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Bazarbashi S, Alghabban A, Aseafan M, Aljubran AH, Alzahrani A, Elhassan TAM. Prognostic significance of peritoneal metastasis from colorectal cancer treated with first-line triplet chemotherapy. World J Clin Cases 2022; 10:2429-2438. [PMID: 35434075 PMCID: PMC8968618 DOI: 10.12998/wjcc.v10.i8.2429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/03/2021] [Accepted: 01/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Peritoneal metastasis from colorectal cancer (CRC) carries a poor prognosis in most studies. The majority of those studies used either a single-agent or doublet chemotherapy regimen in the first-line setting.
AIM To investigate the prognostic significance of peritoneal metastasis in a cohort of patients treated with triplet chemotherapy in the first-line setting.
METHODS We retrospectively evaluated progression-free survival (PFS) and overall survival (OS) in 51 patients with metastatic CRC treated in a prospective clinical trial with capecitabine, oxaliplatin, irinotecan, and bevacizumab in the first-line setting according to the presence and absence of peritoneal metastasis. Furthermore, univariate and multivariate analyses for PFS and OS were performed to assess the prognostic significance of peritoneal metastasis at the multivariate level.
RESULTS Fifty-one patients were treated with the above triplet therapy. Fifteen had peritoneal metastasis. The patient characteristics of both groups showed a significant difference in the sidedness of the primary tumor (left-sided primary tumor in 60% of the peritoneal group vs 86% in the nonperitoneal group, P = 0.03) and the presence of liver metastasis (40% for the peritoneal group vs 75% for the nonperitoneal group, P = 0.01). Univariate analysis for PFS showed a statistically significant difference for age less than 65 years (P = 0.034), presence of liver metastasis (P = 0.046), lung metastasis (P = 0.011), and those who underwent metastasectomy (P = 0.001). Only liver metastasis and metastasectomy were statistically significant for OS, with P values of 0.001 and 0.002, respectively. Multivariate analysis showed that age (less than 65 years) and metastasectomy were statistically significant for PFS, with P values of 0.002 and 0.001, respectively. On the other hand, the absence of liver metastasis and metastasectomy were statistically significant for OS, with P values of 0.003 and 0.005, respectively.
CONCLUSION Peritoneal metastasis in patients with metastatic CRC treated with first-line triple chemotherapy does not carry prognostic significance at univariate and multivariate levels. Confirmatory larger studies are warranted.
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Affiliation(s)
- Shouki Bazarbashi
- Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Riyadh, Saudi Arabia
| | - Abdulrahman Alghabban
- Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Riyadh, Saudi Arabia
| | - Mohamed Aseafan
- Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Riyadh, Saudi Arabia
| | - Ali H Aljubran
- Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Riyadh, Saudi Arabia
| | - Ahmed Alzahrani
- Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Riyadh, Saudi Arabia
| | - Tusneem AM Elhassan
- Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Riyadh, Saudi Arabia
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WGCNA reveals key gene modules regulated by the combined treatment of colon cancer with PHY906 and CPT11. Biosci Rep 2020; 40:226138. [PMID: 32812032 PMCID: PMC7468096 DOI: 10.1042/bsr20200935] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 02/06/2023] Open
Abstract
Irinotecan (CPT11) is one of the most effective drugs for treating colon cancer, but its severe side effects limit its application. Recently, a traditional Chinese herbal preparation, named PHY906, has been proved to be effective for improving therapeutic effect and reducing side effects of CPT11. The aim of the present study was to provide novel insight to understand the molecular mechanism underlying PHY906-CPT11 intervention of colon cancer. Based on the GSE25192 dataset, for different three treatments (PHY906, CPT11, and PHY906-CPT11), we screened out differentially expressed genes (DEGs) and constructed a co-expression network by weighted gene co-expression network analysis (WGCNA) to identify hub genes. The key genes of the three treatments were obtained by merging the DEGs and hub genes. For the PHY906-CPT11 treatment, a total of 18 key genes including Eif4e, Prr15, Anxa2, Ddx5, Tardbp, Skint5, Prss12 and Hnrnpa3, were identified. The results of functional enrichment analysis indicated that the key genes associated with PHY906-CPT11 treatment were mainly enriched in ‘superoxide anion generation’ and ‘complement and coagulation cascades’. Finally, we validated the key genes by Gene Expression Profiling Interactive Analysis (GEPIA) and RT-PCR analysis, the results indicated that EIF4E, PRR15, ANXA2, HNRNPA3, NCF1, C3AR1, PFDN2, RGS10, GNG11, and TMSB4X might play an important role in the treatment of colon cancer with PHY906-CPT11. In conclusion, a total of 18 key genes were identified in the present study. These genes showed strong correlation with PHY906-CPT11 treatment in colon cancer, which may help elucidate the underlying molecular mechanism of PHY906-CPT11 treatment in colon cancer.
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Elshenawy MA, Badran A, Aljubran A, Alzahrani A, Rauf MS, Eldali A, Bazarbashi S. Survival benefit of surgical resection after first-line triplet chemotherapy and bevacizumab in patients with initially unresectable metastatic colorectal cancer. World J Surg Oncol 2020; 18:163. [PMID: 32641137 PMCID: PMC7346377 DOI: 10.1186/s12957-020-01930-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/23/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Surgical resection of metastatic disease in patients with initially non-resectable colorectal cancer (CRC) has improved overall survival. Intensified chemotherapy regimens have increased the probability of converting unresectable metastasis to resectable. Here, we report the result of combining intensive chemotherapy (triplet) and surgical resection of metastatic lesions in patients with metastatic CRC. PATIENTS AND METHODS Patients with unresectable metastatic CRC were enrolled in phase I/II trial of triplet chemotherapy consisting of capecitabine, oxaliplatin, irinotecan, and bevacizumab. Patients were given 5-8 cycles induction chemotherapy of the above regimen followed by maintenance capecitabine and bevacizumab until disease progression, unacceptable toxicity, or patient request. All patients were assessed at a multidisciplinary conference for possible surgical resection of their metastatic disease at the time of inclusion in the trial and 2 monthly intervals thereafter. Patients who underwent R0 resection of their metastatic disease received adjuvant oxaliplatin and capecitabine to complete a total of 6 months of chemotherapy. RESULTS Fifty-three patients were enrolled. The median age was 52 years (range 23-74), 29 (55%) were males, ECOG PS 0-1 was 13 (66%), 11 (42%) had a right-sided tumor, 29 (55%) had resection of their primary tumor, 22 (42%) had a single metastatic site, and 8 (15.1%) had a liver-limited disease. Thirteen patients (24.5%) underwent surgical resection of residual metastatic disease +/- the primary tumor with 10 (18.9%) of them were R0. The surgical group had a higher incidence of males compared to the non-surgical group (69.3% vs 47.2%, p = 0.2), equal performance status, lower median number of metastatic sites (1 vs 2, p = 0.09), higher mutant Kras (53.8% vs 34.2%, p = 0.3), and higher response rate (84.6% vs 56.2%, p = 0.3). With a median follow-up duration of 89 months, the median PFS for the whole group was 16.1 months [95% confidence interval (CI) 9.1-20] and the median OS was 28.2 months (95% CI 22.5-53.3). The median PFS for the surgery group was 18.9 months (95% CI 12.6-not reached) compared to 9.6 months (95% CI 7.0-18.3) for the non-surgical group, log-rank p = 0.0165. The median OS for both groups was not reached (95% CI 53.3-not reached) and 23.2 months (95% CI 17.0-28.4) respectively, log-rank p = 0.0006. Five-year PFS and OS for the surgery group were 46.2% and 67.6% respectively. CONCLUSIONS Patients with unresectable metastatic CRC and fit for triplet chemotherapy should have the benefit of combining this intensified regimen and surgical resection of their metastatic disease if possible. TRIAL REGISTRATION Clinicaltrials.gov , NCT01311050 , registered March 6, 2011, retrospectively registered.
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Affiliation(s)
- Mahmoud A. Elshenawy
- Medical Oncology Section, Oncology Centre, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11211 Saudi Arabia
- Clinical Oncology Department, Faculty of Medicine, Menoufia University, Shebin El Kom, 32511 Egypt
| | - Ahmed Badran
- Medical Oncology Section, Oncology Centre, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11211 Saudi Arabia
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, 11591 Egypt
| | - Ali Aljubran
- Medical Oncology Section, Oncology Centre, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11211 Saudi Arabia
| | - Ahmed Alzahrani
- Medical Oncology Section, Oncology Centre, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11211 Saudi Arabia
| | - M. Shahzad Rauf
- Medical Oncology Section, Oncology Centre, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11211 Saudi Arabia
| | - Abdelmoneim Eldali
- Department of Biostatistics, Epidemiology and Scientific computing, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11211 Saudi Arabia
| | - Shouki Bazarbashi
- Medical Oncology Section, Oncology Centre, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11211 Saudi Arabia
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Tominaga T, Nonaka T, Tabata K, Sawai T, Nagayasu T. A pathological complete response after neoadjuvant triplet chemotherapy for locally advanced transverse colon cancer. Int J Surg Case Rep 2020; 72:127-132. [PMID: 32535526 PMCID: PMC7298320 DOI: 10.1016/j.ijscr.2020.05.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 12/17/2022] Open
Abstract
Perioperative chemotherapy could improve oncological outcome for colon cancer. The effectiveness of triplet chemotherapy as neoadjuvant setting is still unknown. A pathological complete response after neoadjuvant triplet chemotherapy was described.
Introduction Perioperative chemotherapy could improve oncological outcomes for patients with advanced colon cancer. However, the effectiveness of triplet chemotherapy in the neoadjuvant setting is still unknown. Presentation of case A 61-year-old man was referred to our hospital due to abdominal distention. Abdominal computed tomography showed a huge, 18-cm mass in the right upper abdomen. Biopsy showed well-differentiated adenocarcinoma. Locally advanced transverse colon cancer T4b N2a M0 Stage IIIC was diagnosed. Considering the extensive invasion to surrounding organs and difficulties in achieving margin-negative surgery, an emergency ileostomy was performed first. Then, neoadjuvant chemotherapy (NAC) consisting of a combination of 5-fluorouracil (5-FU), oxaliplatin, irinotecan, and leucovorin (FOLFOXIRI) was planned, followed by primary tumor resection. After 6 courses of treatment, the primary tumor shrank remarkably. Finally, laparoscopic radical extended right hemi-colectomy was performed. There were no residual tumor cells in resected specimens, including the primary tumor and surrounding lymph nodes. The pathological diagnosis was complete response. Conclusion A case of pathological complete response after neoadjuvant treatment followed by radical resection was reported. Further research is needed to confirm the appropriate indications for neoadjuvant FOLFOXIRI therapy for patients with LACC.
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Affiliation(s)
- Tetsuro Tominaga
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Takashi Nonaka
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kazuhiro Tabata
- Departments of Pathology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Terumitsu Sawai
- Departments of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takeshi Nagayasu
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Bazarbashi S, Omar AT, Raddaoui L, Badran A, Alzahrani A, Aljubran A, Elhassan T. The Significance of Sidedness in Patients with Metastatic Colorectal Cancer Treated with Triplet First-line Chemotherapy. Asian Pac J Cancer Prev 2019; 20:2891-2896. [PMID: 31653131 PMCID: PMC6982651 DOI: 10.31557/apjcp.2019.20.10.2891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recent data have shown that right-sided colon cancer carries poorer prognosis compared to left-sided tumors. This study was aimed to evaluate the progression-free survival, overall survival of patients with metastatic colon cancer of right-sided versus left-sided primaries treated with triplet chemotherapy regimen. METHODS The medical records of patients with metastatic colorectal cancer treated on phase I-II trial of combination Irinotecan, oxaliplatin, capecitabine, and bevacizumab were reviewed for sidedness of the primary. The analysis was performed for progression-free survival and overall survival according to the sidedness and other known prognostic factors. RESULTS Out of 53 patients treated with triplet therapy, 11 had right sided and 42 had left-sided primaries. The median age for right-sided primaries was 46 (range 24-55) compared to 53 (range 32-74) in left-sided primaries. Median progression-free survival was 14 months for right vs 18 months for left sided tumors (Hazard ratio 0.72, 95% confidence interval 0.27-1.88, p=0.492) and median overall survival was 21 months for right vs 29 months for left sided tumors (Hazard ratio was 0.86, 95% CI 0.32-2.26, p=0.752). CONCLUSION First-line triplet chemotherapy may overcome the difference in prognosis between right sided and left sided primaries in metastatic colorectal cancer. A larger analysis is warranted.
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Affiliation(s)
| | - Ayman T Omar
- Section of Medical Oncology,
- Research Unit, Department of Oncology, King Faisal Specialist Hospital and Research Center,
| | - Leen Raddaoui
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia,
| | - Ahmed Badran
- Section of Medical Oncology,
- Department of Clinical Oncology and Nuclear Medicine, Suez Canal University Hospital, Ismailia,
| | | | | | - Tusneem Elhassan
- Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Gan Z, Zou Q, Lin Y, Xu Z, Huang Z, Chen Z, Lv Y. Identification of a 13-gene-based classifier as a potential biomarker to predict the effects of fluorouracil-based chemotherapy in colorectal cancer. Oncol Lett 2019; 17:5057-5063. [PMID: 31186717 PMCID: PMC6507297 DOI: 10.3892/ol.2019.10159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/25/2019] [Indexed: 12/14/2022] Open
Abstract
The aim of the current study was to develop a predictor classifier for response to fluorouracil-based chemotherapy in patients with advanced colorectal cancer (CRC) using microarray gene expression profiles of primary CRC tissues. Using two expression profiles downloaded from the Gene Expression Omnibus database, differentially expressed genes (DEGs) between responders and non-responders to fluorouracil-based chemotherapy were identified. A total of 791 DEGs, including 303 that were upregulated and 488 that were downregulated in responders, were identified. Functional enrichment analysis revealed that the DEGs were primarily involved in ‘cell mitosis’, ‘DNA replication’ and ‘cell cycle’ signaling pathways. Following feature selection using two methods, a random forest classifier for response to fluorouracil-based chemotherapy with 13 DEGs was constructed. The accuracy of the 13-gene classifier was 0.930 in the training set and 0.810 in the validation set. The receiver operating characteristic curve analysis revealed that the area under the curve was 1.000 in the training set and 0.873 in the validation set (P=0.227). The 13-gene-based classifier described in the current study may be used as a potential biomarker to predict the effects of fluorouracil-based chemotherapy in patients with CRC.
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Affiliation(s)
- Zuhuan Gan
- Department of Medical Oncology, Affiliated Langdong Hospital of Guangxi Medical University, Guangxi Medical University Kaiyuan Langdong Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Qiyuan Zou
- Department of Medicine, Affiliated Langdong Hospital of Guangxi Medical University, Guangxi Medical University Kaiyuan Langdong Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Yan Lin
- Department of Medical Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Zihai Xu
- Department of Medical Oncology, Affiliated Langdong Hospital of Guangxi Medical University, Guangxi Medical University Kaiyuan Langdong Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Zhong Huang
- Department of Medical Oncology, Affiliated Langdong Hospital of Guangxi Medical University, Guangxi Medical University Kaiyuan Langdong Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Zhichao Chen
- Department of Medical Oncology, Affiliated Langdong Hospital of Guangxi Medical University, Guangxi Medical University Kaiyuan Langdong Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Yufeng Lv
- Department of Medical Oncology, Affiliated Langdong Hospital of Guangxi Medical University, Guangxi Medical University Kaiyuan Langdong Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
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Bazarbashi S, Hakoun AM, Gad AM, Elshenawy MA, Aljubran A, Alzahrani AM, Eldali A. Efficacy of second-line chemotherapy after a first-line triplet in patients with metastatic colorectal cancer. Curr Oncol 2019; 26:e24-e29. [PMID: 30853806 PMCID: PMC6380651 DOI: 10.3747/co.26.4217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Exposing patients with metastatic colorectal cancer (mcrc) to all three active chemotherapeutic agents (oxaliplatin, irinotecan, fluorouracil) has improved survival. The benefit of second-line chemotherapy after a first-line triplet is not clearly defined. We evaluated the efficacy of second-line chemotherapy in patients who had received first-line triplet therapy. METHODS The medical records of patients treated on a prospective trial of first-line triplet therapy were reviewed for second-line treatment. Univariate and multivariate analyses were performed to establish factors of prognostic significance. RESULTS Of the 53 patients who received first-line triplet therapy, 28 (53%) received second-line chemotherapy [13 men; 8 with a colon primary; mutant KRAS in 10, wild-type in 15, and unknown status in 3; Eastern Cooperative Oncology Group performance status (ps) of 1 in 16 patients, ps 2 in 3, ps 3 in 2, and unknown in 7; involved organs: liver in 17 patients, lung in 16, and peritoneum in 8]. Second-line chemotherapy consisted of xelox or folfox in 13 patients, xeliri or folfiri in 12, and single-agent irinotecan in 3. Concurrent bevacizumab was given in 16 patients (57%), and cetuximab, in 2 (7%). Median survival was 28.0 months [95% confidence interval (ci): 22.8 months to 33.2 months] for patients receiving second-line therapy and 23.0 months (95% ci: 13.2 months to 32.8 months) for those not receiving it. Best response was partial in 6 patients (21%), stable disease in 11 (39%), and progressive disease in 11 (39%). Median progression-free survival was 4.8 months (95% ci: 2.4 months to 9.6 months), and overall survival was 15 months (95% ci: 9.6 months to 20.4 months). CONCLUSIONS Second-line chemotherapy after first-line triplet therapy in mcrc is feasible and suggests efficacy comparable to that reported for second-line therapy after a doublet, regardless of the agent used.
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Affiliation(s)
- S Bazarbashi
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - A M Hakoun
- Research Office, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - A M Gad
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Ain Shams University, Cairo
| | - M A Elshenawy
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
| | - A Aljubran
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - A M Alzahrani
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - A Eldali
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Research Office, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Ain Shams University, Cairo
- Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
- Department of Biostatistics, Epidemiology and Scientific Computing, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Maroun J, Marginean H, Jonker D, Cripps C, Goel R, Asmis T, Goodwin R, Chiritescu G. A Phase I Study of Irinotecan, Capecitabine (Xeloda), and Oxaliplatin in Patients With Advanced Colorectal Cancer. Clin Colorectal Cancer 2017; 17:e257-e268. [PMID: 29330005 DOI: 10.1016/j.clcc.2017.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 11/13/2017] [Accepted: 12/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The objective of the present phase I study was to define the dose-limiting toxicities (DLTs) and maximum tolerated dose (MTD) of irinotecan, capecitabine, and oxaliplatin given in combination (IXO regimen) to patients with previously untreated, unresectable advanced or metastatic colorectal cancer (CRC). PATIENTS AND METHODS Patients received oxaliplatin followed by irinotecan as intravenous infusions on day 1, with oral capecitabine taken twice daily (BID) on days 2 to 15 of a 3-week cycle. The dose ranges were explored as follows: oxaliplatin, 75 to 120 mg/m2; irinotecan, 160 to 230 mg/m2; capecitabine, 750 to 1000 mg/m2 BID. Dose escalation was performed individually for each drug at each dose level according to the type and severity of toxicity encountered in the previous cohort. RESULTS A total of 39 patients were enrolled at 7 dose levels and the MTD. The recommended doses for phase II evaluation were oxaliplatin 100 mg/m2, irinotecan 160 mg/m2, and capecitabine 950 mg/m2 BID. Diarrhea and febrile neutropenia were DLTs. Of the 39 enrolled patients, 26 (67%) had confirmed objective responses. The median progression-free survival was 11 months, and the median overall survival was 25 months. The survival rate at 5 years was 23%. CONCLUSION The IXO regimen has a manageable toxicity profile with promising antitumor activity as first-line treatment of advanced and metastatic CRC.
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Affiliation(s)
- Jean Maroun
- Department of Medicine, University of Ottawa, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada
| | - Horia Marginean
- Clinical Research, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada.
| | - Derek Jonker
- Division of Medical Oncology, Department of Medicine, University of Ottawa, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada
| | - Christine Cripps
- Division of Medical Oncology, Department of Medicine, University of Ottawa, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada
| | - Rakesh Goel
- Division of Medical Oncology, Department of Medicine, University of Ottawa, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada
| | - Timothy Asmis
- Division of Medical Oncology, Department of Medicine, University of Ottawa, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada
| | - Rachel Goodwin
- Division of Medical Oncology, Department of Medicine, University of Ottawa, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada
| | - Gabriela Chiritescu
- Digestive Oncology Unit, Department of Gastroenterology, Universitair Ziekenhuis Leuven, Leuven, Belgium
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Aziz MA, Yousef Z, Saleh AM, Mohammad S, Al Knawy B. Towards personalized medicine of colorectal cancer. Crit Rev Oncol Hematol 2017; 118:70-78. [PMID: 28917272 DOI: 10.1016/j.critrevonc.2017.08.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 04/18/2017] [Accepted: 08/21/2017] [Indexed: 02/07/2023] Open
Abstract
Efforts in colorectal cancer (CRC) research aim to improve early detection and treatment for metastatic stages which could translate into better prognosis of this disease. One of the major challenges that hinder these efforts is the heterogeneous nature of CRC and involvement of diverse molecular pathways. New large-scale 'omics' technologies are making it possible to generate, analyze and interpret biological data from molecular determinants of CRC. The developments of sophisticated computational analyses would allow information from different omics platforms to be integrated, thus providing new insights into the biology of CRC. Together, these technological advances and an improved mechanistic understanding might allow CRC to be clinically managed at the level of the individual patient. This review provides an account of the current challenges in CRC management and an insight into how new technologies could allow the development of personalized medicine for CRC.
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Affiliation(s)
- Mohammad Azhar Aziz
- King Abdullah International Medical Research Center [KAIMRC], King Saud Bin Abdulaziz University for Health Sciences, Colorectal Cancer Research Program, National Guard Health Affairs, P.O. Box 22490, Riyadh 11426, Saudi Arabia.
| | - Zeyad Yousef
- King Abdullah International Medical Research Center [KAIMRC], King Saud Bin Abdulaziz University for Health Sciences, Department of Surgery, National Guard Health Affairs, P.O. Box 22490, Riyadh 11426, Saudi Arabia.
| | - Ayman M Saleh
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Mail Code 6610, P. O. Box 9515 Jeddah 21423, Saudi Arabia; King Abdullah International Medical Research Center [KAIMRC], King Abdulaziz Medical City, National Guard Health Affairs, P. O. Box 9515, Jeddah 21423, Saudi Arabia.
| | - Sameer Mohammad
- King Abdullah International Medical Research Center [KAIMRC], King Saud Bin Abdulaziz University for Health Sciences, Department of Experimental Medicine, National Guard Health Affairs, P.O. Box 22490, Riyadh 11426, Saudi Arabia.
| | - Bandar Al Knawy
- King Abdullah International Medical Research Center [KAIMRC], King Saud Bin Abdulaziz University for Health Sciences, Office of the Chief Executive Officer, National Guard Health Affairs, P.O. Box 22490, Riyadh 11426, Saudi Arabia.
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Kwakman J, Punt C. Oral drugs in the treatment of metastatic colorectal cancer. Expert Opin Pharmacother 2016; 17:1351-61. [DOI: 10.1080/14656566.2016.1186649] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Ishtikhar M, Khan MV, Khan S, Chaturvedi SK, Badr G, Mahmoud MH, Khan RH. Biophysical and molecular docking insight into interaction mechanism and thermal stability of human serum albumin isoforms with a semi-synthetic water-soluble camptothecin analog irinotecan hydrochloride. J Biomol Struct Dyn 2016; 34:1545-60. [PMID: 26309154 DOI: 10.1080/07391102.2015.1082504] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the present work, we have examined the binding parameters, thermodynamics, and stability of human serum albumin (HSA) isoforms at pH 7.4 and 9.0, using spectroscopic, calorimetric, and molecular docking methods in the presence of water-soluble camptothecin analog irinotecan hydrochloride (CPT-11). We observed that CPT-11 binds to HSA through a static quenching procedure of ground-state complex formation with N-isoform and B-isoform. Hydrogen bond and hydrophobic interactions are the major governing forces that participating in the formation of protein-drug complex. To determine the binding site of CPT-11 within HSA molecules, we also have performed molecular docking experiments. We explored the CPT-11-mediated stability and modulation of HSA by performing dynamic light scattering (DLS) and differential scanning calorimetry (DSC) experiments. DLS and DSC techniques are used to determine the size and the melting point (Tm) of HSA, which was decreased in the presence of CPT-11. Therefore, CPT-11 plays an important role in HSA stability and protein-ligand interactions. The present study provides valuable information in the field of pharmacokinetics, pharmaco-dynamics, and drug discovery.
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Affiliation(s)
- Mohd Ishtikhar
- a Protein Biophysics Laboratory, Interdisciplinary Biotechnology Unit , Aligarh Muslim University , Aligarh 202002 , India
| | - Mohsin Vahid Khan
- a Protein Biophysics Laboratory, Interdisciplinary Biotechnology Unit , Aligarh Muslim University , Aligarh 202002 , India
| | - Shawez Khan
- b School of Computational & Integrative Sciences , Jawaharlal Nehru University , New Delhi 110067 , India
| | - Sumit Kumar Chaturvedi
- a Protein Biophysics Laboratory, Interdisciplinary Biotechnology Unit , Aligarh Muslim University , Aligarh 202002 , India
| | - Gamal Badr
- c Laboratory of Immunology and Molecular Physiology, Faculty of Science, Zoology Department , Assiut University , Assiut 71516 , Egypt
| | - Mohamed H Mahmoud
- d Deanship of Scientific Research , King Saud University , Riyadh , Saudi Arabia.,e Food Science and Nutrition Department , National Research Center , Dokki, Cairo , Egypt
| | - Rizwan Hasan Khan
- a Protein Biophysics Laboratory, Interdisciplinary Biotechnology Unit , Aligarh Muslim University , Aligarh 202002 , India
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Understanding the FOLFOXIRI-regimen to optimize treatment for metastatic colorectal cancer. Crit Rev Oncol Hematol 2016; 100:117-26. [PMID: 26850575 DOI: 10.1016/j.critrevonc.2016.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 10/30/2015] [Accepted: 01/19/2016] [Indexed: 12/12/2022] Open
Abstract
The management of metastatic colorectal cancer substantially improved over the last 10 years and median overall survival of patients might exceed 30 months. The selection of an effective first-line treatment represents a crucial point in order to achieve good outcome results. In the last years, the intensive FOLFOXIRI regimen in combination with bevacizumab became a new standard option in this setting. In the present review we summarized the main steps of FOLFOXIRI regimen development from the first pilot study to the recent findings with biological agents, with a specific focus on practical aspects, such as patient's selection, adverse event management, treatment schedules and post-progression strategies. Possible predictive markers, open issues and ongoing clinical trials have been also deeply described.
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