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Gabrielle Sherer Oncology Jennifer Mahnke MS RD CSO LD

Nutritional Status Is Superior to the ECOG Performance Status in Predicting the Dose-Intensity of the GEMOX Chemotherapy Regimen in Patients with Advanced Cancer. Gabrielle Sherer Oncology Jennifer Mahnke MS RD CSO LD. Citation.

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Gabrielle Sherer Oncology Jennifer Mahnke MS RD CSO LD

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  1. Nutritional Status Is Superior to the ECOG Performance Status in Predicting the Dose-Intensity of the GEMOX Chemotherapy Regimen in Patients with Advanced Cancer Gabrielle Sherer Oncology Jennifer Mahnke MS RD CSO LD

  2. Citation Cessot A, Coriat R, Mir O, et al. Nutritional status is superior to the ECOG performance status in predicting the dose-intensity of the GEMOX chemotherapy regimen in patients with advanced cancer. Nutr and Cancer. 2013; 65(8): 1254-1257. doi: 10.1080/01635581.2013.830315

  3. Background • Increasing number of cancer pts are elderly w/ comorbiditiesand/or advanced condition • Altered PS “unfit” for clinical trials • Inadequate evidence to determine treatment of fragile and/or malnourished pts • Feasibility of chemo based on: • PS • Chemo exposition markers (liver/renal conditions) • Bone marrow reserve estimations • Malnourishment in 40-80% of ca pts – correlation btw nutrition status and chemo tolerance

  4. Eastern Cooperative Oncology Group (ecog)Performance Status (ps)

  5. GEMOX • Gemcitabine - pyrimidine antimetabolite (inhibits DNA production) • Oxaliplatin - alkylating agent (damages DNA) Moderately Toxic

  6. Objective Does nutritional status identify patients who are at risk of failure to complete the planned chemotherapy schedule among those receiving GEMOX?

  7. Design, Participants & Setting • Retrospective cohort study • Cochin Teaching Hospital • Nov 2006-Oct 2010 • 165 unselected, consecutive ca pts treated w/ GEMOX- no exclusion

  8. Methods • Scheduled Dose Intensity • Gemcitabine 500 mg/m2/wk • Oxaliplatin 42.5 mg/m2/wk • Baseline parameters: • Age • Gender • Ht • Primary tumor • ECOG PS • Usual wt • Baseline wt • Alb • CRP • Lymph count • Hemoglobin

  9. Outcome Measures • Relative Dose Intensity (RDI) observed dose intensity / scheduled dose intensity • Discontinuance of chemotherapy: • Receiving less than 2 cycles of GMOX • Malnutrition: • BMI under 18.5 kg/m2 • Premorbid wt loss over 10% • Albuminemia under 35 g/L

  10. Statistical Analysis • Student’s test • Compare means btw groups (A: pts receiving 2 cycles or less. B: pts receiving more than 2 cycles) • Kruskal-Wallis test • Compare BMI in PS 0-1 and 2-3 pts • Chi2 test • PS scores btw group A and B • Pearson’s correlation test • Correlation btw RDI and baseline parameters

  11. Results • Median age: 61 yr • ECOG PS 0-1: 71% of pts • Malnutrition: 48% of pts • 48% in PS 0-1 • 61% in PS 2-3 • RDI of GEMOX- significant, neg. correlation with Loss of baseline wt • Mean PS higher in group A

  12. Conclusions • Malnutrition is independent of PS • Malnutrition is associated with early treatment discontinuance and lower RDI • PS did not correlate with RDI, but did correlate with early treatment discontinuance

  13. ClinicalImplications Nutrition status should be added to PS as a determinant of chemotherapy feasibility, however should not replace it.

  14. Nonprofessional References http://www.ecog.org/general/perf_stat.html http://www.uptodate.com/contents/search

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