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Dr Jeffrey Kirshner discusses the top
abstracts fromASCO 2016 on patient and
survivor care
Jeffrey J. Kirshner MD, FACP is partner of Hematology
Oncology Associates of Central New York (HOACNY) in East
Syracuse. He is the Director of Research and serves as the
Principal Investigator of the HOACNY Community Clinical
Oncology Program.
Chemotherapy-induced peripheral neuropa-
thy (CIPN) continues to be a major compli-
cation of treatment for cancer patients and is
often debilitating and permanent. Successful
treatment has been of limited efficacy and
attempts to understand and prevent this
toxicity have generally been unsuccessful as
well. The following three studies add impor-
tant information to the understanding and
possible treatment of CIPN.
A URCC NCORP nationwide randomized
controlled trial investigating the effect of
exercise on chemotherapy-induced peripheral
neuropathy in 314 cancer patients.
I Kleckner,
CS Kamen, LJ Peppone, et al
•
In a secondary analysis of a phase 3 study,
researchers evaluated the association of ex-
ercise with CIPN. In the original study, 314
patients were randomised to chemotherapy
or chemotherapy with exercise.
•
CIPN was reduced with exercise
(P = 0.04), with greater benefit in older
patients (P = 0.06).
Comorbidities and risk of chemotherapy-induced
peripheral neuropathy among participants in
SWOG clinical trials.
DL Hershman, C Till, JD
Wright, et al
•
Using the SWOG database, researchers
evaluated the association of comorbid
conditions with the development of
peripheral neuropathy among patients
treated with taxane chemotherapy. The
odds of neuropathy increased by 4% with
each 1-year increase in age (P = 0.006).
While patients with autoimmune disease
were about half as likely to have neuropathy
(not statistically significant), patients with
diabetes complications were two times
more likely to develop neuropathy (P =
0.06 and P = 0.002, respectively).
•
Diabetes, age, and drug-related factors
predicted the development of chemotherapy-
induced peripheral neuropathy.
Body mass index, lifestyle factors, and taxane-
induced neuropathy in women with breast
cancer: The Pathways Study.
H Greenlee,
DL Hershman, Z Shi, et al
•
The authors evaluated the association of
BMI and lifestyle factors with CIPN using
data from a prospective cohort of women
diagnosed with breast cancer. Patients with
high levels of physical activity versus low
levels were less likely to have CIPNworsen.
In addition, worsening of CIPN was more
likely to occur in obese vs normal-weight
patients and in patients who initiated or
discontinued an antioxidant supplement
during treatment versus patients who did
not use antioxidant supplements.
•
More severe and sustained CIPN was
associated with obesity, low levels of
physical activity, and change in antioxidant
supplement use among patients receiving
taxane chemotherapy for breast cancer.
In recent years, there has been a trend to
integrate palliative care earlier in the timeline
of treatment for patients with advanced can-
cer. A leader in this field will present another
study which evaluated additional benefits of
early integration of palliative care.
Randomized trial of early integrated palliative
and oncology care.
JS Temel, A El-Jawahri,
JA Greer, et al
•
In total, 350 patients with newly diagnosed
incurable cancer were randomised to
palliative care integrated with oncology care
or usual oncology care. At 24 weeks, the
palliative care group had a higher quality of
life, less depression, and more discussion
about end-of-life preferences than the
usual oncology care group. At 12 weeks,
these differences were not observed.
•
The researchers concluded that early
palliative care offers significant benefit for
patients newly diagnosed with incurable
cancer.
Pegfilgrastim-induced bone pain (PIBP)
continues to be a major toxicity which
may lead to early discontinuation of this
important growth factor. The following
study objectively examined the use of two
commonly used over-the-counter agents to
decrease the incidence of PIBP.
Nolan: A randomized, phase II study to estimate
the effect of prophylactic naproxen (N) or
loratadine (L) vs no intervention on bone pain
in 600 patients (pts) with early-stage breast
cancer receiving chemotherapy (chemo) and
pegfilgrastim (PEG).
J Kirshner, AS Guinigundo,
L Vanni, et al
•
In an open-label, phase 2 study, researchers
randomised 600 patients with newly
diagnosed stage I–III breast cancer treated
with chemotherapy and pegfilgrastim to
receive prophylactic naproxen, loratadine,
or no prophylaxis for bone pain. There were
no differences among the groups in regard
to levels of all-grade bone pain. Loratadine
was associated with fewer adverse events
than naproxen.
•
Naproxen and loratadine are tolerable,
although their effects on bone pain are
comparable to those associated with no
prophylaxis. A trend toward less bone pain
was noted with naproxen and loratadine.
© ASCO/Todd Buchanan 2016
AMERICAN SOCIETY OF CLINICAL ONCOLOGY 2016 ANNUAL MEETING
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PRACTICEUPDATE HAEMATOLOGY & ONCOLOGY