Opioid-induced constipation in patients with cancer pain in Japan (OIC-J study): a post hoc subgroup analysis of patients with lung cancer.

OBJECTIVE: To evaluate the opioid-induced constipation burden in the subgroup of patients with lung cancer who participated in the observational Opioid-Induced Constipation in Patients with Cancer Pain in Japan (OIC-J) study. METHODS: The prospective, observational study, OIC-J, included 212 patients with various tumour types, 33% of whom had lung cancer. The incidence of opioid-induced constipation was evaluated using several diagnostic criteria, as well as the physician's diagnosis and patient's subjective assessment. Following initiation of opioids, patients recorded details of bowel movements (i.e. date/time, Bristol Stool Scale form, sensations of incomplete evacuation or anorectal obstruction/blockage and degree of straining) in a diary for 2 weeks. Relationships between patient characteristics and opioid-induced constipation onset and effects of opioid-induced constipation on quality of life were explored. RESULTS: In total, 69 patients were included in this post hoc analysis. The incidence of opioid-induced constipation varied (39.1-59.1%) depending on which diagnostic criteria was used. Diagnostic criteria that included a quality component or a patient's feeling of bowel movement as an evaluation item (i.e. Rome IV, physician's diagnosis, Bowel Function Index, patient's assessment) showed higher incidences of opioid-induced constipation than recording the number of spontaneous bowel movements alone. Opioid-induced constipation occurred rapidly after initiating opioids and had a significant impact on Patient Assessment of Constipation Symptoms total score (P = 0.0031). Patient baseline characteristics did not appear to be predictive of opioid-induced constipation onset. CONCLUSIONS: In patients with lung cancer, opioid-induced constipation can occur quickly after initiating opioids and can negatively impact quality of life. Early management of opioid-induced constipation, with a focus on quality-of-life improvement and patient's assessments of bowel movements, is important for these patients.

Differential clinical benefits of 5-fluorouracil-based adjuvant chemotherapy for patients with stage III colorectal cancer according to CD133 expression status.

OBJECTIVE: CD133 has been recently identified as a marker of putative cancer stem cells in colorectal tumors. The ability of cancer stem cells to resist chemotherapy was clinically highlighted; however, whether CD133 expression can predict chemoresistance remains controversial. The objective of the study was to determine the relationship between clinical benefits of adjuvant chemotherapy and CD133 expression status in colorectal cancer. METHODS: We enrolled 234 patients with Stage III colorectal cancer who underwent curative resection. Among them, 149 received 5-fluorouracil-based adjuvant chemotherapy (chemotherapy group) and 85 did not (surgery-alone group). We immunohistochemically stained the specimens for CD133 on specimens evaluated the benefits of adjuvant chemotherapy according to CD133 expression using the Kaplan-Meier method and log-rank test. RESULTS: A comparison of disease-free survival between both the groups revealed a significant 3-year disease-free survival benefit of adjuvant chemotherapy in CD133-negative (92.2% versus 74.5%; P = 0.004), but not in CD133-positive patients (46.8% versus 52.9%; P = 0.67). Multivariate analysis corroborated the benefits of adjuvant chemotherapy in CD133-negative (P = 0.003, hazard ratio = 0.26), but not in CD133-positive patients. CONCLUSIONS: CD133-positive patients showed resistance to 5-FU-based chemotherapy, while CD133-negative patients experienced significant survival benefits from adjuvant chemotherapy not shared by CD133-positive patients.