Risks of severe adverse events of docetaxel, cisplatin, and 5-fluorouracil (DCF) combination chemotherapy of esophageal cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 43-43 ◽  
Author(s):  
Sayako Yuda ◽  
Ken Kato ◽  
Yusuke Sasaki ◽  
Naoki Takahashi ◽  
Hirokazu Shoji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
Adverse Events ◽  
Clinical Stage ◽  
Performance Status ◽  
Clinical Situation ◽  
Cancer Center ◽  
Increased Risk ◽  
Severe Adverse Events ◽  
And Performance

43 Background: Although adding docetaxel to cisplatin plus 5-fluorouracil (i.e. the DCF regimen) for esophageal cancer treatment may improve outcomes, this regimen has increased toxicity. However, the risk factors for severe non-hematological toxicities remain unknown. Methods: We analyzed data on esophageal cancer patients given at least one cycle of DCF between July 2009 and April 2014 at the National Cancer Center Hospital, Japan. DCF consisted of docetaxel 70 mg/m2/day (day 1), cisplatin 70 mg/m2/day (day 1), and continuous infusion of 5-fluorouracil 750 mg/m2/day (days 1–5), repeated every 3 weeks. Data on adverse events developing within three cycles were collected from medical records. Risk factors for severe adverse events were analyzed. Results: One hundred patients were enrolled, with a median age of 63 (range, 37 to 76); 81 male and 19 female; 96 squamous cell carcinomas and 4 adenocarcinomas; clinical situation neoadjuvant/induction/palliative: 69/23/8/1; clinical stage I/II/III/IV: 1/12/64/23; and performance status (PS) 0/1/2: 44/55/1. Forty patients (40%) developed grade 3 or more non-hematological adverse events, including anorexia (12%), mucositis (6%), and esophagitis (2%); 45 developed grade 4 hematological adverse events. Seventeen experienced febrile neutropenia (FN). There was one case of treatment-related death from serious infection. In multivariate analysis, age≥63 was at significantly increased risk of FN (P=0.013). Conclusions: DCF chemotherapy was safe in most patients and its toxicity was controllable. However, elderly patients may suffer from intense toxicity during DCF therapy.

scholarly journals Risk factors for FN, mucositis and esophagitis of combination chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for esophageal cancer

2020 ◽  
Author(s):  
Sayako Yuda ◽  
Ken Kato ◽  
Yusuke Sasaki ◽  
Naoki Takahashi ◽  
Hirokazu Shoji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
Platelet Count ◽  
Adverse Events ◽  
Performance Status ◽  
Cancer Center ◽  
Dysphagia Score ◽  
Clinical Stages ◽  
Center Hospital ◽  
Experienced Grade

Abstract BackgroundAddition of docetaxel to cisplatin plus 5-fluorouracil (DCF regimen) for treatment of esophageal carcinoma can improve the clinical outcome, but it is associated with increased toxicity. The risk factors for severe toxicities associated with DCF treatment remain unknown.MethodsWe retrospectively reviewed the data of esophageal cancer patients who received DCF between July 2009 and April 2014 at the National Cancer Center Hospital. Docetaxel 70 mg/m2/day (day 1), cisplatin 70 mg/m2/day (day 1), and continuous infusion of 5-fluorouracil 750 mg/m2/day (days 1–5) were administered every 3 weeks. The risk factors for severe adverse events were explored.ResultsWe included 100 patients with a median age of 63 years (range: 37–76), among whom 81 were men, and 44 and 55 had performance status scores of 0 and 1, respectively. A total of 96 patients had squamous cell carcinoma, while 4 had adenocarcinoma. A total of 1, 12, 64, and 23 patients had clinical stages I, II, III, and IV, respectively. DCF was used as neoadjuvant therapy in 69 patients, induction before chemoradiotherapy in 23, and palliative in 8. Approximately 45 patients experienced grade 4 hematological adverse events, while 40 developed grade >3 non-hematological adverse events: anorexia, 12%; mucositis, 6%; and esophagitis, 2%. Multivariate analysis showed a significant association between dysphagia score >2 (P = 0.022) and febrile neutropenia, and between platelet count ≤27,500/µl and grade >3 mucositis and/or esophagitis (P = 0.007).ConclusionDuring DCF therapy, patients with dysphagia or decreased platelet count should be carefully managed.Trial registration: Not applicable

Pharmaceutical Care for Patients Undergoing S-1 Plus Cisplatin Therapy for Unresectable Recurrent Gastric Cancer

2013 ◽  
Vol 26 (4) ◽  
pp. 409-414 ◽  
Author(s):  
Michio Kimura ◽  
Eiseki Usami ◽  
Tomoaki Yoshimura ◽  
Tadashi Yasuda ◽  
Yuji Kaneoka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Adverse Events ◽  
Nutritional Support ◽  
Performance Status ◽  
Recurrent Gastric Cancer ◽  
Grade 3 ◽  
And Performance ◽  
Treatment Dosage ◽  
Cisplatin Therapy

We examined the adverse gastrointestinal events associated with tegafur/gimeracil/oteracil potassium (S-1) plus cisplatin therapy for unresectable recurrent gastric cancer and risk factors for discontinuing therapy due to adverse events. A total of 65 subjects who had received S-1 plus cisplatin therapy for gastric cancer at Ogaki Municipal Hospital were examined. We found that the risk factors for discontinuation of the therapy due to adverse events were serum albumin (Alb) level less than 3.5 g/dL (odds ratio [OR]: 321.14, P = .0015), creatinine clearance (CrCl) rate less than 78 mL/min (OR: 35.23, P = .0123), and performance status (PS) more than 1 (OR:12.62, P = .0243). Moreover, grade 3 or 4 nonhematological toxicities (including malaise and anorexia) were significantly higher in subjects with Alb less than 3.5 g/dL and CrCl less than 78 mL/min ( P < .01). In conclusion, we should pay attention to the safety and continuity of S-1 plus cisplatin therapy in cases where the Alb level is <3.5 g/dL, CrCl level is <78 mL/min, and PS level is >1. Pharmacists should consider reducing the treatment dosage and providing nutritional support in such cases.

Pleural effusion as a complication of clozapine treatment

2011 ◽  
Vol 26 (S2) ◽  
pp. 1271-1271
Author(s):  
A. Hospers ◽  
J. Arends ◽  
L. Timmerman ◽  
W.V. Oven
Keyword(s):  
Risk Factors ◽  
Pleural Effusion ◽  
Adverse Events ◽  
Literature Search ◽  
Underlying Mechanism ◽  
Clinical Situation ◽  
Immunological Reaction ◽  
Clozapine Treatment ◽  
Severe Adverse Events ◽  
Underlying Mechanisms

IntroductionClozapine treatment has been recognized as a superior treatment in schizophrenia. Clozapine treatment has also be accompanied with several rare but severe adverse events, like neutropenia, agranulocytosis, myocarditis, pericarditis and polyperositis. We report a patient that suffers from hyperleucocytemia, eosinophilia and pleuritis, due to clozapine treatment, the adverse events disappeared after a switch to aripiprazole.ObjectivesTo review the literature on reports on pleuritis and polyserositis in order searching for guidance in these clinical situation, like the need tot interrupt the medication, the prognosis and if rechallenges are reported. Another objective was to discover if something is known about the underlying mechanism.MethodsTo review the literature, we used the following terms: clozapine, treatment, immunological reaction, neutropenia, leucopenia, epicarditis, polyserositis, pleuritis, pleural effusion, underlying mechanisms, risk factors.A literature search was performed in Pubmed® and Embase Psychiatry® in the period longing from 1972 till October 2010ResultsRisk factors as well as the underlying mechanisms offer no guidance for dealing with the clinical critical situations.There are only a few reports on pleural effusion, there are some reports on pleural effusion in combination with epicarditis, there are some reports on polyserositis including pleural effusion.No rechallenges are reported of clozapine on pleural effusion.There is no information in the literature on the risk that a pleuritis will extend to other organs, like the heart and the liver, when continuing the clozapine treatment.ConclusionHypotheses about the underlying mechanism will be presented. A program of additional diagnostics will be described

scholarly journals COVID-19 and cancer registries: learning from the first peak of the SARS-CoV-2 pandemic

2021 ◽  
Author(s):  
Alvin J. X. Lee ◽  
Karin Purshouse
Keyword(s):  
Risk Factors ◽  
Performance Status ◽  
Poor Performance ◽  
Cancer Registries ◽  
Adverse Outcomes ◽  
Smoking History ◽  
Poor Performance Status ◽  
International Studies ◽  
Patients With Cancer ◽  
Increased Risk

AbstractThe SARS-Cov-2 pandemic in 2020 has caused oncology teams around the world to adapt their practice in the aim of protecting patients. Early evidence from China indicated that patients with cancer, and particularly those who had recently received chemotherapy or surgery, were at increased risk of adverse outcomes following SARS-Cov-2 infection. Many registries of cancer patients infected with SARS-Cov-2 emerged during the first wave. We collate the evidence from these national and international studies and focus on the risk factors for patients with solid cancers and the contribution of systemic anti-cancer treatments (SACT—chemotherapy, immunotherapy, targeted and hormone therapy) to outcomes following SARS-Cov-2 infection. Patients with cancer infected with SARS-Cov-2 have a higher probability of death compared with patients without cancer. Common risk factors for mortality following COVID-19 include age, male sex, smoking history, number of comorbidities and poor performance status. Oncological features that may predict for worse outcomes include tumour stage, disease trajectory and lung cancer. Most studies did not identify an association between SACT and adverse outcomes. Recent data suggest that the timing of receipt of SACT may be associated with risk of mortality. Ongoing recruitment to these registries will enable us to provide evidence-based care.

scholarly journals Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in Patients with Therapy-Related Myeloid Neoplasm: A Study from the Chronic Malignancies Working Party of the EBMT

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 45-45
Author(s):  
Marie Robin ◽  
Junfeng Wang ◽  
Linda Koster ◽  
Dietrich W. Beelen ◽  
Martin Bornhäuser ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Solid Tumor ◽  
Research Funding ◽  
Performance Status ◽  
Primary Cancer ◽  
Research Support ◽  
Karnofsky Score ◽  
Adjusted Risk ◽  
And Performance

Patients with t-MN have a poor prognosis with median overall survival &lt; 1 year due to high risk features of the disease and refractoriness to chemotherapy. HSCT represents the only curative treatment. Outcome after HSCT has progressively improved over time with a last EBMT study showing a 2-year OS at 44% in patients with secondary leukemia (79% post MPN or MDS) (BBMT 2018: 1406). Previous large studies showed survival &lt; 30% in patients transplanted for t-MN (Blood. 2010:1850; Haematologica 2009:542). We recently reported in patients transplanted for a leukemia arising from MDS, MPN and CMML that the primary disease impacts the outcome, particularly patients with a previous MPN had the worst outcome (BJH, 2019: 725). We report here outcome of patients who received HSCT for a t-MN (excluding post MDS, MPN and CMML) with the hypothesis that the primary cancer impacts the outcome. From EBMT registry, patients with MDS or AML occurring after a primary cancer who received a HSCT between 01/06 and 12/16 were included. OS and RFS were analyzed using Kaplan Meier curves and log-rank test, relapse and NRM were analyzed as competing risks with cumulative incidence curves and Gray's test. 2334 patients were identified. Primary cancers were CLL in 102, non-Hodgkin lymphoma (NHL) in 668, Hodgkin lymphoma (HL) in 235, plasma cell disease (PCD) in 111, breast cancer in 643 and other solid tumor (ST) in 575. 981 patients had MDS and 1353 had AML at time of transplantation. Performance status by Karnofsky score was 90 or higher in 1376 (59%) patients. 722 (31%) patients were transplanted from HLA matched sibling donor (SIB) and 843 (36%) received a myelo-ablative conditioning regimen (MAC). 1307 patients were in remission at time of transplantation: 29% of MDS and 76% of AML patients. Three-year OS and RFS were 34 and 32% respectively. OS was significantly better in patients with AML in CR (43%) than not in CR (21%). OS and DFS were impacted by the primary cancer: post NHL (30 and 27%), post HL (29 and 28%), post ST (34% for both), post breast cancer (41 and 37%), post CLL (34 and 31%) and post PCD (32 and 25%) (p&lt;0.001). CR status at HSCT did not impact outcome in MDS patients (30%). Patients with normal cytogenetics (n=397) had a better OS than patients with abnormal cytogenetics (n=1036) (43% vs. 33%, p&lt;0.001). OS was significantly better using SIB (38% vs 32%, p=0.05) and in patients with better Karnofsky score (38 vs. 28%, p&lt;0.01). NRM was lower in patients with breast cancer (24% post breast cancer, 36% post NHL, 33% post HL, 29% post ST, 34% post CLL, 26% post PCD p&lt;0.001). NRM was higher after non SIB (34% vs 23%, p&lt;0.001) and after MAC (33 vs. 23%, p&lt;0.001). Relapse rate was higher after RIC (33 vs. 28%, p=0.014) but was not influenced by the primary type of cancer. The multiple variables models includes age, regimen intensity, donor type, Karnofsky score, t-MN category (AML in CR, AML not in CR, MDS) and the primary type of cancer. Patients with HL (HR: 1.36, p=0.005) or NHL (HR: 1.31, p=0.001) had a higher adjusted risk for OS than patients with other primary diseases. Other risk factors for OS were t-MN type (AML not in CR, HR: 1.45, AML in CR, HR: 0.76, MDS = reference, p&lt;0.001), type of donor (no SIB, HR: 1.20, p=0.004) and performance status (karnofsky &lt; 90, HR: 1.34, p&lt;0.001). Patients with HL (HR: 1.24, p=0.05) or NHL (HR: 1.21, p=0.01) had also a higher adjusted risk for DFS than patients with other diseases. Other risk factors for DFS were t-MN (AML not in CR, HR: 1.42, AML in CR: HR:0.76, p&lt;0.001) and performance status (HR: 1.24, p&lt;0.001). Adjusted post-HSCT t-MN relapse risk was not influenced by the primary cancer but was influenced by age (HR: 0.92, p=0.02), MAC (HR: 0.76, p=0.002), t-MN (AML not in CR, HR: 1.51, p&lt;0.001; AML in CR, HR:0.74, p=0.03) and performance status (HR: 1.28, p=0.002). NRM risk was significantly higher in patients with NHL (HR: 1.52, p&lt;0.001), HL (HR:1.58, p=0.007) and CLL (HR: 1.55, p=0.039) than in patients with primary solid tumor or PCD. Other risk factors for NRM were age (HR: 1.15, p=0.01), MAC (1.29, p=0.006), t-MN (AML in CR, HR: 0.76, p=0.005; AML not in CR, HR:1.29, p=0.05), performance status (HR: 1.22, p=0.03). Conclusion: A quarter to one third of patients with t-MN can be cured by HSCT which was influenced by type of t-MN and performance status. The type of primary cancer influenced also the outcome with lower mortality, especially NRM in patients with previous solid tumor or PCD as compared to patients with lymphoma. Disclosures Robin: Novartis Neovii: Research Funding. Beelen:Medac GmbH Wedel Germany: Consultancy, Honoraria. Kroeger:DKMS: Research Funding; Neovii: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Riemser: Research Funding; JAZZ: Honoraria; Sanofi-Aventis: Honoraria; Novartis: Honoraria, Research Funding; Medac: Honoraria. Platzbecker:Celgene: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding; Abbvie: Consultancy, Honoraria. Finke:Riemser: Honoraria, Other: research support, Speakers Bureau; Neovii: Honoraria, Other: research support, Speakers Bureau; Medac: Honoraria, Other: research support, Speakers Bureau. Blaise:Pierre Fabre medicaments: Honoraria; Molmed: Consultancy, Honoraria; Sanofi: Honoraria; Jazz Pharmaceuticals: Honoraria. Chevallier:Daiichi Sankyo: Honoraria; Incyte: Consultancy, Honoraria; Jazz Pharmaceuticals: Honoraria.

NCMP-06. THE RISK AND BURDEN OF THROMBOEMBOLIC AND HEMORRHAGIC EVENTS IN PATIENTS WITH MALIGNANT GLIOMA RECEIVING BEVACIZUMAB

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi148-vi148
Author(s):  
Alexander Ou ◽  
Heather Lin ◽  
Ying Yuan ◽  
Charles Bornstein ◽  
Kristin Alfaro-Munoz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Performance Status ◽  
Univariate Analysis ◽  
Vascular Complications ◽  
Concurrent Chemotherapy ◽  
Vascular Risk Factors ◽  
Competing Risk ◽  
Vascular Risk ◽  
Acute Hemorrhage ◽  
Increased Risk

Abstract BACKGROUND Patients with high-grade gliomas (HGG) often receive anti-angiogenic therapy with bevacizumab to slow disease progression and/or palliate neurological symptoms. Bevacizumab has been associated with an increased risk of two major vascular complications: venous thromboembolism (VTE) and intracranial hemorrhage (ICH). We sought to identify clinical, pathologic, and radiographic variables correlated with risk of either event occurring in patients with HGG receiving bevacizumab. METHODS We retrospectively identified 94 patients with HGG who received bevacizumab at our center from 2015-2021. Variables included demographics, performance status, IDH, MGMT, vascular risk factors, baseline anti-coagulant/anti-platelet use, concurrent chemotherapy, and presence of macrobleeds on MRI (&gt;1 cm3 susceptibility) at the time of bevacizumab initiation. We conducted competing risk analysis using subdistribution hazard models with death as competing risk for ICH or VTE. The effects of covariates on the incidence of hemorrhage or VTE were evaluated in univariate and multivariate settings. RESULTS Of 94 patients, 36 (38.3%) and 27 (28.7%) developed VTE and ICH, respectively. 31 (33%) did not develop either. ICH and VTE events occurred after a mean of 4.46 and 5.94 cycles of bevacizumab, respectively. 20 had baseline anti-platelet/anticoagulant use, and 16 had prior VTEs. Patients with macrobleeds on MRI had a larger HR of developing acute hemorrhage [HR=2.368 (1.112, 5.043), p=0.0254]. Patients older than 50 trended toward larger HR of developing VTE in univariate analysis that approached significance [HR=1.799 (0.889, 3.637), p=0.1023]. Sex, performance status, IDH, MGMT, vascular risk factors, baseline anticoagulant/anti-platelet use and concurrent chemotherapy were not significantly associated with occurrence of VTE. CONCLUSIONS The presence of macrobleeds on MRI is associated with increased risk of developing acute ICH while on bevacizumab. Older age at diagnosis of HGG may be associated with an increased risk of VTE in patients receiving bevacizumab. Larger studies are needed to confirm these findings.

242 ABANDONING RESECTIONAL INTENT IN PATIENTS INITIALLY DEEMED SUITABLE FOR ESOPHAGECTOMY; A NATIONWIDE STUDY OF RISK FACTORS AND OUTCOMES

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
D Edholm ◽  
M Lindblad ◽  
G Linder
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
Educational Level ◽  
Advanced Disease ◽  
Neoadjuvant Treatment ◽  
High Educational Level ◽  
Factors Associated ◽  
Quality Register ◽  
Increased Risk ◽  
National Quality

Abstract   The main curative treatment for esophageal cancer is resection. In some cases, patients initially deemed suitable for resection become unsuitable, often due to signs of generalized disease or having become unfit for surgery. The aim of the present study was to assess frequency and risk factors for patients initially deemed suitable for esophagectomy becoming ineligible for resection. Methods All patients in the Swedish National Quality Register for Esophageal and Gastric Cancer from 2006 to 2016 were included and risk factors associated with becoming ineligible for resection were analyzed and adjusted in multivariable logistic regression analysis calculating Odds ratios (ORs) with 95% Confidence intervals (CIs). Results A total of 1792 patients were planned for resection, of these 303 (17%) became ineligible for resection (114 patients were non-resectable and 189 patients never progressed to surgery). High and intermediate educational level was associated with an increased probability of resection (OR 1.80 95% CI 1.21–2.66 and OR 1.49 95% CI 1.07–2.09, respectively) while patients with clinically advanced disease were more likely to become ineligible (cT4a: OR 0.34, 95%CI 0.14–0.0.87, cN3: OR 0.26, 95%CI 0.09–0.79 respectively). Patients given neoadjuvant treatment were also more likely to become ineligible for surgery (OR 0.62 95%CI 0.46–0.86). Conclusion Of those planned for resection for esophageal cancer, 17% never progressed to esophagectomy. High educational level was associated with an increased chance of undergoing resection whereas clinically advanced disease and neoadjuvant treatment were independent factors associated with increased risk of abandoning resectional intent.

The risk factors for severe adverse events of chemotherapy for advanced non-small cell lung cancer.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e19129-e19129
Author(s):  
Kentaro Suina ◽  
Takehito Shukuya ◽  
Ryo Koyama ◽  
Tetsuhiko Asao ◽  
Yuichiro Honma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Adverse Events ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Small Cell Lung ◽  
Severe Adverse Events

Risk factors of chemotherapy-induced nausea and vomiting in patients with advanced pancreatic cancer receiving modified FOLFIRINOX.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 344-344
Author(s):  
Akira Shinohara ◽  
Masafumi Ikeda ◽  
Ai Irisawa ◽  
Misaki Kobayashi ◽  
Ryoko Udagawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Cancer ◽  
Adverse Events ◽  
Treatment Cycle ◽  
Advanced Pancreatic Cancer ◽  
Incidence Rates ◽  
Nausea And Vomiting ◽  
Cancer Center ◽  
Younger Age ◽  
Delayed Cinv

344 Background: Modified FOLFIRINOX (mFFX) has been reported to be a high incidence of chemotherapy-induced nausea and vomiting (CINV). However, CINV is difficult to adequately control in patients receiving treatment with mFFX. The aim of this study is to evaluate the incidence of delayed CINV and to identify as risk factors for CINV in patients receiving treatment with mFFX. Methods: The study subjects were patients with advanced pancreatic cancer treated with mFFX from December 2013 to June 2015 at National Cancer Center Hospital East. The mFFX regimen consisted of oxaliplatin 85 mg/m2, irinotecan 150 mg/m2, l-leucovorin 200 mg/m2 and a 46-h continuous infusion of fluorouracil 2400 mg/m2. The antiemetic prophylaxis consisted of aprepitant (125 mg on day1 and 80 mg on day 2-3), palonosetron (0.75 mg on day1) and dexamethasone (12 mg on day1 and 8 mg on day 2-3). All adverse events, including nausea and vomiting were graded according to the Common Toxicity Criteria for Adverse Events (CTCAE version 4.0). Results: A total of 115 patients were enrolled in this study. The incidence rates of nausea and vomiting of any grade during the first treatment cycle were 45.2% and 5.2%, respectively. Grade 2-3 of nausea and vomiting were observed in 13.9% and 0.9% of the patients, respectively. Any grade of CINV occurred frequently during days 4 to 7 for the first treatment cycle. Univariate and multivariate analyses identified female and younger age ( < 50 years) as significant independent factors associated with the incidence of any grade of CINV on days 4 to 7 for the first treatment cycle (Odds ratio [OR], 7.44; 95%CI, 2.21 to 25.1; p = 0.001; OR, 4.57; 95% CI, 1.04 to 20.1; p = 0.044). Conclusions: The risk factors of delayed CINV for the first treatment cycle were identified as female and younger age in patients treated with mFFX. Therefore, in patients with these risk factors, additional dexamethasone should be considered as an antiemetic treatment on day 4-5.

Prospective evaluation of the factors predicting the prognosis of advanced hepatocellular carcinoma (HCC) patients treated with sorafenib.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15674-e15674
Author(s):  
Takuya Adachi ◽  
Kazuhiro Nouso ◽  
Koji Miyahara ◽  
Chihiro Dohi ◽  
Nozomu Wada ◽  
...  
Keyword(s):  
Risk Factors ◽  
Growth Factor ◽  
Adverse Events ◽  
Performance Status ◽  
Poor Performance Status ◽  
Significant Variable ◽  
Advanced Hepatocellular Carcinoma ◽  
Large Tumor ◽  
Sorafenib Treatment ◽  
Angiogenic Cytokines

e15674 Background: Several factors including pro-angiogenic cytokines have been reported as predictive markers for the treatment effect of sorafenib in patients with HCC; however, many of them were determined based on the results of retrospective studies. Methods: In this prospective cohort study (UMIN000009771), we recruited advanced HCC patients who were treated with sorafenib, and periodically measured serum levels of eight pro-angiogenic cytokines, which were risk factors for the prognosis reported by us and others. The effect of the cytokine expressions before and at 2 (4) weeks after starting sorafenib and at PD, on progression free survival (PFS), overall survival (OS), and post progression survival (PPS) were evaluated. The effect of early appearance of adverse events within 30 days, which were reported as other risk factors, was also evaluated. Results: Eighty patients were enrolled. Median PFS and OS were 3.1 and 11.7 months, respectively. There was no statistically significant variable that could predict PFS, which included patients’ characteristics, cytokines before the therapy, and early onset of adverse events. However, PFS of the patients who showed the decrease of platelet-derived growth factor after 2 weeks (HR2.78, 95%CI 1.35-6.21, P=0.005) or vascular endothelial growth factor after 4 weeks (HR3.31, 95%CI 1.59-6.83, P=0.001) compared to the values before sorafenib treatment was short. OS was short in patients with poor performance status, large tumor size (>30mm), large tumor number (>5), high des-gamma-carboxyprothrombin (DCP, >100mAU/mL), high hepatocyte growth factor, and high angiopoietin-2 (Ang-2) before therapy, in addition to no hand foot syndrome within 30 days. Multivariate analysis with these factors revealed that high Ang-2 (HR2.25, 95%CI 1.08-4.86, p=0.029) and high DCP (HR3.55, 95%CI 1.25-12.7, p=0.014) were the independent risk factors for OS. High Ang-2 at PD could also be a marker of short PPS. Conclusions: The prediction of PFS, OS and PPS is possible by measuring serum pro-angiogenic cytokines at appropriate timing. Ang-2 is a key cytokine for predicting the prognosis of HCC patients treated with sorafenib.

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