Annual Meeting Proceedings Part 1 - American Society of Clinical ...

9073 General Poster Session (Board #42D), Sat, 8:00 AM-12:00 PM
Genetic polymorphisms of SCNA9 as predictive markers of oxaliplatininduced
neuropathy. Presenting Author: Maria Sereno, Oncology Department,
Hospital Infanta Sofía, Madrid, Spain
Background: Oxaliplatin (OXL) is an active drug in digestive tumors.
Oxaliplatin induced peripheral neuropathy (OIN) is the main dose limiting
toxicity. Around 60-80% of patients developed a mild cold-induced
neurotoxicity that used to disappear few days after but in 15% became a
persistent neuropathy. The pathophysiology of oxaliplatin-induced neuropathy
(OIN) remains unclear, preclinical studies suggest involvement of
voltage Na channels. SCN9A gene codifies to Na channels � subunit highly
expressed in nociceptive neurons. Mutations in SCN9A are involved in
alterations in neuropatic pain perception. This study tried to identify if
variants in SCN9A could be associated to a higher risk to OIN. Methods:
Serum were obtained from 100 patients with digestive cancer (colorectal,
gastric, pancreatic and bile duct) treated with OXL (adjuvant or advanced
setting) in Infanta Sofía University Hospital. No diabetes or hypotiroidism
were detected. Patients were divided in two groups according to the
development of OIN: Arm A 50 patients diagnosed of grade 2-3 OIN after 6
courses and Arm B 50 with no OIN. The evaluation of severity of the OIN by
a neurologist included a classification according to NCI-CTC and OSNS
scales and conduction studies. Genomic DNA was isolated from serum and
variants of SCN9A were analyzed by PCR-RFLP. The relation between
SCN9A genotype and the development of severe OIN was the primary aim
Results: One hundred patients were enrolled between May 2010-November
2011. 56 (56%) females and 44 (44%) males; mean age was 62; mean
ECOG was 1; primary tumor were colorectal 81 pts (81%), gastric 10
(10%); 8 (8%) pancreto-biliar and anus 1(1%). Stage were classified in
localized 65 (65%) and advanced (35%). The chemotherapy regimen
included: 94 (94%) XELOX, 1 (1%) XELOX-Herceptin and 5 (5%) EOX
regimen. The mean of cycles were 7 (1-14). Mean OXL dose intensity was
100mg/m2.The mean PFS was 23 months. High expression of SCN9A
variants were detected in patients 26/50, 52% arm A and in 5/50, 10%
arm B patients, suggesting a possible relationship beetwen the development
of OIN and SCN9A genotype (p�0.04). Conclusions: SCN9A polimorphysms
may help to identify those patients with a higher risk to develop
oxaliplatin induced neuropathy.
9075 General Poster Session (Board #42F), Sat, 8:00 AM-12:00 PM
Pilot study of Scrambler therapy for the treatment of chemotherapyinduced
peripheral neuropathy. Presenting Author: Deirdre R. Pachman,
Mayo Clinic, Rochester, MN
Background: Chemotherapy-induced peripheral neuropathy (CIPN), a common
dose-limiting side effect of chemotherapy, remains without known
effective interventions. Preliminary data support that Scrambler therapy, a
device which treats pain via non-invasive cutaneous electrostimulation, is
beneficial for the treatment of CIPN. This pilot trial was performed to
investigate the effect of Scrambler therapy for the treatment of CIPN.
Methods: Eligible patients included those age �18 years, ECOG PS �2, life
expectancy �3 months, with pain or CIPN symptoms of �1 month duration
and tingling or pain �4/10 during the prior week. Patients were treated
with Scrambler therapy to the affected area for up to 10 daily 30 minute
sessions. Symptoms were monitored daily during therapy using a questionnaire
to measure symptoms of neuropathy with a numerical analogue scale.
Results: We report on the first 11 CIPN patients, enrolled between
7/18/2011 and 12/12/2011, 3 men and 8 women; mean age 57 years.
Patients had history of exposure to various chemotherapeutic agents and
the majority had symptoms �2 years. The table portrays data at baseline, at
the end of the 10 planned days of therapy, and the percent changes from
baseline to the end of treatment, regarding patient reported pain, tingling,
and numbness over the preceding 24 hours. There were no adverse events.
Persistent benefit out to 5 weeks was seen in some patients; maturing data
will be available by May 2012. Descriptive summary statistics formed the
basis of data analysis. Further patients are being entered on this trial.
Conclusions: Scrambler therapy appears to be beneficial in the treatment of
CIPN. A prospective placebo-controlled clinical trial should be performed
to confirm these preliminary findings.
Effect of Scrambler therapy on CIPN score.
Mean baseline score Mean final score Percent change
Symptom Mean Worst Mean Worst Mean Worst
Pain 5.7 (2.20) 6.0 (2.10) 3.0 (2.65) 3.8 (3.06) -48% (2.65) -36% (3.54)
Tingling 6.5 (1.81) 7.0 (1.84) 3.8 (2.82) 4.0 (2.65) -41% (2.34) -43% (1.95)
Numbness 6.5 (1.57) 7.2 (1.78) 5.1 (2.43) 5.2 (2.48) -21% (1.75) -28% (2.14)
Numbers in parentheses represent standard deviations.
Patient and Survivor Care
585s
9074 General Poster Session (Board #42E), Sat, 8:00 AM-12:00 PM
Psychological impact of exercise in women with breast cancer receiving
adjuvant therapy: What is the optimal dose needed? Presenting Author:
Marion Carayol, Laboratory Epsylon EA 4556 Dynamics of Human Abilities
and Health Behaviors, Department of Medicine, Human, Society and Sport
Sciences, University of Montpellier and St-Etienne, Montpellier, France
Background: Several meta-analyses have examined the role of exercise
interventions in improving psychological outcomes in cancer survivors but
most did not focus on adjuvant therapy period and did not investigate the
optimal dose of exercise needed. Methods: The present meta-analysis
examines the impact of exercise interventions delivered at this particular
period on fatigue, anxiety, depression and quality-of-life (QoL) as well as
dose-response relationships between volume of prescribed exercise and
these psychological outcomes. Randomized controlled trials that proposed
an exercise intervention to breast cancer patients undergoing chemotherapy
and/or radiotherapy were systematically identified and coded.
Standardized mean differences (SMDs) of psychological outcomes were
weighted by the inverse of their variances to obtain a pooled estimate using
random effects model. Linear and quadratic regressions were carried out to
explore dose-response relationships. Results: In total, 17 studies involving
1380 participants and 20 exercise interventions were included. Intervention
subjects significantly reduced their fatigue and depression levels
showing pooled effect sizes (EF) and their associated 95% confidence
interval (95%CI) of -0.28 [95%CI: -0.54; -0.03] and -0.28 [95%CI:
-0.46; -0.09] respectively. Levels of anxiety also appeared to be reduced
but pooled estimate did not reach significance (p�0.06). Significantly
increased QoL was observed: EF�0.34 [95%CI: 0.07; 0.62] favouring
intervention. Consistent and significant inverse associations of weekly and
total volume of prescribed exercise were observed with fatigue (F test:
p�0.04, R²�0.19 and p�0.009, R²�0.26 respectively) and QoL (F test:
p�0.01, R²�0.14 and p�0.02, R²�0.29 respectively), implying that
SMDs magnitude decreased as exercise dose increased. Conclusions:
Exercise intervention enhanced fatigue, depression and QoL in breast
cancer patients undergoing adjuvant therapy. Prescription of relatively low
doses of exercise (�12 MET.h per week) consisting in approximately
90-120 min of weekly moderate physical exercise seems more efficacious
in improving fatigue and QoL than higher doses.
9076 General Poster Session (Board #42G), Sat, 8:00 AM-12:00 PM
Paucity of core palliative care elements available to children with cancer at
end-of-life: Perspectives of bereaved parents and clinicians. Presenting
Author: Alisha Kassam, The Hospital for Sick Children, Toronto, ON,
Canada
Background: Recognition of serious deficits in palliative care for children
has prompted hospitals to develop specialized pediatric palliative care
programs. However, only a minority of children who die from advanced
cancer receive services from these dedicated programs. We aimed to
determine which elements of palliative care are considered important
according to bereaved parents and pediatric oncology clinicians and to
determine availability of these elements. Methods: We administered questionnaires
to 75 bereaved parents (response rate 53%) and 48 pediatric
oncology clinicians (response rate 91%) at the Hospital for Sick Children in
Toronto, Canada. The main outcome measures were importance ratings and
availability of core elements of palliative care delivery based on the
National Quality Forum clinical practice guidelines for quality palliative
care. Results: Fifteen of the twenty-one core elements were highly valued by
both parents and clinicians (defined as � 60% of parents and clinicians
reporting the item as important). When compared to clinicians, parents
gave higher importance ratings to receiving cancer-directed therapy during
the last month of life (p � 0.007) and involvement of a religious or spiritual
mentor (p � 0.03). Clinicians gave higher importance ratings to involvement
of a social worker (p � 0.0001). Notably, of the valued elements, only
three of them were available greater than 60% of the time according to
clinicians and parents. Valued elements least likely to be available
included a direct admission policy to hospital, involvement of a religious or
spiritual mentor, sibling support and parent preparation for medical
aspects surrounding death. Conclusions: Children with advanced cancer are
not receiving key elements of palliative care despite both parents and
clinicians recognizing them as important. Evaluation of barriers to provision
of quality palliative care and strategies for overcoming them is critical.
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