Abstract 4497
Background
Capecitabine is an oral pro-drug of 5FU. Dihydropyrimidine dehydrogenase (DPD), an enzyme encoded by the DPYD gene, is the rate-limiting step in 5FU catabolism. Life threatening gut wall injury occurs in a significant minority of patients and can potentially be predicted in patients with specific DPYD gene polymorphisms which result in decreased enzyme activity. Presently DPYD testing is performed in a limited number of centres in the UK. We conducted a retrospective cohort study to assess the frequency and cost of admissions due to capecitabine gut wall injury.
Methods
Using our electronic health records data base patients treated with capecitabine who were admitted for 3 days or more and had a stool sample were identified from 2010 to 2017. Individual records were reviewed to identify patients who had been admitted with severe gut wall toxicity. A Patient Level Costing System (PLiCS) was used to calculate the cost of each admission. Adverse outcomes are defined as significant morbidity (Admission > 14 days) or mortality.
Results
2626 patients were identified over the 7 year period; 131 were admitted with a history of G2 diarrhoea. (4.9%) 40 with grade 4 toxicity (1.5%); 13 post C1, 25 post C2, 2 post C3 of treatment. Median length of stay 16 days (3 - 46 days). Medical management included loperamide (73%), codeine (45%), octreotide (17.5%) and TPN (10%) Low albumin levels (<34g/L) or neutropenia (<1*9/L) on admission was a predictor for increased length of stay and adverse outcomes. 14 patients admitted for >14 days (35%). 11 patients died due to significant toxicity (0.4% of initial patient cohort) The costs of admission in this patient group using PLiCS analysis is approximately £37,000/annum.
Conclusions
Patients presenting with significant toxicity and the potential for DPYD deficiency have significantly prolonged inpatient stays, increased morbidity and mortality. Baseline bloods are a weak predictor of outcome in this patient group. DPYD testing is near cost neutral, the introduction of routine testing for DPD deficiency would allow oncologists to identify a meaningful proportion of patients at risk of significant toxicity ahead of treatment, and the ability to modify treatment plans accordingly and improve safety.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Leeds Cancer Centre.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
4634 - Comparative molecular analyses between microsatellite stable BRAFV600E mutant colorectal cancers and BRAFV600E mutant melanomas.
Presenter: Mohamed Salem
Session: Poster Display session 3
Resources:
Abstract
3264 - A novel preclinical model of RAF-independent MEK1 mutant tumors and its treatment with novel ATP competitive MEK inhibitor
Presenter: Luca Hegedus
Session: Poster Display session 3
Resources:
Abstract
4918 - HER2 inhibition in Aggressive Squamous Cell Carcinomas driven by a common MET Sema Domain Polymorphism
Presenter: Nur Afiqah Mohamed Salleh
Session: Poster Display session 3
Resources:
Abstract
2426 - ADAM9 as a target for lung cancer treatment
Presenter: Yuh-pyng Sher
Session: Poster Display session 3
Resources:
Abstract
5537 - Novel polyurea/polyurethane nanocapsules loaded with a tambjamine analog to improve cancer chemotherapy delivery and safety in lung cancer
Presenter: Marta Perez Hernandez
Session: Poster Display session 3
Resources:
Abstract
1597 - Discovery of Clinical Candidate DBPR112, a Furanopyrimidine-based Epidermal Growth Factor Receptor Inhibitor for the Treatment of Non-Small Cell Lung Cancer
Presenter: Hsing-pang Hsieh
Session: Poster Display session 3
Resources:
Abstract
3543 - Molecular characteristics in lung squamous cell carcinomas dependent on TP53 status – putative targets
Presenter: Vilde Haakensen
Session: Poster Display session 3
Resources:
Abstract
4111 - Comparison of molecular profiles between primary tumour and matched metastasis in non-small cell lung cancer
Presenter: Asuka Kawachi
Session: Poster Display session 3
Resources:
Abstract
4559 - Treatment with BLU-667, a potent and selective RET inhibitor, provides rapid clearance of ctDNA in Patients with RET-altered Non-Small Cell Lung Cancer (NSCLC) and Thyroid Cancer
Presenter: Giuseppe Curigliano
Session: Poster Display session 3
Resources:
Abstract
2501 - Triple MET/SRC/PIM inhibition in MET addicted tumors
Presenter: Ilaria Attili
Session: Poster Display session 3
Resources:
Abstract