Patricia Taranto

Gabapentin for the prevention of chemotherapy- induced nausea and vomiting: a pilot study

INTRODUCTION Chemotherapy-induced nausea and vomiting (CINV) is a distressing side effect that affects many patients undergoing emetogenic chemotherapy, despite the use of antiemetic medications. The purpose of this trial was to evaluate the efficacy and safety of gabapentin for the prevention of CINV during the first cycle of treatment in patients receiving moderately or highly emetogenic chemotherapy. METHODS Eighty chemotherapy-naive patients, scheduled to receive moderately and highly emetogenic chemotherapy, were enrolled in this randomised, double-blind, placebo-controlled clinical trial. All patients received intravenous ondansetron 8 mg, dexamethasone 10 mg and ranitidine 50 mg before chemotherapy on day 1 and oral dexamethasone 4 mg twice a day on days 2 and 3. Patients were randomly assigned to take gabapentin 300 mg or placebo on the following schedule: 5 and 4 days before chemotherapy once daily, 3 and 2 days before chemotherapy twice daily, 1 day before to 5 days after chemotherapy thrice daily. The primary endpoint was complete overall protection from both vomiting and nausea over the course of the entire study (day 1 through day 5), and complete protection during the delayed period (24-120 h after chemotherapy). RESULTS The proportion of patients achieving complete response improved from 40% to 62.5%, (p = 0.04) when comparing the control group and the gabapentin group, respectively. In the subset of patients who achieved complete control in the acute phase, the percentage of patients who achieved delayed complete control was higher in the gabapentin group (89.3 × 60.7%, p = 0.01). Adverse events did not significantly differ between study arms. CONCLUSIONS Gabapentin is a low-cost strategy to improve complete control of CINV, specially delayed CINV control.

Desempenho profissional ou doméstico das pacientes em quimioterapia para câncer de mama

OBJECTIVES: Evaluate patients with breast cancer undergoing chemotherapy with respect to their epidemiologic and clinical variables as well as performance at work or at home. METHODS: this was a cross-sectional study including 52 women interviewed during breast cancer chemotherapy, stratified in two groups: those who continued to work and do household tasks, and did not continue to work or do household tasks. Patients were from two public hospitals in the State of Sao Paulo, one in Santo Andre and the other in Sao Bernardo do Campo. The WPAI - GH (Work Productivity and Activity Impairment) questionnaire was used to evaluate work and household performance of professionals or housewives, respectively. RESULTS: Mean age of the patients was 55.7 (SD=13.8), most were Caucasian (88.5%), married (55.8%), employed (65.3%) and the majority had to stop working because of treatment (51.0%), at more advanced stage (p<0.05), fatigue and nausea (p<0.05). Mean WPAI - GH was 67.04 (|SD = 5.62) for patients who stopped working and 49.17 (SD = 6.89) for those who continued to work (Mann-Whitney U test: p = 0.04). CONCLUSION: Chemotherapy leads to a decrease in performance of a sizable fraction of women with breast cancer undergoing chemotherapy. A more advanced stage of neoplasia was positively associated with withdrawal from these activities probably due to side effects such as fatigue and nausea.

Does Time-to-Chemotherapy Impact the Outcomes of Resected Ovarian Cancer? Meta-analysis of Randomized and Observational Data

Objectives This study is a meta-analysis of prior publications evaluating the impact of time-to-chemotherapy (TTC) on disease recurrence and survival 3 years after the original surgery. Methods We performed a meta-analysis of studies published in PubMed (1950–2016) as of April 2016. Inclusion criteria were as follows: randomized controlled trials and prospective or retrospective cohorts that included patients with ovarian cancer who had undergone surgery with curative intent and use of adjuvant chemotherapy. We compared rates of disease recurrence and death according to the TTC (“early” vs “delayed”) using a random-effects model and performed a metaregression to evaluate the impact of covariates on these outcomes. Results Of 239 abstracts in the original search, 12 were considered eligible. The cutoffs used for TTC were between 20 and 40 days. All studies used a platinum-based chemotherapy, and the rates of patients with suboptimal resection varied from 33% to 70%. A longer TTC was not associated with higher rates of disease recurrence (odds ratio, 0.89; 95% confidence interval, 0.63–1.24) or death at 3 years (odds ratio, 1.06; 95% confidence interval, 0.9–1.24). There was no evidence of significant publication bias (Egger test P = 0.472), but data were heterogeneous (I2 = 64.3%). Metaregression showed that the percentage of patients with suboptimal surgery and values used as cutoff to define “delayed” chemotherapy combined were a significant source of bias (residual I2 = 0%). Conclusions In our analysis, TTC after surgery for ovarian cancer with curative intent was not associated with higher risk of disease recurrence or death. However, this association was influenced by the rate of optimal debulking and definition of “late” initiation of chemotherapy, so we must be careful when applying these data to patients with complete resection.

Sustained Viral Response to Ipilimumab Treatment in a Patient with HCV Chronic Infection and Metastatic Melanoma: A Case Report

The treatment of metastic melanoma has rapidly evolved in the last 5 years, giving clinicians and patients the hope for long lasting responses. In the field of modern immunotherapy, we are reaching the point of an expressive percentage of patients achieving long term survival with anti-CTLA4 and anti-PD1 checkpoint inhibitors. Of note, there is a considerable amount of patients excluded from the checkpoint blockade trials because of comorbidities like chronic viral infections. A precaution to avoid autoimmune induced hepatitis rendered HBV (hepatitis B virus) and HCV (hepatitis C virus) infected patients usually ineligible, but real life data in those patients, who are getting treatment despite of that, is pointing toward the feasibility and safety of immunotherapy in this context. To ilustrate that, we report the case of a metastatic non-BRAF mutated melanoma patient with HCV chronic infection and a surprising benefit derived from ipilimumab and pembrolizumab for his latter condition.

Pancreatic Cancer with Normal CA 19-9 and Lewis Antigen Negative—Case Report

Pancreatic cancer is an aggressive and lethal disease that affects especially older population. Its more relevant tumor marker is CA 19-9 (carbohydrate antigen 19-9), although it can be elevated in others clinical situations, like cholangitis and cholestasis. Otherwise, a small people subset, like our patient, do not produce this tumor marker, as on blood as in the tumor, because they are incapable to express the Lewis Antigen. Therefore, this case report is about a patient without Lewis Antigen express and CA 19-9 low levels. We will report a rapid disease progression, despite of low CA 19-9, comparing with available data that often show better prognosis in this setting. Conclusion: Low levels of CA 19-9 do not predict good response or better prognosis in patients that do not express Lewis Antigen.

Experience with palliative sedation (PS) in an inpatient oncology setting.

63 Background: Palliative sedation (PS) is an intervention to treat refractory symptoms and to relieve suffering at the end of life. Its prevalence and practice patterns vary widely. METHODS This is a retrospective study of the use of PS in cancer patients who died at our comprehensive cancer center between March 1, 2012 and December 31, 2014. PS was defined as the use of continuous infusion of midazolam or neuroleptics for refractory symptoms as stated in the progress notes. Patients who died in the ICU were excluded. The aim of our study was to evaluate PS practice patterns, describing its frequency, clinical indications and outcomes. RESULTS During the study period, 556 cancer patients died at the institution and 203 (36.5%) received PS. Main reasons for exclusion were death in the ICU (168 patients) and no use of midazolam or neuroleptics (77 patients). Patients who received PS as compared to those not sedated were younger (67.8 vs. 71.5 years-old, p = 0.007) and more likely to have a primary diagnosis of lung cancer (23% vs. 15% p < 0.001). Patients receiving PS were more likely to be seen by oncology/hematology rather than other specialties (70% vs 45% p < 0.001) and more likely to have a longer hospital stay from admission to death (47.9 days vs 26.2 days p < 0.001). Only 25 patients (12%) were seen by a dedicated palliative care team. The most common indications for sedation were dyspnea (51.5%) and delirium (19.5%) and the most common dugs used were midazolam (52.9%) or midazolam and a neuroleptic (39.2%). Median initial midazolam infusion rate was 0.75 mg/h (interquartile range - IQR - 0.6-1.5) and final rate was 1.5 mg/h (IQR 0.9-3.0). Median time from sedation to death was 27 hours (IQR 12-58). CONCLUSIONS Palliative sedation is a common practice at our hospital and it is not associated with shortening of hospital stay. Further research is needed to identify factors that may affect the frequency and outcomes associated with palliative sedation.