A dynamic portrait of adverse events for breast cancer patients: results from a phase II clinical trial of eribulin in advanced HER2-negative breast cancer

Adverse events self-reported by patients with extensive-stage small-cell lung cancer in the phase III CASPIAN study

AIM

In the phase III CASPIAN study, first-line durvalumab plus platinum-etoposide (EP) improved survival compared with EP in patients with extensive-stage small-cell lung cancer. We report an exploratory analysis of patient-reported adverse events (AEs).

METHODS

Of 537 patients randomized to durvalumab + EP or EP arms, 164 were asked to complete the Patient-Reported Outcomes version of the Common Terminology Criteria (PRO-CTCAE) for AEs at baseline, every 3 weeks (q3w) during EP, then q4w until disease progression, then post-progression on day 28, 2 months, and q8w until second progression/death. Presence/absence, frequency, or severity of 11 selected AEs were examined during the first 24 weeks of treatment, alongside interference with usual/daily activities for five AEs.

RESULTS AND CONCLUSIONS

A minority of patients reported the examined AEs before starting treatment, from 3-5% who reported hand-foot syndrome, up to 34-41% for dry mouth. AE rates were generally comparable with baseline and the patterns of AEs reported by patients over time were similar in both treatment arms. Most patients indicated that reported AEs occurred rarely/occasionally and were mild/moderate in severity. These PRO-CTCAE data complement the clinician-reported AEs and give insight into patients' experience of treatment.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov identifier is NCT03043872.

A Cross-Sectional Survey of Oral Adverse Events and Oral Management Needs in Outpatients Receiving Cancer Drug Therapy

Objectives: The aim of this study was to investigate the incidence and severity of oral adverse events in outpatients receiving cancer drug therapy and the need for oral management by medical professionals. Methods: A questionnaire-based survey was conducted among patients who received cancer drug therapy at our hospital between 1 and 30 September 2022. The incidence and severity of oral adverse events and the need for intervention by medical professionals were investigated. The risk factors for these events were also analyzed. Results: Of the 216 patients who answered the questionnaire, 127 (58.8%) experienced oral adverse events such as dysgeusia, oral mucositis, and xerostomia. Of the patients who experienced oral adverse events, 53.5% expressed that they wanted to improve their condition, 34.6% expressed that the adverse events affected their quality of life, and 26.8% wanted dental intervention. Thirty-two patients (25.2%) reported that the symptoms of these oral events were as severe as or more severe than those of other adverse events. The incidence of adverse oral events was significantly higher in patients treated with 5FU- and taxane-based regimens than in patients treated with other regimens. Conclusions: Our results suggest that cancer drug therapy, and the frequency and severity of oral adverse events, have a significant impact on the outpatients' quality of life. More than a quarter of outpatients receiving cancer drug therapy wanted oral management through dental interventions. In particular, patients receiving 5FU-, taxane-, and anthracycline-based regimens may require oral management by medical professionals.

Incidence of patient-reported fatigue developing on palbociclib and endocrine therapy for advanced HR+ HER2- breast cancer

OBJECTIVES

Fatigue is a common nonhematologic toxicity of the CDK4/6 inhibitor palbociclib in metastatic breast cancer (MBC) patients with prevalence rates of clinician-rated all-grade and grade 3/4 fatigue of 39.2% and 2.5%, respectively. We prospectively assessed the incidence of fatigue emerging on palbociclib using patient-reported measures and explored potential predictors.

METHODS

Eighty-eight patients with HR+ HER2- MBC without fatigue initiating palbociclib with endocrine therapy were assessed before and monthly across the initial 6 cycles. Clinically meaningful levels of patient-reported fatigue (Functional Assessment of Chronic Illness Therapy Fatigue Scale, FACIT-F < 34), severity of, and functional interference due to fatigue (NCI Patient-Reported Outcomes for CTCAE, PRO-CTCAE) were assessed. Hematologic and nonhematologic predictors were examined pretreatment and concurrent with fatigue assessments.

RESULTS

Patient-reported fatigue emerged in 21/88 patients [incidence rate 23.9% (95%CI, 15.4%-34.1%)] within 2.8 ± 1.7 treatment cycles. PRO-CTCAE-rated incidence rate of severe fatigue and fatigue interference was 14.8% (95%CI, 8.1%-23.9%) and 10.2% (95%CI, 4.8%-18.5%), respectively. Lower pretreatment absolute neutrophil count (ANC) levels predicted treatment-emergent fatigue (P =.01), but ANC levels on treatment did not (P =.78). Other pretreatment predictors were long sleep duration (P =.02) and low physical activity (trend, P =.07). Treatment-emergent fatigue was associated with objectively measured long sleep duration on treatment (P =.02), but not other measures (P ≥.35).

CONCLUSIONS

One-quarter of patients with HR+ HER2- MBC initiating palbociclib report rapidly emergent clinically meaningful fatigue, often with severe symptoms and functional interference. Treatment-emergent fatigue is associated with both pretreatment (lower ANC levels, longer sleep duration) and on-treatment (long sleep duration) hematologic and nonhematologic profiles.

Development and validation of the self-report symptom inventory of immune-related adverse events in patients with lung cancer

Objective

This study aims to develop and validate the Self-Report Symptom Inventory of immune-related Adverse Events in Patients with Lung Cancer (SRSI-irAEs-LC) to allow for systematic assessment of symptomatic irAEs in patients with lung cancer treated with programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) immune checkpoint inhibitors (ICIs).

Methods

A sequential two-phase mixed-methods study was conducted. In phase I, a draft version of the SRSI-irAEs-LC was constructed through item generation and draft inventory construction. Delphi expert consultation, cognitive interviews and a pilot study were conducted to evaluate the content validity and refine the scale. In phase II, psychometric testing was performed on 512 patients with lung cancer treated with PD-1/PD-L1 ICIs using item analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), criterion validity, discriminant validity, and reliability evaluations.

Results

Through 5 sequential steps in phase I, the preliminary version of the SRSI-irAEs-LC comprised 10 dimensions with 41 items. Through EFA, the final version of the SRSI-irAEs-LC included 8 dimensions and 26 items that explained 62.33% of the variance. The CFA model showed that the 8-factor model fitted the data well. Good criteria validity and known-groups discriminant validity were demonstrated. Cronbach's alpha, split-half reliability, and test-retest reliability of the scale were 0.824, 0.725, and 0.851, respectively.

Conclusions

Preliminarily, the SRSI-irAEs-LC is a valid and reliable instrument for assessing symptomatic irAEs in patients with lung cancer treated with PD-1/PD-L1 ICIs. Further research is needed to confirm its generalizability to a broader population as well as its validity and reliability.

A Research Protocol for a Phase II Single-Arm Clinical Trial Assessing the Feasibility and Efficacy of Neoadjuvant Anastrozole in Patients With Luminal Breast Cancer and Low Proliferative Index: The ANNE Trial

INTRODUCTION

Neoadjuvant endocrine therapy (NET) is recommended for the treatment of invasive breast cancer (BC), particularly luminal subtypes, in locally advanced stages. Previous randomized studies have demonstrated the benefits of aromatase inhibitors in this context. However, NET is typically reserved for elderly or frail patients who may not tolerate neoadjuvant chemotherapy. Identifying non-responsive patients early and extending treatment for responsive ones would be ideal, yet optimal strategies are awaited.

AIMS

This non-randomized phase 2 clinical trial aims to assess NET feasibility and efficacy in postmenopausal stage II and III luminal BC patients, identifying predictive therapeutic response biomarkers. Efficacy will be gauged by patients with Ki67 ≤ 10% after 4 weeks and Preoperative Endocrine Prognostic Index (PEPI) scores 0 post-surgery. Study feasibility will be determined by participation acceptance rate (recruitment rate ≥50%) and inclusion rate (>2 patients/month).

METHODS

Postmenopausal women with luminal, HER2-tumors in stages II and III undergo neoadjuvant anastrozole treatment, evaluating continuing NET or receiving chemotherapy through early Ki67 analysis after 2 to 4 weeks. The study assesses NET extension for up to 10 months, using serial follow-ups with standardized breast ultrasound and clinical criteria-based NET suspension. Clinical and pathological responses will be measured overall and in the luminal tumor A subgroup. Toxicity, health-related quality of life, and circulating biomarkers predicting early NET response will also be evaluated.

Evaluating Immune-Related Adverse Events Using PRO-CTCAE in a Phase II Study of Ipilimumab for Hormone-Sensitive Prostate Cancer

Introduction

 Use of the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) during chemotherapy is associated with decreased hospitalization rates, improved quality of life, and longer survival. Limited data exist on the benefit of this symptom assessment tool for monitoring immune-related adverse events (irAEs).

Methods

 We incorporated irAE-related items from the National Cancer Institute's (NCI) PRO-CTCAE in a trial evaluating ipilimumab in combination with androgen deprivation therapy in 16 patients with hormone-sensitive prostate cancer. For comparison, NCI's CTCAE version 4.0 was used by clinicians.

Results

 IrAE-related PRO-CTCAE surveys and matched CTCAEs (184 pairs) reporting abdominal pain, diarrhea, fatigue, anorexia, nausea, vomiting, rash, and pruritus were collected at each treatment administration and during follow-up. Fatigue, diarrhea, rash, and pruritus were the symptoms most frequently reported by both patients and clinicians. Agreement was lowest for pruritus (κ = 0.10) and highest for rash (κ = 0.64). IrAEs were more commonly reported and of higher grade with PRO-CTCAE scores compared with CTCAE grades.

Conclusion

 PRO-CTCAEs focused on irAEs capture the patient's immunotherapy experience while complementing the clinician's toxicity assessment measures. Further study is needed to assess PRO-CTCAE's utility in identifying and managing irAEs.

Developing a Mobile Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events Administration System to Capture Postradiation Toxicity in Oncology: Usability and Feasibility Study

Background

Accurate self-reported symptomatic toxicity documentation via the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) is essential throughout cancer treatment to ensure safety and understand therapeutic efficacy. However, the capture of accurate toxicities from patients undergoing radiation therapy is challenging because this is generally provided only at the time of scheduled visits.

Objective

This study seeks to establish the usability and feasibility of a mobile PRO-CTCAE Administration System (mPROS) to capture toxicities related to radiation therapy.

Methods

English-speaking adult patients who were undergoing radiation therapy for cancer were enrolled and given a brief demonstration of the Say All Your Symptoms (SAYS) and Symptom Tracking Entry Program (STEP) interfaces of the mPROS app, followed by a patient-use phase where patient actions were observed as they navigated mPROS to enter toxicities. Patient feedback was captured via a semistructured interview and brief questionnaire.

Results

We enrolled 25 patients (age: mean 60.7 years; females: n=13, 52%; White patients: n=13; 52%; non-Hispanic patients: n=19, 76%; college graduates: n=17, 68%). Patients almost equally preferred the SAYS (n=14, 56%) or STEP (n=11, 44%) interfaces, with 21 patients (84%) agreeing that they would use mPROS to report their symptoms to their health care team and 19 patients (76%) agreeing that they would recommend mPROS to others.

Conclusions

The mPROS app is usable and feasible for facilitating the patient reporting of radiation therapy–related symptomatic toxicities. A revised version of mPROS that incorporates patient input and includes electronic health record integration is being developed and validated as part of a multicenter trial.