Discontinuation Of Chemotherapy Research Articles

Non-pharmacological Interventions on Pain and Quality of Life in Chemotherapy Induced Polyneuropathy: Systematic Review and Meta-Analysis.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment, resulting in pain, numbness, instability, and thus affecting quality of life (QoL), occasionally leading to discontinuation of chemotherapy. Pharmacological treatments are not sufficient. Non-pharmacological interventions (NPIs) have also been tried. This study aimed to systematically review the efficacy of NPIs on pain and QoL in patients suffering from CIPN. The databases searched were Pubmed, Cohrane, and Scopus for randomized controlled trials (RCTs) published in the last 5 years (2017-2022). Studies were considered eligible, if they assessed adult patients suffering from CIPN because of any chemotherapeutic drug for any type and any stage of cancer and if study protocols included non-pharmacological intervention with a structured protocol. A total of 1,496 records were identified. Finally, 10 RCTs including 495 patients (253 in the intervention group and 242 in the control group) were included for meta-analysis. Intervention protocols included acupuncture (n=6), exercise (n=3), and yoga (n=1). NPIs significantly reduced neuropathic pain. However, the effect on QoL was not significant. NPIs are beneficial in the treatment of pain in patients with CIPN but their impact on QoL is not statistically supported. Larger sample sizes, more homogenous in outcome measures and interventions are needed to further explore NPIs' efficacy on CIPN symptoms.

Effect of malnutrition as defined by the Global Leadership Initiative on Malnutrition criteria on compliance of adjuvant chemotherapy and relapse-free survival for advanced gastric cancer

ObjectivesThe aim of the present study was to clarify the effect of malnutrition as defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria on compliance with postoperative adjuvant chemotherapy and relapse-free survival (RFS) in patients with gastric cancer. MethodsThis single-center, retrospective cohort study included 281 consecutive patients with gastric cancer who underwent radical gastrectomy for pathologic stages II and III and received postoperative S-1 adjuvant chemotherapy between April 2008 and June 2018. Treatment failure was defined as discontinuation of adjuvant chemotherapy ≤1 y. Nutritional assessment was preoperatively performed according to the GLIM criteria for all patients. We analyzed risk factors for treatment failure and poor prognostic factors for RFS using multivariate analyses. ResultsTreatment failure and recurrence were observed in 50 (17.8%) and 97 (34.5%) of the 281 patients, respectively. The median follow-up period was 52 mo. The treatment failure rate was higher (P = 0.032) and RFS was worse (P = 0.017) in the malnutrition group. In multivariate analyses, GLIM criteria–defined malnutrition was an independent risk factor for treatment failure (odds ratio = 3.110; 95% confidence interval [CI], 1.020–9.470; P = 0.046). Furthermore, severe malnutrition was an independent poor prognostic factor for RFS (hazard ratio = 1.767; 95% CI, 1.132–2.759; P = 0.012). ConclusionsPreoperative malnutrition as defined by the GLIM criteria was an independent risk factor for poor compliance with adjuvant S-1 chemotherapy and a poor prognostic factor for RFS after radical gastrectomy in patients with advanced gastric cancer.

The significance of modified Controlling Nutritional Status score on the survival after discontinuation of cancer chemotherapy for advanced and recurrent gastroenterological cancer

【目的】進行再発の消化器癌患者のがん薬物療法中止時のCONUT変法による評価が治療の中止決定に有用であるかを検討する. 【対象および方法】平成23年8月から平成29年2月までの間にがん薬物療法を施行して癌死した進行再発消化器癌患者92例を対象とする後ろ向き研究である. 治療終了時のCONUT変法による栄養評価で正常・軽度障害群, 中等度障害,高度障害群の3群に分類し, 治療中止後の生存期間の差を検討する. 【結果】3群間の生存曲線の解析では正常・軽度障害群に比較して中等度および高度障害群は予後が不良であった. 多変量解析にて年齢, 癌腫, 転移時期, CONUT変法による分類が予後予測因子であった. 中等度および高度障害の生存期間中央値はそれぞれ39日, 31.5日であり, 予後が非常に不良であった. 【結論】がん薬物療法の中止を検討する時期のCONUT変法による中等度または高度栄養障害という評価は予後不良因子であり, 治療中止を決定する一助となり得る.

Pretreatment Nutritional Status in Combination with Inflammation Affects Chemotherapy Interruption in Women with Ovarian, Fallopian Tube, and Peritoneal Cancer

Discontinuing chemotherapy worsens cancer prognosis. This study aimed to investigate the relationship between nutritional status at the start of chemotherapy and chemotherapy discontinuation in patients with ovarian, fallopian tube, and primary peritoneal cancer. This was a retrospective cohort study. One hundred and forty-six patients to whom weekly paclitaxel and carboplatin were administered as postoperative chemotherapy were included. Six courses in 21-day cycles were defined as complete treatment. As nutritional indicators, body mass index, weight change rate, serum albumin, total lymphocyte count, prognostic nutritional index, and C-reactive protein-to-albumin ratio (CAR) were compared between complete and incomplete treatment groups. Patients were divided into two groups according to CAR. The number of chemotherapy cycles was compared between these two groups. A Cox proportional hazard model was used for covariate adjustment. Several indicators differed between complete and incomplete treatment groups, and among the indicators, CAR had the highest discriminatory ability. The number of chemotherapy cycles was shorter in the high CAR group than in the low CAR group. A high CAR was associated with chemotherapy interruption even after adjusting for covariates. Based on CAR, nutritional status before chemotherapy is suggested to be associated with the risk of chemotherapy discontinuation.

Optimal timing of liver transplantation for liver cirrhosis caused by sclerosing cholangitis in a patient with Langerhans cell histiocytosis: a case report.

Liver cirrhosis due to secondary sclerosing cholangitis caused by Langerhans cell histiocytosis (LCH) has a poor prognosis, and liver transplantation is the definitive treatment. However, the optimal timing has not been established. We report a 2-year-old girl with LCH-related liver cirrhosis who successfully underwent liver transplantation before progressing to severe liver dysfunction. Physical examination revealed a tumor on her palate. Biopsy was performed, and a diagnosis of LCH was established, together with hepatomegaly, splenomegaly, and rashes. Percutaneous liver biopsy before treatment revealed extreme fibrosis and absence of LCH cells. After beginning chemotherapy, she experienced several delays in treatment and dose reductions because of unacceptable bone marrow suppression, worsening liver dysfunction, and cholangitis. However, tumor shrinkage was observed in both magnetic resonance imaging and BRAF V600E mutant allele titers in her plasma. Given the good treatment response, liver transplantation was conducted. The postoperative course was uneventful, and chemotherapy was resumed 34days after liver transplantation. Subsequent maintenance treatment was completed with no severe adverse effects. To prevent perioperative complications due to exacerbation of liver dysfunction and possible discontinuation of chemotherapy, liver transplantation should be considered before development of end-stage liver failure, provided that the original disease is well controlled.

Cardiovascular events and risk factors in hematological neoplasms patients treated with anthracyclines

Objective: To explore the incidence and risk factors of cardiovascular events in hematological neoplasms patients treated with anthracyclines in the real world. Methods: A total of 408 patients with lymphoma and leukemia, who were treated with anthracyclines during hospitalization in the First Affiliated Hospital of Dalian Medical University from January 1, 2018 to July 31, 2021, were included in this retrospective study. Patients were divided into cardiovascular event group (n=74) and non-cardiovascular event group (n=334). The primary endpoint was cardiovascular events (arrhythmia, heart failure, acute myocardial infarction etc.) after anthracyclines therapy. The secondary endpoint was all-cause mortality, cardiovascular-cause death, discontinued chemotherapy due to cardiovascular events. Multivariate regression analysis was used to investigate the risk factors of cardiovascular events. Kaplan-Meier was performed to calculate the incidence of all-cause mortality. Results: The mean age was (55.6±14.9) years, and there were 227 male patients (55.6%) in this cohort. The median follow-up time was 45 months. During follow-up, cardiovascular adverse events occurred in 74 patients (18.1%), including 45 heart failure (38 were heart failure with preserved ejection fraction), 30 arrhythmia, 4 acute myocardial infarction and 2 myocarditis/pericarditis. Multivariate regression analysis showed age (OR=1.024, 95%CI 1.003-1.045, P=0.027) and history of hypertension over 10 years (OR=2.328, 95%CI 1.055-5.134, P=0.036) were independent risk factors for the cardiovascular events. Kaplan-Meier survival curve showed mortality was significantly higher in cardiovascular event group than in non-cardiovascular event group (47.3% vs. 26.6%, P=0.001). In the cardiovascular event group, chemotherapy was discontinued in 9 cases (12.2%) due to cardiovascular events and cardiovascular death occurred in 7 cases (9.5%). Conclusions: Although heart failure is the main cardiovascular event in lymphoma and leukemia patients post anthracyclines therapy, other cardiovascular events especially arrhythmias are also common. The presence of cardiovascular events is associated with higher risk of all-cause mortality in these patients. Age and long-term hypertension are independent risk factors for cardiovascular events in lymphoma and leukemia patients after anthracyclines treatment.

Usefulness of Global Longitudinal Strain-Guided Management in Preventing Human Epidermal Growth Factor Receptor 2 (HER2) Inhibitor-Induced Myocardial Damage.

Background: Trastuzumab, an anti-human epidermal growth factor receptor 2 (HER2) monoclonal antibody, is a specific first-line treatment for patients with HER2-positive cancers. Cardiac dysfunction is among the most problematic adverse events associated with trastuzumab. Although regular echocardiographic screening is recommended for early detection of cardiac damage, few reports have investigated the validity of echocardiographic screening in chemotherapy. Therefore, the aim of this study was to determine whether a GLS-guided management approach could reduce cardiotoxicity and discontinuation of trastuzumab chemotherapy. Methods and Results: To evaluate the usefulness of global longitudinal strain (GLS)-guided cardioprotective interventions, we retrospectively analyzed 67 patients treated with trastuzumab who underwent structured echocardiographic assessments before and after 1, 3, and 6 courses of trastuzumab administration. If a >15% relative decrease in GLS was identified, cardioprotective agents were administered. Thirty (44.8%) patients had breast cancer; the remaining patients had salivary gland cancer. The median observation period for the intervention group was 304 days from the initial evaluation. Nineteen (28.4%) patients exhibited a >15% relative decrease in GLS, and consequently received cardioprotective agents. The incidence of trastuzumab discontinuation for cardiogenic reasons was significantly lower among patients receiving GLS-guided interventions than among those not receiving the intervention (2.4% vs. 24.0%; P=0.009). The incidence of a subsequent decline in left ventricular ejection fraction was lower among patients receiving the intervention than among those not receiving the intervention (4.8% vs. 24.0%; P=0.04). Conclusions: GLS-guided cardioprotective intervention significantly decreased the incidence of trastuzumab discontinuation.

EUS-Guided Gastroenterostomy in Malignant Gastric Outlet Obstruction: A Comparative Study between First- and Second-Line Approaches after Enteral Stent Placement.

Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is increasingly used in the setting of malignant gastric outlet obstruction (GOO). However, little is known about the role of primary EUS-GE. The aim of the present study is to compare the outcomes of EUS-GE by using the freehand technique as a first- and second-line approach after enteral stenting (ES). This is an observational single-center study using a prospectively collected database. All consecutive patients who underwent an EUS-GE using the freehand technique due to malignant GOO were included. Patients with previous gastric surgery, a wire-guided EUS-GE technique, or those presenting without GOO were excluded. The primary outcome was the clinical success, defined as a solid oral intake at 1 week after the procedure (GOO Score, GOOSS ≥ 2). The secondary outcomes were technical success and adverse event (AE) rates. The impact on nutritional parameters was also assessed. Forty-five patients underwent an EUS-GE for all indications. Finally, 28 patients (mean age: 63 ± 17.2 years, 57.1% male) with (n = 13, 46.4%) and without (n = 15, 53.6%) a previous ES were included. The technical success was achieved in 25 cases (89.3%), with no differences between the two groups (92.3% vs. 86.7%, p = 1). The median limb diameter and procedure time were 27 mm (range:15-48) and 37 min. Overall, clinical success was achieved in 22 cases (88%), with three failures due to AEs (n = 2) or peritoneal carcinomatosis (n = 1). The diet progression was quicker in patients with a previous ES (GOOSS at 48 h, 2 vs. 1, p = 0.023), but the GOOSS at 1 week (p = 0.299), albumin gain (p = 0.366), and BMI gain (0.257) were comparable in the two groups. The AE rate was 7.1%. EUS-GE achieves a high technical and clinical success in patients with GOO regardless of the presence of a previous ES. Patients with previous ES may have a quicker progression of their diet, but the GOOSS and nutritional status in the long term at 1 week or 1 month are comparable. Primary EUS-GE might require fewer procedures and less discontinuation of chemotherapy to achieve a comparable result.

Can MASCC and CISNE scores predict delays of lung cancer chemotherapy after febrile neutropenia?

Febrile neutropenia (FN) during cancer chemotherapy can lead to morbidity and mortality. The Multinational Association of Supportive Care in Cancer (MASCC) and clinical index of stable febrile neutropenia (CISNE) scores have been widely used to predict the risk of severe medical complications in patients with FN; however, there are few tools for predicting chemotherapy delays or discontinuation after FN. Patients admitted to two university hospitals between 2014 and 2018 with a FN diagnosis during the first cycle of chemotherapy for lung cancer were reviewed retrospectively. Among 539 patients who received 813 courses of chemotherapy for lung cancer, 49 (9%) developed FN during the first treatment cycle. Although all the patients recovered from their primary infection, 19 patients (38.8%) developed serious medical complications, 11 (22.4%) were unable to resume chemotherapy and one (2.0%) declined to resume chemotherapy, and nine (18.4%) died within 90 days. Patients who failed to resume chemotherapy had a lower MASCC score (median 8.5 vs. 17, p < 0.01) and a higher CISNE score (median 3 vs. 1, p < 0.01) at the onset of FN. The specificity to predict the patient who failed to resume chemotherapy was 90% or more with MASCC score ≤9 or CISNE score ≥3, with the sensitivity of 61%. MASCC score ≤ 16 can also be a sensitive indicator with the sensitivity and specificity of 89 and 52%, respectively. The MASCC and CISNE scores are useful in identifying lung cancer patients who are unable to resume chemotherapy as scheduled after the onset of FN.

Cardiac Biomarkers for the Detection and Management of Cancer Therapy-Related Cardiovascular Toxicity.

Cardiotoxicity is one of the major side effects of anti-cancer therapy affecting the overall prognosis of patients and possibly leading to the discontinuation of chemotherapy. Traditional cardiovascular tests such as electrocardiography and transthoracic echocardiography have limited sensitivity and specificity for the early detection of myocardial injury. Cardiovascular imaging generally detects cancer therapy-related cardiac dysfunction (CTRCD) at advanced stages, whereas biomarkers are inexpensive, easily detected, reproducible, and capable of detecting even minimal cardiomyocyte damage or mild hemodynamic fluctuations. The presence of circulating cardiac biomarkers has been investigated as early indicators of cardiotoxicity and predictors of subsequent CTRCD. Currently, the most frequently used cardiac biomarkers are cardiac troponin (cTn) and natriuretic peptides (NPs). This review presents the evidence gathered so far regarding the usefulness and limitations of cardiac biomarkers in the field of cardio-oncology.

Sarcopenia and Treatment Toxicity in Older Adults Undergoing Chemoradiation for Head and Neck Cancer: Identifying Factors to Predict Frailty

<h3>Purpose/Objective(s)</h3> Geriatric tools and objective measures may identify vulnerabilities to inform potential side effects or adjust treatment choices in cancer patients eligible for definitive therapy. Early identification may allow for immediate intervention or enhanced oversight during treatment by the oncologist or a geriatrician. This study was performed to identify treatment related toxicities in older adults undergoing concurrent chemoradiotherapy for head and neck cancer and whether nutritional and skeletal muscle measures may be additional measures of frailty. <h3>Materials/Methods</h3> Definitive and post-operative patients undergoing concurrent chemoradiotherapy for locally advanced (AJCC 7^th edition Stage III-IVB) head and neck cancer at an academic medical center between 2011 and 2016 were reviewed. Imaging analysis was performed to identify sarcopenia, defined as a decrease in skeletal muscle, using the cross-sectional area at the axial slice of the C3 vertebral body. Patients were dichotomized by the age at diagnosis into younger (<70 years old, 221 patients) and older age groups (≥70 years old, 51 patients). <h3>Results</h3> A total 272 patients were included with most primary tumors in the oropharynx (64.7%), 137 (77.8%) were p16-positive. 79% were treated with definitive chemoradiation (21% post-operatively) with a majority former or current smokers (70.2%). Older patients had expected higher ≥2 ECOG performance status pre-treatment (19.6% versus 8.6%, p=0.02), remaining clinical and demographic characteristics were well balanced (p>0.05). Sarcopenia was more common in older patients (86.7%) compared to younger patients (51.7%, p<0.01) despite having similar BMIs <30 kg/m2 (74.5% vs 66.1%, p=0.25). Older patients were significantly more likely to experience chemotherapy toxicity than younger patients (54.9% versus 32.3%, p<0.01). On multivariate analysis age (p<0.01), current smoking status (p<0.01), and sarcopenia (p<0.01) remained as significant predictors for missed chemotherapy cycles or discontinuation. Older patients were more likely to require ≥5-day radiation breaks than younger patients (27.5% versus 8.6%, p<0.01). On multivariate analysis, age (p<0.01), low albumin status (p=0.03), and sarcopenia (p=0.04) were identified as predictors of prolonged radiation treatment breaks. <h3>Conclusion</h3> Older age and sarcopenia were identified as independent pretreatment characteristics for chemotherapy toxicity and prolonged radiation breaks, where sarcopenia was present in most elderly patients. Sarcopenia may be used as an additional marker for frailty compared to traditional performance status scales in older individuals and may identify patients needing intensive supportive care during treatment.

Survival Analysis and Clinical Outcomes between Paclitaxel and Carboplatin Versus Carboplatin and Gemcitabine in Patients with Advanced-stage Non-small-cell Lung Cancer: A Single-center Cohort Study.

Palliative chemotherapy using platinum-based doublet chemotherapy was recommended as one of the standard treatments in patients with advanced-stage non-small cell lung cancer (NSCLC) with negative EGFR mutation. This study aimed to compare clinical outcomes between patients treated with paclitaxel and carboplatin (PC) and those treated with carboplatin and gemcitabine (CG). We conducted a retrospective cohort study comparing PC and CG at Hatyai Hospital between 2012 and 2019. The primary outcome was survival analysis, and the secondary outcome was chemotherapy-related adverse events, and the rate and reason for stopping chemotherapy. The median overall survivals of both groups was comparable (9.0 months for the PC group and 9.6 months for the CG group; log-rank, p=0.287). The CG group had a higher incidence of adverse events (89.7% vs. 77.9%, p=0.010) and tended to have a lower rate of chemotherapy discontinuation (29.6% vs. 41.2%, p=0.080) than the PC group. In the multivariate analysis, female sex (odds ratio [OR]=0.351; 95% confidence interval [CI], 0.158-0.780; p=0.010) and higher performance status (OR=76.374; 95%CI, 32.533-179.295; p<0.001) were independent predictive factors for stopping chemotherapy. In the proportional hazards model, the factors associated with decreased survival included higher performance status (hazard ratio [HR]=1.939; 95%CI, 1.388-2.709; P<0.001) and discontinuation of chemotherapy (HR=2.572; 95%CI, 1.792-3.691; p=<0.001). These two platinum-based regimens had comparable effects on overall survival. The CG group had a higher incidence of chemotherapy-related adverse events, while the PC group had a marginally significantly higher rate of stopping chemotherapy from unacceptable adverse events and deterioration of patients' clinical status.

270. SAFETY AND EFFICACY OF PREOPERATIVE FOLFOX FOR PATIENTS WITH RESECTABLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA WHO ARE NOT CANDIDATES FOR CISPLATIN

Abstract The standard preoperative treatment for resectable locally advanced esophageal squamous cell cancer (LAESCC) in Japan is a cisplatin (CDDP)-containing chemotherapy. However, patients with renal or cardiac dysfunction and elderly patients are not candidates for CDDP because of renal toxicity and the need for hydration. Oxaliplatin, 5-fluorouracil, and leucovorin (FOLFOX) therapy causes less renal toxicity and does not require hydration. We evaluated the preoperative FOLFOX therapy in patients who are unsuitable for CDDP remains unknown. The subjects of this retrospective study were histologically confirmed LAESCC patients unsuitable for CDDP because of an age ≥ 75 years or a creatinine clearance (CCr) &amp;lt;60 mL/min, or cardiac dysfunction who received preoperative FOLFOX therapy at our hospital between 2019 and 2021. Supraclavicular lymph node metastasis was considered resectable. Preoperative FOLFOX therapy (oxaliplatin 85 mg/m2, leucovorin 200 mg/m2, and 5-fluorouracil 400 mg/m2 [bolus] plus 2400 mg/m2 [continuous] every 2 weeks) was administered for 3 or 4 courses. We evaluated adverse events during preoperative chemotherapy (CTCAE version 5.0), complete resection rate, and histopathological response. Thirty-five patients were eligible for inclusion in the study (median age 77 years [range, 65–89]; performance status 0/1, 40%/60%; clinical stage I/II/III/IVB [only supraclavicular lymph node], 11%/29%/57%/3%). The reasons for selecting FOLFOX were renal dysfunction (74%), age ≥ 75 years (69%), and cardiac dysfunction (17%). Four patients (11.4%) discontinued chemotherapy because of progression (n = 2), febrile neutropenia (n = 1), or neutropenia (n = 1). The most common grade ≥ 3 adverse events were neutropenia (60%) and leucopenia (29%). 31 patients underwent surgery. The complete resection rate was 87% (27/31) and the pathological complete resection rate was 16% (5/31). There were no treatment-related deaths. Preoperative FOLFOX therapy was well tolerated and showed promising short-term efficacy in patients with resectable LAESCC who were not candidates for CDDP.

Differences in prognosis and underuse of adjuvant chemotherapy between elderly and non-elderly patients in stage III colorectal cancer.

We aimed to clarify the use of adjuvant chemotherapy and the prognosis of elderly colorectal cancer patients compared with non-elderly patients, and the usefulness of sarcopenia as an indicator for the introduction and completion of adjuvant chemotherapy. Between 2013 and 2021, 215 patients with pStage III disease were included. We investigated perioperative clinicopathological factors, adjuvant chemotherapy details, and prognosis. Preoperative sarcopenia status was evaluated using computed tomography images. Elderly patients were defined as those aged ≥70 years. We included 121 (56.3%) and 94 (43.7%) non-elderly and elderly patients, respectively. Among the elderly patients, 47 had sarcopenia. There were no significant differences in the incompletion rate of adjuvant chemotherapy between elderly and non-elderly patients (27.1%/16.2%, P=0.119). The most common reason for the discontinuation of adjuvant chemotherapy was side effects, regardless of age. The respective 3-year-disease free survival of patients with no/completed/incomplete adjuvant chemotherapy were 65.5%, 80.2%, and 57.7% for non-elderly patients (P=0.045) and 73.4%, 70.6%, and 71.6% for elderly patients (P=0.924). The number of elderly patients with sarcopenia was significantly higher in patients without adjuvant chemotherapy (P=0.004) and those with incomplete adjuvant chemotherapy (P=0.004). The 3-year-disease free survival of elderly sarcopenic patients without and with adjuvant chemotherapy were 78.3% and 59.2%, respectively (P=0.833). Elderly patients did not show a benefit of adjuvant chemotherapy regardless of whether they had completed adjuvant chemotherapy, unlike non-elderly patients. Moreover, the evaluation of preoperative sarcopenia in elderly colorectal cancer patients may be useful in determining the indication for adjuvant chemotherapy.

Enteral nutrition for children with acute leukemia-related pancreatitis

ObjectivePancreatitis in children with acute lymphoblastic leukemia and acute myeloid leukemia may cause discontinuation of chemotherapy, thus adversely affecting treatment outcomes. Enteral nutrition (EN) is recommended for acute pancreatitis. The optimal use of EN for leukemia-related pancreatitis is under debate. The aim of this study was to determine the clinical efficacy of EN for children with leukemia-related pancreatitis. MethodsMedical records of 53 children with characteristics of leukemia-related pancreatitis were abstracted retrospectively. Considering specific outcome variables, the EN-associated factors improving treatment were analyzed. Enzyme and albumin changes during the 14-day follow-up period were also analyzed, to test for the safety of EN. ResultsEarly EN was found to be a protective factor from secondary infection and significant weight loss. Jejunal EN was related to higher risk for enzyme elevation relapse compared with oral EN. Patients with severe pancreatitis had lower risk for significant weight loss but higher risk for abnormal glucose levels than their counterparts. EN type had a significant effect on lipase change, and early EN had interactive effects by time on amylase and lipase changes. ConclusionsEarly EN within 7.5 days could reduce the risk for secondary infection and significant weight loss for pediatric leukemia-related pancreatitis, with decreased serum amylase and lipase levels, in a safe and effective manner. Beneficial effects of EN within 72 h were not observed.

The feasibility of screening for malnutrition in the outpatient setting and the prevalence of malnutrition in patients with newly-diagnosed ovarian carcinoma

IntroductionMalnutrition is an independent risk factor for poor surgical outcomes, early chemotherapy discontinuation, and increased mortality. We evaluated the feasibility of outpatient malnutrition screening in patients with suspected gynecologic malignancy. We estimated the prevalence of malnutrition using Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (AND-ASPEN) criteria in patients undergoing surgery for newly-diagnosed ovarian carcinoma (OC). MethodsPatients scheduling a new clinic appointment for suspected gynecologic malignancy from 2/2018–2/2019 completed the Malnutrition Screening Tool via phone. Patients with positive screening test were recommended expedited Nutrition consultation. To estimate the prevalence of malnutrition in patients with newly-diagnosed OC, formal malnutrition evaluation by a Registered Dietician was ordered during hospitalization for all patients undergoing surgery (primary cytoreduction and interval cytoreduction) for newly-diagnosed OC. ResultsOf 187 outpatients screened, 29 (16%) had a positive malnutrition screen. Eleven of 29 (38%) were willing to schedule outpatient Nutrition appointment; four were evaluated. Two (1% of all outpatients screened) were diagnosed with malnutrition. 107 patients underwent surgery for primary OC; 70 received Nutrition consult. Only 3 of 70 (4%) were formally diagnosed with malnutrition using AND-ASPEN criteria. ConclusionOutpatient screening of patients with suspected gynecologic malignancy for malnutrition is feasible. However, the prevalence of malnutrition detected through outpatient screening and in the newly-diagnosed OC population is surprisingly low, suggesting that outpatient screening at time of initial consultation may not be ideal timing. Improving access to dietitians during chemotherapy and later in the cancer course when malnutrition is likely more prevalent may be beneficial.

Differences in Treatment Modalities and Prognosis of Elderly Patients with Ovarian Cancer: A Two-Center Propensity Score-Matched Study.

Simple SummaryThe standard of care for patients with ovarian cancer is well established. While the prognosis of younger patients has improved significantly, the survival of older patients remains low. Reasons accounting for the poor survival among older patients are controversial. This study aimed to describe the difference in treatment received by older patients in China and to evaluate the prognostic significance of both chronological age and different treatment modalities using a propensity score-matched cohort. Cytoreduction with no residual tumor and the completion of adjuvant chemotherapy were the most important prognostic factors. Chronological age, however, had no influence on recurrence. This relatively large case–controlled study provides evidence that the difference between the standard of care and the treatment of older patients was the main reason that handicaps the efficacy of therapy.Background: The prognosis of older patients with ovarian cancer is poor. We evaluated the effect of chronological age and different treatment characteristics on the prognosis of older patients with ovarian cancer; Methods: The study retrospectively analyzed patients aged over 60 years who underwent cytoreduction followed by platinum-based adjuvant chemotherapy between January 2011 and December 2019 in two national centers in China. Propensity score matching (PSM, 1:1) was performed to stratify the comorbidity- and treatment-related factors. The Kaplan–Meier method was employed to estimate progression-free survival (PFS) in the original cohort and the cohort after PSM; Results: A total of 324 patients were evaluated. The Age ≥ 70 group often received more neoadjuvant chemotherapy (62.3% vs. 31.2%, p < 0.001), more discontinuation of adjuvant chemotherapy (31.2% vs. 10.8%, p < 0.001), and had more severe chemotherapy-related toxicity (45.6% vs. 34.2%, p = 0.040) than the Age < 70 group. After matching, the PFS of the Age < 70 group was not significantly different from the Age ≥ 70 group (median PFS = 12.4 and 11.9 months, respectively, p = 0.850). Furthermore, the advanced FIGO stage, non-R0 cytoreduction, and discontinuation of adjuvant chemotherapy were all found to be poor prognostic factors. Serum albumin level <40 g/L (HR = 2.441, p = 0.018) and age ≥ 70 years (HR = 2.639, p = 0.008) led to more severe chemotherapy-related toxicity. Additionally, poor renal function (HR = 5.128, p = 0.002) was in association with discontinuation of adjuvant chemotherapy; Conclusions: The chronological age of older patients cannot be seen as a poor prognostic factor. Older patients may benefit most from R0 cytoreduction followed by the completion of chemotherapy. Postoperative poor renal function and serum albumin level <40 g/L may help predict the discontinuation of adjuvant chemotherapy.

Mild forms of thrombotic microangiopathy in patients with advanced pancreatic cancer receiving gemcitabine and nab-paclitaxel.

Thrombotic microangiopathy (TMA) is an uncommon complication that may occur in cancer patients usually as an expression of cancer-associated coagulopathy or due to drug-related toxicity. The clinical spectrum of TMA may vary from an incidental laboratory finding in cancer outpatients to potentially severe life-threatening clinical forms with organ involvement requiring prompt recognition and multidisciplinary evaluation. We present the clinical characteristics and outcomes of four patients with advanced pancreatic cancer with acute non-immune intravascular haemolysis compatible with microangiopathic acute haemolytic anaemia associated with mild thrombocytopenia during long-term gemcitabine and nab-paclitaxel treatment. Abnormal blood parameters (all four cases) and renal involvement (one case) were reversed with a conservative approach and chemotherapy discontinuation. One patient required a short hospitalization while the other three were managed as outpatients. The rapid reversibility of the blood abnormalities supported gemcitabine dose-related toxicity as the most likely aetiologic mechanism and demonstrates the current challenges in daily long-term cancer survivor care. Clinicians must take into account TMA in the differential diagnosis of acute anaemia with or without thrombocytopenia and organ damage, since adequate recognition and early treatment discontinuation allow effective outpatient management and favourable patient outcomes.

Statins increase pathological response in locally advanced rectal cancer treated with chemoradiation: a multicenter experience.

Aims: To investigate the influence of various concomitant medications on outcomes in patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation. Materials & methods: The authors retrospectively identified 246 patients from 2003 to 2018, collecting demographic and clinicopathological data of interest. Odds ratio (OR) was used to assess the association between concomitant drugs and outcomes. Results: The authors found an association between statins and a Dworak regression grade of 3-4 (OR=8.78; p=0.01). Furthermore, statins were significantly associated with more frequent chemoradiation-related toxicity (OR=2.39; p=0.0098) and chemotherapy dose reduction or discontinuation (OR=2.26; p=0.03). Conclusion: Despitehigher frequency of radiotherapy and chemotherapy interruption or dose reduction, the concomitant use of statins during neoadjuvant chemoradiation proved to be associated with better tumor regression.

Predictive marker for exposure-driven haematological toxicity of tegafur-uracil and proposed modified-dosage regimen by pharmacometric approach in rats

Myelosuppression is a dose-limiting toxicity of uracil-tegafur (UFT), which contains uracil and the 5‑fluorouracil prodrug tegafur, and inhibits the continuation of chemotherapy, causing treatment failure. A proper dosing strategy to avoid severe myelosuppression-induced discontinuation of chemotherapy is required. Plasma drug concentrations were determined in rats after single oral UFT administration of 15, 30, or 60 mg/kg. Blood cell counts were also measured after oral UFT administration for 5 days. Pharmacokinetic-toxicodynamic (PK-TD) modelling and simulation were performed to describe the time-course alterations in the blood cell counts. Severe neutropenia was observed in rats treated with 60 mg/kg UFT on day 7. A significant decrease in neutrophil counts from baseline levels prior to UFT administration was observed on day 3, whereas leukocyte and lymphocyte counts decreased on day 7. The semi-physiological PK-TD model successfully captured alterations in neutrophil counts after UFT administration, whereas the model could not well describe the platelet, leukocyte, and lymphocyte counts, possibly due to the absence of severe thrombocytopenia, leukocytopenia, and lymphocytopenia, respectively. Neutrophils are sensitive markers for estimating the grade of haematological toxicity of UFT, and a PK-TD model might be an attractive tool for quantitatively evaluating the onset and degree of myelosuppression.