Conventional cytotoxic chemotherapy for gastrointestinal cancer in patients with cirrhosis: A multicentre case-control study.
Résumé
Background & Aims: Progresses in management make a higher proportion of cir-rhotic patients with gastrointestinal (GI) cancer candidates to chemotherapy. Data are needed on the safety and liver-related events associated with the use of chemo-therapy in these patients.Methods: Forty-nine patients with cirrhosis receiving chemotherapy against GI can-cer from 2013 to 2018 were identified in the French Health Insurance Database using ICD-10 codes K70-K74, and matched 1:2 to non-cirrhotic controls (n= 98) on age, tu-mour type and type of treatment. Adverse events (AE), dose tapering, discontinuation rate, liver-related events and survival rate were compared.Results: Patients with cirrhosis (Child–Pugh A 91%) more often received lower doses (38.8% vs 7.1%, p< .001), without significant differences in terms of grade 3/4 AE or dose tapering rates (29.6% vs. 36.7%; 22.3% vs 24.4%, respectively). Treatment discontinuation rate was higher in patients with cirrhosis (23.3% vs. 11.3%, p= .005). Child–Pugh (p= .007) and MELD (p= .025) scores increased under chemotherapy. Five patients with cirrhosis (10.2%) had liver decompensation within 12 months, and 17.2% of deaths in the cirrhosis group were liver-related versus 0% in matched controls. WHO-PS stage > 1 (HR 3.74, CI95%: 2.13–6.57, p< .001), TNM-stage M1 (HR 3.61, CI 95%: 1.82–7.16, p< .001), non-colorectal cancer (HR 1.73, CI 95%: 1.05–2.86, p= .032) and bilirubin higher than 5 mg/dL (HR 2.26, CI 95%: 1.39–3.70, p< .001) were inde-pendent prognostic factors of 2-year mortality, whereas cirrhosis was not.Conclusions: Chemotherapy should be proposed only in patients with compensated cirrhosis with close monitoring of liver function. Dose management remains challeng-ing. Multidisciplinary management is warranted to improve these patients' outcomes.
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Sciences du Vivant [q-bio]
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