In developed countries, more than half of all tumor's cases occurs in patients aged 65 or more, for this reason a (multidisciplinary approach)combinated work between oncologist and geriatric is becoming more and more usefull in pratical oncology. At the same time, however, the oncological treatment results in elderly are far from satisfactory; treatment varies from therapeutic obstinacy to therapeutic abandonment. The understanding of elderly pantient condition and his needs become very important to allow healt, political and social strategies. Aim of the study: 150 patients were submitted to oncogeriatric evaluation, from February 2015 to March 2016. All were evaluatde for:-recognize patients fit for standard oncological treatments and patients in whome the risk of toxicity overcome potential benefits.-organize all medical, psycological and social support to improve treatment tolerance. Material and methods: all patients ( aged 65 or more) were screened with G8 (evaluation tool for geriatric patient); G8 allows to divide patients in 2 groups; those below the cut off score of 14 were sended oncogeriatric unit. Those with score 14 or more were sended directly to the oncology unit. We used CGA as instrument of geriatric evalutation. Results: 150 patients with a score <14 were sended for oncogeriatric evalutation; we identified 106 patients aged >65 that would have required chemoterapy (adiuvant and metastatic setting) 81/106 patients started chemioterapy with an adequate dose reduction (mono- or polychemotherapy) 25 resulted unfit for chemotherapy and were sended to palliative care unit. 52 well tollerated chemotherapy with adequate supportive therapy (myeloid stimulating factors, antiemetic therapy) toxicity was mild (1multifocal pneumonia an 1 anafilactic reaction) 27 patients dead after progression disease. no patient stopped treatment for toxicity, nor was hospitalized Conclusions: oncogeriatric evaluation is important to select patients fit for chemotherapy, getting better the clinical outcome, the management, the assistance and the therapeutical iter so reducing the frequency hospitalization.

Introduction: Nanoparticle Albumin-bound Paclitaxel linked to albumin nanoparticles,wich it makes soluble,allowing drug delivery inside tumor tissue. Moreover,with Nab-P, the usual steroid premedication required for solvent-based paclitaxel (Cremophor) can be avoided. Methods: Between Genuary 2014 to April 2016, 30 patients (pts):18Metastatic Breast Cancer (MBC) and 12 metastatic Pancreatic Cancer (mPC) were treated with Nab-P: as monotherapy in MBC and in combination with Gemcitabine in mPC. All pts had PS: 0-2 (ECOG). Median age was 56 years (range: 39–78) in MBC and 60 years (range 50–74) in mPC. MBC 6 pts received Nab-P as first Line; 5 pts as second Line; 3 pts as third Line, 3 pts as fourth Line and 1 pts as fifth Line. 10/18 patients had HR positive disease HER2 positive status was find in 1/18 patients (Fish Test) HR positive and HER2 positive pts received one or more hormonal therapies and Trastuzumab and Lapatinib based regimen, respectively. Nab-P was administered at 260mg/mq i.v. day 1 every 21 days. Not corticosteroid premedication. mPC Pts mPC received in first Line Nab-P 125mg/mq days 1-8-15 every 28 days plus Gemcitabine 1000mg/mq. days 1-8-15 every 28 days.Not corticosteroid premedication. Toxicity -Results: The main observed toxicities were neurosensory toxicity (G2-3): 56% of pts (17/30); neutropenia(G2-3):40% (12/30); thrombocytopenia (G1-2): 20% (6/30); anemia (G1-2): 30% (9/30); mucositis: 33%(10/30); fatigue (G2): 16% (5/30); nausea (G2): 20% (6/30); diarrhoea (G1): 13% (4/30); alopecia (G3-4): 73% (22/30); emesis(G1): 23% (7/30); arthromyalgie(G2): 36% (11/30). Not febrile neutropenia was observed. 2 pts with neurosensory toxicity (G3) delayed the treatment for 20 days. 2 pts (MBC) presented an Herpes Zoster infection that required treatment suspension for 18 days. To maintain dose-intensity, leukopenia and anemia were managed with G-CSF and Eritropoietin respectively. At a median follow-up of 27 months, median PFS was: MBC: Time to Progression (TTP): 30 weeks (range 12-51); ORR was 88% (16/18); Partial Remission (PR): 10 pts (55%); Stable Disease (SD): 4 pts (22%); Progression Disease (PD): 2 pts.(11%); Complete Remission (CR): 2 pts.(11%) mPC:TTP: 20 weeks (range 3–40); ORR was 75% (9/12); PR: 7 pts (58%); SD: 3 pts (25%); PD: 2 pts (16%). Conclusion: Our experience confirm the discrete tolerability and the efficacy of Nab-P in MBC and in mPC. The avoidance of premedication with corticosteroid required for solvent-based taxanes makes the novel Nab-P an important advance in the treatment of these tumours.

Aim: Progress made in the treatment and better management of cancer pts has significantly improved overall survival. Early involvement of palliative care can translate into improvements in quality of care, QoL and survival.

Nutritional problems due to oral mucositis in patients with head and neck cancer un- dergoing concomitant radio-chemotherapy (RT/CT) significantly correlate with outcome. The aim of our prospective study was to investigate the impact of an early and intensive nutritional pro- gram, intensive dietary counseling, and enteral nutrition through a nasogastric tube on perfor- mance status and quality of life in head and neck cancer patients undergoing RT/CT. Thirty-five consecutive patients with locally advanced, unresectable head and neck cancer who were referred for RT/CT were enrolled. All patients were evaluated for nutritional status (PG-SGA score), serum prealbumin, ECOG performance status and quality of life (measured with EORTC QLQ- C30 version 3.0) before, at the end of, and 1 month after completion of RT/CT. Sixteen patients (46%) were compliant with the nutritional program. Placement of the nasogastric tube was sim- ple, safe and well tolerated by patients. The median duration of enteral nutrition was 31 days (range, 10-93 days). At the end of and 1 month after RT/CT, 94% of compliant patients had main- tained or improved their nutritional status, while in all noncompliant patients the nutritional sta- tus had worsened at the end of RT/CT, and 1 month later nutritional status had improved in only 1 of them (p<0.001). Nutritional status correlated significantly with ECOG performance status and quality of life. (Nutritional Therapy & Metabolism 2006; 24: 176-82)

e15036 Background: It’s well known that in patients with hormone refractory prostate cancer (HRPC) who progressed after first line chemotherapy there are not a lot of therapeutic possibilities. Androgen and androgen receptor interactions are crucial for disease development and progression. In preclinical models the topoisomerase II inhibitor etoposide interfere with androgen mediated cell growth and reduce both intracellular and secreted PSA levels. So, etoposide can be considered not only classical cytotoxic drug but even an agent that directly targets androgen receptor function. Methods: 35 patients were enrolled. All had HRPC progressed after docetaxel and mitoxantrone, first and second line treatment respectively, and were almost asymptomatic (PS 0-1). Patients received oral estramustine (10 mg/kg/die) and intravenous etoposide (100 mg/mq/die 1-3 q21) until disease progression or grade 4 toxicity development. Disease progression was defined as rising PSA over 25% from base line or appearance of new lesions on radiological evaluation. PSA level was detected at every cycle. Median number of cycles administered was 4 (range 2-8). Results: 20 patients (57%) experienced a decreased level of PSA > 50% from baseline. Overall median time to progression was 15 weeks (range 3-35). Median survival of responders was 14 months, compared with 9 months for non responders. Observed toxicities (none more than grade 3) were thrombocytopenia, anemia, nausea and diarrhea, all easily manageable. Conclusions: We conclude that estramustine and etoposide is an active and well tolerated regimen in heavily pretreated and outpatient HRPC

e20718 Background: Anemia, defined as a hemoglobin level < 12 g/dL, is frequent in cancer and affect quality of life and performance status. Of all the pretreatment possible causes of cancer-related anemia, unintentional weight loss, early indicator of malnutrition, is often underestimated or completely ignored. The aim of this study is to evaluate the possible pretreatment correlation between hemoglobin level, recent unintentional weight loss (≥ 5% in the last three months) and inflammatory status (C-reactive protein ≥ 10 mg/dL) in NSCLC. Methods: 56 consecutive outpatients with NSCLC (IIIB - IV stage), 68% males, 32% females, were enrolled. Criteria for eligibility included absence of comorbidity (diabetes, hepatic or renal failure) and not previous oncological treatment All patients were evaluated for hemoglobin level (Hb), percentage of involuntary weight loss (WL) and C- reactive protein (CRP) before chemotherapy. Results: 25% of patients had a Hb level < 12 g/dL, 38% referred a recent WL ≥ 5% and 54% had a CRP ≥ 10 mg/dL. Hb was WL-related (p = 0.001) and not CRP-related (p = 0.160), WL was CRP-related (p = 0.022). In the subgroup of patients, the differences of haemoglobin concentrations were minimal, but stastically significant only when inflammatory status was associated with WL. On Table we reported the mean concentrations of haemoglobin as measured in the subgroups of patients. Conclusions: Our data suggest that an early and intensive management of weight loss might prevent or reduce anemia in NSCLC before treatment. [Table: see text] No significant financial relationships to disclose.

Background:The elderly (>70 years of age) represent a specific group of patients (pts) in which advanced age often causes problems such as impaired organ function, greater frequency of comorbility and reduced tolerability to anticancer treatments.Patients and methods: Between December 2001 and February 2003, 27 pts with colorectal cancer (15 male, 12 female) were treated with CT.All pts had a PS 0-2 (ECOG): PS 0 = 10 pts; PS 1 = 14 pts; PS 2 = 3 pts.The median age was 76 years (range 70-85).Patients were divided into four groups: 11 pts received adjuvant CT with 5-fluorouracil (5-FU) and folinic acid (Mayo regimen); 5 of these, also received neoadjuvant combined radio-chemotherapeutic treatment with 5-FU continuous infusion.5 pts received first-line CT for metastatic disease with irinotecan (CPT11), alone or combined with 5-FU (FOLFIRI regimen); oxaliplatin (OHP), alone or combined with 5-FU (FOLFOX regimen) and uracil/tegafur (UFT).4 pts received second-line CT with OHP or UFT.7 pts received third line CT with Mitomycin C, Capecitabine or UFT.Results: On the whole toxicity was mild and consisted in: asthenia G3:70%, anorexia G2: 40%, nausea G2: 62%, diarrhoea G2: 18%, mucositis G2: 22%, handfoot syndrome G2: 11%, leukopenia G2: 25%,-neurosensory toxicity G2: 40% treated with OHP, hair loss G2: 14%, anemia G1: 66% .To maintain dose-intensity, leukopenia and anemia were managed with G-CSF and Eritropoietin respectively.Moreover, with use of the best supportive care (antiemetic drugs, corticosteroids, antidiarrhoeals, fluid therapy i.v., nutritional support, antifungine and anti-H2 drugs) no pts developed malnutrition.All pts with ECOG PS 0 remain at their initial PS; 57% (8/14) of pts with baseline PS 1, reached PS 0, and 66% (2/3) of pts with baseline PS 2, reached PS 1. Conclusions: In our experience we conclude, that elderly pts with colorectal cancer can be safely treated with CT, but they require a careful evaluation and surveillance of clinical status with better integration of supportive care.

Irinotecan (CPT-11) plus 5-fluorouracil/leucovorin (5-FU/LV) regimen is at present employed as first-line chemotherapy for advanced colorectal cancer (CRC). Its clinical use is associated with an elevated incidence of diarrhoea (∼60–70%). Diarrhoea is the dose-limiting toxicity of this regimen and sometimes represents a serious adverse event [1]. Recently, the role of the intestinal bacterial microflora in the etiopathogenesis of the CPT-11-induced intestinal toxicity has been discovered. The active metabolite of CPT-11, SN38, is generated from CPT-11 by sieric carboxylesterase, and subsequently conjugated to SN38-G by hepatic UDP-glucuronyltransferase. SN38-G is the inactive metabolite of CPT-11 and is excreted into the small intestine, from which it is eliminated in the faeces [2]. Some studies have pointed out the ability of intestinal bacterial β-glucoronidases to transform SN38-G into SN38, causing direct damage to the intestinal mucosa [3]. In recent years, several authors have investigated the possibility that inhibition of the intestinal bacterial microflora with antibiotic therapy may decrease the CPT-11 intestinal toxicity [4]. After such consideration, we started a study to evaluate the role of therapy with neomycin plus bacitracin at a dose of 1000 mg t.i.d. during CPT-11 plus 5-FU/LV chemotherapy (Saltz regimen). Thirty-two patients with metastatic CRC were evaluated between March 2000 and July 2002. Only 15 of these patients experienced diarrhoea after the first cycle of chemotherapy and were enrolled in the study. They were treated in the first cycle of chemotherapy with loperamide 4 mg followed by 2 mg every 2 h, for a period of 12 h after the last stool; from the second cycle of chemotherapy onward, they were treated with an association of neomycin 25000 IU plus bacitracin 2500 IU (bimixin) at a dose of 1000 mg t.i.d. (days 2–5 and 16–19 of each cycle, during chemotherapy). In all 15 patients, we observed complete resolution of diarrhoea from the second until the fourth chemotherapy cycle. Only two patients experienced grade 1 diarrhoea in the fifth chemotherapy cycle, and only five in the last cycle, two grade 1 and three grade 2. At the end of each cycle of chemotherapy, the patients completed a questionnaire on chemotherapy tolerability. All patients treated with neomycin tolerated chemotherapy much better than a control group of 15 patients treated without antibiotic therapy. Our research indicates that in combined treatment with CPT-11 plus FU/LV it is possible to reduce the incidence and severity of diarrhoea by cotreatment with oral neomycin plus bacitracin. In contrast to previous experience of antibiotic therapy in the prevention of CPT-11-related diarrhoea [5], we used neomycin associated with bacitracin in these patients, a more common antibiotic combination used in clinical practice. However, the lower intestinal toxicity of CPT-11 in the Saltz regimen (CPT-11 180 mg/m) compared with CPT-11 monotherapy (CPT-11 350 mg/m) may explain the better control of the CPT-11induced diarrhoea obtained in our patients, making this an interesting finding. Furthermore, this study constitutes a greater awareness of the role of the bacterial β-glucuronidase in CPT-11induced diarrhoea.