Abstract 1854P
Background
Gastrointestinal (GI) cancers are common in patients with cirrhosis, through overlaps in risk factors such as alcohol consumption or metabolic syndrome. However, data on hepatic and extrahepatic tolerance and efficacy of conventional chemotherapy are lacking in this population.
Methods
We performed a multicenter, retrospective cohort study in Northern France, on patients treated with conventional chemotherapy for GI cancer excluding hepatocellular carcinoma from January 2013 to December 2018. The study included all cirrhotic patients of the 3 participating centers, and non-cirrhotic controls matched 1:2 on age, primary tumour location and chemotherapy indication (neoadjuvant, adjuvant or metastatic). Data on drug toxicity (incidence of extrahepatic adverse events (AE) according to CTCAE v5.0, decompensation of cirrhosis, Child-Pugh and MELD score evolution), and oncological endpoints (overall, recurrence-free and progression-free survival) were collected and compared between cirrhotic and non-cirrhotic patients.
Results
Forty-nine cirrhotic patients (Child-Pugh A 90%, 8% history of previous decompensation) and 98 matched controls were included. Cirrhotic patients were more frequently treated with single-agent (22 vs. 10%, p=0.08) and reduced dose (8% vs. 39%, p<0.001) at initiation. There was no difference of extrahepatic grade 3/4 AE (37% vs 30%, p=0,45), but more frequent discontinuation due to toxicity (10% vs 2%, p=0.04). There was no significant difference in overall survival (p=0.41), recurrence-free survival for neoadjuvant and adjuvant therapy (p=0.41) and progression-free survival for metastatic patients (p=0.35). Four out of 49 cirrhotic patients (8%) died due to cirrhosis-related events within 1 year of chemotherapy initiation, despite being Child-Pugh A at baseline. Cirrhosis was frequently not monitored during chemotherapy (75%).
Conclusions
Conservative management of chemotherapy in cirrhotic patients associates with similar extrahepatic AE and oncological outcomes compared to non-cirrhotic controls. Liver-related mortality is frequent and warrants collaborative management between oncologists and hepatologists.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
CHU Lille.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.