AB 12. Chronomodulated chemotherapy in chemo naïve NSCLC patients
Abstract

AB 12. Chronomodulated chemotherapy in chemo naïve NSCLC patients

Paul Zarogoulidis1,2, Konstantinos Porpodis1, Kelly Domvri1, Theodoros Kontakiotis3, George Kalamaras3, Dimitris Matthaios4, Ellada Eleftheriadou1, Georgia Trakada5, Athanasios Zissimopoulos6, Konstantinos Zarogoulidis1

1Pulmonary Department-Oncology Unit, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Pulmonary Department-Interventional Unit, “Ruhrland Clinic”, University of Duisburg-Essen, Essen, Germany; 3Pulmonary Department-Sleep Unit, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 4Oncology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; 5Department of Clinical Therapeutics, Division of Pulmonology, Medical School of National University of Athens, Greece; 6Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece


Background: Lung cancer treatment efficiency has reached a plateau during the last decade. Although targeted therapies according to tumors biology and genome expression (pharmacogenomics) have been introduced in the standard care or are under investigation. Therefore new methods of chemotherapy treatment have been investigated in order to augment the efficiency of the already well-established cytotoxic regimens.
Patients and methods: Twenty non-small cell lung cancer (NSCLC) chemo naïve patients stage IV were included in the protocol. Sleep disorders were measured with questionnaires (FSS, MRC, Pittsburgh, and ESS), polysomnography and actigraphy for 3 consecutive days. The actigraphy (actiwatch spectrum, Philips, Respironics) was initiated 1 day before treatment when the patient was still at home, the second day when the patient received the platinum analogue doublet and during the 3 day where the patient was still hospitalized for follow up. Laboratory values of ACTH, adrenaline, nor-adrenaline, saliva cortisol (4 measurements/day), morning cortisol and DPD enzyme were collected and measured for 3 consecutive days. The measurements were reevaluated after 3 cycles of chemotherapy.
Results: Twenty NSCLC patients entered the protocol and received a doublet of platinum analogue and docetaxel. Two patients were excluded from the protocol since they did not wear the actigraph spectrum watch the proper hours indicated by the treating physicians. No severe hematological toxicity grades 3 or 4 (according to the National Cancer Institute of Canada Common Toxicity Criteria version 3) were observed. An objective tumor response according to the RECIST revised criteria version 1.1 was observed in 10/18 patients. Chronomodulated administration according to the circadian rhythm (rest of cell division of normal cells) is strongly associated with chemo-efficiency (P<0.001). A strong association was observed between circulating hormones and disease status (P<0.006). In addition, sleep disorders were associated with disease status (P<0.005) and normalized with efficient treatment (P<0.003).
Conclusions: Chronomodulate chemotherapy administration is a method to augment the treatment efficiency, however expensive and difficult to perform. Key parameters such as expensive equipment and sleep expert pulmonary physicians are required.

Cite this abstract as: Zarogoulidis P, Porpodis K, Domvri K, Kontakiotis T, Kalamaras G, Matthaios D, Eleftheriadou E, Trakada G, Zissimopoulos A, Zarogoulidis K. Chronomodulated chemotherapy in chemo naïve NSCLC patients. J Thorac Dis 2012;4(S1):AB12. DOI: 10.3978/j.issn.2072-1439.2012. s012

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