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Displaying One Session

Channel 2 Proffered Paper session
Date
21.09.2020
Time
12:30 - 14:10
Room
Channel 2
Chairs
  • Stein Kaasa (Oslo, Norway)
  • Jayne E. Wood (London, United Kingdom)
Proffered Paper - Supportive and palliative care Proffered Paper session

LBA87 - A pragmatic cluster-randomized trial of ambulatory toxicity management in patients receiving adjuvant or neo-adjuvant chemotherapy for early stage breast cancer (AToM)

Presentation Number
LBA87
Lecture Time
12:30 - 12:42
Speakers
  • Monika K. Krzyzanowska (Toronto, Canada)
Room
Channel 2
Date
21.09.2020
Time
12:30 - 14:10

Abstract

Background

Emergency department visits and hospitalizations (EDH) are common during chemotherapy (CH). EDH may be preventable with adequate support between CH visits but large-scale evaluations of virtual supportive care are limited.

Methods

We undertook a pragmatic, cluster-randomized trial to examine the effectiveness of pro-active telephone management of toxicities in early stage breast cancer (BC) patients receiving CH at 20 cancer centres in Ontario, Canada. Centres were allocated using a covariate-constrained approach to standardized, nurse-led calls to assess common toxicities at 2 time points following each cycle (intervention), or routine care (control). Participants were all patients with stage I-III BC commencing adjuvant or neo-adjuvant CH at participating centres during the centre recruitment period. A subset of 25 patients from each centre completed patient-reported outcome questionnaires. Cluster-level mean number of EDH visits/patient during the entire CH course, was evaluated using healthcare administrative data. Secondary outcomes included toxicity (NCI PRO CTCAE), self-efficacy (Stanford) and quality of life (QoL; FACTB). Penetration was the percentage of patients who received the intervention at the 10 intervention sites.

Results

Baseline characteristics of participants, enrolled from 02/16-11/17, were similar in the intervention (n=944) and control groups (n=1214); 22% were older than 65. Most common regimens were AC-paclitaxel (44%) and FEC-docetaxel (26%). Penetration ranged from 50-86%; 47% of patients had at least one EDH during CT. Mean number of ED+H visits/patient was 0.91 (SD=0.40) in the intervention arm and 0.94 (SD=0.28) in the control arm (p=0.94). There were fewer patients with any grade 3 toxicity in the intervention arm (48% vs 58%, p=0.028), especially fatigue and aching muscles and joints. There was no difference in self-efficacy but patients in the intervention arm had smaller decline in the FACT-TOI during treatment (p=0.004).

Conclusions

Virtual pro-active toxicity management during CH did not lead to fewer EDH but was associated with less grade 3 toxicities and a smaller decline in QoL.

Clinical trial identification

NCT02485678.

Legal entity responsible for the study

Ontario Clinical Oncology Group.

Funding

Ontario Institute for Cancer Research.

Disclosure

M.K. Krzyzanowska: Advisory/ Consultancy, Research grant/Funding (institution): Eisai; Research grant/Funding (institution): Exelixis; Advisory/Consultancy: Bayer. All other authors have declared no conflicts of interest.

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Proffered Paper - Supportive and palliative care Proffered Paper session

1809O - TRheuMa registry provides real world data on rheumatic immune-related adverse events

Presentation Number
1809O
Lecture Time
12:42 - 12:54
Speakers
  • Karolina Benesova (Heidelberg, Germany)
Room
Channel 2
Date
21.09.2020
Time
12:30 - 14:10

Abstract

Background

Rheumatic immune-related adverse events (irAEs) are associated with better tumour response to immune checkpoint inhibitors (ICI). Research on this immunological intersection between malignancies and rheumatic and musculoskeletal diseases (RMDs) offers the opportunity for better patient centred care and scientific progress. A registry-based study is an ideal approach to obtain real world data on characteristics and optimal clinical management of rheumatic irAEs.

Methods

The TRheuMa registry is a prospective long-term observational study of a patient cohort suffering from rheumatic side effects of cancer therapies and is part of the large MalheuR project initiated in July 2018 at the University Hospital Heidelberg to explore interrelations of malignancies and RMDs.

Results

So far, 57 patients were recruited due to a rheumatic irAE under ICI treatment (nivolumab n=29, pembrolizumab n=26, ipilimumab n=11, PD-L1i n=4, combined ICI n=10). Of these, 45.6% had NSCLC and 40.4% melanoma. 15.8% experienced a flare of a pre-existing RMD, 7.0% an initial manifestation of a classical RMD. De novo irAEs mostly resembled phenotypes of rheumatoid arthritis (15.8%), polymyalgia rheumatica (14.0%) and spondyloarthritis (38.6%), but differed in laboratory findings with elevated CRP-levels in 73.7% (28.1% >50mg/l) and mostly autoantibody negativity. The majority (77.2%) showed signs of inflammation in ultrasound examination with mostly symmetrical (65.9%) synovialitis (72.7%) and/or tenosynovialitis (68.2%). We developed a severity-based treatment algorithm: in 54.4%, ≤10mg prednisone +/- NSAID were sufficient, 12.3% required add-on cs-/bDMARD. ICI-treatment was discontinued in 5 cases (8.8%). Complete remission of melanoma was observed in 39% of patients with irAE vs. 4% in a historical control without irAE. Additional irAEs were observed in 52.2% of melanoma and 15.4% of NSCLC patients.

Conclusions

Prospective real world data from the TRheuMa-registry show that rheumatic irAEs mostly resemble classical RMDs with some distinct characteristics. Our clinical management strategy was effective and underlines our patient centred approach. Future research agenda includes long-term observation of irAE and specifically oncological outcomes.

Legal entity responsible for the study

Karolina Benesova.

Funding

Has not received any funding.

Disclosure

K. Benesova: Research grant/Funding (self), \"Foundations and Awards” commission of the University of Heidelberg: University of Heidelberg; Honoraria (self), Research grant/Funding (institution), Travel/Accommodation/Expenses: AbbVie; Gilead; Novartis; Honoraria (self): Medac; MSD; Roche; Travel/Accommodation/Expenses: Mundipharma; Research grant/Funding (institution): Rheumaliga Baden-Württemberg e.V.; Honoraria (self), Travel/Accommodation/Expenses: Janssen; BMS; Pfizer; UCB. H-M. Lorenz:Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Abbvie; BMS; MSD; Pfizer; Celgene; Roche; Chugai; Medac; GSK; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Novartis; UCB; Janssen-Cilag; Astra Zeneca; Lilly; Research grant/Funding (institution): Baxter; SOBI; Biogen; Actelion; Mundipharma; Bayer Vital; Octapharm; Sanofi; Hexal; Thermo Fischer; Shire. J. Leipe: Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Pfizer; Novartis; Honoraria (self), Advisory/Consultancy: Abbvie; Astra Zeneca; BMS; Celgene; Hospira; Janssen-Cilag; Gilead; LEO Pharma; Lilly; MSD; Roche; Sanofi; UCB. J.C. Hassel: Honoraria (self), Research grant/Funding (institution), Travel/Accommodation/Expenses: BMS; Honoraria (self), Advisory/Consultancy: MDS; Honoraria (self): Roche; Novartis; Advisory/Consultancy, Travel/Accommodation/Expenses: Pierre Fabre. K. Jordan: Honoraria (self), Advisory/Consultancy: Amgen; Merck; MSD; Riemser; Helsinn; Tesaro; Kreussler; Voluntis; Pfizer; Pomme-med; Hexal. All other authors have declared no conflicts of interest.

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Proffered Paper - Supportive and palliative care Proffered Paper session

1568O - Quality of life in cancer patients treated with immune checkpoint inhibitors: A meta-analysis

Presentation Number
1568O
Lecture Time
12:54 - 13:06
Speakers
  • Brian D. Gonzalez (Tampa, United States of America)
Room
Channel 2
Date
21.09.2020
Time
12:30 - 14:10

Abstract

Background

Immune checkpoint inhibitors (ICIs) have transformed treatment of a variety of different cancer types. Published patient-reported quality of life (QOL) data have been largely limited to phase III trials. The size and heterogeneity of this literature can make patient education about ICIs difficult. The aim of this meta-analysis was to quantitatively summarize change QOL in patients receiving ICI for cancer.

Methods

Two meta-analyses were conducted on publications of PD-1/PD-L1 and/or CTLA-4 inhibitors that provided mean-level QOL using the EORTC QLQ-C30 and/or EQ-5D. One meta-analysis examined change in QOL in patients treated with ICIs from pre-treatment to follow-up approximately 12-24 weeks later. The second meta-analysis compared QOL at follow-up in ICI versus non-ICI regimens in randomized trials. Moderator analyses examined ICI regimen, comparator regimen, disease site, age, gender, follow-up period, and risk of bias.

Results

Of 20,323 publications identified, 26 met inclusion criteria. The first meta-analysis, encompassing 26 studies and 6,965 patients, indicated QOL did not change over time in patients treated with ICIs (P > .05). Significant moderators included ICI regimen, cancer type, sex, and risk of bias (P values <.05). In the second meta-analysis of 16 studies and 6,536 patients (ICI n=3,588, non-ICI n=2,948), better QOL was observed in ICI versus non-ICI regimens (P < .05). Significant moderators included ICI regimen, cancer type, age, and risk of bias (P values <.05).

Conclusions

This study is among the first to quantitatively summarize QOL in patients treated with ICIs. Findings suggest ICI recipients report overall stable QOL and better QOL than patients treated with non-ICI regimens. Results confirm that despite immune-related toxicities, ICIs are generally well-tolerated.

Legal entity responsible for the study

The authors.

Funding

National Cancer Institute grant K01 CA211789 (PI: Gonzalez).

Disclosure

B.D. Gonzalez: Advisory/Consultancy: Elly Health, SureMed Compliance. A.P. Dicker: Advisory/Consultancy: Roche, EMD Serono, Celldex, Janssen, Cybrexa, Self Care Catalysts, Oncohost, ThirdBridge, Noxopharm, Varian, Accordant, Moleculin. H.S.L. Jim: Advisory/Consultancy: RedHill BioPharma; Janssen Scientific Affairs, Merck. All other authors have declared no conflicts of interest.

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Proffered Paper - Supportive and palliative care Proffered Paper session

Invited Discussant LBA87, 1809O and 1568O

Lecture Time
13:06 - 13:16
Speakers
  • Marianne J. Hjermstad (Oslo, Norway)
Room
Channel 2
Date
21.09.2020
Time
12:30 - 14:10
Proffered Paper - Supportive and palliative care Proffered Paper session

Q&A and live discussion

Lecture Time
13:16 - 13:26
Speakers
  • Stein Kaasa (Oslo, Norway)
Room
Channel 2
Date
21.09.2020
Time
12:30 - 14:10
Proffered Paper - Supportive and palliative care Proffered Paper session

1810O - Impact of malnutrition according to the GLIM criteria in cancer patients admitted to hospital

Presentation Number
1810O
Lecture Time
13:26 - 13:38
Speakers
  • Martin Nunez Abad (Valencia, Spain)
Room
Channel 2
Date
21.09.2020
Time
12:30 - 14:10

Abstract

Background

Recently, the Global Leadership Initiative on Malnutrition (GLIM) criteria were proposed to standardize the diagnosis of malnutrition. We aim to determine the nutritional status and the prevalence of malnutrition in cancer inpatients as measured by GLIM criteria, and establish the association between malnutrition with the risk of nosocomial infections (NI) and length of hospital stay.

Methods

Prospective observational study carried out in patients admitted to Oncology Department of General University Hospital of Valencia from November 2019 to March 2020. Nutritional status was evaluated within the first 48 hours after admission. Fat free mass index (FFMI) and phase angle (PA) was measured using a bioelectrical impedance (Akern®), and muscle function using a Jamar® handgrip. Sarcopenia was measured using the cut-off values according to EWGSOP2.

Results

A total of 107 patients were evaluated (mean age 66 years, 66.4% males). Most patients (70.1%) had an advanced disease. On admission, 48 patients (44.9%) presented severe malnutrition and 19 (17.8%) moderate malnutrition based on GLIM criteria. In addition, 77 patients (72%) presented dynapenia and 18 patients (16.8%) sarcopenia. Other parameters of nutritional status were: mean weigh: 67.8 kg, mean BMI: 24 kg/m2, mean FFMI: 18.6 kg/m2 and mean PA: 4.5º. Mean length of stay was 13.9 days. During admission, 43 patients (40,2%) developed a NI, mostly respiratory tract infections (26 patients). Weigh, BMI and FFMI but not PA was significantly lower in patients who developed a NI (p<0.05 in all cases). The proportion of infections was higher in patients with severe malnutrition (25/48, 52.1%) and moderate malnutrition (8/19, 42.1%) as compared with patients with no malnutrition (10/40, 25%), (p=0,035). NI were more common in patients with sarcopenia (61.1% vs. 36%, p=0,044). Length of stay was longer in infected patients (18.6 vs 10.8 days, p<0,024) but was not related to nutritional status.

Conclusions

The prevalence of malnutrition in cancer inpatients is high. Malnutrition measured by GLIM criteria and sarcopenia are associated with a high risk of NI. An adequate nutritional evaluation is essential for a timely implementation nutritional support, to avoid malnutrition, sarcopenia and decrease NI.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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Proffered Paper - Supportive and palliative care Proffered Paper session

1504O - Relationship between sarcopenia and anthracycline related cardiotoxicity in patients with cancer

Presentation Number
1504O
Lecture Time
13:38 - 13:50
Speakers
  • Omer Dizdar (Ankara, Turkey)
Room
Channel 2
Date
21.09.2020
Time
12:30 - 14:10

Abstract

Background

sarcopenia is associated with poor prognosis and increased treatment toxicity in patients with cancer. However, there is limited data about sarcopenia and cardiotoxicity of chemotherapy. The aim of this study is to evaluate relationship between sarcopenia and anthracycline (AC) related cardiotoxicity.

Methods

Patients who received AC-based chemotherapy between 2014-2018, and had baseline abdominal CT containing both L3-L4 levels for measuring skeletal muscle index (L3-L4 SMI) and psoas muscle index (PMI), and baseline and follow-up echocardiography after AC treatment were included. Sex-specific cutoffs for L3 SMI, L4 SMI and PMI were used for diagnosis of sarcopenia. Cardiotoxicity was defined as development of either systolic dysfunction according to European society of Cardiology (ESC) ejection fraction (EF) criteria, or diastolic dysfunction according to American Society of Echocardiography (ASE) diastolic dysfunction criteria. Multivariate analysis was performed to determine potential predictors of cardiotoxicity.

Results

A total of 166 patients (75 male, 91 female) were included; 50 (30.1 %) with breast cancer, 82 (49.4 %) with lymphoma, 11 (6.6 %) with sarcoma and 23 (13.9%) with other cancers. Median age was 48 years and median doxorubicin dose was 238 mg/m2. Sarcopenia was determined in 33 (19.9 %) according to L3 SMI, in 17 (10.2 %) according to L4 SMI and in 45 (27.1 %) according to PMI. After AC treatment, 27 patients (16.3 %) developed cardiotoxicity; 17 (10.2 %) had systolic dysfunction, 9 (5.4%) had diastolic dysfunction and 1 (0.6 %) had both. After adjustment for age, gender, doxorubicin dose, body mass index, and presence of cardiovascular disease; sarcopenia at any of the three levels was significantly associated with increased risk of cardiotoxicity. (L3 SMI Hazard ratio [HR]= 4.14, 95% confidence interval [CI] 1.66-10.31, p=0.002; L4 SMI HR= 3.65, 95% CI 1.21-11.0, p=0.022; PMI HR= 4.39, 95% CI 1.81-10.65, p=0.001).

Conclusions

This is the first study demonstrating a significant association between CT-based diagnosis of sarcopenia and anthracycline-related cardiotoxicity. Routine CT scans may help clinicians identify high risk patients in whom closer follow-up or cardioprotective measures should be considered.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest..

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Proffered Paper - Supportive and palliative care Proffered Paper session

Invited Discussant 1810O and 1504O

Lecture Time
13:50 - 14:00
Speakers
  • Jayne E. Wood (London, United Kingdom)
Room
Channel 2
Date
21.09.2020
Time
12:30 - 14:10
Proffered Paper - Supportive and palliative care Proffered Paper session

Q&A and live discussion

Lecture Time
14:00 - 14:10
Speakers
  • Stein Kaasa (Oslo, Norway)
Room
Channel 2
Date
21.09.2020
Time
12:30 - 14:10