PracticeUpdate: Haematology & Oncology

AMERICAN SOCIETY OF CLINICAL ONCOLOGY 2016 ANNUAL MEETING 6

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.

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.

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.

© ASCO/Todd Buchanan 2016

PRACTICEUPDATE HAEMATOLOGY & ONCOLOGY