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Greg Yothers, Stephanie R. Land, Greg Yothers, Stephanie R. Land, Clifford Y. Ko, D. Lawrence Wickerham, Clifford Y. Ko, D. Lawrence Wickerham, Louis Fehrenbacher, Jeffrey K. Giguere,Louis Fehrenbacher, Jeffrey K. Giguere,Norman Wolmark, and Patricia A. GanzNorman Wolmark, and Patricia A. Ganz
Neurotoxicity is an important acute toxicity associated with oxaliplatin therapy, yet little is known about neurotoxicity in long term colon cancer survivors treated with oxaliplatin as part of adjuvant therapy. NSABP LTS-01 is a comprehensive study examining patient reported outcomes in long term survivors of colon and rectal cancer previously treated on NSABP adjuvant trials. We report preliminary neurotoxicity patient reported outcomes results from LTS-01 for patients accrued to C-07 from 2000-2002.
BackgroundBackground
Eligible patients from NSABP Protocol C-07 were recruited and consented by NSABP investigators providing regular follow-up. After consent, telephone interviews were used to collect patient reported outcomes including neurotoxicity by the validated FACT/GOG Oxaliplatin-Specific neurotoxicity questionnaire (NTX-12). A subset of patients completed the NTX-12 as part of the original C-07 trial. Patients were analyzed according to their randomly assigned treatment in the earlier C-07 trial. Statistical comparisons of neurotoxicity across treatments used the Wilcoxon test.
MethodsMethods
Patient CharacteristicsPatient CharacteristicsCharacteristic
CategoryFULV
(N=136) (%)FLOX
(N=151) (%)P-
Value*
Median time to LTS-01 Interview (Years) 5.8 5.9 0.08
Year C-07 Entry 2000 23.5 34.4
2001 33.8 30.5 0.12
2002 42.7 35.1
Stage II 37.5 29.80.17
III 62.5 70.2
Gender Female 33.8 41.7 0.18
Male 66.2 58.3
Race White 92.6 91.4
0.69 Black 3.7 2.7
Asian/Pacific Isle 1.5 1.3
Other/Unknown 2.2 4.6
Age at Interview < 50 11.8 7.3
50-59 24.3 27.8
60-69 36.8 35.1 0.72
70-79 23.5 25.8
≥ 80 3.7 4.0
* Wilcoxon, Chi Square, or Fisher’s Exact test
CharacteristicCategory
FULV(N=136) (%)
FLOX(N=151) (%)
P-Value*
Marital Stat Married 76.5 75.5 0.98
Not Married 23.5 24.5
Education < College Grad 52.9 55.6
College Grad + 45.6 42.4 0.83
Other/Unk 1.5 2.0
Dis. Status Disease-free 86.8 87.4
Colon Recur 8.1 8.6 0.89
2nd Primary 5.2 4.0
C07 NTX Sbstdy Baseline 25.7 29.8 0.51
Data Available 18 mos. 24.3 23.8 1.00
•LTS-01 opened in October 2006 and, as of March 2008, neurotoxicity (NT) patient reported outcomes data are available from 287 pts (53% on FLOX). •Characteristics were similar across treatments with 50% of pts over age 65, 92% white, 8% with CC recurrence, and 5% with new primary cancer. •Median time from C-07 randomization to LTS-01 interview was 6 years. •FLOX pts had more NT than FULV pts (p = 0.046), but the mean difference in NTX-12 score was 1.4, less than the 4 points considered clinically important. •Individual item scores with significantly more NT on FLOX were: trouble buttoning buttons (8 v 17% with any severity, p = 0.033), numbness/tingling in feet (22 v 44%, p < 0.0001), and pain in hands/feet when exposed to cold (26 v 42%, p = 0.006). •In the subset of 80 pts with baseline (BL) NTX-12 data (56% FLOX), the change from BL score was similar for both treatments. •In a subset of 36 FLOX pts with 18- month data, NT was similar at 18 months and the LTS assessment at 5-7 years.
ResultsResults
NTX-12 Score at LTS-01 InterviewNTX-12 Score at LTS-01 Interview
0
5
10
15
20
25
30
FULVFLOX
NTX12 Score
Per
cen
t of
Pat
ien
ts
FULV FLOX Delta
N 136 151 15
Median 4 6 2 p=0.046
Mean 6.0 7.4 1.4
Wilcoxon rank-sum test
0
10
20
30
40
50
60
Drop 11+ Drop 4-10 0 +/- 3 Incr 4-10 Incr 11+
FULVFLOX
Change in NTX-12 Score at LTS-01 InterviewChange in NTX-12 Score at LTS-01 Interview
0
10
20
30
40
50
Drop 4-5 0 +/- 3 Incr 4-10 Incr 11+
FULVFLOX
NTX-12 Score, Change from Baseline Score
Per
cen
t of
Pat
ien
ts
Wilcoxon signed-rank test
NTX-12 Score, Change from 18 Month Score
Per
cen
t of
Pat
ien
ts
Wilcoxon rank-sum test
FULV FLOX Delta
N 35 45 10
Median 4 4 0 p=0.90
Mean 5.0 4.6 -0.4
FULV FLOX Delta
N 33 36 3
Median 2 p<0.01 0 p=0.5 2
Mean 3.6 1.0 -2.6
0.5 1 1.5 2 2.5
Relative Risk of Symptom (95% Conf. Int.)Joint pain or muscle cramps
Weak all over
Trouble hearing
Discomfort in hands
Ringing or buzzing in ears
Discomfort in feet
Trouble feeling shapeof small objects in hand
Numbness or tingling in hands
Pain in hands/feet with cold temps
Numbness or tingling in feet
Trouble buttoning buttons
Trouble walking
←FavorsFLOX
→FavorsFULV
Individual symptoms from NTX-12 ScaleIndividual symptoms from NTX-12 Scale
This work is supported by grants from the National Cancer Institute and the American Cancer Society. We wish to thank the membership of the NSABP, the staff of the NSABP Biostatistical and Operations Centers and the Jonsson Comprehensive Cancer Center at UCLA, and especially the trial participants without whom this research would not have been possible.
AcknowledgementsAcknowledgements
ASCO Saturday May 31, 2008Patient and Survivor Care Poster Session
Poster 39H, Abstract 9575