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1578 Resting energy expenditure (REE) for risk assessment of anticancer treatments: A prospective study in 277 cancer patients
S230 97% of the participants in both groups rated >1 PAC-SYM symptom as >“moderate” in intensity. Mean EQ-5D visual analog scale score was 54.4±16.3 for CA and 50.4±21.5 for NC. Mean PAC-QOL scores were similar for the 2 groups: 1.2±1.1 (Psychosocial Discomfort), 1.7±1.0 (Physical Discomfort), and 1.9±1.1 (Worries and Concerns) for CA; 1.3±0.9, 1.9±0.9, and 1.8±0.9, respectively, for NC. The rate of sufficient laxative use was 71% for CA and 48% in NC; insufficient laxative use (<4 times, but 1 time) was 7% and 25%, respectively, and non-laxative use was 23% and 27%, respectively. 1xLIR was 96% for CA and 93% for NC. More than 50% of CA and 25% of NC using prescription laxatives reported no/slight relief. Conclusion: OIC is an unmet need for cancer and non-cancer pain patients. Patients with cancer pain commonly experience burdensome constipation symptoms that compromise their pain management. Despite CA being more likely to proactively treat their OIC using sufficient laxatives as compared to patients with non-cancer pain, both patient groups still have high inadequate relief from available laxatives. Conflict of interest: Corporate-sponsored Research: This study was funded by AstraZeneca Pharmaceuticals. Other Substantive Relationships: Mary Kay Margolis and Karin Coyne are employees of Evidera and were paid scientific consultants to AstraZeneca in connection with the Burden of Opioid-Induced Constipation among Patients with Cancer Pain and Patients with Non-cancer Pain study. 1577 POSTER Adult obesity population does not show stronger myelosuppression in Japanese gynecological cancer patients K. Kamimura1,2 , M. Moriyama2 , Y. Matsumoto2 , K. Shu2 , Y. Saijo2 . 1 Saiseikai Niigata Daini Hospital, Pharmacy, Niigata, Japan; 2 Niigata University Graduate School of Medical and Dental Sciences, Medical Oncology, Niigata, Japan Background: American Society of Clinical Oncology (ASCO) provides clinical practice guideline for appropriate cytotoxic chemotherapy dosing for obese adult patients with cancer. The panel recommends that actual body weight should be used when selecting cytotoxic chemotherapy doses regardless of obesity status. However, there has been no report about cytotoxic chemotherapy dose for obese Japanese cancer patient. Patients and Methods: We have collected data from the 92 gynecological cancer patients who were treated with paclitaxel/carboplatin and similar regimen in Niigata University Medical and Dental Hospital from July, 2008 to April, 2014. The collected data included the body surface area (BSA), body mass index (BMI), chemotherapy doses, and peripheral blood counts after chemotherapy. Patients were divided into three groups depend on BMI as obese (BMI 25), normal (BMI 18.5–24.9), and underweight (BMI <18.5). We analyzed the rate of grade3/4 (NCI CTCAE v4.0) leukopenia, neutropenia, thrombocytopenia, anemia in each BMI group. Results: The rate of dose reduction was not significantly different among three groups. In an obese group, grade3/4 neutropenia was lower than normal and underweight group (obese 37.5%, normal 47.4%, underweight 70.6%). An obese group was statistically significant lower leukopenia rates than underweight group (obese 0% vs underweight 64.7%; p < 0.01). The rates of grade3/4 thrombocytopenia and anemia in the obese group were not significantly different in comparison with normal and underweight group. The neutrophil counts in nadirs were not significantly different among three groups (median neutrophil count; obese 1210, normal 1081, underweight 670). There were statistically significant high number of leukocyte and hemoglobin in nadirs in obese group than underweight group (leukocytes, p < 0.01, hemoglobin, p < 0.017). There were statistically significant high number of platelet in nadirs in obese group than normal group (p < 0.017). Between the BMI and the nadirs of leukocytes, neutrophils, platelets, hemoglobin show the significant direct correlation (leukocytes, r = 0.474, neutrophils, rs = 0.374, platelets, r = 0.329, hemoglobin, rs = 0.402). Conclusions: The cytotoxic chemotherapy dose calculation of the actual body weight was feasible and safe in the Japanese obese patient. In the cytotoxic chemotherapy dose calculated by the actual body weight, the myelosuppression was mild in the obese group, but strong in the underweight group. We suggest the cytotoxic chemotherapy dose calculation of the actual body weight should be applied for the obese patient, and should be avoid the unnecessary dose reduction. No conflict of interest.
Abstracts 1578 POSTER Resting energy expenditure (REE) for risk assessment of anticancer treatments: A prospective study in 277 cancer patients A. Jouinot1 , C. Vazeille1 , J.P. Durand1 , N. Neveux2 , A. Cessot1 , P. Boudou-Rouquette1 , J. Giroux1 , I. Gataa1 , S. Bellanger1 , J. Alexandre1 , L. Cynober2 , F. Goldwasser1 . 1 Paris Descartes University, Cochin − Port Royal Hospital, AP-HP, Medical Oncology, Paris, France; 2 Paris Descartes University, Cochin − Port Royal Hospital, AP-HP, Clinical Biochemistry, Paris, France Background: Alterations of performance status (PS) and nutritional status are associated with high risk of acute toxicity following anticancer treatment. REE is the amount of energy expended in 24 hours at rest. REE is often increased in cancer patients and may lead to the alteration of nutritional status up to cachexia. We studied whether abnormal energy metabolism could predict early acute toxicity (EAT). Material and Methods: In this prospective observational monocentric study, REE was measured by indirect calorimetry before anticancer treatment initiation. Measured REE was compared with predicted REE as defined by the Harris-Benedict formula. Patients (pts) were classified as hypometabolic (REE <90%), normometabolic (90–110%) or hypermetabolic (>110%). We measured body mass index (BMI), weight loss, PS, C-Reactive Protein (CRP), albumin and calculated Nutritional Risk Index (NRI, based on albumin and weight loss). Toxicity was assessed after the first cycle of treatment. An EAT was defined as any event leading to unplanned hospital admission, dose reduction, treatment delay (>7 days) or discontinuation. Results: A total of 277 pts were included: 56% male, median age 63 years (20−91), 76% had locally advanced or metastatic disease, 89% received chemotherapy and 11% received targeted therapy; 29% were normo-, 51% hyper and 20% hypometabolic. Compared to normometabolic pts, hyper- and hypometabolic pts showed altered PS (PS > 2: 34% and 33% vs 17%, p = 0.022) and higher systemic inflammation (CRP 10mg/l: 45% and 40% vs 25%, p = 0.004). There were more pts at risk of complications in the hypermetabolic group (NRI <97.5: 35% vs 20% and 19%, p = 0.012). A subset of 59 pts (21%) experienced an EAT. The EAT occurrence was associated with poor PS (2−3 vs 0−1: OR = 2.04 [1.12–3.73], p = 0.029), low albumin (<35 vs 35 g/l: OR = 2.39 [1.03–5.54], p = 0.048), inflammation (CRP 10 vs <10 mg/l: OR = 2.43 [1.35–4.37], p = 0.004) and abnormal REE (abnormal vs normal: OR = 2.36 [1.13–4.95], p = 0.023). In multivariate analysis, elevated CRP was an independent predictor of EAT (p = 0.047). The REE demonstrated higher sensitivity (83%) than CRP (55%), PS (41%) and albumin (17%) to predict EAT. Conclusions: Abnormal energy metabolism correlates with clinical and biological markers of precachexia. Pts with abnormal REE experience more early acute toxicity. The measurement of REE might improve the identification of patients at risk for toxicity and missed with the standard clinical evaluation. Conflict of interest: Ownership: Citrage. Advisory Board: Fresenius Kabi, Baxter International, MSD Oncology, Bayer, Boehringer Ingelheim. Board of Directors: none. Corporate-sponsored Research: Nestle USA, Bayer. Other Substantive Relationships: Amgen Research Munich GmbH, Sandoz Biopharmaceuticals, Roche Pharma AG, Novartis Healthcare A/S, Merck Co., Inc., PharmaMar, Janssen, Sanofi, Asia & Emerging Markets Innovative Medicine of AstraZeneca R&D. 1579 POSTER Efficacy and safety of olanzapine combined with aprepitant, palonosetron, and dexamethasone for preventing nausea and vomiting induced by cisplatin-based chemotherapy in gynecological cancer: Comparison of two prospective phase II trials M. Abe1 , N. Takeshima2 , M. Matoda2 , Y. Hirashima1 , M. Takekuma1 , N. Takahashi1 , A. Tanaka1 , S. Kuji1 , N. Kado1 , Y. Kasamatsu1 , H. Itamochi3 , K. Furuya4 , Y. Ichikawa5 , K. Kai6 , Y. Itonaga6 , T. Hirakawa6 , K. Nasu6 , K. Miyagi7 , J. Murakami7 , K. Ito7 . 1 Shizuoka Cancer Center, Gynecology, Sunto-gun, Shizuoka, Japan; 2 Cancer Institute Hospital, Gynecology, Tokyo, Japan; 3 Tottori University, School of Medicine, Gynecology, Yonago, Japan; 4 National Defense Medical College, Gynecology, Tokorozawa, Japan; 5 Japanese Red Cross Shizuoka Hospital, Gynecology, Shizuoka, Japan; 6 Faculty of Medicine, Oita University, Gynecology, Yufu-City, Japan; 7 Kansai Rousai Hospital, Gynecology, Amagasaki, Japan Background: Although olanzapine is effective in chemotherapy-induced nausea and vomiting (CINV), its preventive effects with triplet therapy (palonosetron, aprepitant, and dexamethasone) for CINV are unknown.
Abstracts 1578 POSTER Resting energy expenditure (REE) for risk assessment of anticancer treatments: A prospective study in 277 cancer patients A. Jouinot1 , C. Vazeille1 , J.P. Durand1 , N. Neveux2 , A. Cessot1 , P. Boudou-Rouquette1 , J. Giroux1 , I. Gataa1 , S. Bellanger1 , J. Alexandre1 , L. Cynober2 , F. Goldwasser1 . 1 Paris Descartes University, Cochin − Port Royal Hospital, AP-HP, Medical Oncology, Paris, France; 2 Paris Descartes University, Cochin − Port Royal Hospital, AP-HP, Clinical Biochemistry, Paris, France Background: Alterations of performance status (PS) and nutritional status are associated with high risk of acute toxicity following anticancer treatment. REE is the amount of energy expended in 24 hours at rest. REE is often increased in cancer patients and may lead to the alteration of nutritional status up to cachexia. We studied whether abnormal energy metabolism could predict early acute toxicity (EAT). Material and Methods: In this prospective observational monocentric study, REE was measured by indirect calorimetry before anticancer treatment initiation. Measured REE was compared with predicted REE as defined by the Harris-Benedict formula. Patients (pts) were classified as hypometabolic (REE <90%), normometabolic (90–110%) or hypermetabolic (>110%). We measured body mass index (BMI), weight loss, PS, C-Reactive Protein (CRP), albumin and calculated Nutritional Risk Index (NRI, based on albumin and weight loss). Toxicity was assessed after the first cycle of treatment. An EAT was defined as any event leading to unplanned hospital admission, dose reduction, treatment delay (>7 days) or discontinuation. Results: A total of 277 pts were included: 56% male, median age 63 years (20−91), 76% had locally advanced or metastatic disease, 89% received chemotherapy and 11% received targeted therapy; 29% were normo-, 51% hyper and 20% hypometabolic. Compared to normometabolic pts, hyper- and hypometabolic pts showed altered PS (PS > 2: 34% and 33% vs 17%, p = 0.022) and higher systemic inflammation (CRP 10mg/l: 45% and 40% vs 25%, p = 0.004). There were more pts at risk of complications in the hypermetabolic group (NRI <97.5: 35% vs 20% and 19%, p = 0.012). A subset of 59 pts (21%) experienced an EAT. The EAT occurrence was associated with poor PS (2−3 vs 0−1: OR = 2.04 [1.12–3.73], p = 0.029), low albumin (<35 vs 35 g/l: OR = 2.39 [1.03–5.54], p = 0.048), inflammation (CRP 10 vs <10 mg/l: OR = 2.43 [1.35–4.37], p = 0.004) and abnormal REE (abnormal vs normal: OR = 2.36 [1.13–4.95], p = 0.023). In multivariate analysis, elevated CRP was an independent predictor of EAT (p = 0.047). The REE demonstrated higher sensitivity (83%) than CRP (55%), PS (41%) and albumin (17%) to predict EAT. Conclusions: Abnormal energy metabolism correlates with clinical and biological markers of precachexia. Pts with abnormal REE experience more early acute toxicity. The measurement of REE might improve the identification of patients at risk for toxicity and missed with the standard clinical evaluation. Conflict of interest: Ownership: Citrage. Advisory Board: Fresenius Kabi, Baxter International, MSD Oncology, Bayer, Boehringer Ingelheim. Board of Directors: none. Corporate-sponsored Research: Nestle USA, Bayer. Other Substantive Relationships: Amgen Research Munich GmbH, Sandoz Biopharmaceuticals, Roche Pharma AG, Novartis Healthcare A/S, Merck Co., Inc., PharmaMar, Janssen, Sanofi, Asia & Emerging Markets Innovative Medicine of AstraZeneca R&D. 1579 POSTER Efficacy and safety of olanzapine combined with aprepitant, palonosetron, and dexamethasone for preventing nausea and vomiting induced by cisplatin-based chemotherapy in gynecological cancer: Comparison of two prospective phase II trials M. Abe1 , N. Takeshima2 , M. Matoda2 , Y. Hirashima1 , M. Takekuma1 , N. Takahashi1 , A. Tanaka1 , S. Kuji1 , N. Kado1 , Y. Kasamatsu1 , H. Itamochi3 , K. Furuya4 , Y. Ichikawa5 , K. Kai6 , Y. Itonaga6 , T. Hirakawa6 , K. Nasu6 , K. Miyagi7 , J. Murakami7 , K. Ito7 . 1 Shizuoka Cancer Center, Gynecology, Sunto-gun, Shizuoka, Japan; 2 Cancer Institute Hospital, Gynecology, Tokyo, Japan; 3 Tottori University, School of Medicine, Gynecology, Yonago, Japan; 4 National Defense Medical College, Gynecology, Tokorozawa, Japan; 5 Japanese Red Cross Shizuoka Hospital, Gynecology, Shizuoka, Japan; 6 Faculty of Medicine, Oita University, Gynecology, Yufu-City, Japan; 7 Kansai Rousai Hospital, Gynecology, Amagasaki, Japan Background: Although olanzapine is effective in chemotherapy-induced nausea and vomiting (CINV), its preventive effects with triplet therapy (palonosetron, aprepitant, and dexamethasone) for CINV are unknown.