329 - A Randomized Controlled Trial: Cognitive Behavior Therapy for Anxiety, Depressive Symptoms and Acute Toxicities in Oligometastatic Nasopharyngeal Carcinoma Patients Receiving Anti-PD-1, Chemotherapy and Stereotactic Body Radiation Therapy

03:45pm - 03:55pm ET

Room 254

Presenter(s)

Feng Liu, MD - Hunan Cancer Hospital, Changsha, Hunan

F. Liu¹, H. Wang¹, Y. Li¹, W. Zhu¹, X. Chen¹, Y. Shi², C. Jiang¹, L. He¹, Y. Li¹, S. Hu¹, K. Chen¹, Y. Qiu¹, W. Wu¹, X. Ye¹, C. Fan¹, H. Liu³, Q. Zhao¹, and X. Wu¹; ¹Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China, ²Hengyang Medical School, University of South China, Hengyang, China, ³Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China

Purpose/Objective(s):

The purpose of this randomized trial was to compare the efficacy of cognitive behavioral therapy (CBT) versus treatment as usual (TAU) on anxiety and depression, and acute toxicities in oligometastatic nasopharyngeal carcinoma (NPC) patients receiving anti-PD-1 antibody, chemotherapy plus stereotactic body radiation therapy (SBRT).

Materials/Methods:

A total of 205 oligometastatic NPC patients (=3 metastatic organs, =5 total lesions) were randomized to CBT (n=102) or TAU (n=103) groups. All patients received anti-PD-1 antibody (tislelizumab/toripalimab/camrelizumab) plus gemcitabine-cisplatin chemotherapy every 3 weeks for 4–6 cycles, with concurrent SBRT initiated on study day 14 (day 1 = first anti-PD-1 dose). Planning target volume (PTV) was gross target volume (GTV) plus 5 mm margin.Thoracic/abdominal lesions received 48 Gy in 6 alternate-day fractions; bone metastases received 24 Gy in 3 alternate-day fractions. Anti-PD-1 maintenance therapy was given for up to 2 years.All patients received irregular health, nutrition, and psychology education sessions. Patients in the CBT group received a series of seventeen CBT sessions integrating behavioral, cognitive, and educational strategies. The CBT group received 17 sessions (behavioral/cognitive/educational strategies): initiated in chemotherapy week 1, with 12 weekly sessions followed by 5 biweekly sessions (13–17). Depression and anxiety symptoms were assessed via Hospital Anxiety and Depression Scale (HADS) at baseline, every 3 weeks during chemotherapy, pre-SBRT, 3 weeks post-SBRT, and quarterly until 1 year after the final chemotherapy cycle. Acute adverse events were evaluated by CTCAE version 5.0.

Results:

CBT group patients had significantly lower HADS-depression (HADS-D) and HADS-anxiety (HADS-A) scores (all P<0.01) from the completion of the first cycle of chemotherapy to 1 year after the last cycle of chemotherapy. The CBT group also had significantly lower rates of acute toxicities (grade 1-4) vs. TAU: weight loss (1.0% vs 8.7%; p=0.019), decreased appetite (44.1% vs 61.2%; p=0.015), fatigue (1.0% vs 7.7%; p=0.037), insomnia (2.9% vs 13.6%; p=0.009), cancer-related pain (9.8% vs 20.4%; p=0.034), anemia (71.6% vs 85.4%; p=0.016), and hypoalbuminemia (3.9% vs 11.7%; p=0.039). No grade 5 toxicity occurred. Objective response rate (ORR: 90.2% vs. 88.3%, P=0.669), disease control rate (DCR: 97.1% vs. 95.1%, P=0.721), and median progression-free survival (PFS: 10.1 vs. 9.9 months, P=0.826) were comparable between groups.

Conclusion:

Adding CBT to anti-PD-1 antibody, chemotherapy, and SBRT significantly alleviated anxiety/depression symptoms and reduced acute toxicities (including weight loss, fatigue, insomnia, cancer-related pain, anemia and hypoalbuminemia) in oligometastatic NPC patients.