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Morizane C, Machida N, Honma Y, Okusaka T, Boku N, Kato K, Nomura S, Hiraoka N, Sekine S, Taniguchi H, Okano N, Yamaguchi K, Sato T, Ikeda M, Mizuno N, Ozaka M, Kataoka T, Ueno M, Kitagawa Y, Terashima M, Furuse J. Effectiveness of Etoposide and Cisplatin vs Irinotecan and Cisplatin Therapy for Patients With Advanced Neuroendocrine Carcinoma of the Digestive System: The TOPIC-NEC Phase 3 Randomized Clinical Trial. JAMA Oncol 2022; 8:1447-1455. [PMID: 35980649 PMCID: PMC9389440 DOI: 10.1001/jamaoncol.2022.3395] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Question For patients with advanced neuroendocrine carcinoma of the digestive system, which of the 2 community standard regimens is more effective: etoposide plus cisplatin (EP) or irinotecan plus cisplatin (IP)? Findings In this randomized clinical trial of 170 patients who were chemotherapy naive and had recurrent or unresectable neuroendocrine carcinoma of the digestive system, median overall survival was 12.5 months in the EP arm and 10.9 months in the IP arm. Meaning Both EP and IP therapy remain standard first-line chemotherapy options. Importance Etoposide plus cisplatin (EP) and irinotecan plus cisplatin (IP) are commonly used as community standard regimens for advanced neuroendocrine carcinoma (NEC). Objective To identify whether EP or IP is a more effective regimen in terms of overall survival (OS) in patients with advanced NEC of the digestive system. Design, Setting, and Participants This open-label phase 3 randomized clinical trial enrolled chemotherapy-naive patients aged 20 to 75 years who had recurrent or unresectable NEC (according to the 2010 World Health Organization classification system) arising from the gastrointestinal tract, hepatobiliary system, or pancreas. Participants were enrolled across 50 institutions in Japan between August 8, 2014, and March 6, 2020. Interventions In the EP arm, etoposide (100 mg/m2/d on days 1, 2, and 3) and cisplatin (80 mg/m2/d on day 1) were administered every 3 weeks. In the IP arm, irinotecan (60 mg/m2/d on days 1, 8, and 15) and cisplatin (60 mg/m2/d on day 1) were administered every 4 weeks. Main Outcomes and Measures The primary end point was OS. In total, data from 170 patients were analyzed to detect a hazard ratio (HR) of 0.67 (median OS of 8 and 12 months in inferior and superior arms, respectively) with a 2-sided α of 10% and power of 80%. The pathologic findings were centrally reviewed following treatment initiation. Results Among the 170 patients included (median [range] age, 64 [29-75] years; 117 [68.8%] male), median OS was 12.5 months in the EP arm and 10.9 months in the IP arm (HR, 1.04; 90% CI, 0.79-1.37; P = .80). The median progression-free survival was 5.6 (95% CI, 4.1-6.9) months in the EP arm and 5.1 (95% CI, 3.3-5.7) months in the IP arm (HR, 1.06; 95% CI, 0.78-1.45). A subgroup analysis of OS demonstrated that EP produced more favorable OS in patients with poorly differentiated NEC of pancreatic origin (HR, 4.10; 95% CI, 1.26-13.31). The common grade 3 and 4 adverse events in the EP vs IP arms were neutropenia (75 of 82 [91.5%] patients vs 44 of 82 [53.7%] patients), leukocytopenia (50 of 82 [61.0%] patients vs 25 of 82 [30.5%] patients), and febrile neutropenia (FN) (22 of 82 [26.8%] patients vs 10 of 82 [12.2%] patients). While incidence of FN was initially high in the EP arm, primary prophylactic use of granulocyte colony-stimulating factor effectively reduced the incidence of FN. Conclusions and Relevance Results of this randomized clinical trial demonstrate that both EP and IP remain the standard first-line chemotherapy options. Although AEs were generally manageable, grade 3 and 4 AEs were more common in the EP arm. Trial Registration Japan Registry of Clinical Trials: jRCTs031180005; UMIN Clinical Trials Registry: UMIN000014795
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Affiliation(s)
| | | | | | | | | | - Ken Kato
- National Cancer Center Hospital, Tokyo, Japan
| | - Shogo Nomura
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan.,The University of Tokyo, Tokyo, Japan
| | | | | | | | - Naohiro Okano
- Kyorin University Faculty of Medicine, Mitaka, Japan
| | - Kensei Yamaguchi
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | | | - Masato Ozaka
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomoko Kataoka
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | | | | | | | - Junji Furuse
- Kyorin University Faculty of Medicine, Mitaka, Japan
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Yasuda S, Harada S, Tsujimoto A, Aoki S, Takei T, Migita K, Ueno M, Tatsumi M, Watanabe A. A pathological complete response by chemotherapy with S-1 and oxaliplatin for a locally advanced duodenal adenocarcinoma in Lynch syndrome: a case report. Surg Case Rep 2019; 5:146. [PMID: 31637551 PMCID: PMC6803604 DOI: 10.1186/s40792-019-0712-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although primary duodenal adenocarcinoma (DA) is a rare malignancy representing ~ 0.5% of all gastrointestinal cancers, the incidence of DA is more frequent in Lynch syndrome. Because of its rarity, treatment strategies or optimal chemotherapeutic regimens have not been clearly defined for advanced DA. CASE PRESENTATION A 72-year-old woman with Lynch syndrome visited our hospital with a right upper abdominal pain. Computed tomography (CT) showed wall thickness with enhancement in the second portion of the duodenum and adjacent abdominal wall, which suggested direct tumor invasion to the abdominal wall. Upper gastrointestinal endoscopy (UGE) showed a large ulcerative tumor in the second portion of the duodenum, and histological analysis revealed a poorly differentiated adenocarcinoma. A cT4N0M0, cStage IIB (Union for International Control Cancer TNM staging) DA was diagnosed. After three courses of chemotherapy with S-1 and oxaliplatin (SOX), follow-up CT and UGE showed shrinkage of the duodenal tumor. Therefore, the patient underwent pancreaticoduodenectomy with lymph node dissection with curative intent. Histological examination showed a pathological complete response to SOX therapy. The postoperative course was uneventful, and the patient was discharged on postoperative day 29. The patient received no adjuvant chemotherapy, and there has been no evidence of recurrence 6 months after the operation. CONCLUSIONS SOX therapy provided a remarkable response and can be an optimal chemotherapeutic regimen for advanced DA in Lynch syndrome.
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Affiliation(s)
- Satoshi Yasuda
- Department of Surgery, Nara Prefecture Western Medical Center, 1-14-16 Mimuro Sango-cho, Ikoma-gun, Nara, 636-0802, Japan.
| | - Suzuka Harada
- Department of Surgery, Nara Prefecture Western Medical Center, 1-14-16 Mimuro Sango-cho, Ikoma-gun, Nara, 636-0802, Japan
| | - Akinori Tsujimoto
- Department of Surgery, Nara Prefecture Western Medical Center, 1-14-16 Mimuro Sango-cho, Ikoma-gun, Nara, 636-0802, Japan
| | - Satoko Aoki
- Department of Surgery, Nara Prefecture Western Medical Center, 1-14-16 Mimuro Sango-cho, Ikoma-gun, Nara, 636-0802, Japan
| | - Takeshi Takei
- Department of Surgery, Nara Prefecture Western Medical Center, 1-14-16 Mimuro Sango-cho, Ikoma-gun, Nara, 636-0802, Japan
| | - Kazuhiro Migita
- Department of Surgery, Nara Prefecture Western Medical Center, 1-14-16 Mimuro Sango-cho, Ikoma-gun, Nara, 636-0802, Japan
| | - Masato Ueno
- Department of Surgery, Nara Prefecture Western Medical Center, 1-14-16 Mimuro Sango-cho, Ikoma-gun, Nara, 636-0802, Japan
| | - Mitsutoshi Tatsumi
- Department of Surgery, Nara Prefecture Western Medical Center, 1-14-16 Mimuro Sango-cho, Ikoma-gun, Nara, 636-0802, Japan
| | - Akihiko Watanabe
- Department of Surgery, Nara Prefecture Western Medical Center, 1-14-16 Mimuro Sango-cho, Ikoma-gun, Nara, 636-0802, Japan
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de Bree E, Rovers KP, Stamatiou D, Souglakos J, Michelakis D, de Hingh IH. The evolving management of small bowel adenocarcinoma. Acta Oncol 2018; 57:712-722. [PMID: 29381126 DOI: 10.1080/0284186x.2018.1433321] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Small bowel adenocarcinoma (SBA) is rare despite the fact that the small bowel represents the longest part and has the largest surface of all alimentary tract sections. Its incidence is 50-fold lower than that of colorectal carcinoma. It is often diagnosed at an advanced stage due to atypical and late symptoms, its low index of suspicion, difficult endoscopic access and poor detection by radiological imaging, resulting in impaired outcome. Due to its rarity and being molecularly a unique intestinal cancer, data regarding its optimal management are relatively sparse. MATERIAL AND METHODS A PubMed search was performed to identify relevant manuscripts that were recently published. Emerging data regarding the pathogenesis, the diagnosis and the treatment of SBA that resulted from recent research are discussed in this comprehensive review. RESULTS Genomic analysis has demonstrated that SBA is a molecularly unique intestinal cancer. Double balloon enteroscopy and capsule endoscopy are novel techniques which may result in earlier diagnosis and consequently in improvement of the generally poor prognosis. For clinically localized disease, the quality of surgery has recently been defined, with removal of at least 8-10 lymph nodes correlating with improved prognosis. Moreover, adjuvant chemotherapy seems to improve outcome of stage III disease. The combination of a fluoropyrimidine and oxaliplatin appears to be the most effective systemic chemotherapy for disseminated disease. Genomic profiling can identify potentially targetable genomic alterations in a significant proportion of SBA patients. The role of administration of targeted agents or immune checkpoint inhibitors is still unknown and subject of ongoing clinical trials. In the common case of peritoneal metastases, recent studies have shown that cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy may be an attractive treatment option in selected patients. CONCLUSIONS SBA is a rare and unique malignancy, whose diagnostic approach and treatment are evolving, resulting in improved outcome.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Heraklion, Greece
| | - Koen P. Rovers
- Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Dimitris Stamatiou
- Department of Surgical Oncology, Medical School of Crete University Hospital, Heraklion, Greece
| | - John Souglakos
- Department of Medical Oncology and Laboratory of Translational Oncology, Medical School of Crete University Hospital, Heraklion, Greece
| | - Dimosthenis Michelakis
- Department of Surgical Oncology, Medical School of Crete University Hospital, Heraklion, Greece
| | - Ignace H. de Hingh
- Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands
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Rovers KP, de Bree E, Yonemura Y, de Hingh IH. Treatment of peritoneal metastases from small bowel adenocarcinoma. Int J Hyperthermia 2017; 33:571-578. [DOI: 10.1080/02656736.2016.1266700] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Koen P. Rovers
- Department of Surgical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Heraklion, Greece
| | - Yutaka Yonemura
- Asian and Japanese School of Peritoneal Surface Oncology, Kyoto, Japan
| | - Ignace H. de Hingh
- Department of Surgical Oncology, Catharina Hospital, Eindhoven, the Netherlands
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Horimatsu T, Nakayama N, Moriwaki T, Hirashima Y, Fujita M, Asayama M, Moriyama I, Nakashima K, Baba E, Kitamura H, Tamura T, Hosokawa A, Yoshimura K, Muto M. A phase II study of 5-fluorouracil/L-leucovorin/oxaliplatin (mFOLFOX6) in Japanese patients with metastatic or unresectable small bowel adenocarcinoma. Int J Clin Oncol 2017; 22:905-912. [PMID: 28536826 PMCID: PMC5608770 DOI: 10.1007/s10147-017-1138-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/08/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several studies have suggested that chemotherapy prolonged survival in patients with metastatic or recurrent small bowel adenocarcinoma (SBA); however, there is still no standard chemotherapy regimen. Here, we evaluated the efficacy and safety of a 5-fluorouracil (5-FU)/L-leucovorin (l-LV)/oxaliplatin (mFOLFOX6) protocol as a first-line therapy for patients with SBA. PATIENTS AND METHODS This was a multicenter, single-arm, open-label phase II study. Eligibility criteria included histologically confirmed adenocarcinoma, age 20-80 years, and an Eastern Cooperative Oncology Group performance status (PS) of 0-2. The primary endpoint was 1-year progression-free survival (PFS). The secondary endpoints included overall response rate (ORR), overall survival (OS), overall PFS, and safety. RESULTS Between April 2010 and November 2012, 24 patients were enrolled from 12 institutions. The median age of the patients was 63 years (range 31-79) and there was a male/female ratio of 18/6. The number of PS 0/1 patients was 17/7 and locally advanced/metastatic disease was seen in 2/22 patients, respectively. The primary tumor site was the duodenum in 14 patients (58%) and jejunum in 10 patients (42%). The median follow-up time was 14.7 months (3.7-40.3). The 1-year PFS was 23.3%. The ORR was 9/20 (45%). The median PFS and OS times were 5.9 months (95% confidence interval [CI] 3.0-10.2) and 17.3 months (95% CI 11.7-19.0), respectively. Major grade 3/4 toxicities were neutropenia (38%), anemia/peripheral neuropathy (25%), and stenosis (17%). There were no treatment-related deaths. CONCLUSIONS Although the primary endpoint was not met, mFOLFOX6 showed effective and good tolerance as a first-line treatment for SBA.
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Affiliation(s)
- Takahiro Horimatsu
- Department of Therapeutic Oncology, Kyoto University Hospital, 54, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Norisuke Nakayama
- Department of Gastroenterology, Kanagawa Cancer Center, Kanazawa, Japan
| | | | - Yoshinori Hirashima
- Department of Medical Oncology and Hematology, Faculty of Medicine, Oita University, Oita, Japan
| | - Mikio Fujita
- Department of Gastroenterology and Hepetology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masako Asayama
- Department of Gastroenterology, Saitama Cancer Center Hospital, Saitama, Japan
| | - Ichiro Moriyama
- Division of Clinical Study of Oncology, School of Medicine, Shimane University, Matsue, Japan
| | - Koji Nakashima
- First Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Eishi Baba
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Kitamura
- Department of Internal Medicine, Medical Oncology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Takao Tamura
- Department of Medical Oncology, Faculty of Medicine, Kinki University, Higashiosaka, Japan
| | - Ayumu Hosokawa
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kenichi Yoshimura
- Innovative Clinical Research Center (ICREK), Kanazawa University Hospital, Kanazawa, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Kyoto University Hospital, 54, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Duerr D, Ellard S, Zhai Y, Taylor M, Rao S. A Retrospective Review of Chemotherapy for Patients with Small Bowel Adenocarcinoma in British Columbia. J Cancer 2016; 7:2290-2295. [PMID: 27994666 PMCID: PMC5166539 DOI: 10.7150/jca.16606] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 09/18/2016] [Indexed: 12/18/2022] Open
Abstract
Background: Small bowel adenocarcinoma (SBA) is associated with a poor prognosis. It is an uncommon malignancy and therefore difficult to study. Randomized phase III trials are not available to guide best approaches. The Provincial Cancer Registry of the British Columbia Cancer Agency contains long-term data on patients with SBA. The authors analyzed characteristics and treatment outcomes for SBA patients diagnosed between 1990 and 2008. Material and methods: Charts of 150 patients with a histological diagnosis of SBA were retrospectively analyzed. Epidemiological and treatment data were collected. Disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method. Results: Baseline characteristics, such as median age at diagnosis (64.5 years), tumor stage (I-II 33%, III-IV 58%, unknown 9%), and location (duodenum 48%, jejunum 31%, ileum 21%) were consistent with published data. 55% of patients had a positive family history of cancer. DFS and OS of 29 patients treated with adjuvant chemotherapy were not significantly different to that of 47 patients without (p = 1 and p = 0.211, respectively). In the palliative setting patients treated with polychemotherapy (21 patients) had statistically better OS than patients treated with monochemotherapy (12 patients) (p = 0.0228). Conclusions: Our study suggests a survival benefit for advanced-stage SBA patients treated with poly- versus monochemotherapy. This, however, was a retrospective analysis with several potential confounders. Nevertheless, our study adds to the evidence suggesting that chemotherapy may be beneficial for patients with SBA, at least in the palliative setting.
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Affiliation(s)
- Donat Duerr
- Department of Medical Oncology / Hematology, City Hospital Triemli, Zurich, Switzerland
| | - Susan Ellard
- BC Cancer Agency - Centre for the Southern Interior, Kelowna, Canada
| | | | - Marianne Taylor
- BC Cancer Agency - Centre for the Southern Interior, Kelowna, Canada
| | - Sanjay Rao
- BC Cancer Agency - Centre for the Southern Interior, Kelowna, Canada
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Aydin D, Sendur MA, Kefeli U, Ustaalioglu BB, Aydin O, Yildirim E, Isik D, Ozcelik M, Surmeli H, Oyman A, Isik S, Sener N, Ercelep O, Odabas H, Aliustaoglu M, Gumus M. Evaluation of Bevacizumab in Advanced Small Bowel Adenocarcinoma. Clin Colorectal Cancer 2016; 16:78-83. [PMID: 27247089 DOI: 10.1016/j.clcc.2016.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/23/2016] [Accepted: 04/27/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Small bowel adenocarcinomas (SBAs) are rarely seen tumors. Data regarding the use of chemotherapy together with bevacizumab in patients with advanced SBA are lacking. The aim of this study was the evaluation of treatment with bevacizumab in advanced SBA. MATERIALS AND METHODS Twenty-eight patients from 5 centers with a diagnosis of advanced SBA who received first-line treatments with modified FOLFOX6 (mFOLFOX6; oxaliplatin, leucovorin, and 5-fluorouracil) and FOLFIRI (leucovorin, 5-fluorouracil, and irinotecan) chemotherapy regimens were involved in the study. All patients were divided into 2 groups; those who received bevacizumab together with these chemotherapy regimens (Chemo+Bev group) and those who did not receive bevacizumab (Chemo group). RESULTS The median progression-free survival (PFS) and overall survival (OS) times of all population were 8.7 months and 16.9 months, respectively. The overall response rate was 43.7% in the Chemo group and 58.3% in the Chemo+Bev group. The median PFSs in the Chemo and Chemo+Bev groups were found to be 7.7 months and 9.6 months, respectively, and the median OSs were 14.8 months and 18.5 months, respectively. There was not a significant difference between the groups in terms of overall response rate, PFS, and OS. CONCLUSION Although there was no significant difference in any of the outcomes, use of bevacizumab together with chemotherapy is a more effective treatment approach compared with chemotherapy alone, and it does not cause an excess of significant toxicity.
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Affiliation(s)
- Dincer Aydin
- Department of Medical Oncology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.
| | - Mehmet Ali Sendur
- Department of Medical Oncology, Numune Education and Research Hospital, Ankara, Turkey
| | - Umut Kefeli
- Department of Medical Oncology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Basak Bala Ustaalioglu
- Department of Medical Oncology, Haydarpasa Education and Research Hospital, Istanbul, Turkey
| | - Ozhan Aydin
- Department of Medical Oncology, Haydarpasa Education and Research Hospital, Istanbul, Turkey
| | - Emre Yildirim
- Department of Medical Oncology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Deniz Isik
- Department of Medical Oncology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Melike Ozcelik
- Department of Medical Oncology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Heves Surmeli
- Department of Medical Oncology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Abdilkerim Oyman
- Department of Medical Oncology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Selver Isik
- Department of Medical Oncology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Nur Sener
- Department of Medical Oncology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Ozlem Ercelep
- Department of Medical Oncology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Hatice Odabas
- Department of Medical Oncology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Aliustaoglu
- Department of Medical Oncology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Mahmut Gumus
- Department of Medical Oncology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
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Jabbour SK, Mulvihill D. Defining the role of adjuvant therapy: ampullary and duodenal adenocarcinoma. Semin Radiat Oncol 2014; 24:85-93. [PMID: 24635865 DOI: 10.1016/j.semradonc.2013.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Adenocarcinomas of the ampulla of Vater and duodenum are more rare than pancreatic cancer and have a better prognosis. However, studies conducted on the management of these cancers, such as adjuvant chemotherapy and radiation therapy, are limited by small sample sizes and series that are retrospective. This review evaluates ampullary and duodenal adenocarcinomas with regard to incidence, anatomy, prognostic features, patterns of failure, and the available literature studying adjuvant therapy.
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Affiliation(s)
- Salma K Jabbour
- Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ.
| | - David Mulvihill
- Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
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Tsushima T, Taguri M, Honma Y, Takahashi H, Ueda S, Nishina T, Kawai H, Kato S, Suenaga M, Tamura F, Morita S, Boku N. Multicenter retrospective study of 132 patients with unresectable small bowel adenocarcinoma treated with chemotherapy. Oncologist 2012; 17:1163-70. [PMID: 22622149 DOI: 10.1634/theoncologist.2012-0079] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND No standard chemotherapy regimen has been established for unresectable or recurrent small bowel adenocarcinoma (SBA). METHODS Clinical courses of 132 patients with unresectable or recurrent SBA who received chemotherapy at 41 institutions in Japan were reviewed retrospectively. Patients were classified into five groups according to first-line chemotherapy regimens: fluoropyrimidine monotherapy (group A), fluoropyrimidine-cisplatin (group B), fluoropyrimidine-oxaliplatin (group C), fluoropyrimidine-irinotecan (group D), and other regimens (group E). RESULTS The number of patients in each group was as follows: groups A, 60 patients; group B, 17 patients; group C, 22 patients; group D, 11 patients; and group E, 22 patients. Median progression-free survival (PFS) times were as follows: group A, 5.4 months; group B, 3.8 months; group C, 8.2 months; group D, 5.6 months; and group E, 3.4 months. Median overall survival (OS) times were as follows: group A, 13.9 months; group B, 12.6 months; group C, 22.2 months; group D, 9.4 months; and group D, 8.1 months. Patients in group C achieved significantly longer PFS times and substantially (but not significantly) longer OS times than patients in group A. After adjusting for clinical background characteristics, fluoropyrimidine-oxaliplatin therapy was a significant positive prognostic factor for PFS and OS times. CONCLUSION The results suggest that fluoropyrimidine-oxaliplatin combination therapy is the most promising first-line chemotherapy regimen for unresectable or recurrent SBA.
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Affiliation(s)
- Takahiro Tsushima
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho Sunto-gun, Shizuoka, Japan.
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Koo DH, Yun SC, Hong YS, Ryu MH, Lee JL, Chang HM, Ryoo BY, Kang YK, Kim TW. Systemic chemotherapy for treatment of advanced small bowel adenocarcinoma with prognostic factor analysis: retrospective study. BMC Cancer 2011; 11:205. [PMID: 21619586 PMCID: PMC3125281 DOI: 10.1186/1471-2407-11-205] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 05/27/2011] [Indexed: 12/21/2022] Open
Abstract
Background We sought to evaluate prognostic factors affecting overall survival (OS), and to investigate the role of palliative chemotherapy using propensity score-based weighting, in patients with advanced small bowel adenocarcinoma (SBA). Methods Data from a total of 91 patients diagnosed with advanced SBA at the Asan Medical Center between January 1989 and December 2009 were retrospectively analyzed. Patients were split into two groups, those who did and did not receive palliative chemotherapy. Results Overall, 81 patients (89.0%) died, at a median survival time of 6.6 months (95% confidence interval [CI], 5.5 - 7.5 months). The 40 patients receiving chemotherapy showed overall response and disease control rates of 11.1% and 37.0%, respectively, with OS and progression-free survival (PFS) of 11.8 months (95% CI, 4.6 - 19.0 months) and 5.7 months (95% CI, 3.5 - 8.0 months), respectively. The 41 patients who did not receive chemotherapy had an OS of 4.1 months (95% CI, 3.1 - 5.1 months) and a PFS of 1.3 months (95% CI, 0.8 - 1.7 months). Multivariate analysis showed that lack of tumor resection, non-prescription of chemotherapy, liver metastasis, and intra-abdominal lymph node metastasis, were all independently associated with poor survival outcomes. After inverse probability of treatment weighting (IPTW) adjustment, the group that did not receive chemotherapy was at a significantly higher risk of mortality (HR 3.44, 95% CI 2.03 - 5.83, p < 0.001) than were patients receiving chemotherapy. Conclusion Palliative chemotherapy may improve survival outcomes in patients with advanced SBA.
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Affiliation(s)
- Dong Hoe Koo
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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12
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Trikudanathan G, Dasanu CA. Evolving pharmacotherapeutic strategies for small bowel adenocarcinoma. Expert Opin Pharmacother 2010; 11:1695-704. [DOI: 10.1517/14656566.2010.484421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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SHIBATA YOSHIHIRO, BABA EISHI, ARIYAMA HIROSHI, ARITA SHUJI, ISOBE TAICHI, KUSABA HITOSHI, MITSUGI KENJI, NAKANO SHUJI, AKASHI KOICHI. Irinotecan-based combination chemotherapy for metastatic small intestinal adenocarcinoma. Oncol Lett 2010; 1:423-426. [PMID: 22966319 PMCID: PMC3436425 DOI: 10.3892/ol_00000074] [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: 12/09/2009] [Accepted: 02/26/2010] [Indexed: 01/13/2023] Open
Abstract
Metastatic small intestinal adenocarcinoma (SIA) is rare among digestive tract malignancies, and a standard therapy has yet to be established. The present study described a patient who was treated with irinotecan-based chemotherapy. A 67-year-old woman with a long history of anemia was diagnosed as having SIA using small bowel endoscopy. Tumor invasion of the mesentery and multiple metastases to the lungs and peritoneal lymph nodes were detected. Nine courses of chemotherapy, each consisting of bolus infusion of 5-fluorouracil at 500 mg/m(2), plus infusion of irinotecan at 100 mg/m(2) with l-leucovorin at 20 mg/m(2) on days 1, 8 and 15, were administered at 4-weekly intervals postoperatively. After two courses, the metastatic nodules in the lungs showed a decrease in number and size, and this response continued for over 6 months. Adverse events were manageable during this period. The patient succumbed to the disease 12 months after the initial diagnosis. The present results therefore suggest that irinotecan-based chemotherapy is a potential treatment for metastatic SIA.
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Affiliation(s)
- YOSHIHIRO SHIBATA
- First Department of Internal Medicine and Department of Biosystemic Science of Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - EISHI BABA
- First Department of Internal Medicine and Department of Biosystemic Science of Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - HIROSHI ARIYAMA
- First Department of Internal Medicine and Department of Biosystemic Science of Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - SHUJI ARITA
- First Department of Internal Medicine and Department of Biosystemic Science of Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - TAICHI ISOBE
- First Department of Internal Medicine and Department of Biosystemic Science of Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - HITOSHI KUSABA
- First Department of Internal Medicine and Department of Biosystemic Science of Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - KENJI MITSUGI
- First Department of Internal Medicine and Department of Biosystemic Science of Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - SHUJI NAKANO
- First Department of Internal Medicine and Department of Biosystemic Science of Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - KOICHI AKASHI
- First Department of Internal Medicine and Department of Biosystemic Science of Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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