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Original research
Malignant bowel obstruction: effectiveness and safety of systemic chemotherapy
  1. Rafael Caparica1,
  2. Larissa Amorim2,
  3. Paulo Amaral2,
  4. Lucas Uratani2,
  5. David Muniz2,
  6. Alain Hendlisz1,
  7. Evandro de Azambuja1,
  8. João Glasberg3,
  9. Tiago Kenji Takahashi4,
  10. Elias Abdo Filho2,
  11. Rodrigo Canellas5,
  12. Daniel Saragiotto2,
  13. Jorge Sabbaga2 and
  14. Milena Mak2
  1. 1 Department of Medical Oncology, Institut Jules Bordet, Brussels, Belgium
  2. 2 Department of Medical Oncology, Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
  3. 3 Department of Medical Oncology, Hospital Sao Luiz Anália Franco, Oncologia D’or, Sao Paulo, Brazil
  4. 4 Department of Medical Oncology, Hospital Santa Paula, Sao Paulo, Brazil
  5. 5 Department of Radiology, Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
  1. Correspondence to Dr Rafael Caparica; rcaparica{at}hotmail.com

Abstract

Objectives Although systemic chemotherapy is often administered to patients with malignant bowel obstruction (MBO), its benefit remains unknown. This study assessed the outcomes of patients who received systemic chemotherapy as part of MBO treatment.

Methods For this retrospective cohort study, data were extracted from records of patients hospitalised due to MBO in a tertiary cancer centre from 2008 to 2020. Eligible patients were not candidates for surgery and received systemic chemotherapy targeting the underlying malignancy causing MBO. Primary objective was to assess patient outcomes after chemotherapy; secondary objectives were rates of intestinal function recovery, hospital discharge and grade ≥3 toxicities. The primary endpoint was overall survival (OS).

Results A total of 167 patients were included: median age was 55 (18–81) years, 91% had an Eastern Cooperative Oncology Group (ECOG) performance status ≥2, 75.5% had gastrointestinal tumours and 70% were treatment-naive. The median OS after chemotherapy was 4.4 weeks (95% CI 3.4 to 5.5) in the overall population. No OS difference was observed according to treatment line (p=0.24) or primary tumour (p=0.13). Intestinal function recovery occurred in 87 patients (52%), out of whom 21 (24.1%) had a reobstruction. Hospital discharge was possible in 74 patients (44.3%). Grade≥3 adverse events occurred in 26.9% of the patients, and a total of 12 deaths (7%) attributed to toxicities were observed after chemotherapy.

Conclusions MBO was associated with a dismal prognosis in this mostly treatment-naive population. The administration of chemotherapy yielded a significant risk of toxicities, whereas it did not appear to provide any relevant survival benefit in this scenario.

  • intestinal obstruction
  • other cancer
  • supportive care

Data availability statement

Data are available on reasonable request. The datasets generated during the current study are not publicly available due to local Institutional policies, but may be available from the corresponding author on reasonable request.

https://doi.org/10.1136/bmjspcare-2020-002656

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    Data availability statement

    Data are available on reasonable request. The datasets generated during the current study are not publicly available due to local Institutional policies, but may be available from the corresponding author on reasonable request.

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    Footnotes

    • Presented at The present work was presented as a poster during the European Society for Medical Oncology (ESMO) virtual conference, 19–21 September 2020.

    • Contributors RC, DM, LA, PA, LU and MPM have conceived this study. RC, DM, LA, PA and LU have extracted data from medical records. MPM performed all statistical analyses. All authors participated in manuscript writing. All authors read and approved the final version of the manuscript before submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests RC has received speaker honoraria from Boehringer-Ingelheim, AstraZeneca and Janssen; and travel grants from AstraZeneca and Pfizer, none related to the present work. DM has received speaker honoraria from Pfizer, Jannsen and Sanofi; and research grants from Pfizer. DFS has received speaker honoraria from ROCHE, AMGEN and Merck KGaA. EdA reports honoraria and/or advisory board from Roche/GNE, Novartis, Seattle Genetics and Zodiac; and travel grants from Roche/GNE and GSK/Novartis. The Institute he works for has received research grants from AstraZeneca, Lilly, MSD, Novartis, Pfizer, Roche-Genentech, Synthon, Radius, and Servier. MPM received honoraria from Bayer, Roche, Pfizer, MSD and Merck, and consulting honoraria from AstraZeneca.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.