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Ghaneh P, Palmer D, Cicconi S, Jackson R, Halloran CM, Rawcliffe C, Sripadam R, Mukherjee S, Soonawalla Z, Wadsley J, Al-Mukhtar A, Dickson E, Graham J, Jiao L, Wasan HS, Tait IS, Prachalias A, Ross P, Valle JW, O'Reilly DA, Al-Sarireh B, Gwynne S, Ahmed I, Connolly K, Yim KL, Cunningham D, Armstrong T, Archer C, Roberts K, Ma YT, Springfeld C, Tjaden C, Hackert T, Büchler MW, Neoptolemos JP. Immediate surgery compared with short-course neoadjuvant gemcitabine plus capecitabine, FOLFIRINOX, or chemoradiotherapy in patients with borderline resectable pancreatic cancer (ESPAC5): a four-arm, multicentre, randomised, phase 2 trial. Lancet Gastroenterol Hepatol 2023; 8:157-168. [PMID: 36521500 DOI: 10.1016/s2468-1253(22)00348-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with borderline resectable pancreatic ductal adenocarcinoma have relatively low resection rates and poor survival despite the use of adjuvant chemotherapy. The aim of our study was to establish the feasibility and efficacy of three different types of short-course neoadjuvant therapy compared with immediate surgery. METHODS ESPAC5 (formerly known as ESPAC-5f) was a multicentre, open label, randomised controlled trial done in 16 pancreatic centres in two countries (UK and Germany). Eligible patients were aged 18 years or older, with a WHO performance status of 0 or 1, biopsy proven pancreatic ductal adenocarcinoma in the pancreatic head, and were staged as having a borderline resectable tumour by contrast-enhanced CT criteria following central review. Participants were randomly assigned by means of minimisation to one of four groups: immediate surgery; neoadjuvant gemcitabine and capecitabine (gemcitabine 1000 mg/m2 on days 1, 8, and 15, and oral capecitabine 830 mg/m2 twice a day on days 1-21 of a 28-day cycle for two cycles); neoadjuvant FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, folinic acid given according to local practice, and fluorouracil 400 mg/m2 bolus injection on days 1 and 15 followed by 2400 mg/m2 46 h intravenous infusion given on days 1 and 15, repeated every 2 weeks for four cycles); or neoadjuvant capecitabine-based chemoradiation (total dose 50·4 Gy in 28 daily fractions over 5·5 weeks [1·8 Gy per fraction, Monday to Friday] with capecitabine 830 mg/m2 twice daily [Monday to Friday] throughout radiotherapy). Patients underwent restaging contrast-enhanced CT at 4-6 weeks after neoadjuvant therapy and underwent surgical exploration if the tumour was still at least borderline resectable. All patients who had their tumour resected received adjuvant therapy at the oncologist's discretion. Primary endpoints were recruitment rate and resection rate. Analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN, 89500674, and is complete. FINDINGS Between Sept 3, 2014, and Dec 20, 2018, from 478 patients screened, 90 were randomly assigned to a group (33 to immediate surgery, 20 to gemcitabine plus capecitabine, 20 to FOLFIRINOX, and 17 to capecitabine-based chemoradiation); four patients were excluded from the intention-to-treat analysis (one in the capecitabine-based chemoradiotherapy withdrew consent before starting therapy and three [two in the immediate surgery group and one in the gemcitabine plus capecitabine group] were found to be ineligible after randomisation). 44 (80%) of 55 patients completed neoadjuvant therapy. The recruitment rate was 25·92 patients per year from 16 sites; 21 (68%) of 31 patients in the immediate surgery and 30 (55%) of 55 patients in the combined neoadjuvant therapy groups underwent resection (p=0·33). R0 resection was achieved in three (14%) of 21 patients in the immediate surgery group and seven (23%) of 30 in the neoadjuvant therapy groups combined (p=0·49). Surgical complications were observed in 29 (43%) of 68 patients who underwent surgery; no patients died within 30 days. 46 (84%) of 55 patients receiving neoadjuvant therapy were available for restaging. Six (13%) of 46 had a partial response. Median follow-up time was 12·2 months (95% CI 12·0-12·4). 1-year overall survival was 39% (95% CI 24-61) for immediate surgery, 78% (60-100) for gemcitabine plus capecitabine, 84% (70-100) for FOLFIRINOX, and 60% (37-97) for capecitabine-based chemoradiotherapy (p=0·0028). 1-year disease-free survival from surgery was 33% (95% CI 19-58) for immediate surgery and 59% (46-74) for the combined neoadjuvant therapies (hazard ratio 0·53 [95% CI 0·28-0·98], p=0·016). Three patients reported local disease recurrence (two in the immediate surgery group and one in the FOLFIRINOX group). 78 (91%) patients were included in the safety set and assessed for toxicity events. 19 (24%) of 78 patients reported a grade 3 or worse adverse event (two [7%] of 28 patients in the immediate surgery group and 17 [34%] of 50 patients in the neoadjuvant therapy groups combined), the most common of which were neutropenia, infection, and hyperglycaemia. INTERPRETATION Recruitment was challenging. There was no significant difference in resection rates between patients who underwent immediate surgery and those who underwent neoadjuvant therapy. Short-course (8 week) neoadjuvant therapy had a significant survival benefit compared with immediate surgery. Neoadjuvant chemotherapy with either gemcitabine plus capecitabine or FOLFIRINOX had the best survival compared with immediate surgery. These findings support the use of short-course neoadjuvant chemotherapy in patients with borderline resectable pancreatic ductal adenocarcinoma. FUNDING Cancer Research UK.
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Affiliation(s)
- Paula Ghaneh
- Department Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
| | - Daniel Palmer
- Department Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Silvia Cicconi
- Department Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK; Swiss Tropical and Public Health Institute, Allschwil, Switzerland; Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Richard Jackson
- Department Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | | | - Charlotte Rawcliffe
- Department Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | | | | | | | | | | | | | - Janet Graham
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | | | | | - Paul Ross
- Guy's and St Thomas'Hospital, London, UK
| | - Juan W Valle
- University of Manchester, The Christie, Manchester, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | - Christine Tjaden
- University Hospital Heidelberg Department of Surgery, Heidelberg, Germany
| | - Thilo Hackert
- University Hospital Heidelberg Department of Surgery, Heidelberg, Germany
| | - Markus W Büchler
- University Hospital Heidelberg Department of Surgery, Heidelberg, Germany
| | - John P Neoptolemos
- Department Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK; University Hospital Heidelberg Department of Surgery, Heidelberg, Germany
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Lin NU, Murthy RK, Abramson V, Anders C, Bachelot T, Bedard PL, Borges V, Cameron D, Carey LA, Chien AJ, Curigliano G, DiGiovanna MP, Gelmon K, Hortobagyi G, Hurvitz SA, Krop I, Loi S, Loibl S, Mueller V, Oliveira M, Paplomata E, Pegram M, Slamon D, Zelnak A, Ramos J, Feng W, Winer E. Tucatinib vs Placebo, Both in Combination With Trastuzumab and Capecitabine, for Previously Treated ERBB2 (HER2)-Positive Metastatic Breast Cancer in Patients With Brain Metastases: Updated Exploratory Analysis of the HER2CLIMB Randomized Clinical Trial. JAMA Oncol 2023; 9:197-205. [PMID: 36454580 PMCID: PMC9716438 DOI: 10.1001/jamaoncol.2022.5610] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022]
Abstract
Importance It is estimated that up to 50% of patients with ERBB2 (HER2)-positive metastatic breast cancer (MBC) will develop brain metastases (BMs), which is associated with poor prognosis. Previous reports of the HER2CLIMB trial have demonstrated that tucatinib in combination with trastuzumab and capecitabine provides survival and intracranial benefits for patients with ERBB2-positive MBC and BMs. Objective To describe overall survival (OS) and intracranial outcomes from tucatinib in combination with trastuzumab and capecitabine in patients with ERBB2-positive MBC and BMs with an additional 15.6 months of follow-up. Design, Setting, and Participants HER2CLIMB is an international, multicenter, randomized, double-blind, placebo-controlled clinical trial evaluating tucatinib in combination with trastuzumab and capecitabine. The 612 patients, including those with active or stable BMs, had ERBB2-positive MBC previously treated with trastuzumab, pertuzumab, and trastuzumab emtansine. The study was conducted from February 23, 2016, to May 3, 2019. Data from February 23, 2016, to February 8, 2021, were analyzed. Interventions Patients were randomized 2:1 to receive tucatinib (300 mg orally twice daily) or placebo (orally twice daily), both in combination with trastuzumab (6 mg/kg intravenously or subcutaneously every 3 weeks with an initial loading dose of 8 mg/kg) and capecitabine (1000 mg/m2 orally twice daily on days 1-14 of each 3-week cycle). Main Outcomes and Measures Evaluations in this exploratory subgroup analysis included OS and intracranial progression-free survival (CNS-PFS) in patients with BMs, confirmed intracranial objective response rate (ORR-IC) and duration of intracranial response (DOR-IC) in patients with measurable intracranial disease at baseline, and new brain lesion-free survival in all patients. Only OS was prespecified before the primary database lock. Results At baseline, 291 of 612 patients (47.5%) had BMs. Median age was 52 years (range, 22-75 years), and 289 (99.3%) were women. At median follow-up of 29.6 months (range, 0.1-52.9 months), median OS was 9.1 months longer in the tucatinib-combination group (21.6 months; 95% CI, 18.1-28.5) vs the placebo-combination group (12.5 months; 95% CI, 11.2-16.9). The tucatinib-combination group showed greater clinical benefit in CNS-PFS and ORR-IC compared with the placebo-combination group. The DOR-IC was 8.6 months (95% CI, 5.5-10.3 months) in the tucatinib-combination group and 3.0 months (95% CI, 3.0-10.3 months) in the placebo-combination group. Risk of developing new brain lesions as the site of first progression or death was reduced by 45.1% in the tucatinib-combination group vs the placebo-combination group (hazard ratio, 0.55 [95% CI, 0.36-0.85]). Conclusions and Relevance This subgroup analysis found that tucatinib in combination with trastuzumab and capecitabine improved OS while reducing the risk of developing new brain lesions, further supporting the importance of this treatment option for patients with ERBB2-positive MBC, including those with BMs. Trial Registration ClinicalTrials.gov Identifier: NCT02614794.
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Affiliation(s)
- Nancy U. Lin
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | | | - Philippe L. Bedard
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - David Cameron
- Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - Lisa A. Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - A. Jo Chien
- University of California at San Francisco, San Francisco
| | - Giuseppe Curigliano
- Istituto Europeo di Oncologia, IRCCS, Milano, Italy
- University of Milano, Milano, Italy
| | | | - Karen Gelmon
- British Columbia Cancer–Vancouver Centre, Vancouver, British Columbia, Canada
| | | | - Sara A. Hurvitz
- David Geffen School of Medicine at UCLA/Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Ian Krop
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Yale Cancer Center, New Haven, Connecticut
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | | | | | - Elisavet Paplomata
- Carbone Cancer Center, University of Wisconsin, Madison
- ICON Plc, Blue Bell, Pennsylvania
| | - Mark Pegram
- Stanford Cancer Institute, Palo Alto, California
| | - Dennis Slamon
- David Geffen School of Medicine at UCLA/Jonsson Comprehensive Cancer Center, Los Angeles, California
| | | | | | | | - Eric Winer
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Yale Cancer Center, New Haven, Connecticut
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Chen X, Leng W, Zhou Y, Yu Y, Meng W, Cao P, Wang Z, Qiu M. Pathological response and safety of FOLFOXIRI for neoadjuvant treatment of high-risk relapsed locally advanced colon cancer: study protocol for a single-arm, open-label phase II trial. BMJ Open 2023; 13:e062659. [PMID: 36720570 PMCID: PMC9890744 DOI: 10.1136/bmjopen-2022-062659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NAC) has been demonstrated effective in several tumours, but its benefit has not yet been elucidated in colorectal cancer, especially locally advanced colorectal cancer (LACRC). METHODS AND ANALYSIS This is a single-arm, open-label, prospective phase II exploratory clinical trial. Patients with LACRC will receive four cycles of NAC with 5-fluorouracil, oxaliplatin and irinotecan (FOLFOXIRI), followed by operation and then adjuvant chemotherapy with capecitabine and oxaliplatin for two to five cycles or single-agent capecitabine for five cycles, or observation. The primary endpoint is the rate of tumour regression grade (TRG) 0-2 in the resected tumour tissue, which is evaluated by experienced pathologists according to the Ryan R TRG grading system. Secondary endpoints include objective response rate, pathologic complete response, microscopically complete resection rate, progression-free survival, distant metastasis-free survival, overall survival, toxicity and compliance to study treatment, molecular markers, quality of life to study treatment and the number of patients with 30-day postoperative mortality. The objective of this study is to analyse the efficacy and safety of FOLFOXIRI as the NAC regimen in patients with LACRC and to identify a promising treatment strategy in this setting. ETHICS AND DISSEMINATION Written informed consent will be required from and provided by all patients enrolled. The study protocol has been approved by the independent ethics committee of West China Hospital, Sichuan University (approval number: 2021403). This study will demonstrate the potential benefit of NAC with the FOLFOXIRI regimen. Results will be shared with policymakers and the academic community to promote the clinical management of colon cancer. TRIAL REGISTRATION NUMBER NCT05018182.
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Affiliation(s)
- Xiaorong Chen
- Department of Colorectal Cancer Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Weibing Leng
- Department of Colorectal Cancer Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - YuWen Zhou
- Department of Biotherapy, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yongyang Yu
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Wenjian Meng
- Department of Colorectal Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Peng Cao
- Department of Colorectal Cancer Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Ziqiang Wang
- Department of Colorectal Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Meng Qiu
- Department of Colorectal Cancer Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
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Wang J, Wang Y, Che X. Pathological pseudoprogression to anti-PD-1 inhibitor in metastatic periampullary carcinoma: Case report. Medicine (Baltimore) 2023; 102:e32644. [PMID: 36705379 PMCID: PMC9875975 DOI: 10.1097/md.0000000000032644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
RATIONALE Pseudoprogression has been deemed as a rare clinical phenomenon during the treatment of immune checkpoint inhibitors in patients with advanced cancers, especially in periampullary carcinoma, however, leaving potential molecular mechanism remain unknown. PATIENT CONCERNS Regular examination after radical pancreaticoduodenectomy because of periampullary carcinoma. DIAGNOSES Recurrent periampullary carcinoma with metastasis in liver. INTERVENTIONS Regimens of XELOX (oxaliplatin at a dose of 130 mg/m2, day 1 and oral capecitabine at a dose of 1000 mg/m2 twice a day, day 1-14, every 21 days), and tislelizumab at a dose of 200 mg, day 1, per 21 days, was prescribed as palliative treatment. OUTCOMES Pseudoprogression and symptom of hair and mustache repigmentation were also observed, which resulted in partial response finally. LESSONS Results of the present case suggested that pseudoprogression, along with hair and mustache repigmentation, possibly caused by anti-PD-1 inhibitors, may also happen in patients with periampullary carcinoma, which should be paid attention to. The potential mechanism should be further investigated.
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Affiliation(s)
- Junhui Wang
- Department of Radiation Oncology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People′s Hospital, RD. Minjiang, Dist. Kecheng. Quzhou, Zhejiang, China
| | - Yan Wang
- Department of Radiation Oncology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People′s Hospital, RD. Minjiang, Dist. Kecheng. Quzhou, Zhejiang, China
| | - Xiaoling Che
- Department of Medical Oncology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, RD. Minjiang, Dist. Kecheng. Quzhou, Zhejiang, China
- * Correspondence: Xiaoling Che, Department of Radiation Oncology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, RD. Minjiang, Dist. Kecheng, Quzhou 324000, Zhejiang, China (e-mail: )
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He J, Liu Y, Liu C, Hu H, Sun L, Xu D, Li J, Wang J, Chen X, Lin R, Jiang Y, Zhang Y, Zhang W, Cheng Y, Wu X, Fang M, Li E, Xu Y, Chen Y, Li J, Cui Y, Pan Z, Zhang S, Yuan Y, Ding K. A Randomized Phase III Study of Anlotinib Versus Bevacizumab in Combination With CAPEOX as First-Line Therapy for RAS/BRAF Wild-Type Metastatic Colorectal Cancer: A Clinical Trial Protocol. Technol Cancer Res Treat 2023; 22:15330338231152350. [PMID: 36727222 PMCID: PMC9900663 DOI: 10.1177/15330338231152350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/09/2022] [Accepted: 01/05/2023] [Indexed: 02/03/2023] Open
Abstract
Background: Chemotherapy combined with antivascular endothelial growth factor (VEGF) or anti-epidermal growth factor receptor monoclonal antibodies is the most promising approach to prolong survival and improve the quality of life of patients with unresectable metastatic colorectal cancer (mCRC). Anlotinib is an oral antiangiogenic tyrosine kinase inhibitor that targets VEGF receptors 1/2/3, fibroblast growth factor receptors 1-4, and platelet-derived growth factor receptors a/β. Since anlotinib combined with oxaliplatin and capecitabine (CAPEOX) as a first-line treatment was previously shown to be effective and safe for patients with RAS/BRAF wild-type (WT) mCRC, we designed this randomized, open-label, parallel-group, non-inferiority, phase III study to evaluate the efficacy and safety of anlotinib plus CAPEOX versus bevacizumab plus CAPEOX in patients with RAS/BRAF WT mCRC. Methods/design: The primary inclusion criteria are Eastern Cooperative Oncology Group performance status 0/1, confirmed RAS/BRAF WT colorectal adenocarcinoma, and unresectable metastases assessed by a multidisciplinary team. The main exclusion criteria are as follows: high microsatellite instability or deficient mismatch repair status, resectable or potentially resectable metastases, and previous systemic therapy for mCRC. A total of 698 patients will be randomized into the anlotinib and bevacizumab groups in a 1:1 ratio. Patients will receive 4 to 8 cycles of induction therapy (CAPEOX plus anlotinib or bevacizumab), followed by maintenance treatment (capecitabine plus anlotinib or bevacizumab) until disease progression or unacceptable toxicity. Progression-free survival (PFS) assessed by an independent review committee is the primary endpoint, whereas investigator-assessed PFS, overall survival, objective response rate, disease control rate, duration of response, resection rate of liver metastases, quality of life, and safety are the secondary endpoints. Enrollment commenced in May 2021. Discussion: A prospective, randomized, phase III trial will provide a meaningful comparison of the efficacy and safety of anlotinib plus CAPEOX with standard treatment for patients with unresectable RAS/BRAF WT mCRC.
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Affiliation(s)
- Jinjie He
- Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention
and Intervention, Ministry of Education, The Second Affiliated Hospital of Zhejiang
University School of Medicine, Hangzhou,
China
| | - Yue Liu
- Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention
and Intervention, Ministry of Education, The Second Affiliated Hospital of Zhejiang
University School of Medicine, Hangzhou,
China
| | - Chengcheng Liu
- Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention
and Intervention, Ministry of Education, The Second Affiliated Hospital of Zhejiang
University School of Medicine, Hangzhou,
China
| | - Hanguang Hu
- Medical Oncology, The Second Affiliated Hospital of Zhejiang
University School of Medicine, Hangzhou,
China
| | - Lifeng Sun
- Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention
and Intervention, Ministry of Education, The Second Affiliated Hospital of Zhejiang
University School of Medicine, Hangzhou,
China
| | - Dong Xu
- Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention
and Intervention, Ministry of Education, The Second Affiliated Hospital of Zhejiang
University School of Medicine, Hangzhou,
China
| | - Jun Li
- Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention
and Intervention, Ministry of Education, The Second Affiliated Hospital of Zhejiang
University School of Medicine, Hangzhou,
China
| | - Junye Wang
- Affiliated
Hospital of Jining Medical University,
Jining, China
| | | | - Rongbo Lin
- Fujian
Provincial Cancer Hospital, Fuzhou,
China
| | - Yi Jiang
- Affiliated
Cancer Hospital of Shantou University Medical
College, Shantou, China
| | - Yanqiao Zhang
- Affiliated
Cancer Hospital of Harbin Medical
University, Harbin, China
| | | | | | - Xiaohong Wu
- Affiliated
Hospital of Jiangnan University, Wuxi,
China
| | - Mingzhi Fang
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing
University of Chinese Medicine, Nanjing, China
| | - Enxiao Li
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an,
China
| | - Ye Xu
- Fudan
University Shanghai Cancer Center,
Shanghai, China
| | - Ye Chen
- The First
Affiliated Hospital of Henan University of Science and
Technology, Luoyang, China
| | - Jiayi Li
- The First
Affiliated Hospital of Xiamen University,
Xiamen, China
| | - Yanyan Cui
- Affiliated Hospital of Chifeng University, Chifeng, China
| | - Zhanyu Pan
- Tianjin
Medical University Cancer Institute and
Hospital, Tianjin, China
| | - Songnan Zhang
- Affiliated Hospital of Yanbian University, Yanbian, China
| | - Ying Yuan
- Medical Oncology, The Second Affiliated Hospital of Zhejiang
University School of Medicine, Hangzhou,
China
| | - Kefeng Ding
- Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention
and Intervention, Ministry of Education, The Second Affiliated Hospital of Zhejiang
University School of Medicine, Hangzhou,
China
- Cancer Center Zhejiang University, Zhejiang, China
- Kefeng Ding, Colorectal Surgery and
Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of
Education, The Second Affiliated Hospital of Zhejiang University School of
Medicine, Hangzhou, China.
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Wheeler SB, Rotter J, Gogate A, Reeder-Hayes KE, Drier SW, Ekwueme DU, Fairley TL, Rocque GB, Trogdon JG. Cost-Effectiveness of Pharmacologic Treatment Options for Women With Endocrine-Refractory or Triple-Negative Metastatic Breast Cancer. J Clin Oncol 2023; 41:32-42. [PMID: 36054865 PMCID: PMC9788984 DOI: 10.1200/jco.21.02473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/31/2022] [Accepted: 07/12/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Treatments for endocrine-refractory or triple-negative metastatic breast cancer (mBC) are modestly effective at prolonging life and improving quality of life but can be extremely expensive. Given these tradeoffs in quality of life and cost, the optimal choice of treatment sequencing is unclear. Cost-effectiveness analysis can explicitly quantify such tradeoffs, enabling more informed decision making. Our objective was to estimate the societal cost-effectiveness of different therapeutic alternatives in the first- to third-line sequences of single-agent chemotherapy regimens among patients with endocrine-refractory or triple-negative mBC. METHODS Using three dynamic microsimulation models of 10,000 patients each, three cohorts were simulated, based upon prior chemotherapy exposure: (1) unexposed to either taxane or anthracycline, (2) taxane- and anthracycline-exposed, and (3) taxane-exposed/anthracycline-naive. We focused on the following single-agent chemotherapy regimens as reasonable and commonly used options in the first three lines of therapy for each cohort, based upon feedback from oncologists treating endocrine-refractory or triple-negative mBC: (1) for taxane- and anthracycline-unexposed patients, paclitaxel, capecitabine (CAPE), or pegylated liposomal doxorubicin; (2) for taxane- and anthracycline-exposed patients, Eribulin, CAPE, or carboplatin; and (3) for taxane-exposed/anthracycline-naive patients, pegylated liposomal doxorubicin, CAPE, or Eribulin. RESULTS In each cohort, accumulated quality-adjusted life-years were similar between regimens, but total societal costs varied considerably. Sequences beginning first-line treatment with paclitaxel, carboplatin, and CAPE, respectively, for cohorts 1, 2, and 3, had lower costs and similar or slightly better outcomes compared with alternative options. CONCLUSION In this setting where multiple single-agent chemotherapy options are recommended by clinical guidelines and share similar survival and adverse event trajectories, treatment sequencing approaches that minimize costs early may improve the value of care.
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Affiliation(s)
- Stephanie B. Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jason Rotter
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anagha Gogate
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine E. Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Medical Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sarah W. Drier
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Donatus U. Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Temeika L. Fairley
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Gabrielle B. Rocque
- Division of Hematology/Oncology, Departments of Medicine and Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
| | - Justin G. Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Yuan Y, Liu X, Cai Y, Li W. Pyrotinib versus lapatinib therapy for HER2 positive metastatic breast cancer patients after first-line treatment failure: A meta-analysis and systematic review. PLoS One 2023; 18:e0279775. [PMID: 36602979 DOI: 10.1371/journal.pone.0279775] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/10/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION It is critical to select subsequent treatments for patients after the failure of trastuzumab therapy. Following the failure of standard trastuzumab therapy guidelines in the Chinese Society of Clinical Oncology, pyrotinib and capecitabine is a grade I recommended regimen for treating patients with HER2-positive metastatic breast cancer. Concurrently, in treating patients with HER2-positive metastatic breast cancer, lapatinib and capecitabine are also recommended regimens for those who have previously received taxanes, anthracyclines, and trastuzumab therapy. However, there is currently no systematic review and meta-analysis comparing pyrotinib with lapatinib among HER2+ MBC patients. Therefore, this study aims to perform a systematic review and meta-analysis and assess whether pyrotinib is superior to lapatinib in efficacy and safety. METHODS Relevant trials were searched in CNKI, Wanfang, VIP, PubMed, Embase, and Cochrane CENTRAL databases from inception until March 27th, 2022. The primary outcomes were PFS and OS, and the secondary outcomes were ORR and grade ≥3 AEs. RESULTS Five relevant studies were included in this study, including 2 RCTs and 3 retrospective cohort studies. Pyrotinib combined with chemotherapy is superior to lapatinib combined with chemotherapy among HER2+ metastatic breast cancer patients, with a significant improvement in PFS (prior trastuzumab therapy) (HR: 0.47, 95% CI: 0.39-0.57, p<0.001, I2 = 0%, FEM), PFS (trastuzumab resistance) (HR: 0.52, 95% CI: 0.39-0.68, p<0.001, I2 = 40%, FEM) and ORR (RR: 1.45, 95% CI: 1.26-1.67, p<0.001, I2 = 8%, FEM), but has higher grade ≥3 diarrhea incidence (RR: 2.68, 95% CI: 1.85-3.90, p<0.001, I2 = 44%, FEM). CONCLUSIONS The efficacy of pyrotinib combined with chemotherapy is superior to lapatinib combined with chemotherapy but has more safety risks.
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Affiliation(s)
- Ye Yuan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xumei Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi Cai
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenyuan Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Christenson ES, Lim SJ, Durham J, De Jesus-Acosta A, Bever K, Laheru D, Ryan A, Agarwal P, Scharpf RB, Le DT, Wang H. Cell-free DNA Predicts Prolonged Response to Multi-agent Chemotherapy in Pancreatic Ductal Adenocarcinoma. Cancer Res Commun 2022; 2:1418-1425. [PMID: 36970054 PMCID: PMC10035498 DOI: 10.1158/2767-9764.crc-22-0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
The treatment of metastatic pancreatic ductal adenocarcinoma (PDAC) is frequently characterized by significant toxicity and rapid development of resistance to current approved therapies. More reliable biomarkers of response are needed to guide clinical decision making. We evaluated cell-free DNA (cfDNA) using a tumor-agnostic platform and traditional biomarkers (CEA and CA19-9) levels in 12 patients treated at Johns Hopkins University on NCT02324543 "Study of Gemcitabine/Nab-Paclitaxel/Xeloda (GAX) in Combination With Cisplatin and Irinotecan in Subjects With Metastatic Pancreatic Cancer." The pretreatment values, levels after 2 months of treatment, and change in biomarker levels with treatment were compared with clinical outcomes to determine their predictive value. The variant allele frequency (VAF) of KRAS and TP53 mutations in cfDNA after 2 months of treatment was predictive of progression-free survival (PFS) and overall survival (OS). In particular, patients with a lower-than-average KRAS VAF after 2 months of treatment had a substantially longer PFS than patients with higher posttreatment KRAS VAF (20.96 vs. 4.39 months). Changes in CEA and CA19-9 after 2 months of treatment were also good predictors of PFS. Comparison via concordance index demonstrated KRAS or TP53 VAF after 2 months of treatment to be better predictors of PFS and OS than CA19-9 or CEA. This pilot study requires validation but suggests cfDNA measurement is a useful adjunct to traditional protein biomarkers and imaging evaluation and could distinguish between patients who are likely to achieve prolonged responses versus those that will have early progression and may benefit from a change in treatment approach. Significance We report on the association of cfDNA with response durability for patients undergoing treatment with a novel metronomic chemotherapy regimen (gemcitabine, nab-paclitaxel, capecitabine, cisplatin, irinotecan; GAX-CI) for metastatic PDAC. This investigation offers encouraging evidence that cfDNA may prove to be a valuable diagnostic tool to guide clinical management.
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Affiliation(s)
- Eric S Christenson
- Bloomberg-Kimmel Institute, Sidney Kimmel Comprehensive Cancer Center, and The Skip Viragh Center for Pancreatic Cancer Research and Clinical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Su Jin Lim
- Bloomberg-Kimmel Institute, Sidney Kimmel Comprehensive Cancer Center, and The Skip Viragh Center for Pancreatic Cancer Research and Clinical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer Durham
- Bloomberg-Kimmel Institute, Sidney Kimmel Comprehensive Cancer Center, and The Skip Viragh Center for Pancreatic Cancer Research and Clinical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ana De Jesus-Acosta
- Bloomberg-Kimmel Institute, Sidney Kimmel Comprehensive Cancer Center, and The Skip Viragh Center for Pancreatic Cancer Research and Clinical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine Bever
- Bloomberg-Kimmel Institute, Sidney Kimmel Comprehensive Cancer Center, and The Skip Viragh Center for Pancreatic Cancer Research and Clinical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel Laheru
- Bloomberg-Kimmel Institute, Sidney Kimmel Comprehensive Cancer Center, and The Skip Viragh Center for Pancreatic Cancer Research and Clinical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy Ryan
- Bloomberg-Kimmel Institute, Sidney Kimmel Comprehensive Cancer Center, and The Skip Viragh Center for Pancreatic Cancer Research and Clinical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Parul Agarwal
- Bloomberg-Kimmel Institute, Sidney Kimmel Comprehensive Cancer Center, and The Skip Viragh Center for Pancreatic Cancer Research and Clinical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert B Scharpf
- Bloomberg-Kimmel Institute, Sidney Kimmel Comprehensive Cancer Center, and The Skip Viragh Center for Pancreatic Cancer Research and Clinical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dung T Le
- Bloomberg-Kimmel Institute, Sidney Kimmel Comprehensive Cancer Center, and The Skip Viragh Center for Pancreatic Cancer Research and Clinical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hao Wang
- Bloomberg-Kimmel Institute, Sidney Kimmel Comprehensive Cancer Center, and The Skip Viragh Center for Pancreatic Cancer Research and Clinical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Jeong SH, Molloy L, Ang E, Helsby N. Re-thinking the possible interaction between proton pump inhibitors and capecitabine. Cancer Chemother Pharmacol 2022; 90:381-388. [PMID: 36098758 PMCID: PMC9556389 DOI: 10.1007/s00280-022-04473-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/05/2022] [Indexed: 12/02/2022]
Abstract
Proton Pump Inhibitors (PPI) rank within the top ten most prescribed medications in Europe and USA. A high frequency of PPI use has been reported amongst patients undergoing chemotherapy, to mitigate treatment-induced gastritis or gastro-oesophageal reflux. Several recent, mostly retrospective, observational studies have reported inferior survival outcomes among patients on capecitabine who concomitantly use PPI. Whilst this association is yet to be definitively established, given the prominence of capecitabine as an anti-cancer treatment with multiple indications, these reports have raised concern within the oncological community and drug regulatory bodies worldwide. Currently, the leading mechanism of interaction postulated in these reports has focussed on the pH altering effects of PPI and how this could diminish capecitabine absorption, leading to a decrease in its bioavailability. In this discourse, we endeavour to summarise plausible pharmacokinetic interactions between PPI and capecitabine. We provide a basis for our argument against the currently proposed mechanism of interaction. We also highlight the long-term effects of PPI on health outcomes, and how PPI use itself could lead to poorer outcomes, independent of capecitabine.
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Affiliation(s)
- Soo Hee Jeong
- Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Lara Molloy
- Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Edmond Ang
- Cancer and Blood Research, Auckland District Health Board, Auckland, New Zealand
| | - Nuala Helsby
- Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Eliason S, Hong L, Sweat Y, Chalkley C, Cao H, Liu Q, Qi H, Xu H, Zhan F, Amendt BA. Extracellular vesicle expansion of PMIS-miR-210 expression inhibits colorectal tumour growth via apoptosis and an XIST/NME1 regulatory mechanism. Clin Transl Med 2022; 12:e1037. [PMID: 36116139 PMCID: PMC9482803 DOI: 10.1002/ctm2.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) has a high mortality rate, and therapeutic approaches to treat these cancers are varied and depend on the metabolic state of the tumour. Profiles of CRC tumours have identified several biomarkers, including microRNAs. microRNA-210 (miR-210) levels are directly correlated with CRC survival. miR-210 expression is higher in metastatic colon cancer cells versus non-metastatic and normal colon epithelium. Therefore, efficient methods to inhibit miR-210 expression in CRC may provide new advances in treatments. METHODS Expression of miRs was determined in several metastatic and non-metastatic cell lines. miR-210 expression was inhibited using PMIS-miR-210 in transduced cells, which were transplanted into xenograft mice. In separate experiments, CRC tumours were allowed to grow in xenograft mice and treated with therapeutic injections of PMIS-miR-210. Molecular and biochemical experiments identified several new pathways targeted by miR-210 inhibition. RESULTS miR-210 inhibition can significantly reduce tumour growth of implanted colon cancer cells in xenograft mouse models. The direct administration of PMIS-miR-210 to existing tumours can inhibit tumour growth in both NSG and Foxn1nu/j mouse models and is more efficacious than capecitabine treatments. Tumour cells further transfer the PMIS-miR-210 inhibitor to neighbouring cells by extracellular vesicles to inhibit miR-210 throughout the tumour. miR-210 inhibition activates the cleaved caspase 3 apoptotic pathway to reduce tumour formation. We demonstrate that the long non-coding transcript XIST is regulated by miR-210 correlating with decreased XIST expression in CRC tumours. XIST acts as a competing endogenous RNA for miR-210, which reduces XIST levels and miR-210 inhibition increases XIST transcripts in the nucleus and cytoplasm. The increased expression of NME1 is associated with H3K4me3 and H3K27ac modifications in the NME1 proximal promoter by XIST. CONCLUSION Direct application of the PMIS-miR-210 inhibitor to growing tumours may be an effective colorectal cancer therapeutic.
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Affiliation(s)
- Steven Eliason
- Department of Anatomy and Cell BiologyThe University of IowaIowa CityIowaUSA
- Craniofacial Anomalies Research CenterThe University of IowaIowa CityIowaUSA
| | - Liu Hong
- Craniofacial Anomalies Research CenterThe University of IowaIowa CityIowaUSA
- Iowa Institute for Oral Health ResearchThe University of IowaIowa CityIowaUSA
| | - Yan Sweat
- Department of Anatomy and Cell BiologyThe University of IowaIowa CityIowaUSA
- Craniofacial Anomalies Research CenterThe University of IowaIowa CityIowaUSA
| | - Camille Chalkley
- Department of Anatomy and Cell BiologyThe University of IowaIowa CityIowaUSA
- Craniofacial Anomalies Research CenterThe University of IowaIowa CityIowaUSA
| | - Huojun Cao
- Iowa Institute for Oral Health ResearchThe University of IowaIowa CityIowaUSA
| | - Qi Liu
- Department of Anatomy and Cell BiologyThe University of IowaIowa CityIowaUSA
| | - Hank Qi
- Department of Anatomy and Cell BiologyThe University of IowaIowa CityIowaUSA
| | - Hongwei Xu
- Department of Internal MedicineUniversity of Arkansas for Medical ScienceLittle RockArkansasUSA
| | - Fenghuang Zhan
- Department of Internal MedicineUniversity of Arkansas for Medical ScienceLittle RockArkansasUSA
| | - Brad A. Amendt
- Department of Anatomy and Cell BiologyThe University of IowaIowa CityIowaUSA
- Craniofacial Anomalies Research CenterThe University of IowaIowa CityIowaUSA
- Iowa Institute for Oral Health ResearchThe University of IowaIowa CityIowaUSA
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Hanna CR, Lemmon E, Hall PS, Ennis H, Morris E, McLoone P, Boyd KA, Jones RJ. Cancer Trial Impact: Understanding Implementation of the Short Course Oncology Treatment (SCOT) Trial Findings in colorectal cancer at a National Level. Clin Oncol (R Coll Radiol) 2022; 34:554-560. [PMID: 35370039 DOI: 10.1016/j.clon.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/16/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Abstract
AIMS The Short Course Oncology Treatment (SCOT) trial indicated that 3 months of adjuvant doublet chemotherapy was non-inferior to 6 months of treatment for patients with colorectal cancer, with considerably less toxicity. The SCOT trial results were disseminated in June 2017. The aim of this study was to understand if SCOT trial findings were implemented in Scotland. MATERIALS AND METHODS A retrospective analysis was carried out on a dataset derived from a source population of 5.4 million people. Eligible patients were those with stage II or III colorectal cancer who received adjuvant chemotherapy. Logistic regression was applied to understand the extent of practice change to a 3-month adjuvant chemotherapy duration after the SCOT trial results were disseminated. Interrupted time series analysis was used to visualise differences in prescribing trends before and after June 2017 for the overall cohort, and by SCOT trial eligibility. RESULTS In total, 2310 patients were included in the study; 1957 and 353 treated pre- and post-June 2017, respectively. The median treatment duration decreased from 21 weeks (interquartile range 14-24) prior to June 2017 to 12 weeks (interquartile range 12-21 weeks) after June 2017 (P < 0.001). The proportion of patients receiving over 3 months of adjuvant treatment decreased from 75% to 42% (P < 0.001). This change was most noticeable for patients who met the SCOT trial eligibility criteria, and specifically for those with low-risk stage III disease and those treated with capecitabine and oxaliplatin (CAPOX). Although practice change occurred in all locations, there were differences between regions that could be explained by pre-SCOT trial prescribing trends. DISCUSSION A significant change in chemotherapy prescribing occurred after dissemination of the SCOT trial results. National, real-world data can be used to capture the extent of implementation of clinical trial results. In this case, implementation was aligned with clinical trial subgroup findings. This type of analysis could be conducted to evaluate the impact of other clinical trials.
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Affiliation(s)
- C R Hanna
- CRUK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.
| | - E Lemmon
- Edinburgh Health Economics, Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - P S Hall
- Edinburgh Health Economics, Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK; Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - H Ennis
- Edinburgh Health Economics, Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E Morris
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - P McLoone
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - K A Boyd
- Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - R J Jones
- CRUK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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Sun L, Zhang X, Gong P, Zhang L, Zhao Y. Clinical Efficacy of Bevacizumab Plus XELOX Chemotherapy in Colorectal Cancer and Application Value of Mindfulness-Based Stress Reduction Intervention. Altern Ther Health Med 2022; 28:65-71. [PMID: 35452419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Colorectal cancer (CRC) is a malignant tumor with an extremely high incidence rate worldwide. This study explores the influence of mindfulness-based stress reduction (MBSR) in the care of patients with CRC undergoing bevacizumab (BVZ) plus XELOX chemotherapy, aiming at providing reliable reference and guidance for further improving their rehabilitation and prognosis. METHODS Between January 2019 and March 2020, 88 patients with CRC admitted consecutively to Jiangsu Cancer Hospital in China were enrolled in the study. Of them, 42 patients receiving BVZ plus XELOX chemotherapy, conventional care and MBSR intervention were assigned to the intervention group, and the remaining 46 patients receiving XELOX chemotherapy and conventional care were included in the control group. Clinical efficacy, safety and improvement in functional status were compared. Patients' psychological state, treatment compliance and self-care ability were evaluated. Finally, prognostic quality of life (QoL) was recorded at 1-year follow-up. RESULTS The overall response rate and incidence of adverse events in the intervention group were not different in the control group, but the total control rate and improvement rate in the intervention group were higher. After treatment, Sedation-Agitation Scale (SAS) and Self-Rating Depression Scale (SDS) scores in the intervention group were decreased, compliance and self-care ability were improved, all of which were better than in the control group. Prognostic follow-up showed that the QoL in the intervention group was also higher than in the control group. CONCLUSIONS The combined use of BVZ in XELOX-based chemotherapy can improve the clinical outcome and functional status of patients with CRC. In addition, MBSR intervention implemented during chemotherapy can effectively optimize patients' psychological state and treatment compliance, strengthen their self-care ability and improve their prognostic QoL.
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Okuda Y, Mikame Y, Sato R, Shinada M, Saito T, Kezuka C, Wakamori M, Aoki R, Kano S, Sanbe R, Otsuka Y, Nakazawa T, Yamaguchi H, Imai Y. [Evaluation of the Usefulness of Pharmaceutical Outpatient Clinic for Gastric Cancer Patients Receiving Capecitabine plus Oxaliplatin as Postoperative Adjuvant Chemotherapy]. Gan To Kagaku Ryoho 2022; 49:963-967. [PMID: 36156015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Capecitabine plus oxaliplatin(CapeOX)is widely used as postoperative adjuvant chemotherapy for gastric cancer. The CapeOX regimen often causes digestive symptoms, such as nausea and vomiting under postoperative conditions, and oxaliplatin- induced neurological symptoms, for which supportive intervention is needed. The pharmaceutical outpatient clinic of Jichi Medical University provides pharmaceutical intervention for cancer patients. This study evaluated the usefulness of the pharmaceutical outpatient clinic for gastric cancer patients receiving postoperative adjuvant chemotherapy. The primary endpoint was defined as the effect of the number of outpatient pharmacist interventions on the relative dose intensity of the CapeOX regimen. The secondary endpoint was the correlation between the number of outpatient pharmacist interventions and the worst grade of each side effect. It was observed that patients who received at least 5 outpatient pharmacist interventions had significantly higher dose intensities(p=0.019). Outpatient pharmaceutical interventions were associated with the reduction of side effect symptoms that could be managed with preventive and supportive care. These results showed that continuous intervention by outpatient pharmacists contribute to the optimization of dose intensity and reduction of side effects in gastric cancer patients receiving CapeOX as postoperative adjuvant chemotherapy.
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Murali B, Durbin L, Vijaykumar S, Yang L, Li S, Zhao L, Hawthorne S, Kanas G, Davis C, Clark O. Treatment of HR+/HER2− breast cancer in urban mainland China: results from the CancerMPact Survey 2019. Breast Cancer Res Treat 2022; 195:441-451. [PMID: 35986800 PMCID: PMC9464725 DOI: 10.1007/s10549-022-06709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 08/03/2022] [Indexed: 11/27/2022]
Abstract
Abstract
Purpose
To report the treatment utilization patterns for hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) breast cancer in urban mainland China (CancerMPact®).
Methods
The results presented are from an online survey conducted in September 2019 with 45 physicians treating breast cancer patients from 11 cities in mainland China.
Results
Surveyed physicians reported that Stage I HR+/HER2(−) breast cancer patients are often treated with surgery alone (42%), whereas the use of surgery in combination with systemic therapy with or without radiotherapy increases in later stages (Stage II 67%, Stage III 77%). Doxorubicin–cyclophosphamide (AC)-based regimens were the most common in both the neoadjuvant and adjuvant settings in HR+/HER2(−) breast cancer patients, across all stages. In metastatic patients, use of surgery and radiotherapy decreases in favor of utilization of systemic therapy alone. Pre- and post-menopausal metastatic patients were frequently treated with hormone therapy or AC-based regimens in first line. Regardless of the first-line therapy administered, capecitabine-based regimens were commonly used in second line. In third line, chemotherapy regimens containing capecitabine or gemcitabine were given to nearly 40% of HR+/HER2(−) breast cancer patients. There were no standard of care regimens established for fourth or greater lines of treatment. In metastatic HR+/HER2(−) breast cancer, physicians reported 50% objective response rates in first-line settings with a progression-free survival of 16 months.
Conclusion
HR+/HER2(−) breast cancer patients in urban mainland China were prescribed chemotherapy regimens more frequently than CDK4/6 inhibitors. Treatment practices varied, with physicians reporting the use of multiple modalities and treatment regimens for their patients.
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Affiliation(s)
- Bhavna Murali
- Cerner Enviza, 2800 Rock Creek Pkwy, North Kansas City, MO, 64117, USA.
| | - Laura Durbin
- Cerner Enviza, 2800 Rock Creek Pkwy, North Kansas City, MO, 64117, USA
| | - Sapna Vijaykumar
- Cerner Enviza, 2800 Rock Creek Pkwy, North Kansas City, MO, 64117, USA
| | - Linda Yang
- Cerner Enviza, 2800 Rock Creek Pkwy, North Kansas City, MO, 64117, USA
| | - Song Li
- Cerner Enviza, 2800 Rock Creek Pkwy, North Kansas City, MO, 64117, USA
| | - Linda Zhao
- Cerner Enviza, 2800 Rock Creek Pkwy, North Kansas City, MO, 64117, USA
| | | | - Gena Kanas
- Cerner Enviza, 2800 Rock Creek Pkwy, North Kansas City, MO, 64117, USA
| | - Christine Davis
- Cerner Enviza, 2800 Rock Creek Pkwy, North Kansas City, MO, 64117, USA
| | - Otávio Clark
- Cerner Enviza, 2800 Rock Creek Pkwy, North Kansas City, MO, 64117, USA
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Garcia-Aguilar J, Patil S, Gollub MJ, Kim JK, Yuval JB, Thompson HM, Verheij FS, Omer DM, Lee M, Dunne RF, Marcet J, Cataldo P, Polite B, Herzig DO, Liska D, Oommen S, Friel CM, Ternent C, Coveler AL, Hunt S, Gregory A, Varma MG, Bello BL, Carmichael JC, Krauss J, Gleisner A, Paty PB, Weiser MR, Nash GM, Pappou E, Guillem JG, Temple L, Wei IH, Widmar M, Lin S, Segal NH, Cercek A, Yaeger R, Smith JJ, Goodman KA, Wu AJ, Saltz LB. Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy. J Clin Oncol 2022; 40:2546-2556. [PMID: 35483010 PMCID: PMC9362876 DOI: 10.1200/jco.22.00032] [Citation(s) in RCA: 248] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/01/2022] [Accepted: 03/17/2022] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Prospective data on the efficacy of a watch-and-wait strategy to achieve organ preservation in patients with locally advanced rectal cancer treated with total neoadjuvant therapy are limited. METHODS In this prospective, randomized phase II trial, we assessed the outcomes of 324 patients with stage II or III rectal adenocarcinoma treated with induction chemotherapy followed by chemoradiotherapy (INCT-CRT) or chemoradiotherapy followed by consolidation chemotherapy (CRT-CNCT) and either total mesorectal excision (TME) or watch-and-wait on the basis of tumor response. Patients in both groups received 4 months of infusional fluorouracil-leucovorin-oxaliplatin or capecitabine-oxaliplatin and 5,000 to 5,600 cGy of radiation combined with either continuous infusion fluorouracil or capecitabine during radiotherapy. The trial was designed as two stand-alone studies with disease-free survival (DFS) as the primary end point for both groups, with a comparison to a null hypothesis on the basis of historical data. The secondary end point was TME-free survival. RESULTS Median follow-up was 3 years. Three-year DFS was 76% (95% CI, 69 to 84) for the INCT-CRT group and 76% (95% CI, 69 to 83) for the CRT-CNCT group, in line with the 3-year DFS rate (75%) observed historically. Three-year TME-free survival was 41% (95% CI, 33 to 50) in the INCT-CRT group and 53% (95% CI, 45 to 62) in the CRT-CNCT group. No differences were found between groups in local recurrence-free survival, distant metastasis-free survival, or overall survival. Patients who underwent TME after restaging and patients who underwent TME after regrowth had similar DFS rates. CONCLUSION Organ preservation is achievable in half of the patients with rectal cancer treated with total neoadjuvant therapy, without an apparent detriment in survival, compared with historical controls treated with chemoradiotherapy, TME, and postoperative chemotherapy.
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Affiliation(s)
- Julio Garcia-Aguilar
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marc J. Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jin K. Kim
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan B. Yuval
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hannah M. Thompson
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Floris S. Verheij
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dana M. Omer
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Meghan Lee
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard F. Dunne
- Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Jorge Marcet
- Division of Colon and Rectal Surgery, Department of Surgery, University of South Florida, Tampa, FL
| | - Peter Cataldo
- Division of General Surgery, Department of Surgery, University of Vermont, Burlington, VT
| | - Blase Polite
- Department of Medicine, Comprehensive Cancer Center, University of Chicago, Chicago, IL
| | - Daniel O. Herzig
- Division of Gastrointestinal and General Surgery, Oregon Health and Science University, Portland, OR
| | - David Liska
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH
| | - Samuel Oommen
- Division of Gastrointestinal Oncology, John Muir Cancer Institute, John Muir Health, Walnut Creek, CA
| | - Charles M. Friel
- Division of General Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - Charles Ternent
- Department of Surgery, Colorectal Service at Bergan Mercy Medical Center, Omaha, NE
| | - Andrew L. Coveler
- Department of Medicine, Fred Hutch Cancer Center, University of Washington, Seattle, WA
| | - Steven Hunt
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Anita Gregory
- Department of Surgery, St Joseph Hospital Orange County, Orange, CA
| | - Madhulika G. Varma
- Section of Colon and Rectal Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Brian L. Bello
- Division of Colorectal Surgery, Department of Surgery, Medstar Washington Hospital Center, Washington, DC
| | - Joseph C. Carmichael
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Irvine, CA
| | - John Krauss
- Department of Medicine, Rogel Cancer Center at the University of Michigan, Ann Arbor, MI
| | - Ana Gleisner
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Denver, CO
| | - Philip B. Paty
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Martin R. Weiser
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Garrett M. Nash
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emmanouil Pappou
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - José G. Guillem
- Division of Gastrointestinal Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Larissa Temple
- Division of Colorectal Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Iris H. Wei
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria Widmar
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sabrina Lin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neil H. Segal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J. Joshua Smith
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Karyn A. Goodman
- Department of Radiation Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Abraham J. Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leonard B. Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Zhang X, Gao YY, Song DZ, Qian BX. Isolated gastric variceal bleeding related to non-cirrhotic portal hypertension following oxaliplatin-based chemotherapy: A case report. World J Gastroenterol 2022; 28:3524-3531. [PMID: 36158260 PMCID: PMC9346464 DOI: 10.3748/wjg.v28.i27.3524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 04/27/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sinusoidal obstruction syndrome has been reported after oxaliplatin-based chemotherapy, but liver fibrosis and non-cirrhotic portal hypertension (NCPH) are rarely reported.
CASE SUMMARY Here, we describe the case of a 64-year-old woman who developed isolated gastric variceal bleeding 16 mo after completing eight cycles of oxaliplatin combined with capecitabine chemotherapy after colon cancer resection. Surprisingly, splenomegaly and thrombocytopenia were not accompanied by variceal bleeding, which has been reported to have predictive value for gastric variceal formation. However, a liver biopsy showed fibrosis in the portal area, suggesting NCPH. The patient underwent endoscopic treatment and experienced no further symptoms.
CONCLUSION It is necessary to guard against long-term complications after oxaliplatin-based chemotherapy. Sometimes splenic size and platelet level may not always accurately predict the occurrence of portal hypertension.
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Affiliation(s)
- Xu Zhang
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases; Artificial Cell Engineering Technology Research Center; Tianjin Institute of Hepatobiliary Disease, Tianjin 300000, China
| | - Yan-Ying Gao
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases; Artificial Cell Engineering Technology Research Center; Tianjin Institute of Hepatobiliary Disease, Tianjin 300000, China
| | - De-Zhao Song
- Department of Interventional Radiology, The Third Central Hospital of Tianjin; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases; Artificial Cell Engineering Technology Research Center; Tianjin Institute of Hepatobiliary Disease, Tianjin 300000, China
| | - Bao-Xin Qian
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases; Artificial Cell Engineering Technology Research Center; Tianjin Institute of Hepatobiliary Disease, Tianjin 300000, China
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Bridgewater J, Fletcher P, Palmer DH, Malik HZ, Prasad R, Mirza D, Anthony A, Corrie P, Falk S, Finch-Jones M, Wasan H, Ross P, Wall L, Wadsley J, Evans TR, Stocken D, Stubbs C, Praseedom R, Ma YT, Davidson B, Neoptolemos J, Iveson T, Cunningham D, Garden OJ, Valle JW, Primrose J. Long-Term Outcomes and Exploratory Analyses of the Randomized Phase III BILCAP Study. J Clin Oncol 2022; 40:2048-2057. [PMID: 35316080 DOI: 10.1200/jco.21.02568] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/16/2021] [Accepted: 02/09/2022] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The BILCAP study described a modest benefit for capecitabine as adjuvant therapy for curatively resected biliary tract cancer (BTC), and capecitabine has become the standard of care. We present the long-term data and novel exploratory subgroup analyses. METHODS This randomized, controlled, multicenter, phase III study recruited patients age 18 years or older with histologically confirmed cholangiocarcinoma or muscle-invasive gallbladder cancer after resection with curative intent and an Eastern Cooperative Oncology Group performance status of < 2. Patients were randomly assigned 1:1 to receive oral capecitabine (1,250 mg/m2 twice daily on days 1-14 of a 21-day cycle, for eight cycles) or observation. The primary outcome was overall survival (OS). This study is registered with EudraCT 2005-003318-13. RESULTS Between March 15, 2006, and December 4, 2014, 447 patients were enrolled; 223 patients with BTC resected with curative intent were randomly assigned to the capecitabine group and 224 to the observation group. At the data cutoff of January 21, 2021, the median follow-up for all patients was 106 months (95% CI, 98 to 108). In the intention-to-treat analysis, the median OS was 49.6 months (95% CI, 35.1 to 59.1) in the capecitabine group compared with 36.1 months (95% CI, 29.7 to 44.2) in the observation group (adjusted hazard ratio 0.84; 95% CI, 0.67 to 1.06). In a protocol-specified sensitivity analysis, adjusting for minimization factors, nodal status, grade, and sex, the OS hazard ratio was 0.74 (95% CI, 0.59 to 0.94). We further describe the prognostic impact of R status, grade, nodal status, and sex. CONCLUSION This long-term analysis supports the previous analysis, suggesting that capecitabine can improve OS in patients with resected BTC when used as adjuvant chemotherapy after surgery and should be considered as the standard of care.
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Affiliation(s)
| | | | - Daniel H Palmer
- Molecular and Clinical Cancer Medicine, Liverpool, United Kingdom
| | | | - Raj Prasad
- Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Darius Mirza
- Birmingham Woman's and Children's NHS Trust, Birmingham, United Kingdom
| | - Alan Anthony
- Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Pippa Corrie
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Stephen Falk
- University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Meg Finch-Jones
- University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Harpreet Wasan
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Paul Ross
- Guys and St Thomas's NHS Trust, London, United Kingdom
| | - Lucy Wall
- Western General Hospital, Edinburgh, United Kingdom
| | | | | | - Deborah Stocken
- Leeds Institute of Clinical Trials Research, Leeds, United Kingdom
| | - Clive Stubbs
- Cancer Clinical Trials Unit, Birmingham, United Kingdom
| | - Raaj Praseedom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Yuk Ting Ma
- Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
| | | | | | - Tim Iveson
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | | | | | - Juan W Valle
- University of Manchester, Manchester, United Kingdom
| | - John Primrose
- University of Southampton, Southampton, United Kingdom
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Araki H, Takenaka T, Takahashi K, Yamashita F, Matsuoka K, Yoshisue K, Ieiri I. A semimechanistic population pharmacokinetic and pharmacodynamic model incorporating autoinduction for the dose justification of TAS-114. CPT Pharmacometrics Syst Pharmacol 2022; 11:604-615. [PMID: 34951129 PMCID: PMC9124359 DOI: 10.1002/psp4.12747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/17/2021] [Accepted: 11/09/2021] [Indexed: 12/20/2022] Open
Abstract
TAS-114 is a dual deoxyuridine triphosphatase (dUTPase) and dihydropyrimidine dehydrogenase (DPD) inhibitor expected to widen the therapeutic index of capecitabine. Its maximum tolerated dose (MTD) was determined from a safety perspective in a combination study with capecitabine; however, its inhibitory effects on DPD activity were not assessed in the study. The dose justification to select its MTD as the recommended dose in terms of DPD inhibition has been required, but the autoinduction profile of TAS-114 made it difficult. To this end, an approach using a population pharmacokinetic (PPK)/pharmacodynamic (PD) model incorporating autoinduction was planned; however, the utility of this approach in the dose justification has not been reported. Thus, the aim of this study was to demonstrate the utility of a PPK/PD model incorporating autoinduction in the dose justification via a case study of TAS-114. Plasma concentrations of TAS-114 from 185 subjects and those of the endogenous DPD substrate uracil from 24 subjects were used. A two-compartment model with first-order absorption with lag time and an enzyme turnover model were selected for the pharmacokinetic (PK) model. Moreover, an indirect response model was selected for the PD model to capture the changes in plasma uracil concentrations. Model-based simulations provided the dose justification that DPD inhibition by TAS-114 reached a plateau level at the MTD, whereas exposures of TAS-114 increased dose dependently. Thus, the utility of a PPK/PD model incorporating autoinduction in the dose justification was demonstrated via this case study of TAS-114.
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Affiliation(s)
- Hikari Araki
- Pharmacokinetics Research LaboratoriesTaiho Pharmaceutical Co. Ltd.TsukubaIbarakiJapan
| | - Toru Takenaka
- Pharmacokinetics Research LaboratoriesTaiho Pharmaceutical Co. Ltd.TsukubaIbarakiJapan
| | - Koichi Takahashi
- Pharmacokinetics Research LaboratoriesTaiho Pharmaceutical Co. Ltd.TsukubaIbarakiJapan
| | - Fumiaki Yamashita
- Pharmacokinetics Research LaboratoriesTaiho Pharmaceutical Co. Ltd.TsukubaIbarakiJapan
| | - Kazuaki Matsuoka
- Pharmacokinetics Research LaboratoriesTaiho Pharmaceutical Co. Ltd.TsukubaIbarakiJapan
| | - Kunihiro Yoshisue
- Pharmacokinetics Research LaboratoriesTaiho Pharmaceutical Co. Ltd.TsukubaIbarakiJapan
| | - Ichiro Ieiri
- Department of Clinical Pharmacology and Biopharmaceutics, Graduate School of Pharmaceutical SciencesKyushu UniversityFukuokaJapan
- Department of PharmacyKyushu University HospitalFukuokaJapan
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Russell J, Fanchon L, Alwaseem H, Molina H, O’Donoghue I, Bahr A, de Stanchina E, Pillarsetty N, Humm JL. Analysis of capecitabine metabolites in conjunction with digital autoradiography in a murine model of pancreatic cancer suggests extensive drug penetration through the tumor. Pharmacol Res Perspect 2022; 10:e00898. [PMID: 35257504 PMCID: PMC8902142 DOI: 10.1002/prp2.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 12/01/2022] Open
Abstract
Previously published digital autoradiography of 3 H-labeled capecitabine reveals a near-uniform distribution of activity throughout a murine pancreatic model. This is in contrast both to 14 C-labeled gemcitabine, and established expectations, as the dense stroma of pancreatic cancer is understood to inhibit drug penetration. Capecitabine is a pro-drug for 5 FU. The positioning of the radiolabel on capecitabine leaves open the possibility that much of the autoradiographic signal is generated by nontoxic compounds. Studies were performed on tumors derived via organoid culture from a murine KPC tumor. As before, we performed autoradiography comparing 3 H capecitabine to the gemcitabine analog 18 F-FAC. The metabolism of capecitabine in this model was studied through LC-MS of tumor tissue. The autoradiographs confirmed that the 3 H label from capecitabine was much more uniformly distributed through the tumor than the 18 F from the gemcitabine analog. LC-MS revealed that approximately 75% of the molar mass of capecitabine had been converted into 5 FU or pre-5 FU compounds. The remainder had been converted into nontoxic species. Therapeutically relevant capecitabine metabolites achieve a relatively even distribution in this pancreatic cancer model, in contrast to the gemcitabine analog 18 F-FAC. In a human xenograft model, (BxPC3), the 3 H label from capecitabine was also uniformly spread across the tumor autoradiographs. However, at 2 h post-administration the metabolism of capecitabine had proceeded further and the bulk of the agent was in the form of nontoxic species.
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Affiliation(s)
- James Russell
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Louise Fanchon
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Hanan Alwaseem
- The Proteomics Resource CenterThe Rockefeller UniversityNew YorkNew YorkUSA
| | - Henrik Molina
- The Proteomics Resource CenterThe Rockefeller UniversityNew YorkNew YorkUSA
| | - Isabella O’Donoghue
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Amber Bahr
- Anti‐Tumor Assessment Core FacilityMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Elisa de Stanchina
- Anti‐Tumor Assessment Core FacilityMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | | | - John L. Humm
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
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Hiramatsu S, Sugimoto A, On O, Aomatsu K. [A Case of Rectal Cancer and Multiple Lung Metastases That Had Complete Response Treated by XELOX plus Bevacizumab after Primary Lesion Resection]. Gan To Kagaku Ryoho 2022; 49:226-228. [PMID: 35249069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A 54-year-old woman visited our hospital complaining of abdominal distension. Endoscopic examination revealed type 3 tumor in the rectum located 15 cm from the anal edge. Enhanced computed tomography showed multiple ground glass-like shadows in both lungs that were suspected of multiple metastases. We diagnosed as having rectal cancer with multiple lung metastases. After placing the stent transanally to release the intestinal obstruction, we performed laparoscopic high anterior resection. Then, the patient received chemotherapy with 10 courses of XELOX plus bevacizumab and 9 courses of the regimen without oxaliplatin. A whole-body CT revealed complete response. And while taking capecitabine the patient remains well and without recurrence. We describe the present case with reference to the literature.
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Yan M, Ouyang Q, Sun T, Niu L, Yang J, Li L, Song Y, Hao C, Chen Z, Orlandi A, Ishii N, Takabe K, Franceschini G, Ricci F, Verschraegen C, Liu Z, Zhang M, Lv H, Liu L, Yang X, Xiao H, Gao Z, Li X, Dong F, Chen X, Qiao J, Zhang G. Pyrotinib plus capecitabine for patients with human epidermal growth factor receptor 2-positive breast cancer and brain metastases (PERMEATE): a multicentre, single-arm, two-cohort, phase 2 trial. Lancet Oncol 2022; 23:353-361. [PMID: 35085506 DOI: 10.1016/s1470-2045(21)00716-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Min Yan
- Henan Breast Cancer Centre, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
| | - Quchang Ouyang
- Department of Breast Medicine, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Tao Sun
- Breast Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Limin Niu
- Henan Breast Cancer Centre, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Jin Yang
- Department of Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Li
- Department of Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Yuhua Song
- Breast Cancer Centre, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chunfang Hao
- Department of Breast Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Zhanhong Chen
- Department of Breast Cancer Internal Medicine, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, China
| | - Armando Orlandi
- Unit of Medical Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | - Naohiro Ishii
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Kazuaki Takabe
- Division of Breast Surgery, Roswell Park Comprehensive Cancer Centre, Buffalo, NY, USA
| | - Gianluca Franceschini
- Multidisciplinary Breast Centre, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | | | | | - Zhenzhen Liu
- Henan Breast Cancer Centre, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Mengwei Zhang
- Henan Breast Cancer Centre, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Huimin Lv
- Henan Breast Cancer Centre, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Liping Liu
- Department of Breast Medicine, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiaohong Yang
- Department of Breast Medicine, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Huawu Xiao
- Department of Breast Medicine, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhichao Gao
- Breast Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Xiaorui Li
- Breast Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Fangyuan Dong
- Breast Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Xiuchun Chen
- Henan Breast Cancer Centre, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Jianghua Qiao
- Henan Breast Cancer Centre, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Guifang Zhang
- Department of Medical Oncology, Xinxiang Central Hospital, Xinxiang, China
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Morelli C, Formica V, Doldo E, Riondino S, Rofei M, Vergilii L, Palmieri G, Arkenau HT, Roselli M, Orlandi A. OUP accepted manuscript. Oncologist 2022; 27:e420-e421. [PMID: 35325223 PMCID: PMC9075005 DOI: 10.1093/oncolo/oyac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Elena Doldo
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
| | - Silvia Riondino
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Michela Rofei
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Lorena Vergilii
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
| | - Giampiero Palmieri
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
| | - Hendrik-Tobias Arkenau
- Sarah Cannon Research Institute, Cancer Institute, University College London, London, UK
| | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
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Patel A, Spychalski P, Antoszewska M, Regula J, Kobiela J. Proton pump inhibitors and colorectal cancer: A systematic review. World J Gastroenterol 2021; 27:7716-7733. [PMID: 34908809 PMCID: PMC8641055 DOI: 10.3748/wjg.v27.i44.7716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/14/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of proton pump inhibitors (PPI) is common worldwide, with reports suggesting that they may be overused. Several studies have found that PPI may affect colorectal cancer (CRC) risk.
AIM To summarize current knowledge on the relationship between PPI and CRC from basic research, epidemiological and clinical studies.
METHODS This systematic review was based on the patients, interventions, comparisons, outcome models and performed according to PRISMA guidelines. MEDLINE, EMBASE, Scopus, and Web of Science databases were searched from inception until May 17, 2021. The initial search returned 2591 articles, of which, 28 studies met the inclusion criteria for this review. The studies were categorized as basic research studies (n = 12), epidemiological studies (n = 11), and CRC treatment studies (n = 5). The quality of the included studies was assessed using the Newcastle-Ottawa Scale or Cochrane Risk of Bias 2.0 tool depending on the study design.
RESULTS Data from basic research indicates that PPI do not stimulate CRC development via the trophic effect of gastrin but instead may paradoxically inhibit it. These studies also suggest that PPI may have properties beneficial for CRC treatment. PPI appear to have anti-tumor properties (omeprazole, pantoprazole), and are potential T lymphokine-activated killer cell-originated protein kinase inhibitors (pantoprazole, ilaprazole), and chemosensitizing agents (pantoprazole). However, these mechanisms have not been confirmed in human trials. Current epidemiological studies suggest that there is no causal association between PPI use and increased CRC risk. Treatment studies show that concomitant PPI and capecitabine use may reduce the efficacy of chemotherapy resulting in poorer oncological outcomes, while also suggesting that pantoprazole may have a chemosensitizing effect with the fluorouracil, leucovorin, oxaliplatin (FOLFOX) regimen.
CONCLUSION An unexpected inhibitory effect of PPI on CRC carcinogenesis by way of several potential mechanisms is noted. This review identifies that different PPI agents may have differential effects on CRC treatment, with practical implications. Prospective studies are warranted to delineate this relationship and assess the role of individual PPI agents.
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Affiliation(s)
- Agastya Patel
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk 80-210, Poland
| | - Piotr Spychalski
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk 80-210, Poland
| | - Magdalena Antoszewska
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk 80-210, Poland
| | - Jaroslaw Regula
- Department of Gastroenterology, Hepatology and Oncology, Center of Postgraduate Medical Education, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw 01-813, Poland
| | - Jarek Kobiela
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk 80-210, Poland
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Wang X, Wang Y, Zhang Z, Zhou M, Zhou X, Zhao H, Xing J, Zhou Y. Rim enhancement on hepatobiliary phase of pre-treatment 3.0 T MRI: A potential marker for early chemotherapy response in colorectal liver metastases treated with XELOX. Eur J Radiol 2021; 143:109887. [PMID: 34454297 DOI: 10.1016/j.ejrad.2021.109887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To assess the value of the enhanced features on the hepatobiliary phase (HBP) of pre-treatment Gd-EOB-DTPA MRI in evaluating response to chemotherapy in colorectal liver metastases (CRLMs). METHODS We retrospectively studied 65 patients with CRLMs who underwent Gd-EOB-DTPA enhanced MRI before chemotherapy from October 2015 to November 2017. The diagnosis of liver metastasis was established on the basis of imaging findings. Two radiologists evaluated the size, contrast-enhanced (CE) patterns of the maximum lesion on the HBP. According to the different CE patterns, we quantified area signal intensity (SI) by applying SI ratio (such as SIcenter/outer and SIrim/center). All of the above parameters were analyzed in terms of chemotherapy response. RESULTS Rim enhancement on the HBP was more frequent in the responding group of 28 patients (72%) than in the non-responding group of eight patients (31%). Additionally, there was a significant association between chemotherapy response and quantitative parameters: including diameter (P = 0.04), SIcenter/outer (P = 0.047) and SIrim/center (P = 0.012). The HBP CE pattern (P = 0.007) and SIcenter/outer (P = 0.022) were independent factors for chemotherapy response. The areas under the curve (AUCs) of the above-mentioned parameters were significant associated with response to chemotherapy, in which diameter, HBP CE patterns, SIcenter/outer, and SIrim/center were 0.638, 0.706, 0.712, and 0.673, respectively. Moreover, the combination of these parameters obtained the largest AUC of 0.821. CONCLUSION The CE patterns, in particular with rim enhancement, and SI ratio parameters on the HBP are useful indicators for early evaluation of therapeutic response after chemotherapy in patients with CRLMs.
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Affiliation(s)
- Xinxin Wang
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - Yu Wang
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - Ziqian Zhang
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - Meng Zhou
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - Xueyan Zhou
- School of Technology, Harbin University, 109 Zhongxing Street, Harbin 150010, Heilongjiang, China.
| | - Hongxin Zhao
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - JiQing Xing
- Harbin Engineering University, Harbin 150001, Heilongjiang Province, China.
| | - Yang Zhou
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China.
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Hall PS, Swinson D, Cairns DA, Waters JS, Petty R, Allmark C, Ruddock S, Falk S, Wadsley J, Roy R, Tillett T, Nicoll J, Cummins S, Mano J, Grumett S, Stokes Z, Kamposioras KV, Chatterjee A, Garcia A, Waddell T, Guptal K, Maisey N, Khan M, Dent J, Lord S, Crossley A, Katona E, Marshall H, Grabsch HI, Velikova G, Ow PL, Handforth C, Howard H, Seymour MT. Efficacy of Reduced-Intensity Chemotherapy With Oxaliplatin and Capecitabine on Quality of Life and Cancer Control Among Older and Frail Patients With Advanced Gastroesophageal Cancer: The GO2 Phase 3 Randomized Clinical Trial. JAMA Oncol 2021; 7:869-877. [PMID: 33983395 PMCID: PMC8120440 DOI: 10.1001/jamaoncol.2021.0848] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Abstract
Importance Older and/or frail patients are underrepresented in landmark cancer trials. Tailored research is needed to address this evidence gap. Objective The GO2 randomized clinical trial sought to optimize chemotherapy dosing in older and/or frail patients with advanced gastroesophageal cancer, and explored baseline geriatric assessment (GA) as a tool for treatment decision-making. Design, Setting, and Participants This multicenter, noninferiority, open-label randomized trial took place at oncology clinics in the United Kingdom with nurse-led geriatric health assessment. Patients were recruited for whom full-dose combination chemotherapy was considered unsuitable because of advanced age and/or frailty. Interventions There were 2 randomizations that were performed: CHEMO-INTENSITY compared oxaliplatin/capecitabine at Level A (oxaliplatin 130 mg/m2 on day 1, capecitabine 625 mg/m2 twice daily on days 1-21, on a 21-day cycle), Level B (doses 0.8 times A), or Level C (doses 0.6 times A). Alternatively, if the patient and clinician agreed the indication for chemotherapy was uncertain, the patient could instead enter CHEMO-BSC, comparing Level C vs best supportive care. Main Outcomes and Measures First, broad noninferiority of the lower doses vs reference (Level A) was assessed using a permissive boundary of 34 days reduction in progression-free survival (PFS) (hazard ratio, HR = 1.34), selected as acceptable by a forum of patients and clinicians. Then, the patient experience was compared using Overall Treatment Utility (OTU), which combines efficacy, toxic effects, quality of life, and patient value/acceptability. For CHEMO-BSC, the main outcome measure was overall survival. Results A total of 514 patients entered CHEMO-INTENSITY, of whom 385 (75%) were men and 299 (58%) were severely frail, with median age 76 years. Noninferior PFS was confirmed for Levels B vs A (HR = 1.09 [95% CI, 0.89-1.32]) and C vs A (HR = 1.10 [95% CI, 0.90-1.33]). Level C produced less toxic effects and better OTU than A or B. No subgroup benefited from higher doses: Level C produced better OTU even in younger or less frail patients. A total of 45 patients entered the CHEMO-BSC randomization: overall survival was nonsignificantly longer with chemotherapy: median 6.1 vs 3.0 months (HR = 0.69 [95% CI, 0.32-1.48], P = .34). In multivariate analysis in 522 patients with all variables available, baseline frailty, quality of life, and neutrophil to lymphocyte ratio were independently associated with OTU, and can be combined in a model to estimate the probability of different outcomes. Conclusions and Relevance This phase 3 randomized clinical trial found that reduced-intensity chemotherapy provided a better patient experience without significantly compromising cancer control and should be considered for older and/or frail patients. Baseline geriatric assessment can help predict the utility of chemotherapy but did not identify a group benefiting from higher-dose treatment. Trial Registration isrctn.org Identifier: ISRCTN44687907.
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Affiliation(s)
- Peter S. Hall
- University of Leeds, Leeds, United Kingdom
- University of Edinburgh, Edinburgh, United Kingdom
| | - Daniel Swinson
- Leeds Teaching Hospitals National Health Service Trust, United Kingdom
| | | | - Justin S. Waters
- Maidstone and Tunbridge Wells National Health Service Trust, Maidstone, United Kingdom
| | | | | | | | - Stephen Falk
- Bristol Oncology Centre, Bristol, United Kingdom
| | | | - Rajarshi Roy
- Hull University Hospitals National Health Service Trust, Hull, United Kingdom
| | | | - Jonathan Nicoll
- North Cumbria University Hospitals National Health Service Trust, Carlisle, United Kingdom
| | - Sebastian Cummins
- Royal Surrey County Hospital National Health Service Foundation Trust, Guildford, United Kingdom
| | - Joseph Mano
- The Royal Wolverhampton National Health Service Trust, Wolverhampton, United Kingdom
| | - Simon Grumett
- The Dudley Group National Health Service Foundation Trust, Dudley, United Kingdom
| | - Zuzana Stokes
- United Lincolnshire Hospitals National Health Service Trust, Lincoln, United Kingdom
| | | | - Anirban Chatterjee
- The Shrewsbury and Telford Hospital National Health Service Trust, Shrewsbury, United Kingdom
| | - Angel Garcia
- Betsi Cadwaladr University Local Health Board, Bangor, United Kingdom
| | - Tom Waddell
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Kamalnayan Guptal
- Worcestershire Acute Hospitals National Health Service Trust, Worcester, United Kingdom
| | - Nick Maisey
- Guys and St Thomas’s National Health Service Foundation Trust, London, United Kingdom
| | - Mohammed Khan
- York Teaching Hospital National Health Service Foundation Trust, Scarborough, United Kingdom
| | - Jo Dent
- Calderdale and Huddersfield National Health Service Foundation Trust, Huddersfield, United Kingdom
| | - Simon Lord
- University of Oxford, Oxford, United Kingdom
| | - Ann Crossley
- Leeds Teaching Hospitals National Health Service Trust, United Kingdom
| | | | | | - Heike I. Grabsch
- University of Leeds, Leeds, United Kingdom
- Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Pei Loo Ow
- University of Leeds, Leeds, United Kingdom
| | | | | | - Matthew T. Seymour
- University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals National Health Service Trust, United Kingdom
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76
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Liu AJ, Ueberroth BE, McGarrah PW, Buckner Petty SA, Kendi AT, Starr J, Hobday TJ, Halfdanarson TR, Sonbol MB. Treatment Outcomes of Well-Differentiated High-Grade Neuroendocrine Tumors. Oncologist 2021; 26:383-388. [PMID: 33496040 PMCID: PMC8100548 DOI: 10.1002/onco.13686] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/12/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Recent classification of neuroendocrine neoplasms has defined well-differentiated high-grade neuroendocrine tumors (NET G3) as a distinct entity from poorly differentiated neuroendocrine carcinoma. The optimal treatment for NET G3 has not been well-described. This study aimed to evaluate metastatic NET G3 response to different treatment regimens. MATERIALS AND METHODS This was a retrospective study of patients with NET G3 within the Mayo Clinic database. Patients' demographics along with treatment characteristics, responses, and survival were assessed. Primary endpoints were progression-free survival (PFS) and overall survival. Secondary endpoints were objective response rate (ORR) and disease control rate (DCR). RESULTS Treatment data was available in 30 patients with median age of 59.5 years at diagnosis. The primary tumor was mostly pancreatic (73.3%). Ki-67 index was ≥55% in 26.7% of cases. Treatments included capecitabine + temozolomide (CAPTEM) (n = 20), lutetium 177 DOTATATE (PRRT; n = 10), Platinum-etoposide (EP; n = 8), FOLFOX (n = 7), and everolimus (n = 2). CAPTEM exhibited ORR 35%, DCR 65%, and median PFS 9.4 months (95% confidence interval, 2.96-16.07). Both EP and FOLFOX showed similar radiographic response rates with ORR 25.0% and 28.6%; however, median PFS durations were quite distinct at 2.94 and 13.04 months, respectively. PRRT had ORR of 20%, DCR of 70%, and median PFS of 9.13 months. CONCLUSION Among patients with NET G3, CAPTEM was the most commonly used treatment with clinically meaningful efficacy and disease control. FOLFOX or PRRT are other potentially active treatment options. EP has some activity in NET G3, but responses appear to be short-lived. Prospective studies evaluating different treatments effects in patients with NET G3 are needed to determine an optimal treatment strategy. IMPLICATIONS FOR PRACTICE High-grade well-differentiated neuroendocrine tumors (NET G3) are considered a different entity from low-grade NET and neuroendocrine carcinoma in terms of prognosis and management. The oral combination of capecitabine and temozolomide is considered a good option in the management of metastatic NET G3 and may be preferred. FOLFOX is another systemic option with reasonable efficacy. Similar to other well-differentiated neuroendocrine tumors, peptide receptor radionuclide therapy seems to have some efficacy in these tumors.
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Affiliation(s)
- Alex J. Liu
- Mayo Clinic Internal Medicine ResidencyPhoenixArizonaUSA
| | | | | | | | | | - Jason Starr
- Mayo Clinic Cancer CenterJacksonvilleFloridaUSA
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77
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Tanaka H, Goto Y, Iwase T. [Disseminated Bone Marrow Carcinomatosis from Breast Cancer Improved by Capecitabine-A Clinical Case Report]. Gan To Kagaku Ryoho 2021; 48:69-71. [PMID: 33468726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 63-year-old woman who underwent breast cancer surgery 9 years ago visited our hospital with palpitations. Laboratory examination revealed severe anemia and thrombocytopenia. Positron emission tomography-computed tomography(PET- CT)demonstrated fluorodeoxyglucose(FDG)uptake at several vertebrae, including the pelvis, ribs, and sternum. Accordingly, bone marrow aspiration cytology was performed and atypical large cells were confirmed. After the diagnosis of disseminated carcinomatosis caused by multiple bone metastases from breast cancer, capecitabine monotherapy was started. At 6 months after the diagnosis, the anemia and thrombocytopenia improved to within normal limits. FDG uptake of multiple bones also improved according to PET-CT. Capecitabine administration was stopped at 30 months due to cancer progression. Chemotherapy with docetaxel, epirubicin, cyclophosphamide(EC), and vinorelbine was alternately continued after capecitabine; nevertheless, the cancer progressed gradually. She died at 62 months without either anemia or thrombocytopenia.
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Affiliation(s)
- Hiroshi Tanaka
- Dept. of Breast and Endocrine Surgery, Japanese Red Cross Nagoya First Hospital
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78
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79
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Lestuzzi C, Tartuferi L, Viel E, Buonadonna A, Vaccher E, Berretta M. Fluoropyrimidine-Associated Cardiotoxicity: Probably Not So Rare As It Seems. Oncologist 2020; 25:e1254. [PMID: 32436298 DOI: 10.1634/theoncologist.2020-0053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Chiara Lestuzzi
- Cardiology Department, AAS5 Friuli Occidentale; and Cardiology and Cardio-Oncology Rehabilitation Unit, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Lucia Tartuferi
- Cardiology Department, AAS5 Friuli Occidentale; and Cardiology and Cardio-Oncology Rehabilitation Unit, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Elda Viel
- Cardiology Department, AAS5 Friuli Occidentale; and Cardiology and Cardio-Oncology Rehabilitation Unit, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Angela Buonadonna
- Oncology Department, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, IRCCS, Aviano, Italy
| | - Emanuela Vaccher
- Oncology Department, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, IRCCS, Aviano, Italy
| | - Massimiliano Berretta
- Oncology Department, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, IRCCS, Aviano, Italy
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80
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Huo Z, Wang S, Shao H, Wang H, Xu G. Radiolytic degradation of anticancer drug capecitabine in aqueous solution: kinetics, reaction mechanism, and toxicity evaluation. Environ Sci Pollut Res Int 2020; 27:20807-20816. [PMID: 32248418 DOI: 10.1007/s11356-020-08500-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/17/2020] [Indexed: 06/11/2023]
Abstract
The occurrence of anticancer drugs in the environment has attracted wide attention due to its potential environmental risks. The aim of this study was to investigate degradation characteristics and mechanism of anticancer drug capecitabine (CPC) by electron beam (EB) irradiation. The results showed that EB was an efficient water treatment process for CPC. The degradation followed pseudo-first-order kinetics with dose constants ranged from 1.27 to 3.94 kGy-1. Removal efficiencies in natural water filtered or unfiltered were lower than pure water due to the effect of water matrix components. The degradation was restrained by the presence of NO2-, NO3- and CO32-, and fulvic acid due to competition of reactive radical •OH. It demonstrated that oxidizing radical played important role in irradiation process. The appropriate addition of H2O2 and K2S2O8 providing with oxidizing agents •OH and •SO4- was favorable to improve degradation efficiency of CPC. The possible transformation pathways of CPC including cleavage of the ribofuranose sugar and defluorination were proposed based on intermediate products and were consistent with the theoretical calculation of charge and electron density distribution. Toxicity of CPC and intermediate products were estimated by ECOSAR program. It was found that CPC was transformed to low toxicity products with EB.
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Affiliation(s)
- Zhuhao Huo
- School of Environmental and Chemical Engineering, Shanghai University, 99 Shangda Road, Shanghai, 200444, China
| | - Siqi Wang
- School of Environmental and Chemical Engineering, Shanghai University, 99 Shangda Road, Shanghai, 200444, China
| | - Haiyang Shao
- School of Environmental and Chemical Engineering, Shanghai University, 99 Shangda Road, Shanghai, 200444, China
| | - Hongyong Wang
- School of Environmental and Chemical Engineering, Shanghai University, 99 Shangda Road, Shanghai, 200444, China
| | - Gang Xu
- School of Environmental and Chemical Engineering, Shanghai University, 99 Shangda Road, Shanghai, 200444, China.
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81
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Korehisa S, Kabashima A, Nambara S, Watanabe K, Umeda K, Koso H, Tahara K, Nakamura Y, Anai H. [A Case of Severe Aortic Thrombosis during the First Chemotherapy Regimen of CapeOX plus Bevacizumab for Metastatic Colon Cancer]. Gan To Kagaku Ryoho 2020; 47:989-992. [PMID: 32541181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 61-year-old man underwent CapeOX plus bevacizumab chemotherapyafter right hemicolectomyfor metastatic ascending colon cancer. On the 7th dayafter the first administration, he had sudden abdominal pain and nausea. Contrast-enhanced computed tomographyrevealed aortic thrombosis and a superior mesenteric artery(SMA)embolism that was considered to be associated with bevacizumab. Bevacizumab was discontinued and anticoagulation therapyusing heparin and urokinase was performed. Brain infarction of the left middle cerebral arteryoccurred on the 15th dayafter the first administration and thrombectomywas performed. Anticoagulation therapyusing heparin, bayaspirin, and edoxaban tosilate hydrate was performed. The aortic thrombosis and SMA embolism resolved with treatment, but the patient died following an increase in peritoneal dissemination. It should be noted that unexpectedlysevere aortic thrombosis occurred during the first administration of CapeOX plus bevacizumab for metastatic colon cancer.
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Affiliation(s)
- Shotaro Korehisa
- Dept. of Surgery, National Hospital Organization, Oita Medical Center
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82
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Ueno M. [The Current and Future Status of Perioperative Therapy in Pancreatic Cancer]. Gan To Kagaku Ryoho 2020; 47:578-581. [PMID: 32389955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In metastatic pancreatic cancer, combined chemotherapy such as FOLFIRINOX and gemcitabine plus nab-paclitaxel became standard of care. Current standard of care in preoperative settingwas adjuvant S-1 for 6 months in Japan. Neoadjuvant gemcitabine plus S-1 became the new standard in 2019. In Western countries, gemcitabine plus capecitabine and modified FOLFIRINOX without bolus 5-FU and with reduction of irinotecan to 150mg/m2 became standard of care. We will implement in current and future status of preoperative therapy.
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Affiliation(s)
- Makoto Ueno
- Dept. of Gastroenterology, Division of Hepatobiliary and Pancreatic Medical Oncology, Kanagawa Cancer Center
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83
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Mao J, Du P, Yang HT, Hu H, Wang SY, Wu X, Cheng ZB. Prognostic value of carbohydrate antigen125 and carcino embryonic antigen expression in patients with colorectal carcinoma and its guiding significance for chemotherapy. Medicine (Baltimore) 2020; 99:e19420. [PMID: 32243362 PMCID: PMC7220750 DOI: 10.1097/md.0000000000019420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The aim of this study is to evaluate the predictive value of carbohydrate antigen125 (CA125) and carcino embryonic antigen (CEA) expression and its guiding role of choosing chemotherapy regimen in post-operation patients with colorectal carcinoma.The clinical data of all patients, including laboratory data and pathological data, were collected from the electronic medical records. Kaplan-Meier Log rank test, COX regression model and subgroup analyses were employed to assess the correlation between the expression of CA125 and CEA in patients with colorectal carcinoma and the survival, and the effect on chemotherapy efficacy.Kaplan-Meier showed that CA125 expression is negatively related to the progression-free survival (PFS) of the post-operative patients, Median PFS was 1140 days in the patients with high expression, and Median PFS was 1387 days in the patients with low expression (χ = 4.715, P = .030); CEA expression is also negatively associated with the PFS of the post-operative patients, Median PFS was 1197 days in the patients with high expression, and Median PFS was 1424 days in the patients with low expression (χ = 4.992, P = .025). Subgroup analysis also showed that the patients with normal CA125 and CEA had better prognosis, median PFS was 1505 days, and the patients with CA125 and (or) CEA high expression had poor prognosis and median PFS was 1162 days (χ = 13.346, P = .001), and found that there was no statistical difference in patients with oxaliplatin plus capecitabine (XELOX) and oxaliplatin, 5-fluorouracil and Calcium folinate (FOLFOX) chemotherapy in patients with CA125 and CEA low expression. However, in these patients with CA125 or (and) CEA high expression, the median PFS of patients treated with XELOX was 1082 days, and the median PFS of patients treated with FOLFOX chemotherapy was 1335 (χ = 4.547, P = .033).Expression of CA125 and CEA associated with the survival of patients, and have some guiding significance for chemotherapy in patients with colorectal cancer after operation; Compared with XELOX, FOLFOX chemotherapy is more effective for CA125 or (and) CEA high expression patients with colorectal carcinoma.
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Affiliation(s)
- Jie Mao
- The Department of General Surgery, Lanzhou University Second Hospital
| | - Peng Du
- The Department of General Surgery, Lanzhou University Second Hospital
| | - Han-teng Yang
- The Department of General Surgery, Lanzhou University Second Hospital
| | - Huan Hu
- Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Shi-Yao Wang
- Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Xia Wu
- The Department of General Surgery, Lanzhou University Second Hospital
| | - Zhi-Bin Cheng
- The Department of General Surgery, Lanzhou University Second Hospital
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84
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Kharofa J, Hallemeier CL, Huguet F, Anker CJ, Buckstein MH, Tait D, Olsen JR, Jabbour SK. Gastrointestinal Cancers: Moving the Needle for Rectal, Gastroesophageal, Pancreaticobiliary, and Liver Cancers. Int J Radiat Oncol Biol Phys 2020; 106:653-662. [PMID: 32092335 DOI: 10.1016/j.ijrobp.2019.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Jordan Kharofa
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Florence Huguet
- Department of Radiation Oncology, Tenon Hospital, Paris Sorbonne University, Paris, France
| | - Christopher J Anker
- Division of Radiation Oncology, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Michael H Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Diana Tait
- Gastrointestinal Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, Surrey, United Kingdom
| | - Jeffrey R Olsen
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey.
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85
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Takeno A, Kimura Y, Sugimoto N, Hirao M, Akiyoshi K, Murakami K, Sakai D, Shimokawa T, Kurokawa Y, Sato T. [A Phase Ⅱ Study of Systemic Chemotherapy with Capecitabine and Cisplatin Followed by Surgery for Advanced Gastric Cancer with Extensive Lymph Node Metastasis(OGSG1401)]. Gan To Kagaku Ryoho 2020; 47:481-483. [PMID: 32381922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Gastric cancer with extensive lymph node metastasis(ELM)is commonly considered unresectable and has a poor prognosis. We conducted a phase Ⅱ study to evaluate the safety and efficacy of capecitabine and cisplatin(XP)as preoperative chemotherapy for gastric cancer with ELM. METHODS The patients received 2 21-day cycles of XP therapy(ca- pecitabine at 2,000mg/m2 twice daily for 2 weeks and cisplatin at 80 mg/m2 on day 1)followed by gastrectomy with D2 plus para-aortic nodal dissection. After R0 resection, S-1 chemotherapy was administered for 1 year. The primary end point was response rate(RR). The planned sample size was 30. RESULTS Between April 2015 and November 2016, 4 patients were enrolled, but the enrollment was terminated because of poor patient recruitment. The clinical RR was 50%, and R0 resection was achieved in 75% of the patients. The common Grade 3 adverse events during XP therapy were leukocytopenia(25%), anemia(25%), and hyperlipidemia(25%). The common Grade 3 surgical morbidity was abdominal abscess(33%)and pancreatic fistula(33%). The pathological RR was 25%. CONCLUSIONS Preoperative XP therapy was feasible, but its efficacy was difficult to evaluate because of the small sample size.
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Affiliation(s)
- Atsushi Takeno
- Dept. of Gastrointestinal Surgery, Kansai Rosai Hospital
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86
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Affiliation(s)
- Ankit Jain
- Canberra Region Cancer Centre, The Canberra Hospital, Garran, ACT 2605, Australia.
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87
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Affiliation(s)
| | - Franco Roviello
- Department of Medicine, Surgery, and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Enrico Mini
- Department of Health Sciences, University of Florence, Florence 50139, Italy
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88
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Nara A, Udagawa M, Onishi I, Sueyoshi K, Gokita K, Watanabe Y, Adikrisna R. [Long-Term Survival of a Patient with Advanced Recurrent Rectal Cancer Treated with a Multidisciplinary Therapy including Five Operations-A Case Report]. Gan To Kagaku Ryoho 2020; 47:114-116. [PMID: 32381876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 68-year-old female with rectal cancer underwent low anterior resection with regional lymph node dissection. The final pathological diagnosis was Stage Ⅲa, and an adjuvant therapy(S-1)was provided for 6 months. One year after the surgery, an anastomotic recurrence was detected. Therefore, pelvic chemoradiotherapy with folinic acid and 5-fluorouracil(FL)was provided, and resection was performed with the Hartmann procedure. Following the second surgery, chemotherapy with bevacizumab(BV)and capecitabine plus oxaliplatin(CapeOX)was provided, and the patient showed no signs of recurrence for several years. However, lung metastasis appeared, which was resected. A year later, the patient underwent hepatectomy and radiofrequency ablation for liver metastasis. Another year later, she underwent lung resection again because of new lung metastasis. During the periods between the surgeries, various chemotherapy regimens were followed continuously, however, the patient died of progressive recurrence 8 years and 4 months after the initial surgery. Recurrences and distant metastases are poor prognostic factors for rectal cancers. However, combined effective chemotherapy and radiotherapy with surgery may improve the patient's chances of survival.
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89
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Lamarca A, Barriuso J, McNamara MG, Hubner RA, Manoharan P, Mansoor W, Valle JW. Temozolomide- Capecitabine Chemotherapy for Neuroendocrine Neoplasms: The Dilemma of Treatment Duration. Neuroendocrinology 2020; 110:155-157. [PMID: 31527383 DOI: 10.1159/000503392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom,
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom,
| | - Jorge Barriuso
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Richard A Hubner
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Prakash Manoharan
- Department of Radiology and Nuclear Medicine, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Wasat Mansoor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
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90
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Okano M, Okuyama M, Hata T, Tanizaki K, Kawada J, Kim Y, Imamoto H, Tsujinaka T. [Long-Term Survival of a Patient with Metastatic Ovarian Cancer and Local Recurrence of Rectal Cancer]. Gan To Kagaku Ryoho 2020; 47:162-164. [PMID: 32381892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 60s woman with upper rectal cancer underwent low anterior resection; the patient was diagnosed with pSSN1, Stage Ⅲa cancer. She received adjuvant therapy with UFT. Three years after the primary resection, metastasis to the right ovary and local recurrence were diagnosed. She was treated with CAPOX plus bevacizumab(Bev), capecitabine, FOLFIRI, and irinotecan plus S-1. Because only the ovarian metastasis increased rapidly, we were able to perform surgery and R0 resection. Two years after resection, local recurrence became apparent, and chemotherapy was reinitiated. After treating the patient with chemotherapy and chemo-radiation therapy for 2 years, R0 resection was performed. Twelve years after primary tumor resection and 9 years after primary resection, we observed recurrence-free survival.
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91
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Chatzellis E, Daskalakis K, Angelousi A, Tsoli M, Alexandraki KI, Wachula E, Meirovitz A, Maimon O, Grozinsky-Glasberg S, Gross D, Kos-Kudła B, Koumarianou A, Kaltsas G. Authors' Response to the Letter by Lamarca et al. Entitled "Temozolomide- Capecitabine Chemotherapy for Neuroendocrine Neoplasms: The Dilemma of Treatment Duration" Regarding "Activity and Safety of Standard and Prolonged Capecitabine/Temozolomide Administration in Patients with Advanced Neuroendocrine Neoplasms". Neuroendocrinology 2020; 110:158-160. [PMID: 31597137 DOI: 10.1159/000503999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Eleftherios Chatzellis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece,
- 251 HAF and VA Hospital, Athens, Greece,
| | - Kosmas Daskalakis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Angelousi
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina Tsoli
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Krystallenia I Alexandraki
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ewa Wachula
- Department of Clinical Oncology and Radiotherapy, Medical University of Silesia, Katowice, Poland
| | - Amichay Meirovitz
- Oncology Department and Radiation Therapy Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofra Maimon
- Oncology Department and Radiation Therapy Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Department of Endocrinology and Metabolism, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Gross
- Neuroendocrine Tumor Unit, Department of Endocrinology and Metabolism, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Neoplasms, Medical University of Silesia, Katowice, Poland
- Department of Endocrinology and Neuroendocrine Tumors, Medical University of Silesia, Katowice, Poland
- Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Anna Koumarianou
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gregory Kaltsas
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
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92
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Kato S, Miyake M, Uemura M, Kato T, Fujiwara A, Maeda S, Hamakawa T, Hama N, Nishikawa K, Miyazaki M, Miyamoto A, Hirao M, Takami K, Sekimoto M. [A Case of Two Curative Resections for the Peritoneal Dissemination of Transverse Colon Cancer]. Gan To Kagaku Ryoho 2019; 46:2479-2481. [PMID: 32156971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
No large clinical trials have been conducted to prove the efficacy of peritoneal dissemination resection for colorectal cancer, and no evidence has shown the usefulness of resection for metachronous peritoneal dissemination. An elderly woman in her 70s underwent a laparoscopic transverse colectomy for transverse colon cancer in 2014, which was performed by another physician. The pathological diagnosis was tub2-por>muc, pT3, ly2, v0, pN2, and pStage Ⅲb. The patient was followed up with capecitabine plus oxaliplatin(CapeOX)therapy as an adjuvant chemotherapy for 6 months. Three years postoperatively, the CEA level increased to 10 ng/mL, and CT showed a nodular shadow in front of the left prerenal fascia. After the diagnosis of peritoneal dissemination recurrence and 8 courses of capecitabine plus bevacizumab therapy, other metastases were not observed. She was referred to our hospital for surgery and underwent laparoscopic peritoneal dissection at 3 years and 6 months after the first operation. Only one apparent disseminated recurrent lesion, which was resectable, was observed. However, at 4 years and 9 months after the initial operation, CT showed a recurrence of Douglas pouch peritoneal dissemination without any other obvious metastasis. Laparoscopic low anterior resection of the rectum and hysterectomy were performed. Here, we encountered a case that could be radically resected for peritoneal dissemination twice after the colon cancer surgery.
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Affiliation(s)
- Shinya Kato
- Dept. of Surgery, National Hospital Organization, Osaka National Hospital
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93
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Hasegawa K, Kazama A, Takatsuno Y, Kondo I, Maejima K, Kaneko J, Higashi Y, Maejima S. [Stage Ⅳ Breast Cancer with Difficulty in Initiating Chemotherapy-A Case Report]. Gan To Kagaku Ryoho 2019; 46:2589-2591. [PMID: 32157008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We report a case of breast cancer(T4b[skin], N1, M1[lung], ER-, PR-, HER2 3+)in a 63-year-old woman with liver dysfunction of unknown cause(T-Bil 3.6mg/dL, ALP 3,483 U/L, AST 214 U/L, ALT 320 U/L, g / -GTP 1,943 U/L). Further- more, serum CA19-9(4,670 U/mL)and HbA1c(8.8%)levels were both elevated. First, she underwent chemotherapy with trastuzumab and capecitabine. Subsequently, liver dysfunction relieved gradually. CA19-9 and HbA1c levels were also decreased, but the tumor size was NC. Subsequently, trastuzumab, pertuzumab, and docetaxel were administered, as liver function became normal. The tumor shrank significantly after this treatment. Finally, she underwent mastectomy. Five years after the first visit, she has continued chemotherapy, with lung metastases almost scarred(CR).
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94
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Funamizu N, Hiramoto Y, Tomori K, Nakabayashi Y, Yanaga K. [Subcutaneous Metastasis from Rectal Carcinoma after Low Anterior Resection-A Case Report]. Gan To Kagaku Ryoho 2019; 46:1323-1325. [PMID: 31501380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 63-year-old woman was admitted to our hospital owing to advanced rectal carcinoma. The patient underwent laparoscopic lowanterior resectionwith D3 lymph node dissection and partial resection of the uterus. The histopathological diagnosis was fT4bN2M0, fStage Ⅲb. Thus, capecitabine plus oxaliplatin(CapeOX)therapy as adjuvant chemotherapy was scheduled for 6 months. However, after the 4th course of chemotherapy, contrast-enhanced CT revealed multiple metastases of the rectal carcinoma including metastases in the liver, peritoneum, retroperitoneum, and subcutaneous tissue of the left lower back. The patient received palliative treatment and died 8 months after surgery. Only a fewcases of subcutaneous metastasis of rectal carcinoma have been reported. Therefore, we herein report this case with a review of the literature.
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95
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Liang Y, Liu L, Xie X, Xia L, Meng J, Xu R, He D. Tumor Size Improves the Accuracy of the Prognostic Prediction of Lymph Node-Negative Gastric Cancer. J Surg Res 2019; 240:89-96. [PMID: 30913463 DOI: 10.1016/j.jss.2019.02.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 02/07/2019] [Accepted: 02/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tumor size has been regarded as the "T" stage of many solid tumors because of its effect on prognosis. However, the prognostic impact of tumor size in gastric cancer (GC) is still controversial. MATERIALS AND METHODS A total of 436 patients with curatively resected GC and those without lymph node metastasis in our center were retrospectively enrolled. The appropriate cutoff points for tumor size were determined. Potential prognostic factors were analyzed. In addition, a pathological tumor-size (pTS) classification system was proposed to evaluate the superiority of its prognostic prediction of node-negative GC patients compared with that of the pT staging system. RESULTS The ideal cutoff points for tumor size were 4 and 8 cm. In the multivariate analysis, tumor size was identified as an independent prognostic factor for node-negative GC patients after surgery, as was pT stage. The pTS classification was found to be more appropriate for predicting the overall survival of node-negative GC patients after curative surgery than pT stage, and the -2 log-likelihood of the pTS classification (1680.782) was smaller than the value of pT (1695.239). CONCLUSIONS As an independent prognostic factor, tumor size should be incorporated into the pT staging system to enhance the accuracy of the prognostic prediction of node-negative GC patients.
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Affiliation(s)
- Yuexiang Liang
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou City, China
| | - Lijie Liu
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou City, China
| | - Xiaoming Xie
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou City, China
| | - Liping Xia
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou City, China
| | - Jin Meng
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou City, China
| | - Ronghua Xu
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou City, China
| | - Donglei He
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou City, China.
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96
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Abstract
RATIONALE Mixed adenoneuroendocrine carcinoma (MANEC) is a rare neoplasm, and consensus on the treatment is unavailable. PATIENT CONCERN A 60-year-old Chinese man presented with obstructive symptoms while eating and paroxysmal stomach pain for more than a month. DIAGNOSIS MANEC was diagnosed based on clinical manifestations, imaging findings, and pathological examinations. INTERVENTIONS The patient underwent radical gastrectomy and received XELOX adjuvant chemotherapy (oxaliplatin 200 mg day 1 + capecitabine 1.5 g twice a day) after surgery. OUTCOMES After 4 cycles of XELOX adjuvant chemotherapy were administered, abdominal computerized tomography and liver magnetic resonance showed liver metastasis. LESSONS The therapy of gastric MANEC is based on surgical operation, and adjuvant chemotherapy program has an important influence on its prognosis. Therefore, further studying the effectiveness of XELOX adjuvant chemotherapy for gastric MANEC is necessary.
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Affiliation(s)
- Zhixian Lin
- The First Clinical Medical College of Zhejiang Chinese Medical University
| | - Jiangfeng Chen
- The First Clinical Medical College of Zhejiang Chinese Medical University
| | - Yong Guo
- Department of Oncology, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang, China
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97
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Affiliation(s)
- Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea.
| | - Hyungwoo Cho
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
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98
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Affiliation(s)
- David Malka
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
| | - Julien Edeline
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
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99
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Sánchez-Gundín J, Fernández-Carballido AM, Torres-Suárez AI, Barreda-Hernández D. Quality of life in non-metastasic colorectal cancer patients in FOLFOX or XELOX therapy. Farm Hosp 2019; 43:56-60. [PMID: 30848178 DOI: 10.7399/fh.11156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE To evaluate and to compare quality of life of patients with non- metastasic colorectal cancer treated either with FOLFOX or with XELOX scheme. METHOD Descriptive prospective study during 24 months (October 2015- October 2017) for patients with non-metastasic colorectal cancer in chemotherapy adyuvant treatment. EORTC QLQ-C30 questionnaire was filled by patients at the beginning and at week 12 of adjuvant treatment. Variables collected: exposure (chemotherapeutic scheme administered), control (demographic data, disease data, treatment data) and response (scores obtained from the questionnaire). The data statistical analysis was carried out with the SPSS® 15.0 programme. RESULTS 30 patients were included. Statistically significant differences were found in emotional role item at the middle of the treatment (FOLFOX 92 points vs. XELOX 82 points; p = 0,036). Patients with FOLFOX presented a clinically relevant worsening in terms of daily activities, constipation and insomnia. Patients treated with XELOX a clinically relevant worsening in daily activities, constipation, fatigue, nausea, vomiting, anorexia and diarrhoea were observed. CONCLUSIONS Patients with XELOX scheme referred to have worse emotionally status in the middle of the adjuvant treatment than patients treated with FOLFOX scheme and presented a worsening in items fatigue, nausea, vomiting, anorexia and diarrhoea.
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Affiliation(s)
- Julia Sánchez-Gundín
- Servicio de Farmacia, Hospital Virgen de la Luz, Cuenca. Departamento de Farmacia y Tecnología Alimentaria, Universidad Complutense de Madrid, Madrid.
| | - Ana María Fernández-Carballido
- Departamento de Farmacia y Tecnología Alimentaria, Universidad Complutense de Madrid, Madrid, nstituto de Farmacia Industrial, Universidad Complutense de Madrid, Madrid..
| | - Ana Isabel Torres-Suárez
- Departamento de Farmacia y Tecnología Alimentaria, Universidad Complutense de Madrid, Madrid, nstituto de Farmacia Industrial, Universidad Complutense de Madrid, Madrid..
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100
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Inoue T, Hasegawa J, Mikuriya K, Marukawa D, Makutani Y, Ozato Y, Shinno N, Furukawa H, Sueda M, Matsumura T, Koga C, Murakami M, Kawabata R, Noura S, Shimizu J. [A Case of Conversion Surgery Following Combined Chemotherapy with Molecular Targeting Agent for Unresectable Colorectal Liver Metastases]. Gan To Kagaku Ryoho 2019; 46:499-501. [PMID: 30914594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 76-year-old woman complaining of constipation was diagnosed with advanced rectosigmoid colon cancer with unresectable liver metastases. We performed a laparoscopic high-anterior resection due to the obstruction. The patient then received a capecitabine plus oxaliplatin(CapeOX)plus cetuximab(Cmab)combination chemotherapy. After 7 cycles of CapeOX with Cmab, the multiple liver metastases had reduced remarkably in size. Therefore, a liver metastases resection was performed. The patient underwent 6 cycles of postoperative CapeOX with Cmab therapy and has survived 7 years with no recurrence after the primary surgery.
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