Notes on ESMO17: Palliative oncology

Clinical Brief – September 21st

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.

Chemo is often dosed based on a person’s body-surface area. However, giving someone chemo based on how much drug the body actually gets instead, or pharmacokinetic-guided dosing, may help optimize the dose and reduce severe toxicities.

Researchers from China ran a study with about 300 patients with non-small cell lung cancer. Patients were randomized roughly 1:1 to receive carboplatin, followed by paclitaxel that’s dose-optimized by body-surface area or by their pharmacokinetic profile.

Patients whose doses were guided by their pharmacokinetic profile received on average 24% less drug than those whose doses were guided by body-surface area.

Pharmacokinetic-guided dosing was linked to significantly less severe side effects vs body-surface-area-guided dosing:

30% fewer cases of grade 4 neutropenia (16% vs 23%)

60% fewer cases of grade 2+ neuropathy (8% vs 20%)

Tumor response remained comparable between patients who received treatment which was dose-guided using either method. Objective response rates were 29% with pharmacokinetic-guided dosing vs 23% with body-surface-area-guided dosing.

Abstract #1388PD

Chronic and recurrent pleural effusion refers to fluids collecting in the sac surrounding the lungs. It’s a common cause of difficulty breathing, cough, and chest pain for patients with metastatic cancer.

Charité Universitätsmedizin Berlin, Germany, reported their 10-year experience using indwelling pleural catheters to manage pleural effusion. They found that in nearly 400 patients who got the catheter, 29% experienced a spontaneous clearing of the fluids around their lungs.

Patients whose lungs were cleared of surrounding fluids had a 46% better chance of survival than those who did not. Overall, the median survival for all patients who got the catheter were 2.4 months.

About 12% of patients experienced complications due to the procedure, most commonly infection, empyema, and a mechanical obstruction of the catheter.

Abstract #1397P

“Eight in ten kids dying from cancer experience [aggressive care] in their last month of life,” reports a study from Portugal.

Researchers followed 300 kids diagnosed with cancer to monitor the prevalence of “aggressive care near the end of life”.

In the last 14 days of their lives, 88% of kids dying from cancer experienced aggressive care. These included:

  • Receiving IV chemo or immunotherapy within the last 30 days of life
  • Spending more than 14 days in the hospital
  • Being hospitalized more than once
  • Being admitted to intensive care (ICU)
  • Receiving advanced life support such as CPR
  • Receiving an inserted device like a catheter
  • Being on IV nutrition

It’s unfortunate, but about half of these kids spent more than 14 days in the hospital. In other words, they passed away in the hospital instead of their homes.

“The findings also prompt healthcare professionals to reflect on their current practice, balancing treatments and hospitalizations with patients’ quality of life in the days they have to live.”

– Cardoso A, et al.

Abstract #1398P

For more presentations from #ESMO17, take a look at my hand-curated Twitter moment 🤓.

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