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
3367 - Treatment-Free Survival, With and Without Toxicity, as a Novel Outcome Applied to Immuno-Oncology Agents in Advanced Renal Cell Carcinoma
Presenter: Meredith Regan
Session: Poster Display session 3
Resources:
Abstract
5105 - Fresh blood Immune cell monitoring in patients treated with nivolumab in the GETUG-AFU26 NIVOREN study: association with toxicity and treatment outcome
Presenter: Aude DESNOYER
Session: Poster Display session 3
Resources:
Abstract
1877 - Advanced clear-cell renal cell carcinoma (accRCC): association of microRNAs (miRNAs) with molecular subtypes, mRNA targets and outcome.
Presenter: Annelies Verbiest
Session: Poster Display session 3
Resources:
Abstract
5543 - Prior tyrosine kinase inhibitors (TKI) and antibiotics (ATB) use are associated with distinct gut microbiota ‘guilds’ in renal cell carcinoma (RCC) patients
Presenter: Valerio Iebba
Session: Poster Display session 3
Resources:
Abstract
2689 - mTOR mutations are not associated with shorter PFS and OS in patients treated with mTOR inhibitors
Presenter: Cristina Suarez Rodriguez
Session: Poster Display session 3
Resources:
Abstract
3069 - Efficacy of immune checkpoint inhibitors (ICI) and genomic alterations by body mass index (BMI) in Advanced Renal Cell Carcinoma (RCC)
Presenter: Aly-Khan Lalani
Session: Poster Display session 3
Resources:
Abstract
5089 - Finding the Right Biomarker for Renal Cell Carcinoma (RCC): Nivolumab treatment induces the expression of specific peripheral lymphocyte microRNAs in patients with durable and complete response.
Presenter: Lorena Incorvaia
Session: Poster Display session 3
Resources:
Abstract
2594 - Algorithms derived from quantitative pathology can be a gatekeeper in patient selection for clinical trials in localised clear cell renal cell carcinoma (ccRCC)
Presenter: In Hwa Um
Session: Poster Display session 3
Resources:
Abstract
2566 - High baseline blood volume is an independent favorable prognostic factor for overall and progression-free survival in patients with metastatic renal cell carcinoma
Presenter: Aska Drljevic-nielsen
Session: Poster Display session 3
Resources:
Abstract
2675 - Impact of estimand selection on adjuvant treatment outcomes in renal cell carcinoma (RCC)
Presenter: Daniel George
Session: Poster Display session 3
Resources:
Abstract