P-192 The impact on comorbidities in deciding the dose for the first cycle of chemotherapy

Abstract

Introduction: The treatment of patients with cancer and comorbidities could be challenging as these patients are not represented in clinical trials. We carried out a study to evaluate the relevance of the comorbidities in deciding the first cycle dose of chemotherapy and the patients' tolerance and compliance. Methods:We included cancer patients who had at least two different comorbidities and at least one involving main organs such as respiratory, cardiac, liver, cerebrovascular or renal comorbidities. All the patients included were about to start a first line of palliative chemotherapy for metastatic colorectal cancer. Results:We studied 562 patients who met the inclusion criteria. 395 men/167 women. 402 older than 65 years. The use of chemotherapy was modified either in the number of drugs administered or in the schedule or dosage for the first cycle. Most of these patients received only monotherapy (59%) and those who received a combination of drugs received a dose reduction of each drug by 20% if the comorbidities were under control or by 50% if they were impacting on daily activities. Generally the tolerance was acceptable with low rate of grade 3 toxicities (8%) especially thrombocytopenia, neutropenia, fatigue, diarrhoea or mucositis. In those patients who did not experience any toxicity grade 2 or above, the dose was increase one step (20-25%) for the second cycle onwards. By using this method we did achieve good compliance with the treatment.We will continue evaluating the PFS and OS in this population. Conclusion: Chemotherapy use and compliance among cancer patients with comorbidities are generally inferior to healthy population due to the expected toxicities. This could impact on survival. However, if the compliance is improved, this might have a positive impact on patients' survival. Our study suggests that by using the first cycle dose reduced chemotherapy and then reassessing again we have kept compliance. We need further studies to evaluate if this has got an impact on survival.