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Ioannis Dimitroulis
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P2.01 - Advanced NSCLC (ID 618)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:00 - 16:00, Exhibit Hall (Hall B + C)
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P2.01-039 - Erythropoiesis-Stimulating Agents for Chemotherapy-Induced Anaemia in Lung Cancer: Efficacy, Toxicity and Effect on Survival (ID 9576)
09:00 - 09:00 | Author(s): Ioannis Dimitroulis
- Abstract
Background:
Erythropoiesis-stimulating agents (ESAs) are widely used for treatment of chemotherapy-induced anaemia (CIA) in patients with various solid tumors, mainly including lung cancer and gynaecological malignancies, but concerns regarding their potential effect on tumor growth and disease progression have been raised. We herein aimed to further investigate the efficacy, toxicity and correlation with overall survival (OS) of treatment with ESAs in a real-world cohort of lung cancer patients.
Method:
The medical records of all patients > 18 years old, with newly-diagnosed advanced-stage lung cancer (non-small cell lung cancer /NSCLC or small cell lung cancer/SCLC) and CIA, treated at the Oncology Unit of Sotiria Athens General Hospital from January 2007 to December 2016 were retrospectively reviewed. The ESAs administered in our cohort were epoetin alfa, epoetin zeta and darbepoetin alfa. Patients were stratified into two subgroups, according to use of ESAs (ESAs-treated vs. those not treated with ESAs). Demographic, laboratory and clinicopathological features, hematological response and toxicity, response to chemotherapy and overall survival (OS) of patients were compared between groups, using univariate and multivariate regression analysis.
Result:
A total of 138 patients (110 males/28 females; mean age ±SD : 66.4± 8.7 years) with baseline (pretreatment) hemoglobin (Hb) values <11 mg/dl and ECOG performance status (PS) 0-2 were included in final analysis. ESAs were administered in 70/138 patients (50.7 %). Age, sex, histological type of tumor (NSCLC vs. SCLC), baseline values of Hb and PS were evenly distributed between groups (p=0.672, p=0.155, p=0.078, p=0.01 and p=0.647, respectively). Hematological response rates and incidence of thromboembolic events were both increased in ESA-treated patients, albeit without reaching statistical significance (p=0.229 and p=0.288, respectively). Neither response to chemotherapy nor OS were found to be significantly correlated with use of ESAs (p=0.498 and p=0.119, respectively).
Conclusion:
According to our study results, administration of ESAs was not significantly correlated with hematological response, response to chemotherapy or OS. Furthermore, treatment of CIA with ESAs was, generally, well-tolerated, with no significantly increased risk of thromboembolic events. A trend for improved partial/complete hematological response and improved OS among ESA-treated patients in our cohort needs to be interpreted with caution. Further randomized trials and larger prospective studies are warranted to investigate the efficacy, toxicity and potential prognostic implications of CID treatment with ESAs in patients with lung cancer.
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P3.01 - Advanced NSCLC (ID 621)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.01-077 - Effectiveness of Methylnaltrexone Bromide in Opioid-Induced Constipation in Advanced NSCLC Patients (ID 7900)
09:30 - 09:30 | Presenting Author(s): Ioannis Dimitroulis
- Abstract
Background:
Methylnaltrexone Bromide (MB) is a selective antagonist of opioid binding at the mu-receptor (μ or MOR receptor). Constipation is a quite common side effect in Non-Small-Cell-Lung-Cancer (NSCLC) patients receiving opioids for chronic pain, usually due to skeletal metastases. We set out to investigate if MB is effective in those patients who received opioids and complained of constipation.
Method:
Sixty-eight NSCLC patients with a life expectancy of at least three months were recruited for our study after providing written consent. All patients received either fentanyl as a transdermal patch, in its inhaled form or per os. Patients were randomized (1:1) to four weeks of treatment with either MB 12mg/0.6ml (n=22) administered subcutaneously (sc) or a placebo, on alternate days. We recorded the number of patients who defecated within four hours of the MB or placebo injection, and the number of patients needing a second dose of MB or placebo within six hours from the first dose. We recorded the side effects of this treatment. Patients were not allowed to use other laxatives.
Result:
In the MB group after one injection, fifty one patients (75%) had a bowel movement within four hours compared to nine placebo patients (13%), p=0.02. Fifteen patients in the MB group had a bowel movement after two or more doses of MB, raising the percentage of patients who responded to MB to 96%. The more severe the constipation, the higher the response with MB. The overall rate of adverse events was similar in the MB (43%) and placebo groups (42%). In the MB group, the most commonly reported adverse events were abdominal pain (16%), flatulence (16%), vomiting (11%), and nausea (13%). Most treatment related adverse events were rated as mild or moderate by the patients. Discontinuation due to adverse events occurred in 5% and 6% of patients in the MB and placebo groups, respectively.
Conclusion:
Methylnaltrexone Bromide has been shown to be superior to placebo in achieving defecation within a short time, in NSCLC patients with opioid-induced constipation, The more severe constipation, the higher the response with MB. There were no serious adverse events. We conclude that Methylnaltrexone Bromide is effective, safe and superior to other commonly used laxatives.
