bluuebunny/crossref_metadata_2025_split huggingface dataset:
How much can patients, with low Karnofsky performance status and advanced non-small cell lung cancer, benefit from cisplatin-based chemotherapy? A retrospective analysis of a phase III randomised trial
Authors: Paesmans M. , Lafitte J. , Berghmans T. , Lecomte J. , Alexopoulos C. , Van Cutsem O. , Giner V. , Efremidis A. , Berchier M. , Sculier J. 
Published: March 2020

19516 Background: Performance status (PS) is a strong independent prognostic factor for survival in patients with advanced non- small cell lung cancer and administration of platinum-based chemotherapy (CT) in patients with poor PS is associated to more severe toxicity. Our purpose was to determine whether poor PS patients (ie those registered with a performance index of 60–70 on the Karnofsky scale) could benefit from CT in terms of clinical improvement defined as reaching, during CT, a PS of at least 80 on the same scale (ECOG PS 0 or 1). Methods: Retrospective analysis of a randomised trial performed in advanced NSCLC where 485 patients received three courses of GIP (gemcitabine + ifosfamide + cisplatin) induction CT, in order to determine the potential clinical benefit of conventional cisplatin-based CT in patients with poor PS defined as 60–70 on the Karnofsky scale. Results: 387 (80%) patients had good PS (Karnofsky 80–100) and 98 (20%) poor PS. Response rates were respectively 38 and 28% (p=0.06), no independent predictive value for PS was found using response to CT as endpoint. Clinical improvement was observed in 25% (95% CI : 15%-38%) of the poor PS patients (respectively 38%, 20% and 14% in case of response, no change and progression, p=0.05). Nine additional patients improved from 60 to 70 during induction CT. Improvement occurred earlier in responders (rates of patients with improvement were 12% after 1 course, 31% after 2 courses and 38% after 3 courses compared to 3%, 5% and 17% in the non responders). Survival of patients with poor PS was significantly worse but survival of responders was similar, whatever initial poor or good PS (logrank test after landmark, p=0.47, HR=1.18, 95%CI: 0.76–1.84 for poor responders). If non fatal toxicity was relatively similar as well as dose intensity delivered after 3 CT courses, there were more toxic deaths (including vascular and cardiac fatalities) in poor PS patients (2.1% versus 9.2%; p=0.002). Conclusions: Although toxicity is increased, combination chemotherapy is associated with clinical improvement in a non negligible rate of patients with poor PS in case of advanced NSCLC. No significant financial relationships to disclose.
How different are epidemiology and treatment of cancer persistent pain (PP) and breakthrough pain (BTP) in elderly patients (pts)? Results of a French prospective survey
Authors: Di Palma M. , Duclos R. , Tessier C. 
Published: March 2020

19520 Background: Efforts have been made in the recent years to improve pain care in cancer pts, especially for elderly ones Methods: We conducted a national survey in France in order to evaluate the actual situation. Data were collected from 100 cancer centers and analyzed using SAS software. Only adult pts treated for cancer pain, with their treatment initiated less than 8 days before study, were considered. Comparisons were made considering pts under and over 70 years old Results: Epidemiology: 793 pts were included, 565 being under 70 years old (mean 54), 228 over 70 years old (mean 76). There were more men in the elder group (67% vs 54%, this being explained by some differences in tumor type (more prostate cancer). Proportion of metastatic pts was not different (78 vs 79%) but metastatic sites were not the same, especially bone mets (70 vs 55%). Fewer pts were currently treated with chemo or radiotherapy in the elder group. Median WHO performance status was worse in elderly pts (3 vs 2). Characteristics of pain: Of note, characteristics of PP and BTP (pain location, nociceptive or neuropathic pain, intensity for PP and BTP, number of BTP episodes) were not different between the 2 groups. Pain treatment: Almost all the pts received opioids in both groups for PP and BTP, while elder pts were treated less frequently with specific drugs for neuropathic pain (antidepressant and anti-epileptic), and psychological support was less likely offered to them (36 vs 48%) Conclusions: Characteristics of PP and BTP in cancer pts are not influenced by pts age. Progresses have been made as elder pts receive opioids as often as younger ones, but improvements are still needed concerning the treatment of neuropathic pain and psychological support in elderly pts. No significant financial relationships to disclose.
Early detection of cardiotoxicity during chemotherapy using biomarkers
Authors: Lenihan D. J. , Massey M. R. , Baysinger K. , Steinert D. , Fayad L. , Yusuf S. W. , Chiu A. , Durand J. , Yeh E. T. 
Published: March 2020

19521 Cancer chemotherapy (CHEMO), especially anthracycline-containing regimens, may result in heart failure and left ventricular dysfunction (LVD) due to cardiotoxicity (CVTx). The ability to detect CVTx currently utilizes techniques to assess LVD, such as MUGA or echocardiography (Echo), which have substantial limitations and only detect LVD well after it occurs. Cardiac biomarkers, troponin (Trop I) and B-Type Natriuretic Peptide (BNP) are well established for detecting myocardial injury and LVD in patients without cancer. Limited evidence suggests that these may be important predictors of subsequent CVTx during CHEMO, but these markers have not been systematically investigated prospectively. Methods: Patients undergoing anthracycline-containing combination CHEMO were evaluated at baseline with: history and physical; electrocardiogram; Echo; and BNP and Trop I. Biomarkers were repeated before and after up to 6 cycles of CHEMO. ECHO was repeated after 6 cycles or at 6 months from baseline. Cardiac events (heart failure, LVD, sudden death, or arrhythmia) were documented, if present. Results: To date, 111 (53M/58F) patients, age 56±14 (mean±SD), with either lymphoma (n=39, 35%), sarcoma (n=60, 54%), or breast cancer (n=12, 11%) were enrolled. At least one traditional cardiac risk factor was identified in 77 (69%) and 2 or more risk factors noted in 46 (41%). Baseline ECHO parameters including ejection fraction (EF) and biomarkers were normal. With CHEMO, the mean post CHEMO BNP value (pg/ml) for the group did not change significantly; however, in the 8 patients with cardiac events, the BNP post CHEMO was elevated. The Trop I values were not abnormal except in 2 patients with events. Conclusion: Preliminary data collected to date indicates that BNP values during CHEMO remain normal unless cardiac events occur. Additionally, elevated BNP levels appear to detect CVTx, but LVEF did not. Furthermore, patients receiving CHEMO frequently have cardiac risk factors that may promote CVTx. [Table: see text] No significant financial relationships to disclose.
Quality of life following amputation or limb salvage in patients with lower extremity sarcoma
Authors: Mason G. E. , Aung L. , Gall S. , Meyers P. A. , Sklar C. , Butler R. , Healey J. H. , Gorlick R. G. 
Published: March 2020

19530 Background: Currently between 80–90% of patients with lower extremity sarcoma undergo limb salvage procedures. A few trials show that the functional quality of life is significantly higher for limb salvage surgery compared to patients with amputation. While taking quality of life and psychological consequences into account it would seem that limb salvage would be the procedure of preference; however, this difference has yet to be demonstrated in previous studies. Methods: Eighty-two long-term survivors of lower extremity sarcoma were studied to make a comparison of the overall quality of life in limb salvage and amputation patients. Forty-eight patients with limb salvage (age 14–49 years) and thirty-four patients with amputations (age 15–49 years) were studied who were at least one-year post- surgical procedure. Sensitive psychometric measures such as self-report questionnaires and visual analog scales were used to assess psychological consequences and quality of life. Results: The overall quality of life of patients with the limb salvage was significantly higher than patients with amputation (p-value < 0.01). For the quality of life questionnaire, the limb salvage patients had a higher mean value in every domain except parent-child relations. The domains that showed a significant difference between patients with limb salvage and patients with amputations are material well being, occupational relations, creative-aesthetic behavior, and sports activity. Conclusions: For patients with lower extremity sarcoma, the psychological quality of life is better for those who received the limb salvage procedure. The significance of this study is that it one of the first to show that there is a direct benefit to limb salvage surgery as compared to amputation in regards to several psychological factors and total quality of life. No significant financial relationships to disclose.
Weight change among breast cancer patients receiving chemotherapy: A retrospective analysis
Authors: Nair B. P. , Khalil O. , Phooshkooru V. R. , Hutchins L. F. 
Published: March 2020

19535 Background: Weight gain occurs in patients with early stage breast cancer receiving chemotherapy. The etiology is unknown. Most pre-menopausal patients receiving chemotherapy enter menopause during the course of treatment. We explored the relation between weight gain and development of menopause in breast cancer patients. We hypothesized that, among breast cancer patients receiving chemotherapy, those in the pre/perimenopausal group will gain more weight compared to postmenopausal group in the first 2 years. Methods: The electronic database at University of Arkansas was queried for breast cancer patients treated with chemotherapy between May 1992 and Nov 2003. Age, chemotherapy and weight at multiple time points (diagnosis, 6, 12, 24 and 60 months) were obtained. The mean weight changes across these time points were then calculated for the entire population and also after categorizing by age. Age was used as a surrogate for menstrual status. Women aged >=50 yrs were considered postmenopausal, those <50 yrs were considered pre or perimenopausal. Results: 617 patients were included in the analysis. There were 371 patients in the >=50 age group and 246 patients in the <50 age group. The average baseline weight for the entire population was 75.21 kg: 74.44 for women <50 yrs and 75.71 for women >= 50 yrs. Patients <50 yrs of age gained weight in the first 2 yrs: 1.11 kg weight in the 1st year and 0.65 kg in the second yr. This was followed by loss of 1.19 kg over next 3 yrs which paralleled the loss of weight in the >=50 group. The mean weight of the >=50 age decreased by 0.27 kg in the first 2 years and then by 1.16 kg over the next 3 yrs following chemotherapy. Conclusions: Pre/perimenopausal breast cancer patients in our study gained weight, while postmenopausal patients had slight weight loss during the first 2 years. These findings imply that onset of menopause itself may be playing a significant role in weight gain among pre/perimenopausal breast cancer patients receiving chemotherapy. [Table: see text] No significant financial relationships to disclose.
Randomized study of early intervention compared to standard intervention with darbepoetin-alpha (DA) for chemotherapy-induced anemia (CIA) in early stage breast cancer (ESBC)
Authors: Blakely L. , Schwartzberg L. S. , Henry D. , Sabbath K. , Fu D. , Epperson A. , Fortner B. V. 
Published: March 2020

19538 Background: Dose dense chemotherapy (DDC) with sequential doxorubicin/ cyclophosphamide followed by paclitaxel Q 14 days has an established place in the treatment of ESBC. However, moderate/severe CIA is a common consequence and therapeutic intervention is frequent. We sought to determine if early intervention at the onset of anemia with DA could reduce the emergence of more severe anemia during therapy and maintain quality of life compared to later intervention. Material and Methods: Non-iron deficient (ferritin > 50) patients (pts) with hemoglobin (Hb) levels >11.0 g/dl scheduled to receive adjuvant or neoadjuvant DDC for ESBC were recruited. Pts were randomly assigned prior to chemotherapy to initiate treatment with DA 200 μg q2w SQ when Hb < 11.5 g/dl (early intervention, EARLY), or DA 200 μg q2w SQ when Hb < 10.0 g/dl (standard intervention, STD) with end of treatment defined as 14 days after the last cycle of chemotherapy. Dose escalation for inadequate response of < 1 g/dl after 6 weeks of DA and dose withholding/reduction for Hb >13 g/dl were pre-specified. Results: The complete sample of 149 pts have been accrued (median age of 53.1, range 28.7 - 74.5). Analysis of fatigue ratings show a trend towards lower fatigue scores in EARLY at Hb nadir, and at end of study,(ANOVA, Group x Time interaction, p=.07). Discussion: Early intervention with DA significantly reduces the risk of developing moderate/severe CIA and increases time spent in the target range during DDC for ESBC. [Table: see text] No significant financial relationships to disclose.
The role of reduced glutathione on oxaliplatin-induced neuropathy in colorectal cancer patients
Authors: Lelli G. , Romano G. , Ardito R. , Bochicchio A. , Capobianco A. , Coccaro M. , Di Leo P. , Tartarone A. , Romano C. , Calvi N. , Lorusso V. 
Published: March 2020

19539 Background: Peripheral sensory neuropathy is a common side-effect of oxaliplatin based chemotherapy. The neuropathy is cumulative and dose-related. Symptoms include sensory ataxia and dysesthesia of the limbs, mouth, throat and larynx, and may be exacerbated by exposure to cold. Studies suggest that Glutathione (GSH) is neuroprotective against oxaliplatin-induced neuropathy. Methods: From Jan. 2004, 83 consecutive colorectal cancer patients (pts) elegibile to oxaliplatin-based regimen were treated with GSH 1500 mg/mq over a 15-minute infusion period before oxaliplatin. Treatment-related toxicity was evaluated based on National Cancer Institute (NCI) Criteria. Results: After four cycles of chemotherapy, 5 pts (6%) experienced G1 neurotoxicity. After eight cycles, 2 pts (2.4%) experienced G2 sensory neuropathy (duration < 7 days) and 8 (9.6%) pts G1. After 12 cycles, G3 sensory neuropathy was observed in 2 pts (2.4%), G2 in 8 (9.6%) and G1 in 11 pts (13%). Neither G4 sensory neuropathy was registered nor treatment interruption was required. Conclusions: These findings suggest that use of GSH may protect from oxaliplatin-induced neuropathy. In fact, in our series, only 2 (2.4%) pts experienced severe paresthesia interfering with daily activities and none hade permanent sensory loss. However, only a well designed randomised controlled study will definitely prove the protective effect of GSH on oxaliplatin induced neurotoxicity. No significant financial relationships to disclose.
Hematologic outcomes of epoetin-alpha-treated cancer patients based on initial intervention of Hb <10 compared to Hb 10–11 g/dL: Results from a prospective observational study
Authors: Wang Q. , Chen E. , Larholt K. , Bookhart B. , McKenzie R. , Tak Piech C. 
Published: March 2020

19542 Background: Current guidelines recommend consideration of epoetin alfa (EPO) therapy for chemotherapy-induced anemia (CIA) when Hb <11 g/dL (National Comprehensive Cancer Network) or Hb < 10g/dL (ASCO/ASH). To evaluate clinical outcomes in EPO-treated patients initiated at Hb < 10 v. 10–11 g/dL, an analysis was conducted of clinical outcomes from practice settings. Data were analyzed from the Dosing and Outcomes Study of Erythropoiesis-Stimulating Therapies (D.O.S.E.) Registry, an ongoing, prospective registry collecting data on real-world practice patterns. Methods: Data from 29 U.S. hospital and community-based outpatient practices were assessed from 1/04–10/06. Chemotherapy-treated adult patients with a non-myeloid malignancy, baseline anemia (Hb < 11 g/dL), receipt of at least two EPO doses, and study completion were included. This analysis stratified patients based on Hb level at EPO initiation. Outcomes assessed included proportion of patients requiring RBC transfusion, mean treatment duration, and proportion of patients achieving an Hb = 11 g/dL. Results: 245 patients were eligible for analysis. 97 patients were initiated at a Hb < 10 g/dL and 148 patients were initiated at Hb 10–11 g/dL Baseline characteristics (age, gender distribution, weight, platinum-based therapy, Karnofsky score, primary tumor type) were similar except baseline Hb (9.4 g/dL v. 10.5 g/dL). Treatment duration was similar in both groups at approximately nine weeks. Transfusion outcomes and time to NCCN target Hb level (Hb =11 g/dL) are described in the table . Conclusions: This ongoing observational study demonstrated over two-thirds of patients achieved NCCN target Hb = 11 g/dL. Additional benefits for the patients initiated at Hb 10–11 g/dL were a shorter time to NCCN target Hb and a lower proportion of patients requiring transfusions. These results support the use of EPO for patients with chemotherapy-induced anemia and Hb < 11 g/dL. [Table: see text] No significant financial relationships to disclose.
Predicting bacteraemia following chemotherapy administration in patients with hematological cancer (HC)
Authors: Moreau M. , Schwarzbold A. , Klastersky J. , Georgala A. , Muanza F. , Aoun M. , Ferrant A. , Bron D. , Paesmans M. 
Published: March 2020

19543 Background: Infections cause important morbidity and mortality in patients undergoing treatment for cancer. The type and the intensity of chemotherapy play an important role in the risk of infection which manifests itself most often as febrile neutropenia (FN) but regimen-specific risks are not well defined. Since bacteraemia is associated with increased mortality, we tried to determine predictors of it and to validate a classification of aggressiveness of a given chemotherapy regimen (CR) to be used in a risk prediction model in patients with HC. Methods: Patients older than 16 years, diagnosed with HC of any type were prospectively enrolled and followed at the “Institut Jules Bordet” and at the “Cliniques Universitaires Saint-Luc (UCL)” between 2001–2005. Out of the 266 patients, 22.9%, 43.6% and 33.5% were followed respectively during one cycle, 2 to 4 cycles and more than 4 cycles, totalizing 1053 cycles. Relevant patient’s information were collected at the beginning of the first cycle. Before each cycle, the CR score was computed, a blood examination performed and the temperature measured. Bacteraemia was defined according to IDSA criteria. FN was defined as a neutrophil count < 500/μl and fever. Generalized Estimating Equations (GEE) was used for the analysis. Results: Among 1017 evaluable cycles, 148 (14.5%) were followed by an episode of bacteraemia. Among the cycles with FN, 35.5% had bacteraemia. In the final model, adjusted for antimibrobial prophylaxis (R2=0.22), the CR score was the most important predictor of bacteraemia (OR 4.2 [95% CI, 2.3–7.6]), for patients given an aggressive regimen compared to the others. The other predictors associated with bacteraemia were: underlying disease (3.2 [1.9–5.2]), a baseline monocytopenia (<150/μL) (2.7 [1.6–4.3]), a baseline CRP >10 mg/L (2.1 [1.2–3.7]), the first cycle of patient’s treatment (0.3 [0.2–0.7]) and the administration of immunosuppressive agents (2.2 [1.2–4.0]). Conclusions: Bacteraemia was frequent in patients with HC undergoing myelosuppressive chemotherapy, especially in patients with FN. The CR plays an important role but further studies are needed to investigate yet unidentified additional risk factors. Grant given by the FNRS in Belgium (“Fonds National pour la Recherche Scientifique”) No significant financial relationships to disclose.
The expanded role of palliative procedures with minimally invasive tumor ablation techniques
Authors: Miner T. J. , Gaydos-Gabriel J. , Kim W. , Mayo-Smith W. , Dupuy D. 
Published: March 2020

19548 Background: To effectively and appropriately manage the debilitating symptoms of advanced cancer, physicians must balance the potential promise of palliative interventions against requirements to avoid toxic or futile therapy. Ablative technologies are increasingly used for the local destruction of tumors. This study examines the outcomes of ablative procedures performed with palliative intent. Methods: Minimally invasive ablative procedures (microwave and radiofrequency) to explicitly palliate symptoms of advanced cancer were identified from all procedures performed. Patients were observed for >90 days or until death. Results: There were 175 palliative ablative procedures performed in 129 patients from 1999 to 2004. Ablations were performed most commonly for pain (90%) caused by metastatic (90%), locally advanced (5%), and locally recurrent (5%) disease. Primary malignancies treated were lung (31%), colorectal (14%), renal (11%), breast (9%), sarcoma (9%) and other (26%). Symptom improvement or resolution within 30 days was achieved in 69% (89/129). Median duration of symptom control was 315 days. Recurrence of the primary symptom occurred in 46% (59/129) while treatment of additional symptoms was needed in 22% (29/129). Palliative ablative procedures were associated with postoperative morbidity (25%) and mortality (7%). A postoperative complication reduced the probability of symptom improvement to 25% (p<0.001). Effective symptom relief was associated with improved overall survival (median 408 days vs. 161 days, p<0.001). Conclusions: In carefully selected patients, relief of symptoms following palliative ablative procedures can be expected, but new or recurrent symptoms limit durability. As observed in other palliative procedures, potential benefits are minimized by postoperative complications. Optimal management for these patients with advanced cancer, who are often not suitable candidates for operation, requires the highest level of multidisciplinary care. No significant financial relationships to disclose.
Role of IL-1β and IL-4 in 5-fluorouracil- induced intestinal mucositis in mice
Authors: Mota J. S. , Soares P. M. , Brito G. A. , Cunha F. Q. , Souza M. L. , Ribeiro R. A. 
Published: March 2020

19551 Background: Intestinal mucositis is a frequent side-effect associated to 5-fluorouracil (5-FU) clinical use. The participation of cytokines in the 5-FU- induced intestinal mucositis was not completely elucidated. We evaluated the role of IL-4 and IL-1β in 5- FU induced- intestinal mucositis in mice. Methods: Wild-type C57BL/6 mice or IL-4 deficient mice (-/-) were treated with 5-FU (450 mg/Kg, i.p.). Other group were treated with the soluble receptor IL-1Ra (100 mg/Kg, i.p., per day) or saline. Then, received the 5-FU (450 mg/Kg, ip). After three days, animals were sacrificed and pieces of duodenum (D), jejunum (J) and ileum (I) were harvested for assessment of epithelial damage by morphometry, myeloperoxidase (MPO) activity and cytokines (both in duodenum) quantification by ELISA. Statistical analysis was performed with ANOVA and Bonferroni test. Significance was set at p<0.05. Results: 5-FU induced a significant (p<0.05) epithelial intestinal damage (reduction of villus height/crypts depht reason) in all segments (duodenum-C= 3.3±0.2, 5- FU= 1.0±0.1; jejunum-C= 2.3±0.2, 5-FU= 1.0±0.1; ileum-C= 2.1±0.1, 5-FU= 0.7±0.1), increased MPO activity (n° neutrophil/mg of tissue) (C= 663.5±76.6, 5- FU= 3579±492) and cytokines concentration (pg/ml) (IL-1β: C= 134.8±31.9, 5-FU= 280.3±41.5; KC: C= 123.9±27.3, 5-FU= 177.2±28.2; TNF-a: C= 9.9±0.4, 5-FU= 12.1±1.8). IL-1Ra protected all segments from 5-FU- induced intestinal injury (D= 1.7±0.1, J= 2.0±0.1, I= 1.1±0.1), reduced MPO activity (2061±308) and cytokines concentration (IL-1β= 8.6±41.7; KC= 100±17.1; TNF-a= 7±.1.1). IL4 -/- presented with less epithelial intestinal damage (D= 2.9±0.2, J= 2.0±0.2, I= 1.4±0.1), less MPO activity (1702±315) and cytokines concentration (IL-1β:=86.5± 29.6; KC=105.6± 21.6, TNF-a:=7.4±0.5) . Conclusions: Our data suggest that IL-4 and IL-1β participates in the 5-FU induced- intestinal mucositis in mice. No significant financial relationships to disclose.