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Sun V, Guthrie KA, Crane TE, Arnold KB, Colby S, Freylersythe SG, Braun-Inglis C, Topacio R, Messick CA, Carmichael JC, Muskovitz AA, Nashawaty M, Bajaj M, Cohen SA, Flaherty DC, O'Rourke MA, Jones L, Krouse RS, Thomson CA. SWOG S1820: A pilot randomized trial of the Altering Intake, Managing Bowel Symptoms Intervention in Survivors of Rectal Cancer. Cancer 2024. [PMID: 38386696 DOI: 10.1002/cncr.35264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/08/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Survivors of rectal cancer experience persistent bowel dysfunction after treatments. Dietary interventions may be an effective approach for symptom management and posttreatment diet quality. SWOG S1820 was a pilot randomized trial of the Altering Intake, Managing Symptoms in Rectal Cancer (AIMS-RC) intervention for bowel dysfunction in survivors of rectal cancer. METHODS Ninety-three posttreatment survivors were randomized to the AIMS-RC group (N = 47) or the Healthy Living Education attention control group (N = 46) after informed consent and completion of a prerandomization run-in. Outcome measures were completed at baseline and at 18 and 26 weeks postrandomization. The primary end point was total bowel function score, and exploratory end points included low anterior resection syndrome (LARS) score, quality of life, dietary quality, motivation, self-efficacy, and positive/negative affect. RESULTS Most participants were White and college educated, with a mean age of 55.2 years and median time since surgery of 13.1 months. There were no statistically significant differences in total bowel function score by group, with the AIMS-RC group demonstrating statistically significant improvements in the exploratory end points of LARS (p = .01) and the frequency subscale of the bowel function index (p = .03). The AIMS-RC group reported significantly higher acceptability of the study. CONCLUSIONS SWOG S1820 did not provide evidence of benefit from the AIMS-RC intervention relative to the attention control. Select secondary end points did demonstrate improvements. The study was highly feasible and acceptable for participants in the National Cancer Institute Community Oncology Research Program. Findings provide strong support for further refinement and effectiveness testing of the AIMS-RC intervention.
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Affiliation(s)
- Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, California, USA
- Department of Surgery, City of Hope, Duarte, California, USA
| | - Katherine A Guthrie
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Tracy E Crane
- Division of Medical Oncology, Miller School of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Kathryn B Arnold
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Sarah Colby
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Sarah G Freylersythe
- Division of Medical Oncology, Miller School of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | | | | | - Craig A Messick
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joseph C Carmichael
- University of California Irvine Health/Chao Family Comprehensive Cancer Center, Orange, California, USA
| | | | - Mohammed Nashawaty
- Minnesota Oncology (Metro Minnesota Community Oncology Research Consortium), Edina, Minnesota, USA
| | - Madhuri Bajaj
- Illinois Cancer Care (Heartland Cancer Research NCORP), Peoria, Illinois, USA
| | | | - Devin C Flaherty
- Valley Health Surgical Oncology (Virginia Commonwealth University Massey Cancer Center Minority Underserved NCORP), Winchester, Virginia, USA
| | - Mark A O'Rourke
- Prisma Health Cancer Institute (NCORP of the Carolinas Prisma Health NCORP), Greenville, South Carolina, USA
| | | | - Robert S Krouse
- Perelman School of Medicine, University of Pennsylvania and the Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Cynthia A Thomson
- University of Arizona Cancer Center, Tucson, Arizona, USA
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
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Rao RD, Flynn PJ, Sloan JA, Wong GY, Novotny P, Johnson DB, Gross HM, Renno SI, Nashawaty M, Loprinzi CL. Efficacy of lamotrigine in the management of chemotherapy-induced peripheral neuropathy: a phase 3 randomized, double-blind, placebo-controlled trial, N01C3. Cancer 2008; 112:2802-8. [PMID: 18428211 DOI: 10.1002/cncr.23482] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Lamotrigine, an antiepileptic agent, has been reported as being effective in reducing symptoms of neuropathy associated with various etiologies. Based on such data, a multicenter double-blind, placebo-controlled, randomized trial was conducted to evaluate the effect of lamotrigine on pain and other neuropathic symptoms due to chemotherapy-induced peripheral neuropathy (CIPN). METHODS Patients with symptomatic CIPN with symptom scores of either 1) >3 on a 0-10 Numerical Rating Scale (NRS) or 2) >1 on the 0-3 the Eastern Cooperative Oncology Group (ECOG) neuropathy scale (ENS) were eligible (higher numbers corresponding to greater severity of symptoms in both scales). Patients were randomly assigned to receive lamotrigine (target dose of 300 mg/day) or placebo for 10 weeks. Endpoints were measured biweekly. RESULTS In all, 131 patients were enrolled. Both groups were well matched at baseline. Over the 10-week period of the trial, the average pain scores (NRS) for the lamotrigine and placebo arms declined in both arms, with no statistically significant difference noted between the changes in the 2 groups (0.3 and 0.5 unit reduction from baseline, respectively; P=.56). Similarly, decreases in the ENS with therapy were not statistically different (0.4 and 0.3, respectively; P=.3). Changes in other subjective symptom scales were also not found to be statistically different between the 2 groups. Toxicities were mild and similar in each group. CONCLUSIONS The results suggest that lamotrigine is not effective for relieving neuropathic symptoms in patients because of CIPN.
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Affiliation(s)
- Ravi D Rao
- Department of Medical Oncology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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Dimitrov NV, Leece CM, Tompkins ER, Seymour E, Bennink M, Gardiner J, Crowell J, Hawk E, Nashawaty M, Bennett JL. Oltipraz concentrations in plasma, buccal mucosa cells, and lipids: pharmacological studies. Cancer Epidemiol Biomarkers Prev 2001; 10:201-7. [PMID: 11303588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Oltipraz is considered one of the most potent cancer chemoprevention agents, as shown in preclinical studies. Its pharmacological effects in humans have been associated with unusual toxicity affecting the fingers and toes. This study was designed to test intermittent dosing schedules using two dosage levels: 500 mg as a single weekly dose and 200 mg as a biweekly dose, each for 30 days. Fifteen men and women were studied in each dosing group. All were heavy smokers considered to be at high risk for developing lung cancer. Plasma, buccal mucosa cell, and lipoprotein concentrations were measured at different intervals corresponding to the time period when most of the adverse effects occur. No serious toxicities were observed using these doses and schedules. The plasma and buccal mucosa cell concentrations of Oltipraz showed substantial interindividual variations at each sampling. Some subjects had no detectable plasma or buccal mucosal cell Oltipraz concentrations. The distribution of Oltipraz incorporation into the lipid fractions and albumin was changed by the administration of different schedules of Oltipraz. The results of this study suggest that the intermittent dosing is well tolerated and does not result in steady state in plasma or buccal mucosa cells. The variation and lack of detectable Oltipraz concentration in plasma, buccal mucosa cells, and lipids may affect both the toxicity and the pharmacological effects when these doses and schedules are used.
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Affiliation(s)
- N V Dimitrov
- Department of Medicine, Michigan State University, East Lansing 48824, USA
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