In the ever-evolving field of oncology, the efficient management of therapy side effects is crucial for improving patient quality of life and any potential treatment outcomes. Join us as we explore 3 clinical studies that shed new light on innovative approaches to managing side effects in patients with cancer.
Two-year follow-up findings from a phase 3 clinical trial showed that stereotactic body radiotherapy (SBRT) guided by magnetic resonance imaging (MRI) significantly reduced long-term side effects when compared with conventional treatment guided by computed tomography (CT). This method also improved quality of life (QoL), especially regarding bowel and sexual health.
Between May 2020 and October 2021, a total of 156 patients with localized prostate cancer were randomized to receive SBRT that was guided by CT (77) or MRI (79). The primary end point was acute genitourinary (GU) toxicity grade ≥2 within 90 days of SBRT, and secondary end points included late GU and gastrointestinal toxicity grade ≥2. Patients were also evaluated for toxicity and surveyed regarding QoL at baseline and at months 1, 3, 6, 9, 12, 18, and 24 post-SBRT.
Results demonstrated significantly fewer urinary and bowel side effects among patients receiving MRI-guided SBRT, with 27% of MRI-guided patients reporting moderate or severe urinary issues versus 51% of patients receiving CT-guided SBRT.
Furthermore, only 1.4% of MRI-guided patients reported gastrointestinal toxicities compared with 9.5% in the CT-guided group. MRI guidance was also tied to improvements in certain QoL measures, such as bowel function and sexual health.
“This study adds strong evidence that the enhanced precision and accuracy afforded by MRI-guided SBRT leads to significantly fewer urinary, bowel, and sexual side effects for men receiving prostate SBRT,” said Amar U. Kishan, MD, lead researcher and executive vice chair of radiation oncology at the David Geffen School of Medicine, University of California-Los Angeles (UCLA), in a press statement by UCLA Health.
“The MRI-guided approach, which includes real-time tracking of the prostate itself and the use of a built-in MRI to help deliver the radiation, allows us to use significantly narrower planning margins when delivering radiation, leading to less radiation to normal tissues. This in turn reduces the risk of enduring side effects that can impact a patient’s quality of life,” he added.
Kishan AU, Lamb JM, Wilhalme H, et al. Magnetic resonance imaging versus computed tomography guidance for stereotactic body radiotherapy in prostate cancer: 2-year outcomes from the MIRAGE randomized clinical trial. Eur Urol. 2024:S0302-2838(24)02688-5. Epub ahead of print.
Findings from a randomized, phase 2/3 clinical trial show that tetrahydrocannabinol and cannabidiol (THC:CBD) administered in capsule form can benefit adults who still have chemotherapy-induced nausea and vomiting despite receiving standard antiemetic prophylaxis. The adjunct treatment of THC:CBD was, however, associated with additional adverse events.
Between 2016 and 2022, a total of 147 patients were given oral capsules containing 2.5 mg each of THC:CBD or matching placebo to take three times daily from days 1 to 5, supplemental to guideline-consistent antiemetics (a corticosteroid and 5-hydroxytryptamine antagonist, a neurokinin-1 antagonist, and olanzapine).
The difference in number of patients who—0 to 120 hours after the first cycle of chemotherapy—reported no vomiting or retching and no use of rescue medications (a complete response) was the primary outcome measure.
Ultimately, THC:CBD was shown to increase the complete response rate from 8% to 24% (absolute difference, 16%; 95% confidence interval, 4-28; P=.01) versus placebo. Similar results were seen in lack of significant nausea, rescue medication use, and daily vomits.
Although THC:CBD was associated with more frequent bothersome adverse events including sedation (18% vs 7% with placebo), dizziness (10% vs 0% with placebo), and transient anxiety (4% vs 1% with placebo), no serious adverse events were attributed to the treatment.
“THC:CBD is an effective adjunct for chemotherapy-induced nausea and vomiting despite standard antiemetic prophylaxis, but was associated with additional adverse events,” concluded the researchers, who added that implementation of this treatment may be affected by drug availability, personal preferences, laws, and cultural attitudes.
The cost-effectiveness of THC:CBD will be evaluated in future studies.
Grimison P, Mersiades A, Kirby A, et al. Oral cannabis extract for secondary prevention of chemotherapy-induced nausea and vomiting: final results of a randomized, placebo-controlled, phase II/III trial. J Clin Oncol. 2024;34:4040-4050.
According to researchers behind a recent study, maintaining treatment adherence among patients with breast cancer having skin reactions to radiation therapy is a challenge. However, study findings yield a low-risk, effective approach to managing the severity of radiodermatitis in these patients in the form of chicory root extract gel.
From September 2022 through February 2023, a total of 44 patients with breast cancer receiving radiation therapy were randomized to receive topical chicory root extract gel (n=21) or the placebo (n=20) and apply the treatment twice daily from the start of their radiotherapy.
A questionnaire designed by the researchers was used to gather patient characteristics, and information on the incidence and severity of dermatitis was assessed using the Radiation Therapy Oncology Group scale.
Findings from the study showed that fewer patients developed dermatitis in later weeks with the chicory root extract gel than with placebo, despite no significant differences being found between the 2 treatment arms in terms of individual and clinical characteristics at the beginning of the study.
Rates of grade 1 and 2 dermatitis were higher among recipients of placebo in weeks 2 and 3 of treatment, but the average duration of dermatitis was longer with the chicory root extract gel.
“Chicory root extract gel offers an effective, low-risk option for managing radiodermatitis in breast cancer patients. This aligns with the goals of supportive cancer care, which emphasize minimizing side effects, maintaining treatment efficacy, and improving the patient's quality of life,” the investigators concluded.
Jafari F, Izadi-Avanji FS, Maghami M, Sarvizadeh M. Topical use of chicory root extract gel on the incidence and severity of radiodermatitis in breast cancer patients: a randomized controlled trial. Support Care Cancer. 2024;12:805.
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