic non-cisplatin agents. Methods: We reviewed 53 patients between 2011 and 2017 with HNSCC treated with CCRT ineligible for cisplatin. Chemotherapy and radiotherapy treatment tolerance was evaluated in those receiving CTX versus non-CTX chemotherapy (NCC). Of the NCC regimens, the majority were carboplatin/paclitaxel and were dosed at an area under the curve (AUC) of 2 and 45–50 mg/m², respectively. Standard radiation dosing was 70 Gray (Gy) in the definitive setting and 60–66 Gy in the postoperative setting. Patient characteristics and treatment toxicities were evaluated using categorical methods. Results: Patients were well balanced overall including differences between performance status and the comorbidity score. NCC patients experienced more radiation treatment breaks (52.4% vs. 21.9%, p = 0.022), radiation delays >1 week (33.3% vs. 3.1%, p < 0.01), and chemotherapy dose-limiting toxicity (61.9% vs. 28.1%, p = 0.015) compared to CTX patients. Nutritional dependence on a PEG tube was more likely in the NCC cohort (52.4% vs. 22.6%, p = 0.027). Conclusion: Our results suggest decreased treatment tolerance in non-cisplatin cytotoxic chemotherapy compared to cetuximab. Further prospective study is needed to clarify optimal chemotherapy in patients unable to receive cisplatin.

An Observational Study on Tolerability and Safety of Cisplatin Chemotherapy in Various Cancer

Abstract: Aim: To find out the safety and tolerability of cisplatin either given as individual therapy or in combination with other anticancer drugs or with radiotherapy. Materials and Methods: A prospective observational study was conducted in the oncology department (inpatient) of tertiary care hospital. The data was collected from the in-patient department after considering inclusion and exclusion criteria for a period of 6 months. Safety was analyzed using EORTC scales and Tolerability was assessed by collecting the laboratory data every week of the therapy. Statistical tools like Chi-square test were applied to the data by using SPSS software. Results: A total of 107 cancer patients, female patients predominated over males. Most common age group were under of 51-60 years. All the patients in our study were treated with cisplatin in combination with radiotherapy than monotherapy or in combination with other anticancer drugs. Higher incidence of tongue cancer cases were reported followed by less number of anal cancer cases. The quality of life and the functioning ability of cancer patients are calculated via EORTC scale. The QOL is highest in esophageal cancer patients and the lowest in cervical cancer patients. The social functioning of the subjects is very good in every cancer whereas the physical functioning is decreased in anal and buccal cancer patients. The cisplatin is given in the combination with radiotherapy for a total of 6 weeks. Every week after the therapy, the blood samples were collected and the toxicities are checked. Nausea and vomiting, fatigue, loss of appetite, insomnia are the side effects seen during the therapy. Few cases of Hematological toxicities like reduction in Hb count, PCV, lymphocyte count and increase in Neutrophil count were seen. By this, we can say that cisplatin is well tolerated and is safe in the chemotherapy with minimal side effects. Conclusion: Cisplatin is well tolerated in adults who are diagnosed with various cancers with minimal side effects which were controlled with supportive therapy. Whereas no serious ADRs reported in the study and no recurrence of the disease was observed. Thus, cisplatin is beneficial in the treatment of various cancers as it is safe and well tolerated. Keywords: Cisplatin, ADR, Re-occurrence, Hb, PCV, Safety and tolerability, Various cancers, EORTC scale.

Comparative efficacy and tolerability of novel agents vs chemotherapy in relapsed and refractory T-cell lymphomas: a meta-analysis

AbstractOptimal treatment strategies for (relapsed and refractory [R/R]) peripheral T-cell lymphoma (PTCL) have not been well defined, and with the approval of several novel single agents (SA), the comparative efficacy of combination chemotherapy (CC) to single-agent strategies remains unclear. We conducted a meta-analysis to evaluate overall response rates (ORR) and toxicities of SA to CC. MEDLINE, Embase, Web of Science Core Collection, and Cochrane were systematically searched for phase I, phase II, and phase III trials investigating a defined SA or an anthracycline-, ifosfamide-, gemcitabine-, and platinum-based regimens. One hundred and fifty-one articles were included, encompassing single and combinations of 60 phase I trials involving 1075 patients, 95 phase II trials involving 3246, and 23 phase III trials involving 1888 patients. There was a high degree of heterogeneity in the trials. Using a random-effects model, the estimated ORR for SA in phase I trials were 40% (95% confidence interval [CI], 34.7%, 46.9%) relative to 41% for CC (95% CI, 27.4%, 56.1%; P = .97) and in phase II trials 34.4% (95% CI, 30.4%, 38.7%) for SA vs 55.3% (95% CI, 31%, 77.2%; P = .1) for CC. There were significant subgroup differences in ORR between histological subtypes of PTCL and drug classes. Our results highlight SA as an attractive outpatient option for R/R PTCL, and their incorporation in the development of upfront treatment paradigms merits urgent consideration. Our results underscore enrollment in clinical trials of SA as a critical strategy for R/R PTCL.

Hepatic arterial infusion chemotherapy plus regorafenib in advanced colorectal cancer: a real-world retrospective study

BackgroundHepatic arterial infusion chemotherapy delivers the drug directly to the liver. We aim to explore the benefits and tolerability of Hepatic arterial infusion chemotherapy plus regorafenib in advanced colorectal liver metastasis refractory to standard systemic chemotherapy.MethodsThis study analyzed 47 patients treated with hepatic arterial infusion chemotherapy plus regorafenib after standard systemic oxaliplatin and/or irinotecan in combination with bevacizumab or cetuximab between Jan 2017 and Jun 2020. Regorafenib was given for only 3 weeks in a 4-week cycle.ResultsAmong 47 patients, 32 (68%) were males. The median age was 61 (29–75). With a median follow-up of 22.2 months (3.7–50.7 months). Before Hepatic arterial infusion chemotherapy administration in combination with regorafenib, 34 (72.3%) patients previously received ≥ 2 prior lines of systemic therapy and 37 (78.7%)patients previously received targeted biological treatment (anti-VEGF or anti-EGFR, or both). The initial doses of regorafenib were 40 mg/d (n = 1, 2.13%), 80 mg/d (n = 11, 23.43%), 120 mg/d (n = 2, 4.26%), and 160 mg/d (n = 23, 48.94%), while for 24.6% (n = 14) dose was unknown. Median Overall Survival was 22.2 months. Median Progression-Free Survival was 10.8 (95% CI: 9.0–13.7) months. Common Adverse Events were hand-foot skin reaction (12.77%), fatigue (6.38%), vomiting (6.38%), and decreased appetite (6.38%). Only 2 patients discontinued regorafenib due to Adverse Events.ConclusionsRegorafenib combined with Hepatic arterial infusion was effective and tolerable in patients with liver predominant metastasis of colorectal cancer. Hence, this therapy can be considered as an alternative for second- or subsequent lines of therapy in patients refractory to standard systemic chemotherapy.

Clinical observation on the benefits of antidepressant intervention in advanced cancer patients.

To observe the interventional effect of antidepressants on advanced cancer patients from the perspective of patient benefit and analyze patient characteristics to explore reasonable drug use.Pharmaceutical care was administered to patients with advanced cancer. From June 2018 to June 2020, 152 advanced cancer patients underwent sertraline intervention. The Hospital Anxiety/Depression Scale (HADS) was used to screen for the risk of anxiety and depression, and patients were divided into 4 groups: high, medium, low, and no risk. Concomitant clinical symptoms and antidepressant intervention results were recorded. HADS score change and symptom improvement were used to evaluate the antidepressant intervention effect, and effective intervention time for both indicators was recorded. The guidelines for antidepressant medication for these patients were analyzed, and depression/anxiety assessments and treatment models in this population were discussed.We observed that concomitant refractory clinical symptoms were the main target for the antidepressant intervention. Of those considered high risk on the basis of the HADS score (i.e., ≥15 points), 41.5% had depression, 26.3% had anxiety, and 20.4% had comorbid anxiety and depression. For the 142 patients who completed the study, the improvement rate of mood-related symptoms based on the efficacy index was 78.2%, with a median of 7 days until improvement was observed. The improvement rate based on the HADS score was 57.0%, with a median of 19 days for improvement. Improvement rate and median days until improvement under both indices were statistically significant. Comparisons by risk group showed that improvement in clinical symptoms was significantly greater in the high- and medium-risk groups than in the low-risk group, and HADS score improvement was significantly greater in the high-risk group than in the other 2 groups. Moreover, sertraline improved chemotherapy tolerance, unhealthy emotions, and clinical symptoms such as fear, dyspnea, agrypnia, fatigue, and intractable pain.We observed a positive effect of antidepressant drug intervention on refractory clinical symptoms in patients with advanced cancer that was particularly pronounced in those with a high-to-medium risk of depression and anxiety. However, the effect was not correlated with improved HADS score. Antidepression treatment improves concomitant clinical symptoms and benefits patients.

Tumor metabolic reprogramming in lung cancer progression.

Metabolic reprogramming is an important characteristic of tumor cells. Tumor cells reprogram their metabolic pathways to meet the material, energy and redox force needs for rapid proliferation. Metabolic reprogramming changes the level or type of specific metabolites inside and outside cells, and promotes tumor growth by affecting gene expression, cell state and the tumor microenvironment. Glucose metabolism, glutamine metabolism and lipid metabolism are significant metabolic pathways in tumors. Targeting metabolic reprogramming can significantly inhibit tumor growth and induce apoptosis. Metabolic reprogramming also plays an important role in maintaining the growth advantage of tumor cells and enhancing the chemotherapy tolerance of lung cancer. This review summarizes abnormal changes in the metabolism of glucose, fat and amino acids in lung cancer, and the underlying molecular mechanism, with the aim of providing novel ideas for the prevention, early diagnosis and treatment of lung cancer.

Abstract 3995: Identification of perp as a tumor promoter in pancreatic cancer via the utilization of an aged model of cancer cachexia

Abstract Cachexia is a multifactorial syndrome characterized by extensive body weight, lean muscle and fat mass loss. Cachexia worsens cancer patient prognoses and contributes to poor chemotherapy tolerance and response rates. About 80% of pancreatic cancer patients suffer from cachexia and one-third die due to cachexia-related complications such as respiratory failure and cardiac arrest. Although there has been considerable research into cachexia mechanisms and interventions, there are, to date, no FDA-approved cachexia therapies. A major contributing factor could be the failure of animal models to accurately recapitulate the human condition. In this study, we generated an aged murine model of pancreatic cancer cachexia to compare cachexia progression in young versus aged tumor-bearing mice. Comparative transcriptomic analyses of the muscles identified 3-methyladenine (3-MA), a known autophagy inhibitor, as a candidate anti-wasting compound. In vitro analyses confirmed anti-wasting effects while in vivo analysis demonstrated that 3-MA could rescue muscle wasting and suppress tumor growth. Surprisingly, transcriptome analyses of 3MA-treated tumor cells did not reveal autophagy-related signatures but instead implicated Perp as a novel 3-MA target. Probing further, we 1) observed significantly higher expression of Perp in pancreatic cancer cell lines compared to control cells, 2) noted a survival disadvantage associated with elevated PERP in the TCGA database, 3) found that PERP knockdown in cancer cells led to reduced tumor proliferation, and 4) confirmed that 3-MA-associated Perp reduction inhibited tumor growth. Moreover, we also demonstrate that survival benefits associated with 3MA is independent of tumor progression. Finally, we queried Perp expression in human tumor samples and observed increased Perp expression in adenocarcinoma regions compared to tumor adjacent tissue. Taken together, we report a novel mechanism linking 3-MA to Perp inhibition, and further implicate Perp as a novel tumor promoting factor in pancreatic cancer. Citation Format: Aneesha Dasgupta, Paige C. Arneson-Wissink, Rebecca E. Schmitt, Dong Seong Cho, Alexandra M. Ducharme, Tara L. Hogenson, Eugene W. Krueger, William R. Bamlet, Lizhi Zhang, Gina Razidlo, Martin E. Fernandez-Zapico, Jason D. Doles. Identification of perp as a tumor promoter in pancreatic cancer via the utilization of an aged model of cancer cachexia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3995.

A phase II study of anlotinib in the first-line treatment of locally advanced or metastatic soft-tissue sarcoma: Updated results.

e23559 Background: Standard treatment for patients with unresectable locally advanced or metastatic soft-tissue sarcoma is chemotherapy based on anthracyclines, while the tolerance of chemotherapy is limited. Anlotinib had demonstrated promising efficacy and favorable tolerance in the first-line treatment of these patients in the previously report ( 2021 ASCO). We updated the latest long-term efficacy and safety data. Methods: This multicenter, open-label, single-arm, phase II clinical trial (NCT03792542) was done at 7 hospitals in China. Patients diagnosed with locally advanced or metastatic soft-tissue sarcoma who had evaluable lesion per Response Evaluation Criteria in Solid Tumors version 1.1 were eligible for inclusion. Additional inclusion criteria were 1) 18-70 years old, 2) ECOG PS 0-2, 3) chemotherapy intolerance judged by investigators, 4) chemotherapy and anti-angiogenesis treatment naïve. All patients received 12mg anlotinib once daily for 14 days every 3 weeks until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS). Safety assessment was done in patients who received at least one dose of anlotinib. Results: 39 patients (24 males and 15 females) were enrolled between April 2019 to October 2021with a median follow-up 13.4 months (IQR 6.55-19.40), and the median age is 58 (range 23-69) years old. Pathological types included liposarcoma (n = 11), fibrosarcoma (n = 8), undifferentiated pleomorphic sarcoma (n = 5), leiomyosarcoma (n = 4), synovial sarcoma (n = 4), malignant peripheral nerve sheath tumor (n = 4), and others (n = 3). At the data cutoff date on December 27, 2021, the median PFS and median overall survival (OS) were 7.1 months [95%CI 5.42-8.77], 24.3 months [95%CI 14.9-33.7], respectively. The PFS at 6 months was 60.0%, and the OS at 12 months was 76.6%. 37 patients were eligible for the evaluation of tumor response.1 achieved confirmed partial response (PR) and the objective response rate (ORR) was 2.7% (1/37). 30 had stale disease (SD) and the disease control rate (DCR) was 83.8% (31/37). The incidence of adverse events of grade 3 was 33.3%, with a higher incidence of hypertension (12.8%), proteinuria (7.7%) and fatigue (5.1%). Conclusions: Anlotinib has shown encouraging anti-tumor activity and well tolerance in the first-line treatment of locally advanced or metastatic soft-tissue sarcoma who were not suitable for chemotherapy. Clinical trial information: NCT03792542.

CT scan versus bioelectrical impedance spectrometry sarcopenia assessment to predict chemotherapy toxicity in early breast cancer.

12078 Background: There is growing literature on the impact of the progressive loss of skeletal muscle known as sarcopenia in women with early breast cancer (EBC). Imaging techniques such as Computed Tomography (CT) scans are the most studied methods to detect sarcopenia in patients with cancer; however, most patients with EBC do not require routine CT scans. Bioelectrical impedance spectrometry (BIS) is a method that does not expose patients to radiation and provides measurements to assess sarcopenia instantaneously. The extent to which BIS-assessed sarcopenia correlates with CT-assessed sarcopenia is uncertain. It is also unclear whether sarcopenia detected with either method can be associated with chemotherapy tolerance To address these questions, we evaluated the correlation between CT and BIS sarcopenia and associations of sarcopenia by each method with chemotherapy related outcomes in patients with EBC. Methods: This retrospective study identified patients with EBC who received chemotherapy (ACT, TC, TH, THP), underwent BIS analyses (ImpediMed) at any point between diagnosis and treatment completion and also received a CT abdomen including L3 level. Axial CT L3 segments were analyzed using Slice-O-Matic software. CT L3, and BIS generated the Skeletal Muscle (SM). Skeletal Muscle Index (SMI) was then calculated to assess for sarcopenia: BIS SMI= (SM in kg)/ (patient height, m2) and CT L3 SMI (SM cm2/ height m2). Patients were divided into normal SMI, and sarcopenia (if BIS was used SMI &lt;6.75 kg/m2 and if CT SMI &lt;40 cm2/m2). Patient medical records were reviewed for patient characteristics, grade 3 and 4 toxicity, including neuropathy symptoms, chemotherapy dose reductions, early treatment discontinuation or need for hospitalization during chemotherapy treatment. Spearman's rank coefficient was used to assess the correlation between CT SMI and BIS SMI. Multivariable logistic regression was used to associate sarcopenia with outcomes, controlling for age and BMI. Results: 361 patients received chemotherapy, underwent BIS; of those 171 had L3 CT scans. The correlation between L3 CT SMI and BIS SMI was r= 0.64 p&lt;0.0001. In the multivariable model, sarcopenia assessed by L3 CT scan was associated with chemotherapy dose reduction (CI 0.04-0.60 p=0.01) and neuropathy (CI 0.10-0.95 P=0.04) but not with grade 3 or 4 chemotherapy toxicity (CI 0.13-1.09 p=0.07), early treatment discontinuation (p=0.3) or hospitalization (p=0.60). Sarcopenia assessed by BIS was associated with grade 3 or 4 chemotherapy toxicity (CI 0.2-0.83 p=0.01), neuropathy (CI 0.1-0.51 p=0.0003), early treatment discontinuation (OR 0.26 CI 0.11-0.80 p=0.001), and hospitalization (CI 0.12-0.68 p=0.004). Conclusions: There is a strong correlation between L3 CT scan and BIS screened sarcopenia in patients with EBC. Sarcopenia detected with either CT L3 or BIS is associated with worse chemotherapy tolerance.

The EHA Research Roadmap: Malignant Lymphoid Diseases.

The EHA Research Roadmap: Malignant Lymphoid Diseases.

Impact of protein-energy malnutrition on outcomes among patients with diffuse large B cell lymphoma admitted for inpatient chemotherapy.

e19539 Background: Protein-Energy Malnutrition (PEM) is a major factor contributing to morbidity and mortality in cancer patients. Chemotherapy causes anorexia, decreasing the caloric intake and affects the lean body mass which requires significant energy expenditure to surmount. Empiric data does not abound on the effect of PEM and its impact on the outcomes of patients receiving chemotherapy, specifically in diffuse large B cell lymphoma (DLBCL). Methods: A retrospective cohort study was designed using data from 2016 to 2018 combined National Inpatient Sample (NIS) database. Adult patients (age &gt; 18) admitted for chemotherapy with a principal diagnosis of DLBCL were identified using the International Diseases Classification code, 10th revision. They were stratified into two cohorts based on presence of a secondary diagnosis of PEM. Primary outcomes assessed were mortality, length of stay (LOS), and total hospitalization charges. Secondary outcomes included a diagnosis of neutropenia, urinary tract infections (UTI), septic shock, bacteremia, candida sepsis, acute kidney injury (AKI), acute liver failure, and acute respiratory failure (ARF). Multivariate linear and logistic regressions were used to adjust for confounders. Results: There was a total of 76,425 adult hospitalizations for chemotherapy among patients with DLBCL out of which 2.32% had a secondary diagnosis of PEM. PEM was associated with an increased odds of mortality, 3.94% vs 0.37% (AOR :12.69, p &lt; 0.001, 95% CI: 6.34 – 25.38). There was also an increased LOS in patients with PEM, 7.55 days vs 4.96 days (adjusted difference of 2.74 days, p &lt; 0.001, 95% CI: 1.88 – 3.61), as well as an increase in total charge, 97,500.55 USD vs 60,600.12 USD (adjusted difference of 37,109 USD, p &lt; 0.001, 95% CI: 20,139.59 – 54,080.18). Similarly, the presence of PEM was associated with increased odds of several secondary outcomes measured, including neutropenia (AOR : 1.87, p &lt; 0.001, 95% CI: 1.29 – 2.69), candida sepsis (AOR : 12.28, p = 0.033, 95% CI: 1.22 – 123.39), septic shock (AOR : 14.11, p &lt; 0.001, 95%CI: 6.31 – 31.52), bacteremia (AOR : 5.51, p &lt; 0.001, 95% CI: 2.61 – 11. 63), ARF (AOR : 7.83, p &lt; 0.001, 95% CI: 4.75 – 12.92) and an increased odds of AKI (AOR : 1.87, p &lt; 0.001, 95% CI: 1.37 – 2.55) compared to the other cohort. However, there was no difference in the odds of UTI and acute liver failure between the two groups. Conclusions: Clinical outcomes among patients with DLBCL during chemotherapy admissions are worse in patients with PEM and are associated with a 4-fold increased odds of death and attendant increase in LOS and total charge. The odds of secondary adverse clinical outcomes including neutropenia, bacteremia, candida sepsis, septic shock, AKI, and ARF are also increased. Prospective trials to evaluate PEM as an independent prognostic marker of chemotherapy tolerance and adequate nutritional support can improve the clinical outcomes.

222P Is quality of life (QoL) during chemotherapy affected by body composition?

Clinical studies conducted in patients with different types of tumours showed a significant influence of body composition on the metabolism of anticancer drugs and consequently on the response to treatment and its toxicity which could affect the overall prognosis. Available data clearly defines the impact of chemotherapy and its side effects on QoL of breast cancer patients, however there have been few studies that have analysed the impact of body composition on chemotherapy tolerance as well as on the QoL of breast cancer patients in the course of treatment.

Tolerability of neoadjuvant chemotherapy for esophageal cancer in elderly patients over 76 years of age.

ABSTRACTAlthough the Japan Clinical Oncology Group trial demonstrated that neoadjuvant chemotherapy (NAC) with 5-fluorouracil plus cis-diamminedichloroplatinum had significant survival benefits, it excluded elderly patients aged ≥ 76 years. Therefore, our study aimed to evaluate the tolerability of NAC in elderly patients with esophageal cancer. Classified 174 patients with clinical stage II/III esophageal cancer who underwent esophagectomy from 2010 to 2020 into the E (aged ≥ 76 years; 55 patients) and Y (aged < 76; 119 patients) groups, and retrospectively investigated for clinicopathological findings, tolerability of NAC, relative dose intensity (RDI) and short- and long-term result. Patients who received NAC were fewer in the E group than in the Y group (51% vs 77%, p = 0.001). The E group had relatively lower completion rate of NAC (71% vs 85%, p = 0.116) and significantly lower mean RDI of 5-fluorouracil and cis-diamminedichloroplatinum than the Y group (73% vs 89%, p < 0.001). However, histological and radiological were comparable between both groups. Severe adverse events (grade ≥ 3) were relatively frequent (E, 42.9%; Y, 27.5%, p = 0.091), especially, neutropenia was significantly more frequent in the E group (25.0% vs 7.7%, p = 0.022). There were no differences in the incidence of postoperative complications between with and without NAC in both E and Y groups. Elderly patients with esophageal cancer might be more susceptible to toxicity of NAC. Hence, adequate case selection and careful of dose reduction are needed for elderly with esophageal cancer.

Rehabilitation and physical activity in gynecological oncological diseases.

The cause of gynecological tumors is multifactorial. Risk factors include higher BMI and lack of physical activity. Gynecological oncological diseases are associated with loss of function due to the pathophysiological effects of the disease, treatment, and also mental stress in patients. These problems lead to greater rehabilitation demand of patients. Rehabilitation aims to help the patient to achieve the best possible level of functional status, to foster independence, to improve acceptance of the disease, to improve patient fatigue and improve the quality of life of the patients It is essential to focus the rehabilitation examination on several factors associated with impaired function, such as impaired cardiovascular and pulmonary function, urinary incontinence or psychological or psychological distress. The pleiotropic effect of rehabilitation can also be used in pain relief, improvement of chemotherapy tolerance, in the treatment of lymphedema and in the improvement of pelvic floor muscle function. The main aim of this paper is to summarize available options for rehabilitation after gynecological oncological diseases.

Gastrointestinal Cancer Patient Nutritional Management: From Specific Needs to Novel Epigenetic Dietary Approaches.

Nutritional habits impinge on the health of the gastrointestinal (GI) tract, contributing to GI disorder progression. GI cancer is a widespread and aggressive tumor sensitive to nutritional changes. Indeed, specific nutritional expedients can be adopted to prevent GI cancer onset and to slow down disease activity. Moreover, the patient’s nutritional status impacts prognosis, quality of life, and chemotherapy tolerance. These patients encounter the highest frequency of malnourishment risk, a condition that can progressively evolve into cachexia. Clinical studies dealing with this topic stressed the importance of nutritional counseling and put under the spotlight nutrient delivery, the type of nutrient supplementation, and timing for the start of nutritional management. A medical practitioner well-prepared on the topic of nutrition and cancer should operate in the clinical team dedicated to these oncological patients. This specific expertise needs to be implemented as soon as possible to adopt nutritional interventions and establish a proper patient-tailored dietary regimen. The nutritional gap closure should be prompt during anticancer treatment to stabilize weight loss, improve treatment tolerability, and ameliorate survival rate. Recently, novel nutritional approaches were investigated to target the bidirectional link between epigenetics and metabolism, whose alteration supports the onset, progression, and therapeutic response of GI cancer patients.

Comparison of synbiotics combined with enteral nutrition and prophylactic antibiotics as supportive care in patients with esophageal cancer undergoing neoadjuvant chemotherapy: A multicenter randomized study

Established supportive care to reduce the toxicity of neoadjuvant chemotherapy (NAC) is lacking. This multicenter randomized study compared the administration of synbiotics combined with enteral nutrition (EN) versus that of prophylactic antibiotics as supportive care treatment for patients with esophageal cancer undergoing NAC. Patients with advanced esophageal cancer scheduled to receive NAC were randomly administered either prophylactic antibiotics (antibiotic group) or synbiotics combined with EN (Syn+EN group). The primary endpoint was the febrile neutropenia (FN) incidence during the first course, and the secondary endpoints were other adverse events, changes in intestinal environment, including fecal microbiota, organic acid concentrations, pH, and chemotherapy tolerability. Eighty-one patients were enrolled. The FN incidence was nonsignificantly lower (P=0.088) in the Syn+EN group. The incidences of grade 4 neutropenia and grades 2-4 diarrhea were significantly lower in the Syn+EN group (P=0.014 and 0.033, respectively). Relative dose intensity was significantly higher in the Syn+EN group (92.0±10.9%) than in the antibiotic group (83.2±18.2%) (P=0.01). Alpfa diversity was significantly higher in the Syn+EN group than in the antibiotic after chemotherapy (P=0.002). The numbers of Bifidobacterium (P<0.05), Lacticaseibacillus (P<0.001), and Enterobacteriaceae (P<0.001) and the concentration of acetic acid (P<0.001) were significantly higher in the Syn+EN group than in the antibiotic group after chemotherapy. The severity of diarrhea and occurrence of FN were significantly correlated with Clostridioides difficile abundance and were significantly inversely correlated with acetic acid concentration after chemotherapy. Synbiotics combined with EN may be an alternative supportive care treatment to prophylactic antibiotics in patients with cancer undergoing toxic chemotherapy (https://jrct.niph.go.jp; jRCTs051180153).

Review of Mechanisms and Treatment of Cancer-Induced Cardiac Cachexia.

Cancer cachexia is a multifactorial, paraneoplastic syndrome that impacts roughly half of all cancer patients. It can negatively impact patient quality of life and prognosis by causing physical impairment, reducing chemotherapy tolerance, and precluding them as surgical candidates. While there is substantial research on cancer-induced skeletal muscle cachexia, there are comparatively fewer studies and therapies regarding cardiac cachexia in the setting of malignancy. A literature review was performed using the PubMed database to identify original articles pertaining to cancer-induced cardiac cachexia, including its mechanisms and potential therapeutic modalities. Seventy studies were identified by two independent reviewers based on inclusion and exclusion criteria. While there are multiple studies addressing the pathophysiology of cardiac-induced cancer cachexia, there are no studies evaluating therapeutic options in the clinical setting. Many treatment modalities including nutrition, heart failure medication, cancer drugs, exercise, and gene therapy have been explored in in vitro and mice models with varying degrees of success. While these may be beneficial in cancer patients, further prospective studies specifically focusing on the assessment and treatment of the cardiac component of cachexia are needed.

Abstract P1-08-04: The impact of sarcopenia and sarcopenic obesity detected by bioelectrical impedance analysis in patients with early breast cancer

Abstract Background: Low muscle mass, known as sarcopenia, is associated with chemotherapy toxicity and reduced survival in women with breast cancer (BC). Sarcopenic obesity, a process in which patients lose muscle mass and increase body adipose mass, is associated with multiple comorbidities and worse outcomes in BC. Most studies to date used Computer Tomography (CT) to obtain the parameters necessary to calculate sarcopenia and sarcopenic obesity. However, CT scans are not routinely performed in women with early BC. Bioelectrical impedance analysis (BIA) is a noninvasive, easy to use tool to assess multiple body composition parameters; it does not expose patients to radiation, and gives results instantaneously. BIA can assess for both sarcopenia and sarcopenic obesity. Our study aims to evaluate the impact of BIA assessed sarcopenia and sarcopenic obesity on treatment-related adverse events in patients with early-stage BC who received (neo)adjuvant chemotherapy.Methods: From a cohort of 713 patients with stage I-III breast cancer who had undergone BIA analyses around the time of their initial cancer diagnosis and treatment, 361 were treated with chemotherapy. BIA was used to generate the Skeletal Muscle Area (SMA), Fat Mass (FM) and Fat-Free Mass (FFM). Skeletal Muscle Index (SMI) was calculated to assess for sarcopenia: SMI= (SMA, cm2)/(patient height, m2). Patients were divided into normal (SMI &amp;gt; 6.75 kg/m2), moderate sarcopenia (SMI between 6.75 and 5.76 kg/m2), and severe sarcopenia (SMI &amp;lt;5.75 kg/m2). Sarcopenic obesity is suggested by an elevated ratio of FM to FFM. Since there is no predefined cut-point for sarcopenic obesity, we compared patients with FM/FFM at or above the median to those below the median. Fisher's exact test was performed to associate patient characteristics and toxicity outcomes with sarcopenia and sarcopenic obesity status.Results: Median age was 60 years old (range: 26 to 88). Moderate Sarcopenia was present in 28% and severe sarcopenia in 6% of patients. The presence of sarcopenia was associated with higher rates of early chemotherapy termination at 17% and 38% among those with moderate or severe sarcopenia compared with 8% of those without sarcopenia (p=0.0006). Hospitalizations related to chemotherapy were higher in patients with moderate (17%) and severe sarcopenia (15%) compared with those without sarcopenia (8%; p=0.02). In addition, grade 3-4 neuropathy was more common in patients with moderate or severe sarcopenia (38% and 12%) compared to those without sarcopenia (9%; p=0.006). Similarly, patients with sarcopenic obesity had a significantly higher chance of early chemotherapy termination (16% versus 7%; p=0.004), hospitalization related to chemotherapy (15% versus 7%; p=0.008), and grade 3-4 neuropathy (17% versus 6%; p=0.0004). No significant differences were observed in rates of dose delay or dose reduction between the groups.Conclusion: Patients with early-stage breast cancer and baseline evidence of BIA assessed sarcopenia or sarcopenic obesity had poorer tolerance of (neo)adjuvant chemotherapy. Future studies should address whether body composition-based dosing strategies can improve patient outcomes. Citation Format: Gabriel F. P. Aleixo, Wei Wei, Sephanie A Valente, Halle CF Moore. The impact of sarcopenia and sarcopenic obesity detected by bioelectrical impedance analysis in patients with early breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-08-04.