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Although a short hydration protocol for cisplatin has been recently developed for use in lung cancer, this has yet to be established for gastric cancer. This study reviewed medical records of patients with gastric cancer who received XPT(capecitabine/cisplatin/trastuzumab) therapy containing cisplatin. Patients received either the conventional or short hydration regimen. Nephrotoxicity was compared between these two regimens by monitoring the serum creatinine. Out of the 26 total patients, 19 received the conventional regimen while 7 received the short hydration regimen. There was a higher nephrotoxicity was observed in the group receiving the conventional regimen (42.1%, 8/19) as compared to the short hydration regimen (0%, 0/7). There was a statistically significant difference in nephrotoxicity between the regimens (

Hypothyroidism is one of the side-effects caused by regorafenib. In the Japanese subset of the CORRECT study, hypothyroidism developed in 1.5% of the patients, but was not grade 3 or higher in any patient. Regorafenib is an oral multi-kinase inhibitor that has the same mechanism of action as sunitinb. However, the reported incidence of sunitinb-related hypothyroidism varies widely, ranging from 16.0% in clinical trials to 35.4% in post-marketing surveillance studies. In general, symptoms of hypothyroidism include fatigue and dysphonia. Hyperthyroidism must, therefore, be appropriately managed in order to maintain patient quality of life and avoid a critical level of hypothyroidism. During the first cycle of treatment with regorafenib, the incidence of abnormal thyroid-stimulating hormone (TSH) elevation was 31.4%. Our results suggest that thyroid function tests should be performed from day 1 of treatment with regorafenib. It would be prudent to consider routine monitoring of thyroid function in all patients who receive regorafenib and to recommend endocrinological consultation as necessary.

211 Background: Cisplatin is administered in combination with massive and long term hydration to avoid renal toxicity. Although a short hydration protocol for cisplatin has been recently developed in lung cancer, which in gastric cancer has not been well clarified. We modified our XPT (capecitabine / cisplatin / trastuzumab) regimen, adopting short hydration method. This study was conducted to compare the preventive effect for renal toxicity of XPT therapy between the short hydration regimen and the conventional regimen. Methods: Medical records of patients with gastric cancer who received XPT therapy containing cisplatin at a dose of ≥ 80 mg/m2 were reviewed for 3 cycles of the observational period. Patients received either the short hydration regimen or the conventional regimen; short hydration regimen consisted of 2200 - 2500 mL of hydration over a period of 6.2 hours with furosemide and magnesium supplementation on day 1 and 1050 mL of hydration over 4 hours on day2 and 3, and the conventional regimen consisted of 3200 - 3500 mL of hydration over 24 hours on day 1 and 1550 ml of hydration over 6 hours on day2 and 3. Renal toxicity was then compared between the two groups. Results: Out of the total 31 patients, 6 received the short hydration regimen and 25 received conventional regimen. An elevated serum creatinine level ≥ grade 1 was significantly less frequent in the group receiving the short hydration regimen (0%, 0/6) than in the group receiving the conventional regimen (48.0%, 12/25) ( P < 0.05). The completion rate for the planned treatment in the short hydration group (100.0%, 6/6) was higher than that in the conventional hydration group (84.0%, 21/25). Conclusions: Based on the results of this study, short hydration may be a feasible regimen for XPT therapy in gastric cancer.

Kazuyoshi Kawakami,1 Eri Nakamoto,1 Takashi Yokokawa,1 Kazuo Sugita,1 Yutarou Mae,1 Akane Hagino,1 Mitsukuni Suenaga,2 Nobuyuki Mizunuma,2 Sayaka Oniyama,3 Yoshiaki Machida,3 Toshiharu Yamaguchi,2 Toshihiro Hama1 1Department of Pharmacy, 2Gastroenterology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3Section for Practical Education, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Tokyo, Japan Background: Capecitabine plus oxaliplatin (XELOX) has been established as a first-line treatment for metastatic colorectal cancer. Adherence is particularly important with capecitabine to maintain appropriate curative effect. In this study, we monitored the adherence to capecitabine on XELOX treatment and investigated which factors might decrease compliance.Methods: The study included 242 consecutive patients who received XELOX treatment for metastatic colorectal cancer between October 2009 and March 2012. Adherence to capecitabine was checked by pharmacists with a patient-reported treatment diary at a pharmaceutical outpatient clinic. Adherence rate was defined as the number of times that a patient took capecitabine in a 14-day cycle/28 prescribed doses. We retrospectively surveyed median relative dose intensities of capecitabine and the factors deteriorating adherence across eight cycles from electronic patient records and examined differences in compliance rates according to age. Results: The study included 144 male and 98 female patients. The overadherence rate was 1.5% (n=23). The median adherence rate was 93.5% (n=242) in the first cycle of XELOX treatment, which gradually rose to 96.1% (n=148) in the eighth cycle. The median relative dose intensity of capecitabine was 79.2%. The main factors contributing to decreased adherence to capecitabine were diarrhea (22.5%, 352 instances) and nausea/vomiting (13.8%, 215 instances). The rate of missed dose was 12.1%. Analysis of adherence issues in relation to patient age showed a trend toward worse adherence to capecitabine therapy in the group of patients aged ≥80 years (hazard ratio =3.83; 95% confidence interval 2.48–5.91, P

690 Background: Capecitabine plus oxaliplatin (XELOX) has been established as adjuvant therapy for stage II/III colon cancer. Adherence to capecitabine is particularly important with XELOX to maintain appropriate curative effect. In this study, we monitored the adherence to capecitabine during adjuvant treatment with XELOX, and investigated the candidate factors that might decrease the adherence. Methods: The study included 139 consecutive patients who received XELOX treatment as adjuvant therapy for colorectal cancer between November 2011 and March 2014. Adherence to capecitabine was checked by pharmacists using a patient-reported treatment diary at a pharmaceutical outpatient clinic. Adherence rate was defined as the number of which a patient took capecitabine between d1 evening and d15 morning per 28 in each treatment cycle. The relative dose intensities and the deteriorating factors of adherence to capecitabine were retrospectively surveyed from electronic patient records. Results: 70 male and 69 female patients received adjuvant XELOX. Median adherence rate was 95.4% (n=139) in the first cycle of XELOX treatment, which gradually rose to 98.3% (n=121) in the eighth cycle. The median relative dose intensity of capecitabine was 76.7%. The main factors contributing to decreased adherence to capecitabine were diarrhea (34.7%) and nausea/vomiting (20.2%), peripheral neuropathy (10.7%). Conclusions: In this study, patient-reported adherence to capecitabine on XELOX treatment in clinical practice was highly maintained during all treatment cycles, and poor-adherence appeared to correlate with gastrointestinal events such as diarrhea, nausea, or vomiting. Our results suggest that assessment for compliance along with management of adverse events is needed to maintain treatment effect in clinical practice.