Efficacy of fulvestrant in the treatment of postmenopausal women with endocrine-resistant advanced breast cancer in routine clinical practice

INTRODUCTION

This study aimed to describe the efficacy of fulvestrant 500 mg in postmenopausal women with estrogen receptor (ER)-positive advanced/metastatic breast cancer who had disease progression after receiving anti-estrogen therapy in clinical practice, getting real-world data.

MATERIALS AND METHODS

Multicenter, retrospective, observational study conducted in Spain. Postmenopausal women with locally advanced/metastatic ER-positive breast cancer who received treatment with fulvestrant 500 mg after progression with a previous anti-estrogen therapy were eligible. The primary endpoint was progression-free survival (PFS); secondary endpoints were overall survival (OS), clinical benefit rate (CBR), duration of clinical benefit (DoCB), and safety profile.

RESULTS

A total of 263 women were evaluated (median age, 65.8 years). At a median follow-up of 21.5 months, median PFS and OS were 10.6 and 43.2 months, respectively. PFS according to 1st, 2nd, 3rd, and ≥ 4th lines were 11.5, 10.6, 9.9, and 8.5 months, respectively (p = 0.0245). PFS in patients with visceral involvement was 10 months vs 10.6 months in patients without visceral involvement (p = 0.6604), 9.6 months in patients with high Ki67 vs 10 months in patients with low Ki67 (p = 0.7224), and 10.2 months in HER2+ patients vs 10.3 months in HER2- patients (p = 0.6809). The CBR was 56.5% and the DoCB was 18.4 months. The most frequently adverse events were injection site pain (10.3%) and musculoskeletal disorders (7.6%).

CONCLUSIONS

Fulvestrant 500 mg administered in clinical practice was shown to be effective (PFS, 10.6 months; CBR, 56.5%) and well tolerated, in accordance with previous trials.

Darbepoetin alfa administered once every three weeks for the treatment of anemia in elderly patients with non-myeloid tumors receiving chemotherapy

AIMS AND BACKGROUND

The present study aims to describe the hematological response to darbepoetin alfa (DA) under daily clinical practice conditions in anemic elderly patients with non-myeloid tumors receiving chemotherapy.

METHODS AND STUDY DESIGN

This was a prospective, observational, multicenter study in elderly (≥65 years) patients with non-myeloid cancer receiving DA (500 μg every 3 weeks) for chemotherapy-induced anemia (hemoglobin [Hb] level ≤11.0 g/dL).

RESULTS

A total of 102 anemic patients with solid tumors and 51 with hematological malignancies were included in 28 centers in Spain. Mean age (±SD) was 73.4 (±5.8) years, and mean baseline Hb level was 10.0 (±0.8) g/dL. DA was administered for a median of 8 weeks. Of the 115 subjects with a post-baseline Hb value, the percentage of patients who achieved a hematopoietic response (Hb increase ≥2 g/dL or reaching ≥12 g/dL without transfusions in the previous 28 days) was 69.7% (95% CI 56.1% to 83.3%). Functional Assessment of Cancer Therapy-Fatigue subscale scores increased during the study (median change 1.0 [Q1 -5.0, Q3 9.0], P = 0.04). One patient (0.7%) experienced a non-serious adverse reaction (cutaneous rash).

CONCLUSION

The study results suggest that DA is an effective and well-tolerated therapy for the treatment of chemotherapy-induced anemia in elderly patients.

Darbepoetin Alfa Administered Once Every Three Weeks for the Treatment of Anemia in Elderly Patients with Non-myeloid Tumors Receiving Chemotherapy

Aims and Background

The present study aims to describe the hematological response to darbepoetin alfa (DA) under daily clinical practice conditions in anemic elderly patients with non-myeloid tumors receiving chemotherapy.

Methods and Study Design

This was a prospective, observational, multicenter study in elderly (≥65 years) patients with non-myeloid cancer receiving DA (500 g every 3 weeks) for chemotherapy-induced anemia (hemoglobin [Hb] level ≤11.0 g/dL).

Results

A total of 102 anemic patients with solid tumors and 51 with hematological malignancies were included in 28 centers in Spain. Mean age (±SD) was 73.4 (±5.8) years, and mean baseline Hb level was 10.0 (±0.8) g/dL. DA was administered for a median of 8 weeks. Of the 115 subjects with a post-baseline Hb value, the percentage of patients who achieved a hematopoietic response (Hb increase ≥2 g/dL or reaching ≥12 g/dL without transfusions in the previous 28 days) was 69.7% (95% CI 56.1% to 83.3%). Functional Assessment of Cancer Therapy-Fatigue subscale scores increased during the study (median change 1.0 [Q1 −5.0, Q3 9.0], P = 0.04). One patient (0.7%) experienced a non-serious adverse reaction (cutaneous rash).

Conclusion

The study results suggest that DA is an effective and well-tolerated therapy for the treatment of chemotherapy-induced anemia in elderly patients.

Hyponatremia and cancer: Results of a retrospective analysis of 45 patients treated with a short course of low-dose tolvapan

e20705

Background: Hyponatremia in the cancer patient is usually caused by the syndrome of inappropriate antidiuretic hormone (SIADH). Other factors may cause hypovolemic hyponatremia, diarrhea, and vomiting. It’s present in 47% of cancer admissions. Introduction of vaptans acting as V2-receptor antagonists considerably improved the unconvincing results of conventional treatment consisting of fluid restriction potentially combined with sodium supplementation and/or demeclocycline therapy. Methods: We present a retrospective analysis of hyponatremic cancer patients treated with Tolvaptan. 45 patients, [31 men 14 women], median age 69 years old. 31.1 % had lung cancer, 17,6% other tumors, 11,1% colorectal and 11,1% prostate cancer. Histology: 53,3% Adenocarinoma, 15,6% SCLC, 15,2% others and 5,6% Epidermoid.The mean of the lowest sodium level was associated with squamous histology (Na 118 mEq/L). Descriptively, older patients (>66 y) had lower levels of Na compared to those younger than 66y (Na 122 mEq/L vs Na124 mEq/L). Median of Na at diagnosis of hyponatremia was 124 mEq/L,"waiting period" days before starting treatment,1d (SD= 1,745). Duration treatment [ Sodium levels out of risk according to the doctor criteria]. Results: Participants improved significantly after treatment period (p=.000). There were no differences in TOLVAPTAN improvements between patients with ≤ 124 mEq/L vs >124 mEq/L (p=.142), but patients with Na ≤ 124 mEq/L tend to achieved higher levels of sodium at the end of treatment (p=.016). No significant differences between different histology, location, "waiting period", duration of treatment, or age. However, Men significantly improved after treatment with tolvaptan (p=.000) and women do not showed significant changes (p=.753) (women had significantly higher pretreatment sodium level than men (122.4 mEq/L vs. 126.2 mEq/L,(p= .05). Conclusions: Tolvaptan is effective in the treatment of hyponatremia in patients with differents histological cancers especially with levels lower than 124 mEq/L. Tolvaptan had good safety profile with no side effects. A short course of two days and low dose (15mg/p.o./d ) with Tolvaptan restored safe Sodium levels.

Phase II study: Docetaxel-cisplatin and pro drug tegafur (TPF) as neoadjuvant treatment in advanced patients with head and neck cancer (HNC): Results and correlation between tandem magnesium/creatinine and toxicity

e16025

Background: Due to hospital control difficulties of patients with HNC, a phase II with oral fluoropyrimidines was conducted. Oral administration of 5-FU itself is not feasible owing to the high activity of dihydropyridine dehydrogenase (DPD) in the gut wall. To bypass this problem, oral fluoropyrimidine derivatives were developed in the form of 5-FU prodrugs. This phase II Trial focuses on the oral 5-FU prodrug tegafur to allow similar responses and toxicities. On the other hand a secondary objective was to correlate the effect of CDDP that induces renal injury through multiple pathways. For that reason, the correlation between Mg/Cr and Toxicity was studied. Methods: From 2006 to 2011 seventeen patients with locally advanced head and neck carcinomas were treated in our institution. A phase II clinical trial was conducted as neoadjuvant treatment [docetaxel 75 m2 d-1, cisplatin 75 mgm2 d-1, and tegafur 800 mg twice daily for 14 days, administered every 21 days with GCSF support]. If tumor response, patients received radiotherapy (RT) 70 Gy concomitant with weekly cisplatin 25mg/m2. If no response, palliative surgery or RT or/second line of chemotherapy was administered.) Results: Sixteen were male, one female, three died (2 sepsis secondary to neutropenia grade IV/ 1 secondary to direct tumor complication after 1st course of chemotherapy). Only 14 patients were evaluable for response [mean age was 54,24]. Toxicity grade >2 was present in a range [13,33-21,43%]. Partial responses (PR) were present in 9 patients (52,94%), complete response or no evidence of disease in 3 (17,63%). After RT witth weekly cisplatin the diseas control was 70,57%. An association trend was detected between hypomagnesaemia and a greater toxicity. Conclusions: The implementation of an oral chemotherapy regimen has been feasible and effective with similar results to other studies. The idiosyncrasy of patients with HNC have kept their prized autonomy and independence. A new study is in progress to assess more accurately magnesium levels as predictors of severe toxicities when platinum is used.

Long-term progression-free survival (PFS) and overall survival (OS) to pemetrexed (P) as single agent in metastatic urothelial carcinoma (MUC): A Spanish Oncology Genitourinary Group (SOGUG) systematic review

4587

Background: The effect of pemetrexed in MUC is not well characterized. Vinflunine is the standar second-line in MUC with adjusted benefits and no more drugs have been aproved. SOGUG reports a systematic review of MUC patient series with high activity of P in monotherapy. Methods: Patients with locally advanced urothelial carcinoma and/or MUC whom received P 500 mg/m(2) every 21 days with folic acid and vitamin B12 supplementation, were elected. These patients received P in second, third or fourth-line of chemotherapy. Results: 44 patients have been reported (39males), median age 62 [41-82]. Of all 44 patients; 21, 22, and 1 patients received P as second-line, third and fourth-line respectively. A median of 4 courses were administered [1-12] and disease control (SD+PR+CR) was achieved in 19 patients for an overall control rate of 43.2%. Four groups with significant differences in PFS (p=.033) were established (1.bone-metastasis, 2.visceral-metastasis, 3. nodal-visceral-metastasis and 4.nodal-metastasis). OS was significant between 2nd and 4th group (p=.036) . Mean PFS and OS were 125days [17-606] and 219days [17-1168] respectively for all 44 patients. Mean PFS and OS of 8 patients with bone metastasis were 75 days and 134 days. Mean PFS and OS of 10 patients with visceral metastasis were 65 days and 144 days. Mean PFS and OS of 8 patiens with nodal+visceral metastasis were 154 and 228 days. Mean PFS and OS of 18 patients with nodal metastasis were 166 days and 299 days. Conclusions: Our longer and multicenter follow-up shows that single agent P in monotherapy as second, third and fourth line in MUC is associated with high activity and long-time survival specially in metastatic nodal MUC. These results suggest that P as monotherapy requires to be further studied, more patients are being collected.

Quantification of circulating endothelilial cells (CECs) as a predictor of response to chemotherapy with platinum and pemetrexed in patients with nonsquamous non-small cell lung carcinoma

e18053

Background: CECs play an important role in tumor neovascularisation and may have prognostic value in cancer patients (pts). The objective of this study is to assess the quantification of CECs as a predictor of response to chemotherapy (CT) in non-squamous NSCLC. Methods: 10ml of blood was obtained prior to the first, second and third cycle of CT in pts treated with platinum plus Pemetrexed. The quantification of CECs was undertaken using CellSearch technology in a central laboratory. The basal levels and the evolution of CECs was correlated with response to treatment according to RECIST criteria after 3 cycles of CT using analysis of variance (ANOVA). Results: Between July 2010 and June 2011 67 pts were included: 43 pts (64.2%) received CDDP/PEM and 24 (35.8%) received CBDCA/PEM. Median age: 60 years (range 40-82), 46 male (68,7%). Nine (13,4%) PS 0; 46 (68,7%) PS 1; 11 (16,4%) PS 2; 1 (1,5%) PS 3. Range of basal CECs: 8 - 1171 cel (median of 85 cel). CECs prior to cycle 2: median of 100 cel (range: 10-1388). CECs prior to ciclo 3: median of 94,5 cel (range: 5-1857). Response after 3 cycles was: 25 PR (36%), 17 SD (25%) and 16 PD (23%) and 11 NE (16%). In the analysis of variance, no significant relationship between the basal CEC count and response was found (p-value=0,831). Decrease >50% between the 1st and 2nd cycle is correlated significantly with progression disease (p=0.026). Conclusions: In this homogeneous group of patients with NSCLC there is no correlation between response to treatment and basal levels of CECs. The decrease in CEC numbers after the first cycle could be a negative predictive factor. The correlation between the variations of CECs with PFS and OS will be presented during the conference.

Clinical benefits of sequential administration of docetaxel and intermittent erlotinib as a second-line therapy for advanced non-small cell lung cancer (NSCLC): A phase II randomized study

e18049

Background: Patients (p) with advanced NSCLC have few treatment options after progressing to 1st-line platinum doublet chemotherapy. Several preclinical and phase I studies have suggested that sequential administration of erlotinib (E) and docetaxel could avoid possible negative interactions and optimize the benefit obtained against NSCLC. This randomized phase II was designed to address the clinical benefit obtained with the use of sequential administration of docetaxel and intermittent E. Methods: 70 p with advanced NSCLC progressing to previous PDC for advanced disease were randomized (1:1): Group A (n = 34): Docetaxel 75 mg/m2 day 1 and intermittent E (day 2-16), up to 4 cycles, followed by E in monotherapy; and Group B (n = 36): E in monotherapy. Treatment was administered until unacceptable toxicity or disease progression. Primary endpoint: rate of p free of progression at 6 months; secondary endpoints: progression-free survival (PFS), overall survival (OS), disease control rate (DCR) and safety. The study has completed enrolment. At the date of cut-off for this communication, data of 60 patients were available: 30 in Group A/30 in Group B. Results: Baseline characteristics: non-adenocarcinoma (60.3%), current/former smokers (95%), male (90%) and stage IV (87.9%). 6 months PFS: 13.5% in the sequential arm. PFS: 2.7 months (m) in Group A (95% CI 2.1 – 3.8) and 2 m in Group B (95% CI 1.7 – 2.4) p value 0.08. Median OS: 11.0 m (95% CI 4.5 – 13.4) in group A and 4.7m (95% CI 2.5 – 6.6) in Group B with a p value 0.02. DCR: 44.4% in the experimental group whereas in the E one was 30.8%. Adverse events (AEs), including skin rash and diarrhea, were all generally tolerable. Of interest, the low number of p developing neutropenia in the D + E arm. Conclusions: Although the primary objective has not been met, an encouraging benefit on survival has been shown in the exploratory analysis, with a median overall survival of 11 months for patients treated with the sequential regimen (p value 0.02). Final data will be presented during the meeting.

Promotion of emotional wellbeing in oncology inpatients using VR

INTRODUCTION

In Psycho-oncology, VR has been utilized mainly to manage pain and distress associated to medical procedures and chemotherapy, with very few applications aimed at promotion of wellbeing in hospitalized patients. Considering this, it was implemented a psychological intervention that uses VR to induce positive emotions on adult oncology inpatients with the purpose of evaluating its utility to improve emotional wellbeing in this population.

METHOD

Sample was composed of 33 patients (69.7% men, aged from 41 to 85 years old; X=62.1; SD=10.77). Intervention lasted 4 sessions of 30 minutes, along one week. In these sessions, two virtual environments designed to induce joy or relaxation were used. Symptoms of depression and anxiety (Hospital Anxiety and Depression Scale, HADS) and level of happiness (Fordyce Scale) were assessed before and after the VR intervention. Also, Visual Analogue Scales (VAS) were used to assess emotional state and physical discomfort before and after each session.

RESULTS

There were significant improvements in distress and level of happiness after the VR intervention. Also, it was detected an increment in positive emotions and a decrease in negative emotions after sessions.

CONCLUSIONS

Results emphasize the potential of VR as a positive technology that can be used to promote wellbeing during hospitalization, especially considering the shortness of the intervention and the advanced state of disease of the participants. Despite the encouraging of these results, it is necessary to confirm them in studies with larger samples and control groups.

Cure rate in early colorectal cancer estimated from disease-free survival curves from phase III comparative clinical trials: Necessity of long follow-up

e15006

Background: The traditional end point for adjuvant clinical trials is overall survival (OS). Short-term disease-free survival (DFS) has been accepted as a surrogate of 5-year OS in colorectal cancer trials. Nevertheless, recent adjuvant trials have not shown a consistent improvement in OS despite a significant improvement in DFS. Two reasons may explain this effect: 1) a delay in relapse produced by treatment, not affecting the cure rate, or 2) more effective treatments in relapsing patients which delay death, hiding a real difference in cure rates. The aim of this project is to study the relationship between DFS and OS in trials of early colorectal cancer. Methods: Phase III comparative trials in colorectal cancer were searched in databases and cancer meetings. Trials were split to build and validate the model. United States 2000 population life table data were obtained from Berkeley Mortality Database. Survival curves were modelled according to a cured fraction following a Weibull distribution and a relapsing fraction following a binomial distribution. DFS was modelled as time to a single event and OS was modelled as time to two events. Cured fraction was estimated and odds ratio (OR) with 95% confidence interval was calculated for experimental arms. Time to achieve a plateau in DFS was estimated as the curve point with a risk of relapse below 1%. Regression analysis between DFS and OS was performed for different intervals of follow up. Results: Thirty six study arms reporting DFS were analyzed to build the model. The model is consistent with an annual event rate of 0.33. DFS curves with this event rate predict a mean cure rate of 0.58 (range: 0.11–0.73). Estimated time to achieve a plateau in DFS is 9.3 years (range: 8.3–11.2 years). Significance of OR is coherent with hazard ratio reported in the studies. Trials finished after 1999 show more OS related to DFS. Regression analysis between DFS and OS show changing parameters at different intervals of follow up and some non-linearities. Trial validation, and analysis with trials reporting relapse free survival will be presented. Conclusions: Follow up of up to 10 years in colon adjuvant trials appears to be appropriate to reliably detect benefit in OS instead of a delay effect on relapse.

No significant financial relationships to disclose.

Final results of a prospective, observational study of the effectiveness of darbepoetin alfa administered every three weeks for the treatment of chemotherapy-induced anaemia in elderly patients

e20654

Background: Cancer incidence is increasing in elderly but specific treatment data in this population is not often available. The objectives of this study were to evaluate the effectiveness and safety of darbepoetin alfa (DA) administered once every 3 weeks (Q3W) for the treatment of chemotherapy-induced anaemia (CIA) in elderly within routine clinical practice. Methods: Prospective, observational, single-arm, multicentre study performed in 28 centres across Spain. Eligible patients (pts):≥65 years, anaemic (haemoglobin [Hb] 11 g/dl), with non-myeloid malignancies, and scheduled to receive ≥9 weeks (wks) of chemotherapy. Pts were treated with a fixed dose of DA 500 μg Q3W and treatment stopped if Hb levels exceeded 13g/dl. Primary endpoint was hematopoietic response (Hb increase ≥2g/dl or Hb ≥12g/dl without transfusions in the previous 28 days). Secondary endpoints included percentage of pts achieving target Hb (>11g/dl from wk 5 till end of treatment without red blood cell transfusion within 28 days), changes in the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) scale and the incidence of adverse reactions. Results: Data were prospectively collected from 153 pts: women (56.86%), mean (SD) age 73.43 (5.77) years, ECOG Performance Status 0–1 (65.36%) with solid tumors (66.67%) and lymphoproliferative malignancies (33.33%) and stage III/IV (63.40%). Most pts (90.20%) had baseline Hb levels between 9–11g/dL. DA was administered for a median of 9.0 wks (range: 1–22.57). The Kaplan-Meier percentage (KM; 95% CI) of pts who achieved hematopoietic response was 69.70% (56.06–83.34) and 72.22% (57.5–86.94) for pts who achieved target Hb (>11g/dL). FACT-F median score at baseline was 29.00 and 33.00 at the end of the study. Only one (0.7%) non-serious adverse reaction (cutaneous eruption) was reported. Conclusions: These results suggest that DA given at 500 μg Q3W to elderly pts with non-myeloid malignancies is an effective and well-tolerated treatment for CIA.

[Table: see text]

An assessment of cancer-related fatigue in patients (pts) with chemotherapy-induced anaemia (CIA) treated with darbepoetin alfa (DA): Comparison of two quality of life (QoL) questionnaires

19654

Background: CIA is often associated with debilitating fatigue and reduced QoL. DA can effectively treat CIA when administered once every 3 weeks (Q3W).This study aims to compare the psychometrics of the Functional Assessment of Cancer Therapy Fatigue Subscale (FACT-F) and The Fatigue Symptom Inventory (FSI) in CIA pts treated with DA Q3W. Methods: Longitudinal single- centre prospective study in adult pts with solid tumours undergoing chemotherapy (CT) and with mild to moderate cancer-related fatigue (CRF) (Visual Analogue Scale (VAS) =30 mm). Pts with haemoglobin (HB) levels <11 g/dL were treated with DA 500 mcg Q3W. Key clinical parameters, FACT-F, and FSI measurements were collected at the beginning and end of the CT treatment period. Psychometric indicators for reliability and validity were calculated. Results: A preliminary analysis was conducted in 58 pts: mean age, 61.3 years (SD 12.3), 51.7% women, 25.9% with breast cancer, 91.4% ECOG 0–1, 69.0% IV stage, 63% had no prior CT. At baseline, the mean CRF score by VAS was 58.8 mm (SD 19.4) and the mean Hb was 10.2 g/dL (SD 0.7). Median CT duration was 15.1 weeks (range, 3.3 - 25.7) and all pts received DA treatment during CT (median duration of CT, 6.6 wks [range, 0 - 19]). The median number of DA doses administered was 3 (range, 1–7). The rate of hematopoietic response (Hb ≥ 12 g/dL or Hb rise from baseline ≥ 2 g/dL) was 69.0%. FACT-F and FIS scores improved by 5.6 and 13.0 points respectively during CT. Consistency (Cronbach alpha coefficient - CA) was high and similar for both questionnaires (FACT-F=0.98; FSI=0.97). Conclusions: Both the FACT-F and FIS QoL questionnaires measured a change in fatigue during the study with high and similar consistency. DA administered at a fixed dose of 500 mcg Q3W seems to be effective in clinical practice.

No significant financial relationships to disclose.

MAP4/OP18 mRNA expression predicts progression in patients treated with vinorelbine plus carbolpatin in advanced lung cancer patients in a Multicenter trial

14088

Background: Non-small-cell lung cancer patients with locally advanced or metastatic disease at the time of diagnosis show marginal response to chemotherapy in terms of tumor shrinkage, time to progression and median survival. MAP4 and stahmin have been previously reported as potential markers of resistance to treatment based on microtubule-destabilizing agents. Methods: In this multicenter study, we have used quantitative PCR to analyse expression of MAP4, stathmin, beta-tubulin III, BRCA1 and ERCC1 in mRNA isolated from peripheral blood samples of 51 non-small-cell lung cancer patients treated with vinorelbine/carboplatin. Results: In a preliminary set, 29 patients with stage IIIB and IV were analyzed. Lower levels of MAP4/OP18 mRNA expression are statistically related with response to vinorelbine-based treatment (p=0,029). This significant relationship is maintained in a second analysis after third cycle of treatment (p=0,032). Higher levels of MAP4/op18 were associated with a lower TTP (p=0,05). Conclusions: Our preliminary results suggest that the ratio MAP4/OP18 may be a good predictor of response for patients with non-small-cell lung cancer treated with vinorelbine-based chemotherapy.

No significant financial relationships to disclose.

Influence of single agent gemcitabine (GEM) schedule on the pattern of response and toxicity in patients with advanced pancreas, lung and breast carcinoma: A systematic review

13009

Background: Dose dense chemotherapy has been advocated as a way to improve results in patients with cancer. Increasing dose (and the area under the curve of concentration-time, AUC) may increase response and toxicity, limiting clinical benefit. For phase-specific agents such as GEM, different schedules with the same dose and AUC may produce different patterns of efficacy and toxicity. Partial comparisons between schedules in clinical trials are not able to design optimal schedules. A systematic analysis of all different schedules of GEM, integrating clinical, pharmacodynamic and pharmacokinetic data in a mathematical model may provide an optimum. Methods: Clinical trials of single agent GEM in advanced pancreas, lung and breast carcinoma have been searched in PubMed, references of published clinical trials, and presentations in cancer meetings. Prognostic factors (age, sex, sex, performance status, previous chemotherapy, stage), schedule details (dose, time and frequency of infusions), response rate and toxicity (hematological, mucosal, skin and diarrhea) were analyzed in a multivariate model. In vitro data (concentration and time of exposure) and pharmacokinetic/pharmacodynamic data were included in the model, estimating the AUC above a concentration threshold (AUCt) obtained for every clinical schedule. Results: Ninety five clinical trials including 7917 patients with cancer of the pancreas (39 trials), lung (45 trials) or breast cancer (11 trials) were pooled. GEM was administered at doses of 90–2800 mg/m2 (median 1000 mg/m2) infused in 0.5–24 hours (median 0.5 h). Except for 1 schedule, treatment was repeated for 1–7 consecutive weeks (median 3) followed by a 2 week rest period. Response rate was 2.7–33.3% (median 8%) for pancreas, 0–38.5% (median 18.5%) for lung and 0–37.1% (median 20%) for breast cancer. Epithelial toxicity was inferior to hematological toxicity (grade 3/4: 0% vs 11% for leucopenia). A mathematical model was applied to 24 different schedules. Conclusions: GEM schedules in literature show great homogeneity, most of them 1000 mg/m2 for 3 consecutive weeks followed by a 2 week rest period. The model allows simulations to optimize concentration over 12 nM.

No significant financial relationships to disclose.

Assessment of functional status, symptoms and comorbidity in elderly patients with advanced non-small-cell lung cancer (NSCLC) treated with gemcitabine and vinorelbine

BACKGROUND

The incidence and prevalence of comorbid conditions in lung cancer patients increase with age. The aim of the study was to determine response and tolerability with the biweekly combination gemcitabine-vinorelbine in elderly non-small-cell lung cancer (NSCLC) patients. In order to characterise the population included in the study well and assess the results achieved properly, an evaluation of the functional status, comorbidity and survival was performed.

PATIENTS AND METHOD

Between June 2001, and December 2003, 59 untreated advanced NSCLC patients over the age of 70 years entered the study. Treatment consisted of gemcitabine 1750 mg/m(2) and vinorelbine 30 mg/m(2) on day 1 every two weeks. The response was evaluated every f ive cycles (RECIST guidelines). Comorbidity was evaluated according to the Charlson and Kaplan Feinstein scales. To measure functional status, activities of daily living (ADL) and instrumental ADL (IADL) were considered.

RESULTS

Median age was 74; ECOG performance status was >2 in 59.3%; no dependence in ADL or IADL was found in 24.8% and 42.4% of patients, respectively. A total of 381 courses were administered. Grade 3-4 neutropenia was present in 6.8% of these courses and correlated with IADL. Objective response was 22% (95% CI 12-32). Mean global survival and cause-specific survival were 29 weeks (95% CI 19.9-38.1) and 32 weeks (95% CI 23.4-40.8) respectively. Comorbidity displayed no close correlation with functional status, but comorbidity according to the Kaplan Feinstein index correlated with IADL. Performance status, ADL, IADL and weight loss were significantly related to survival in multivariate analysis.

CONCLUSIONS

This biweekly combination is feasible in elderly lung cancer patients with a high burden of comorbidity and dependence. Toxicity is acceptable, whereas response rate and survival fall in the range of active regimens. ADL and IADL indices allow the identification of elderly patients with a worse prognosis.

Biweekly docetaxel and carboplatin as first line chemotherapy in advanced non small cell lung cancer (NSCLC)

17016

Background: Platinum therapy has been the backbone treatment in NSCLC. The concomitant use of platinum derivatives and taxanes has shown high antitumoral activity with moderate toxicity. To improve the therapeutic index of this combination, we performed a study with biweekly carboplatin and docetaxel. Primary objective was determination of objective response rate (ORR). Secondary objectives were time to progression, tolerability and overall survival. Methods: Patients histologically confirmed of non-small cell lung cancer, aged ≥ 18, ECOG PS 0–2, measurable lesion according RECIST criteria, adequate bone marrow, renal and hepatic function were included. Prior chemotherapy was not allowed. Patients received treatment with a combination of Docetaxel 50 mg/m2 and Carboplatin AUC-4 each 15 days for a maximum of 8 cycles. Results: Fifty patients were included between March 2004 and July 2005, 84% were male, median age was 63 years old (range 48–77), 78% had ECOG PS 0–1 and 64% of patients had stage IV. Histology was squamous cell carcinoma (54%) adenocarcinoma (36%) and large cell carcinoma (10%). A total 316 cycles were administrated (median 7, Range 1–12). Over 46 evaluable patients for response, one achieved CR, 13 PR, 21 SD and 11 PD, with an overall response rate of 30.5% (95% CI: 17.2–43.8). Median follow up of patients is 8.3 months, with a median TTP of 6.3 months and median overall survival of 11.1 months. Grade 3–4 toxicity per patient was: neutropenia (22.0%), asthenia (16.0%), anaemia (10.0%), thrombocytopenia (2%), mucositis (2%) and nauseas (2%). Conclusions: These results suggest that biweekly schedule of carboplatin / docetaxel is a safe and active regimen in first line advanced NSCLC patients.

No significant financial relationships to disclose.