A. Del Giglio

Cancer-related fatigue: a practical review

Fatigue is an exceedingly common often treatable problem in cancer patients that profoundly affects all aspects of quality of life. Prevalence estimates have ranged from 50% to 90% of cancer patients overall. After addressing reversible or treatable contributing factors, such as hypothyroidism, anemia, sleep disturbance, pain, emotional distress, climacterium, medication adverse events, metabolic disturbances, or organ dysfunction such as heart failure, myopathy, and pulmonary fibrosis, patients may be screened with a brief fatigue self-assessment tool. All cancer patients should be screened regularly for fatigue. Those with moderate or severe fatigue may benefit from both pharmacologic and nonpharmacologic interventions, while mild fatigue that does not interfere with quality of life can be treated with nonpharmacologic measures alone. Physicians often have insufficient knowledge about fatigue and its treatments or underestimate the impact of fatigue on quality of life, while patients may consider it an unavoidable and untreatable side-effect and fear that reporting it may incite a change toward less aggressive cancer treatment. A practical review may therefore be useful to health care professionals in order to avoid the common barriers to its treatment that exist on the sides of both physicians and patients.

Drug interactions in oncology: how common are they?

BACKGROUND Drug-drug interactions (DDIs) comprise an important problem in medical oncology practice. We systematically reviewed the frequency of DDIs in oncology. METHODS We searched PubMed for eligible articles and on-line databases for abstracts of major oncology meetings. RESULTS Eight studies reported on the frequency of DDIs: six evaluated the frequency of potential DDIs, while two studies reported on real DDIs, i.e. interactions that had clinical consequences. Studies of potential DDIs found that approximately one-third of patients are exposed to dangerous drug doublets, with the most common ones involving warfarin and anticonvulsants. One study of real DDIs found that 2% of hospitalized cancer patients had a DDI as the cause of admission. CONCLUSIONS Drug interactions comprise an important issue in oncology, with approximately one-third of ambulatory cancer patients being at risk of DDIs. Data are limited on the clinical consequences of drug interactions among cancer patients.

638PMOLECULAR MARKER ANALYSES OF EGFR AND KRAS FROM THE RANDOMIZED PHASE II STUDY OF NIMOTUZUMAB IN LOCALLY ADVANCED ESOPHAGEAL CANCER (NICE TRIAL)

ABSTRACT Aim: NICE trial showed that combination of chemoradiation and nimotuzumab, a humanized antibody against EGFR, is safe and appears to increase the combined complete response (cCR) rate, defined as endoscopic and/or pathologic CR, in pts with locally advanced esophageal cancer (ASCO 2014). Here we present the results of the exploratory analyses of molecular markers and their correlation to clinical outcomes. Methods: Tumor samples were obtained before chemoradiation with or without nimotuzumab. All samples were formalin-fixed and paraffin-embedded. Tumor areas were selected and macrodissected, followed by whole DNA extraction and amplification by PCR. Mutations and single nucleotide polymorphisms (SNPs) were searched in codons 12 and 13 of exon 2 for KRAS, and exons 18 to 24 for EGFR through DNA sequencing by Sangeŕs methodology. Fishers exact test was used to compare groups. Results: Molecular analyses were performed in tumor samples from 51 of the 107 randomized patients, 18 from the control arm (chemoradiation) and 37 from the experimental arm (chemoradiation plus nimotuzumab). No mutations or SNPs were identified in KRAS among the 48 samples analyzed. Indeed, no mutations were found in EGFR, but some SNPs were identified. Except for exon 21, for all other sequenced exons at least one patient had one SNP identified, more frequently in exons 20 and 23. SNPs identified in exon 20 included 167339G > A (rs10251977) and 167339G > A (rs1050171). The latter was the most frequent detected SNP and it was identified in 11 patients (3 in the control group and 8 in the nimotuzumab group). Within each treatment arm, the cCR rates were similar between patients whose tumors harboring or not the SNP rs1050171. Although not statistically significant (P = 0.074), in the nimotuzumab group, cCR rate of tumors harboring rs1050171 was nominally higher than the rate observed for tumors without this SNP (87.5% [7/8] vs. 42.9% [6/14]). Conclusions: No mutations were found in KRAS or EGFR. Several EGFR SNPs were identified, being rs1050171 in exon 20 the most frequently found. Although exploratory, these results suggest an association between response to nimotuzumab and tumor biologic characteristics. Further exploration of this hypothesis is planned in a phase III trial. Disclosure: L.P.D.G. Neusquen: Clinical Research Department of Eurofarma S.A. All other authors have declared no conflicts of interest.

Burden in caregivers of patients with cancer.

e19707 Background: Families and informal caregivers experience substantial psychological distress and fatigue. Their vital role play in supporting cancer patients is well recognized, but the burden and economic impact on these caregivers is poorly understood. We aimed at evaluating the prevalence of burden on informal caregivers of cancer patients and to relate possible predictors facing patients health and the information received concerning the disease and the proposed treatment for the patient. METHODS We examined 120 informal caregivers of patients with cancer in ABC Foundation School of Medicine affiliated service to answer to questionnaires of depression (The Hospital Anxiety and Depression Scale), fatigue (The Chalders Fatigue Scale) and Burden (the Zarit Burden Inventory). We also evaluated the quality of the clinical information conveyed to these families. Caregiver and patient sociodemographic data were collected. RESULTS Most of the caregivers were female; a half of caregivers showed from moderate to severe burden and has to diminish their job. There was a significant correlation between burden and depression (p <0.001, correlation coefficient = 0, 521) and fatigue (p <0.001, correlation coefficient = 0.520). Palliative care exclusively had significant association with both depression (p=0.002) and fatigue (p=0.022). Regression analysis showed that interference in their daily actives was a determinant of burden (OR 7.76; CI 2.79 - 21.5) as well as presence of physical fatigue (OR 2.96; CI 1.18-7.87). We also found that disagreement between caregiver and physician regarding the treatment was a determinant of dissatisfaction (OR 11.8; CI 1.48-94.6). CONCLUSIONS The change of daily activities of informal caregivers with restriction of their previous activities and incorporation of new tasks can cause fatigue and depression. Enhancing agreement regarding the proposed treatment and clarity of the diagnostic information may improve caregivers satisfaction.

A systematic review and meta-analysis of bone metabolism in prostate adenocarcinoma.

e15149 Background: Osteoporosis could be associated with the hormone therapy for metastatic prostate carcinoma (PCa) and with PCa per se. The objective of the study is to clarify the relationship of prostate cancer and/or androgen deprivation therapy (ADT) with osteoporosis. Methods: The Medline, Embase, Cancerlit, and American Society of Clinical Oncology Abstract databases were searched for published studies on prostate cancer and bone metabolism. The outcomes assessed were: fracture, osteoporosis and osteopenia. Results: Thirty-one articles (78,753 participants) were included in the meta-analysis. PCa patients under ADT had a higher risk of osteoporosis (RR, 1.30; p < 0.00001) and a higher risk of fractures (RR, 1.10; p < 0.00001) as compared to patients not under ADT. The total bone mineral density was lower in patients under ADT when compared with patients not under ADT (p = 0.031) but it was similar to bone mineral density found in healthy controls (p = 0.895). The time of androgen deprivation thera...

Bupropion improves sexual function in women diagnosed with breast cancer? A pilot study in this population

8058 Background: Sexual morbidity after chemotherapy and hormonal therapy for breast cancer is an important problem that can negatively affect women’s quality of life. Bupropion is an antidepressant that appears to increase libido. Methods: We performed a pilot study using Bupropion in breast cancer patients that received adjuvant chemotherapy and were currently in use of hormonal therapy diagnosed with sexual dysfunction using the Arizona Sexual Experience Scale (ASEX), validated in Portuguese. This scale contains five questions that evaluate sexual function in the following areas: libido, excitability and hability to reach orgasm. The scale is coded, for each item as 1 (normal) to 6 (totally absent). Women received oral Bupropion 150mg/ daily for eight weeks and the ASEX, Beck’s Depression and the EORTC Q30 scales were applied prior to initiation of the study and on weeks 4 and 8. Results: Eight pacients were included in the study. The mean age was 49,75 +/- 3,95. Seventy five percent were married and 2...