Virtual Library
Start Your Search
R. Gunapala
Author of
-
+
P1.03 - Chemotherapy/Targeted Therapy (ID 689)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
-
+
P1.03-029 - Study of Plasma Homocysteine as a Marker of Toxicity and Depression in Patients Treated with Pemetrexed-Based Chemotherapy (ID 8643)
09:30 - 09:30 | Author(s): R. Gunapala
- Abstract
Background:
Vitamin supplementation reduces pemetrexed toxicity. Raised plasma homocysteine levels reflect folate deficiency and are suppressed by supplementation. Depression is common in lung cancer patients. Elevated homocysteine levels are linked to neurotoxicity; its association with depression is less clear.
Method:
This prospective observational study of 112 lung cancer patients receiving pemetexed-based chemotherapy assessed homocysteine level after 3 weeks of vitamin B12 and folate supplementation, hypothesizing that high levels reflect an ongoing deficiency and would correlate with increased chemotherapy toxicity and depression. All patients received B12 and folate supplementation and had a homocysteine level checked 3 weeks later. The primary objective was proportion of patients with a treatment delay/ dose reduction/ drug change or hospitalisation during the first six weeks of chemotherapy, between patients showing normal plasma homocysteine (i.e. successfully supplemented, SS group) and patients showing high levels (i.e. unsuccessfully supplemented, US group). Secondary objectives included grade 3-4 toxicity, overall survival and exploratory analyses for depression.
Result:
100 patients were included in the primary end-point analysis. 84% of patients demonstrated appropriate supplementation (SS group). The proportion of patients undergoing a treatment delay/ dose reduction/ drug change or hospitalisation in the SS group was 44.0% (37/84) (95% confidence interval [CI] 33.2% to 55.3%) and in the US group was 18.8% (3/16) (95% CI 4.0% to 45.6%) (p=0.093). Proportion of patients experiencing grade 3-4 toxicity in SS group was 14.5% (95% CI 7.7% to 23.9%) and in US group was 18.8% (95% CI 4.0% to 45.6%) (p=0.705). The proportion of patients with a Hospital Anxiety and Depression (HAD) score >7 (indicative of depression) in the SS group was 63.9% (95% CI 46.2% to 79.2%) and in the US group was 75% (95% CI 34.9% to 96.8%) (p=0.695). Median overall survival was 11.8 months (95% CI 8.6 – 16.5 months) in the SS group and 8.8 months (95% CI 6.6 – 16.2 months) US group (Log Rank test; p-value = 0.484).
Conclusion:
Standard vitamin supplementation was adequate in the majority of patients and thus our US population was small. Homocysteine levels at 3 weeks did not correlate with increased toxicity or overall survival and is unlikely to be useful to identify patients at an increased risk of toxicity, though analysis was limited by the smaller than expected number of patients in the US group. Depression is very common in this population, and HAD score is a feasible assessment tool in this patient group.
-
+
P3.12 - Pulmonology/Endoscopy (ID 728)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Pulmonology/Endoscopy
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
-
+
P3.12-003 - Optimised Inhaler Therapy Is Superior to Supportive Care Alone for Dyspnoea in Patients with Coexisting COPD and Lung Cancer (ID 9368)
09:30 - 09:30 | Author(s): R. Gunapala
- Abstract
Background:
Breathlessness is a common, debilitating symptom associated with both COPD and lung cancer. Opiates remain the mainstay of treatment for breathlessness in oncology.
Method:
Lung cancer patients were prospectively enrolled in this single-centre, open-label, randomised controlled trial. Eligible patients met British Thoracic Society diagnostic criteria for COPD, had a visual analogue score (VAS) dyspnoea ≥ 4 and had other reversible causes for breathlessness excluded. Patients were randomly assigned (1:1) between the intervention arm of salbutamol 100 mcg, 2 puffs QDS and tiotropium 18 mcg OD +/- salmeterol 50 mcg/fluticasone 500 mcg 1 puff BD (if FEV~1~ <50% predicted) in combination with best supportive care (BSC) or to BSC alone (control). Control arm patients could continue on any short-acting bronchodilators and BSC included oral morphine and/or benzodiazepines. Patients underwent spirometry, 6 minute walk test (6MWT), VAS dyspnoea and quality of life questionnaires (QOLQ) at baseline and after 2 and 4 weeks. The primary endpoint was the proportion of patients with ≥ 2 point improvement in VAS dyspnoea at 4 weeks.
Result:
Among the intention to treat population (n=63), 53 patients (84%) had NSCLC and 10 (16%) had SCLC. The median baseline VAS was 7.1 and the median baseline FEV~1~ was 1.5L (63% predicted). The primary endpoint response rate (RR) was higher in the intervention group n= 32 [RR: 53% (95%CI 35% to 71%)] than in the control group n= 31 [RR: 26% (95% CI 12% to 45%) p = 0.02]. Figure 1 There were no statistically significant differences between the groups for change in 6MWT or QOLQ between baseline and the 4 week assessments.
Conclusion:
For patients with co-existing COPD and lung cancers, VAS dyspnoea is significantly improved by the addition of inhaled therapies to best supportive care. This study highlights the importance of diagnosing and treating COPD in all lung cancer patients.
