A Prospective Observational Study on Effect of Short-Term Periodic Steroid Premedication on Bone Metabolism in Gastrointestinal Cancer (ESPRESSO-01).
A multicenter prospective observational study evaluated the effect of gastrointestinal cancer chemotherapy with short-term periodic steroid premedication on bone metabolism.



Seventy-four patients undergoing chemotherapy for gastrointestinal cancer were studied. The primary endpoints were changes in bone mineral densities (BMDs) and metabolic bone turnover 16 weeks after initiation of chemotherapy. BMDs, measured by dual-energy x-ray absorptiometry, and serum cross-linked N-telopeptides of type I collagen (sNTX), and bone alkaline phosphatase (sBAP) were assessed for evaluation of bone resorption and formation, respectively.



In 74.3% (55/74) of the patients, BMDs were significantly reduced at 16 weeks relative to baseline. The percent changes of BMD were -1.89% (95% confidence interval [CI], -2.67% to -1.11%:p< .0001) in the lumbar spine, -2.24% (95% CI, -3.59% to -0.89%:p= .002) in the total hip, and -2.05% (95% CI, -3.11% to -0.99%:p< .0001) in the femoral neck. Although there was no significant difference in sNTX levels during 16 weeks (p= .136), there was a significant increase in sBAP levels (p= .010). Decreased BMD was significantly linked to number of chemotherapy cycles (p= .02). There were no significant correlations between changes in BMDs and the primary site of malignancy, chemotherapy regimens, total cumulative steroid dose, steroid dose intensity, and additive steroid usage.



Gastrointestinal cancer chemotherapy with periodic glucocorticoid premedication was associated with reduced BMD and increased sBAP levels, which were linked to number of chemotherapy cycles but independent of primary site, chemotherapy regimen, duration, and additive steroid usage.The Oncologist2017;22:592-600 IMPLICATIONS FOR PRACTICE: Bone health and the management of treatment-related bone loss are important for cancer care. The present study showed that a significant decrease in bone mineral density (BMD) and an increase in serum bone alkaline phosphatase levels occurred in gastrointestinal cancer patients receiving chemotherapy, which were linked to number of chemotherapy cycles but were independent of primary site, chemotherapy regimen, total steroid dose, and steroid dose intensity. Surprisingly, it seems that the decreasing BMD levels after only 16 weeks of chemotherapy for gastrointestinal cancer were comparable to that of 12-month adjuvant aromatase inhibitor therapy for early-stage breast cancer patients.
Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan michio.nakamura@icloud.com.
Michio
M
Nakamura
Department of Medical Oncology, Teine Keijinkai Hospital, Sapporo, Japan.
Atsushi
A
Ishiguro
Division of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo, Japan.
Tetsuhito
T
Muranaka
Department of Gastroenterology, Japan Community Health Care Organization Sapporo Hokushin Hospital, Sapporo, Japan.
Hiraku
H
Fukushima
Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.
Satoshi
S
Yuki
Hokkaido University Hospital Clinical Research and Medical Innovation Center, Sapporo, Japan.
Kota
K
Ono
Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan.
Taichi
T
Murai
Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan.
Chika
C
Matsuda
Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan.
Ayane
A
Oba
Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan.
Kazufumi
K
Itaya
Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan.
Takayuki
T
Sone
Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan.
Masataka
M
Yagisawa
Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan.
Yuta
Y
Koike
Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan.
Ayana
A
Endo
Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan.
Yoko
Y
Tsukuda
Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan.
Yuji
Y
Ono
Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.
Takahiko
T
Kudo
Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan.
Atsushi
A
Nagasaka
Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan.
Shuji
S
Nishikawa
Division of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo, Japan.
Yoshito
Y
Komatsu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015502:Absorptiometry, Photon; D000469:Alkaline Phosphatase / Q000097:blood; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D015519:Bone Density / Q000187:drug effects; D024042:Collagen Type I / Q000378:metabolism; D005770:Gastrointestinal Neoplasms / Q000097:blood / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000473:pathology; D010024:Osteoporosis / Q000097:blood / Q000139:chemically induced / Q000473:pathology; D010455:Peptides / Q000378:metabolism
D000469:Alkaline Phosphatase; D024042:Collagen Type I; C052929:collagen type I trimeric cross-linked peptide; D005938:Glucocorticoids; D010455:Peptides
bone alkaline phosphatase; bone mineral density; chemotherapy; gastrointestinal cancer; glucocorticoid premedication; steroid-induced osteoporosis