Abstract 358P
Background
Capecitabine (CapX) monotherapy is often employed as a second/third line regimen for various malignancies in the metastatic setting. The use of radical doses of CapX in the palliative setting entails severe toxicities which makes it incompatible with the principles of palliative care. It was a local policy to offer each patient eligible for palliative CapX monotherapy the choice of a standard dose (StD) approach (1-1.25g/m2 bid on Days 1-14 of a 21 day cycle) or a continuous low dose (CLD) approach (0.5g bid daily without a break). Patients were provided information about each regimen's toxicity and efficacy. We recognized a unique retrospective opportunity to compare StD versus CLD.
Methods
After alteast one prior line of chemotherapy, 52 & 44 patients had received CapX monotherapy with StD & CLD, respectively between march 2013 & August 2016 for metastatic malignancies of the gall bladder, pancreas and stomach. Differences in toxicities/discontinuations were assessed by the Fisher Exact Test. For each patient, the date of initiation of CapX, the date of progression and the date of death were noted. The differences in survival outcomes between the two groups was assessed by the Mann Whitney U test.
Results
The incidence of Grade>2 toxicity was significantly higher in the StD compared to the CLD group (68% vs. 3.8%; p < 0.0001). Discontinuations were significantly higher in the StD compared to the CLD group (41% vs. 3.8%; p < 0.0001). The median PFS after initiation of CapX was higher in the CLD than the StD group (123 vs 106 days; z score 2.24, p 0.0251). The median OS after initiation of CapX was higher in the CLD than the StD group (199 vs 166 days; z score 1.98, p 0.047).
Conclusions
While lower toxicities and discontinuation rates were expected in the CLD arm, it was very surprising that survival outcomes too were better in the CLD group. In addition to possible pharmacodynamic advantages of the CLD approach, the better outcomes could also be attributed to better tolerability when compared to the StD approach. Further research would be worthwhile as it could potentially help spare future patients from toxicity while improving efficacy.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Swami Rama Cancer Hospital & Research Institute.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
528P - High-biologically effective dose radiotherapy may improve local control of small cell lung cancer patients with brain metastases: A propensity-matching analysis
Presenter: Qingyang Zhuang
Session: Poster display session
Resources:
Abstract
530P - Prognostic value of C-reactive protein, albumin and C-reactive protein to albumin ratio in small cell lung cancer: A meta-analysis
Presenter: Carla Emille Barbon
Session: Poster display session
Resources:
Abstract
531TiP - CANOPY-A: A phase III, placebo-controlled study of canakinumab as adjuvant therapy in patients (pts) with surgically resected NSCLC
Presenter: Byoung Chul Cho
Session: Poster display session
Resources:
Abstract
532TiP - CANOPY-1: A phase III, placebo-controlled study of pembrolizumab (PEM) plus platinum-based doublet chemotherapy (Ctx) with/without canakinumab in untreated patients (pts) with stage IIIB/IIIC-IV NSCLC
Presenter: Daniel Shao Weng Tan
Session: Poster display session
Resources:
Abstract
533TiP - CANOPY-2: A phase III, placebo-controlled study of canakinumab with or without docetaxel in patients (pts) with NSCLC previously treated with PD-(L)1 inhibitors and platinum-based chemotherapy (Ctx)
Presenter: Darren Lim
Session: Poster display session
Resources:
Abstract
534TiP - A randomized phase III study of carboplatin plus nab-paclitaxel with or without nintedanib for NSCLC with IPF (J-SONIC)
Presenter: Kohei Otsubo
Session: Poster display session
Resources:
Abstract
535TiP - Phase II study of atezolizumab for pretreated advanced / recurrent non-small cell lung cancer with idiopathic interstitial pneumonia (TORG1936 / AMBITIOUS study)
Presenter: Satoshi Ikeda
Session: Poster display session
Resources:
Abstract
536TiP - INSIGHT 2: Tepotinib plus osimertinib in patients with EGFR-mutant NSCLC having acquired resistance to EGFR TKIs due to MET-amplification: A phase II trial in progress study
Presenter: James C-H Yang
Session: Poster display session
Resources:
Abstract
YO8 - Carcinosarcoma of the Breast in a Filipino Female: A Case Report
Presenter: Ma. Angelle Lalaine Dantes
Session: Poster display session
Resources:
Abstract
YO9 - Small Malignant Phyllodes Tumor of the Breast with Metastases to the Lung and Bone
Presenter: Gusti Harti
Session: Poster display session
Resources:
Abstract