Clinical Brief – September 13th
ESMO, or the European Society of Medical Oncology Congress, is an annual gathering of cancer experts and patient advocates. Here are some studies from this year’s ESMO that may be of use.
Treatment with radioactive iodine may be linked to the risk of developing acute myeloid leukemia, or AML.
In a population-based study, patients with well-differentiated thyroid cancer treated with surgery + radioactive iodine had significantly increased risks of developing AML that peaked within the first three years after treatment, compared to surgery alone.
Patients who develop AML after surgery and radioactive iodine had significantly shorter survival than those who did not develop AML. Median overall survival for patients who had AML was 7.5 years vs 24.4 years in matched control patients who did not develop AML.
Benefits of relatively modern treatments may benefit both younger and older patients with relapsed and refractory multiple myeloma.
A review of published studies found that biologics, HDAC inhibitors, and second-generation proteasome inhibitors all improved progression-free survival in both younger and older patients. The age cut-off was 65-75 years.
Unfortunately, overall survival was not mentioned.
Infusion-related reactions to daratumumab (Darzalex) may be managed with pre- and post-infusion meds.
An analysis of clinical trials summarized the pre- and post-infusion meds which were used to manage infusion-related reactions to daratumumab in patients with multiple myeloma.
Pre-infusion meds consisted of 20 mg dexamethasone or equivalent, 650-1000 mg paracetamol or acetaminophen, and 25-50 mg diphenhydramine or equivalent.
Patients at high risk of respiratory complications received diphenhydramine on days 1 and 2 of their treatment, a short-acting beta-2 adrenergic receptor agonist, and control medications for lung disease after their daratumumab infusion.
Autologous stem cell transplantation may be considered for patients with non-Hodgkin lymphoma who are over 65.
The Centre Antoine Lacassagne in Nice, France, presented their experience treating such patients. They noted that comorbidities were higher in patients over 65 vs those under 65; especially cardiovascular issues.
Patients over 65 received similar conditioning regimens compared to those under 65, as were the number of stem cells infused, the number of transfusions received, weight loss after the start of treatment, length of their hospital stay, and the duration of aplasia.
Patients over 65 didn’t experience more grade 3+ toxicities than those under 65, and cancer-specific survival 3 years after autologous stem cell transplant were similar.
The trick here may be patient selection. For patient over 65 who can tolerate similar conditioning regimens as their counterparts under 65, perhaps they may expect similar results? A larger trial is needed to confirm.
Screening patients for multi-drug resistant bacteria may help predict sepsis involving such bacteria after chemotherapy.
Febrile neutropenia is a major concern for patients receiving chemotherapy. Multi-drug resistant bacteria in the gut is thought to be a potential risk factor for subsequent infection by the same bacteria during febrile neutropenia.
One study found that in patients receiving chemo for acute leukemia, 34% of those who had multi-drug resistant bacteria in their stool experienced multi-drug resistant sepsis; compared to 24% of those who had negative stool samples.
This may have been a single-center study at one Indian institution.
For more presentations from #ESMO17, take a look at my hand-curated Twitter moment 🤓.