Giulia Baciarello

Predicting and preventing thromboembolic events in patients receiving cisplatin-based chemotherapy for germ cell tumours

BACKGROUNDnPatients with germ cell tumours (GCT) receiving cisplatin-based chemotherapy are at high risk of thromboembolic events (TEE). Previously, we identified serum lactate dehydrogenase (LDH) and body surface area (BSA) as independent predictive factors for TEE. The aim of this study was to validate these predictive factors and to assess the impact of thromboembolism prophylaxis in patients at risk of deep venous thrombosis (DVT).nnnMETHODSnBetween 2001 and 2014, 295 patients received first-line cisplatin-based chemotherapy for GCT. Preventive anticoagulation with low-molecular-weight heparin (LMWH) was progressively implemented in patients with predictive factors. Sixteen patients with evidence of TEE before starting chemotherapy were excluded from the analysis.nnnRESULTSnAmong 279 eligible patients, a TEE occurred in 38 (14%) consisting of DVT (nxa0=xa026), arterial thrombosis (nxa0=xa02), and superficial thrombophlebitisxa0(nxa0=xa010). DVT occurred in 26 (12.7%) of 204 patients with risk factors versus two (2.6%) of 75 patients with no risk factors (pxa0=xa00.01). After a prevention protocol was progressively implemented from 2005, primary thromboprophylaxis was administered to 104 patients (68%) with risk factors. Among patients at risk (nxa0=xa0151), the incidence of DVT decreased by roughly half when they received a LMWH: 9/97 (9.2%) and 9/54 (16.6%), respectively (pxa0=xa00.23).nnnCONCLUSIONnPatients with GCT who receive cisplatin-based chemotherapy are at risk of developing a TEE which can be predicted by elevated serum LDH. To our knowledge this is the first study exploring LMWH as thromboprophylaxis in GCT patients. A prospective trial testing prophylactic anticoagulation is warranted.

796PEARLY PSA RESPONSE IS AN INDEPENDENT PROGNOSTIC FACTOR IN PATIENTS WITH MCRPC TREATED WITH NEXT-GENERATION ANDROGEN PATHWAY INHIBITORS

ABSTRACT Aim: To determine the clinical significance of early PSA response during the first 4 weeks of therapy with next-generation androgen pathway inhibitors (enzalutamide, abiraterone acetate [AA], TAK-700) for metastatic castration-resistance prostate cancer (mCRPC). Methods: Data from patients prospectively recruited in clinical trials were studied. PSA values were obtained at baseline and 28 days (+/- 7d) after treatment initiation. PSA response defined as a decline > 50% from baseline was calculated according to PCWG2 (Scher et al, 2008). The effects of patient, tumor, and treatment characteristics on progression-free survival (PFS) and overall survival (OS) were examined using the Cox model. An independent cohort of patients treated with AA was used as validation population. Results: Early PSA response (EPR) was assessed in 118 patients treated with enzalutamide (AFFIRM and PREVAIL studies), AA (COU-AA-301 and 302 studies) and TAK-700 (C21004 and C21005 study). EPR was associated with longer PFS and OS (P Conclusions: Early PSA response is an independent prognostic factor in patients with mCRPC treated with next-generation androgen pathway inhibitors and may be useful for the therapeutic management of these patients. Disclosure: C. Massard: Consultant for Astellas Lectures for Sanofi, Astellas, Janssen; L. Albiges Sauvin: Advisory board Sanofi; K. Fizazi: Consultant Lectures for si, Astellas, Janssen, Takeda; Y. Loriot: Grant from Sanofi, Astelllas, Consultant for Astellas, Sanofi, Sellgene Lectures for Sanofi, Astellas, Janssen. All other authors have declared no conflicts of interest.

Treatment of Castration-naive Metastatic Prostate Cancer

Both docetaxel+androgen deprivation therapy (ADT) and abiraterone acetate 1000mg/d+prednisone/prednisolone 5mg/d+ADT improved survival in patients with metastatic castration-naive prostate cancer. Their use should be offered and guided by patients own characteristics.