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Annals of Oncology
1425P PAIN MANAGEMENT IN EIGHT ITALIAN ONCOLOGICAL
CARE CENTRES
S. Barni 1 , K.F. Borgonovo 1 , F. Di Costanzo 2 , F. Cognetti 3 , G. Bernardo 4 ,
C. Boni 5 , B. Agostara 6 , P. Pronzato 7 , G. Colucci 8 , M. Mammucari 9
1 Medical Oncology Division, Azienda Ospedaliera Treviglio-Caravaggio, Treviglio,
ITALY, 2 Medical Oncology Unit, Azienda Ospedaliero Universitaria Careggi,
Firenze, ITALY, 3 Division Medical Oncology A, Istituto Regina Elena, Roma, ITALY,
4 Oncologia Medica 2, Fondazione S. Maugeri IRCCS, Pavia, ITALY, 5 Oncology
Dept., Arcispedale S. Maria NuovaDivisione di Oncologia, Reggio Emilia, ITALY,
6 Oncology Division, A.O. Civico Palermo, Palermo, ITALY, 7 Oncologia Medica A,
IRCCS AOU San Martino - IST-Istituto Nazionale per la Ricerca sul Cancro,
Genova, ITALY, 8 Oncology Division, Istituto Tumori Ospedale Oncologico, Bari,
ITALY, 9 RMF, RMF, Roma, ITALY
Introduction: Management of oncologic patients is different between treating
centers, and in particular management of pain. We decided to perform a
retrospective study to explore different approaches to oncological painful patients
(pts) in different Italian Cancer Units.
Materials and methods: We evaluated in 8 Italian cancer hospitals all consecutive
pts during 5 days in order to investigate level of pain in the previous 7 days and in
the following two weeks from the basal visit. Patients and oncologists filled up a
questionnaire (type of pain, intensity, site of pain, and analgesic therapy).
Results: 265 pts were enrolled, 59% female and 41% male; median age 61.5. 88% of
pts had ECOG PS 0-1; 72.8% of pts reported metastatic disease and 86.4% were
under chemotherapy treatment. Pain measured with VAS (Visual Analogic Scale) at
baseline was 2.9. Pain was somatic in 32.4%, visceral in 12.5% visceral, 13.9%
neuropathic, 41.2% mixed. The current analgesic therapy at baseline had been
prescribed by oncologist in 38.2%, by other specialist in 42.1%, by family doctor in
18.5% and by other doctor in 1.1%. The basal analgesic treatment was confirmed in
57.3%, adjusted in 34%, and changed in 8.6%. At baseline we detected NSAIDS in
69.4% pts, weak opioids in 34% of pts; strong opioids in 38.9%, and 27.7% of pts also
had adjuvants (24.5% pregabalin, 57.1% steroids, 18.4% other drugs). At first weekly
follow-up (216 pts) the intensity of pain was 2.6 (VAS). The analgesic therapy was
confirmed in 72.2% and adjusted in 27.8%. New drugs prescribed at first follow-up
were NSAIDS in 43.3%, weak opioids in 21.7%, strong opioids in 86.7%, adjuvants in
55%. At second weekly follow-up (131 pts): 80.9% of therapies were confirmed and
19.1% adjusted. 90.3% therapies of 72 pts coming to third follow-up were confirmed.
In 85.7% of the adjusted therapies an adjuvant was prescribed.
Conclusions: Our data suggest two important comments. First, we observed a poor
utilization of adjuvants by physicians in oncologic patients, especially when therapies
are not prescribed by oncologists. Second, our data confirmed the need for a close
follow-up to improve analgesic therapy.
Disclosure: All authors have declared no conflicts of interest.
1426P PAIN PALLIATION OF BONE METASTASES USING
MAGNETIC RESONANCE GUIDED FOCUSED ULTRASOUND -
MULTI-CENTER MULTI-TRIAL RESULTS
R. Catane 1 , D. Gianfelice 2 , M. Kawasaki 3 , D. Iozeffi 4 , S. Kanyev 5 , A. Napoli 6 ,
P. Ghanouni 7 ,G.Lo 8 , Y. Inbar 9 , L. Shay Levi 10
1 Division of Oncology, Chaim Sheba Medical Center, Ramat Gan, ISRAEL,
2 Vascular/interventional Radiology, University Health Network, Toronto, CANADA,
3 Orthopaedic Surgery, Kochi Medical School, Kochi, JAPAN, 4 Radiology, Rostov
State Scientific Research Institute of Oncology, Rostov-on-Don, RUSSIAN
FEDERATION, 5 Radiology, N.N. Petrov Institute of Oncology, Saint Petersburg,
RUSSIAN FEDERATION, 6 Radiology, Sapienza University of Rome, Rome, ITALY,
7 Radiology, Stanford University, Stanford, CA, UNITED STATES OF AMERICA,
8 Radiology, Hong Kong Sanatorium & Hospital, Happy Valley, HONG KONG,
9 Radiology, Chaim Sheba Medical Center, Ramat Gan, ISRAEL, 10 Application,
InSightec, Tirat Carmel, ISRAEL
Introduction: Magnetic Resonance guided Focused Ultrasound (MRgFUS) is a
non-invasive, non-ionizing treatment for thermal ablation of tumors. The technology
uses high intensity focused ultrasound ablation combined with continuous MR
imaging to denervate pain. Precise targeting of the lesion and real time monitoring
of tissue temperature rise are cornerstones of the technique. We present here results
of multiple multi-center studies evaluating the safety and effectiveness of MRgFUS
for painful bone metastases.
Methods: 93 patients with painful bone metastases underwent MRgFUS in 14
medical centers worldwide. Treated lesions had to be remote from nervous structures
or joints. Effectiveness of pain palliation was evaluated with a standardized 11-point
pain rating scale (0-no pain/10-worst pain) and by monitoring changes in
pain-relieving medication. A reduction of 2 points or more was considered a
significant response. Safety events were recorded and evaluated by severity. Results of
31 patients treated in initial safety studies were previously reported by Liberman et al
(Ann Surg Oncol. 2009 Jan; 16(1):140-6).
Results: 107 procedures were performed, targeting 96 lesions in 93 patients. 3
patients were treated twice targeting a different lesion; another 11 patients underwent
a second treatment due to large lesions. Patients were followed-up for a period of 3
months. Pain response was relatively rapid: within 3 days, on average, the clinical
endpoint was met and maintained. Pain scores averaged 6.9 pre-treatment, decreased
to 4.5 within 3 days post-treatment, to 3.3 at one month post-treatment, and further
decreased to 2.6 at three month follow-up. There were no serious adverse events
related to the treatment. 2 patients had mild skin erythema following the treatment
and 5 patients (5%) had pain progression. Our updated results are similar to early
reports.
Conclusions: The presented results clearly show that MRgFUS can provide a quick,
effective and safe palliative therapy for patients suffering from painful bone
metastases. Current results are consistent with initial reported results. Randomized
trials are being conducted in patients as a first line treatment of painful bone
metastases vs. radiation therapy and in patients who failed radiation therapy vs.
sham.
Disclosure: L. Shay Levi: I work in InSightec as the global bone applications
specialist. InSightec is the company sponsered these clinical trials.All other authors
have declared no conflicts of interest.
1427P CURCUMA LONGA EXTRACT IS EFFECTIVE IN IMPROVING
INFLAMMATORY STATUS AND REDOX BALANCE IN
PATIENTS WITH CANCER-RELATED CACHEXIA AND
OXIDATIVE STRESS
G. Mantovani 1 , C. Madeddu 1 , F. Panzone 1 , M.C. Cau 1 , G. Antoni 1 ,F.Leo 1 ,
A. Maccio’ 1 , R. Serpe 2
1 Department of Medical Oncology, University of Cagliari, Cagliari, ITALY, 2 Parco
Scientifico e Tecnologico della Sardegna, Nutrisearch SRL, Cagliari, ITALY
Background: Curcumin (diferuloylmethane) is the biologically active compound of
Turmeric (Curcuma Longa) and has long been used in traditional Asian medicine to
treat diseases ranging from heartburn to arthritis: it is thought to have antioxidant
and antinflammatory properties.
Aim: To assess the antioxidant and antinflammatory properties of a curcumin extract
in advanced cachectic cancer patients.
Methods: From September 2011 to March 2012, 15 cachectic patients (M 7/F 8; age
range 55–85 y) with cancer at different sites were enrolled, all stage IV. Twenty-one
age/sex matched healthy controls were studied. All enrolled patients had
inflammation and oxidative stress (high blood levels of proinflammatory cytokine
Interleukin-6 (IL-6), high levels of blood C-reactive protein (CRP), high levels of
ROS, low levels of blood antioxidant enzymes GPx and SOD and low levels of total
blood antioxidant status, TAS, compared to controls. Patients were administered 4
tablets (2 g/day, equivalent to 400 mg/day of active curcuminoids extract, Meriva,
Indena, Milan, Italy). Treatment duration was 4 weeks.
Results: A significant reduction of ROS levels ( 510 ± 120 vs 390 ± 186 Fort U)
and a significant improvement of circulating levels of GPx (5630 ± 1189 vs 6590 ±
2390 U/l) as well as a significant improvement of TAS (0.61 ± 0.23 vs 0.69 ± 0.4
mmol Trolox eq.) was observed after treatment. The inflammatory marker CRP
decreased significantly (38.12 ± 28.4 vs 20.24 ± 17.37 mg/dl), no significant decrease
of serum IL-6 (25.58 ± 23.67 vs. 19.9 ± 16.8) was observed. No patient was withdrawn
from the study and the treatment was safe and well tolerated.
Conclusions: Curcumin extract added to the normal diet was able to significantly
improve inflammatory status and counteract key parameters of oxidative stress, such
as ROS, GPx and TAS. Curcumin antinflammatory-antioxidant activity could be
useful in a multi-targeted combined pharmaco-nutritional approach to treat
cancer-cachexia. Dr. Roberto Serpe was supported by grant CRP1_296 from the
Regione Autonoma della Sardegna by PO Sardegna FSE 2007-2013 (L.R.7/2007)
titled”Promotion of scientific and technological research in Sardinia”, Italy
Disclosure: All authors have declared no conflicts of interest.
1428P APPLICATION OF KM-CART (ADVANCED CELL-FREE AND
CONCENTRATED ASCITES REINFUSION THERAPY)
TREATMENT TO PATIENTS WITH CANCEROUS ASCITES
K. Matsusaki, K. Ohta, A. Yoshizawa, S. Goto
Ascites Treatment Center, Japanese CART Study Group, Tokyo, JAPAN
Purpose: The purpose of our study was to demonstrate the utility of KM-CART
therapy in the care of patients with refractory ascites. We also report one colon
cancer case treated with a dendritic cell vaccine that was prepared utilizing the high
yield number of autologous carcinoma cells collected in KM-CART processing.
Patients with refractory ascites can suffer severe bloating and/or respiratory
discomfort disrupting both their activities of daily living (ADL) and terminating
their anticancer therapy. We developed a novel KM-CART system for cancerous
ascites using original CART system approved by the Ministry of Health, Labor and
Welfare. KM-CART consists of ex vivo double filtration processing of autologous
ascites fluid to prepare: (1) a protein (albumin and globulins) concentrate fraction
suitable for intravenous fluid therapy back to the donor patient intravenously, and
(2) a cell concentrate suitable for research for anticancer drug sensitivity and
immunotherapy.
Volume 23 | Supplement 9 | September 2012 doi:10.1093/annonc/mds411 | ix463