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Germani MM, Borelli B, Boraschi P, Antoniotti C, Ugolini C, Urbani L, Morelli L, Fontanini G, Masi G, Cremolini C, Moretto R. The management of colorectal liver metastases amenable of surgical resection: How to shape treatment strategies according to clinical, radiological, pathological and molecular features. Cancer Treat Rev 2022; 106:102382. [PMID: 35334281 DOI: 10.1016/j.ctrv.2022.102382] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 02/05/2023]
Abstract
Metastatic colorectal cancer (mCRC) patients have poor chances of long term survival, being < 15% of them still alive after 5 years from diagnosis. Nonetheless, patients with colorectal liver metastases (CRLM) may be eligible for metastases resection thus being able to achieve long-term disease remission and survival. The likelihood for patients with CRLM of being or becoming eligible for liver metastasectomy is increasing, thanks to the evolution of surgical techniques, the availability of active systemic treatments and the widespread diffusion of experienced multidisciplinary boards to manage these patients. However, disease relapse after liver surgery is common and occurs in two-thirds of resected patients. Therefore, adequate radiological staging and risk stratification is crucial for the optimal selection of patients candidate to surgery in order to maximize the benefit-risk ratio of liver metastasectomy and to individualize the treatment strategy. Based on the multidimensional assessment, three possible approaches are available: upfront liver surgery followed by adjuvant chemotherapy, perioperative chemotherapy preceding and following liver surgery, and an upfront systemic treatment including chemotherapy plus a targeted agent, both chosen according to patients' and tumours' characteristics, then followed by liver surgery if indicated. In this review, we describe the most important factors impacting the therapeutic choices in patients with resectable and potentially resectable CRLM, and we discuss the most promising factors that may reshape the future decision-making process of these patients.
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Affiliation(s)
- Marco Maria Germani
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Beatrice Borelli
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Piero Boraschi
- Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Carlotta Antoniotti
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Clara Ugolini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Lucio Urbani
- Unit of General Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Luca Morelli
- General Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gabriella Fontanini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
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Eriksson S, Bengtsson J, Torén W, Lätt J, Andersson R, Sturesson C. Changes in apparent diffusion coefficient and pathological response in colorectal liver metastases after preoperative chemotherapy. Acta Radiol 2022; 64:51-57. [PMID: 35084232 DOI: 10.1177/02841851221074496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The pathological response to preoperative chemotherapy of colorectal liver metastases (CRLMs) is predictive of long-term prognosis after liver resection. Accurate preoperative assessment of chemotherapy response could enable treatment optimization. PURPOSE To investigate whether changes in lesion-apparent diffusion coefficient (ADC) measured with diffusion-weighted magnetic resonance imaging (MRI) can be used to assess pathological treatment response in patients with CRLMs undergoing preoperative chemotherapy. MATERIAL AND METHODS Patients who underwent liver resection for CRLMs after preoperative chemotherapy between January 2011 and December 2019 were retrospectively included if they had undergone MRI before and after preoperative chemotherapy on the same 1.5-T MRI scanner with diffusion-weighted imaging with b-values 50, 400, and 800 s/mm2. The pathological chemotherapy response was assessed using the tumor regression grade (TRG) by AJCC/CAP. Lesions were divided into two groups: pathological responding (TRG 0-2) and non-responding (TRG 3). The change in lesion ADC after preoperative chemotherapy was compared between responding and non-responding lesions. RESULTS A total of 27 patients with 49 CRLMs were included, and 24/49 lesions showed a pathological chemotherapy response. After chemotherapy, ADC increased in both pathological responding (pretreatment ADC: 1.26 [95% confidence interval (CI)=1.06-1.37] vs. post-treatment ADC: 1.33 [95% CI=1.13-1.56] × 10-3 mm2/s; P = 0.026) and non-responding lesions (1.12 [95% CI=0.980-1.21] vs. 1.20 [95% CI=1.09-1.43] × 10-3 mm2/s; P = 0.018). There was no difference in median relative difference in ADC after chemotherapy between pathological responding and non-responding lesions (15.8 [95% CI=1.42-26.3] vs. 7.17 [95% CI=-4.31 to 31.2]%; P = 0.795). CONCLUSION Changes in CRLM ADCs did not differ between pathological responding and non-responding lesions.
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Affiliation(s)
- Sam Eriksson
- Surgery, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Center for Medical Imaging and Physiology, Skane University Hospital, Lund, Sweden
| | - Johan Bengtsson
- Center for Medical Imaging and Physiology, Skane University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - William Torén
- Surgery, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Jimmy Lätt
- Center for Medical Imaging and Physiology, Skane University Hospital, Lund, Sweden
| | - Roland Andersson
- Surgery, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Christian Sturesson
- Surgery, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Zhang C, Wang X, Han J, Zhang R, Chen Z, Li Y, Ma X, Zhang G, Fan J, Chen J. Histological tumor response to neoadjuvant chemotherapy correlates to Immunoscore in colorectal cancer liver metastases patients. J Surg Oncol 2021; 124:1431-1441. [PMID: 34406653 DOI: 10.1002/jso.26651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/02/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study investigated the correlation between tumor regression grade (TRG) score and Immunoscore, and prognostic values of TRG score and a risk score in colorectal cancer liver metastases (CRLMs) patients after neoadjuvant chemotherapy. METHODS Patients undergoing neoadjuvant chemotherapy from 2014 to 2019 were selected. TRG score and Immunoscore were evaluated in 200 CRLMs. A risk score combining TRG score, Immunoscore, and clinical risk score (CRS) was defined and divided patients into the low-, medium-, and high-risk groups. Differences in relapse-free survival (RFS) and overall survival (OS) between groups were determined. RESULTS The densities of CD3+ and CD8+ immune cells were higher in TRG1-3 group than in TRG4-5 group, and the ratio of high Immunoscores was higher in TRG1-3 group than in TRG4-5 group (60.0% vs. 15.8%, p < 0.001). Patients in TRG1-3 group had significantly longer RFS and OS than those in TRG4-5 group. The low-risk group shows a significantly higher 2-year RFS and 5-year OS rate than the medium- and high-risk group (RFS: 59.9%, 36.2%, and 6.4%, p < 0.001; OS: 82.0%, 41.0%, and 16.9%, p < 0.001). CONCLUSION TRG score may be proposed to evaluate the prognosis of neoadjuvant chemotherapy and may be used for predicting the postoperative survival of CRLMs.
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Affiliation(s)
- Chong Zhang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiangyu Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiahao Han
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Rui Zhang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhenmei Chen
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yitong Li
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaochen Ma
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Guo Zhang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Fan
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinhong Chen
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
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Velichko YS, Mozafarykhamseh A, Trabzonlu TA, Zhang Z, Rademaker AW, Yaghmai V. Association Between the Size and 3D CT-Based Radiomic Features of Breast Cancer Hepatic Metastasis. Acad Radiol 2021; 28:e93-e100. [PMID: 32303447 PMCID: PMC10029938 DOI: 10.1016/j.acra.2020.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate the effect of the anatomic size on 3D radiomic imaging features of the breast cancer hepatic metastases. MATERIALS AND METHODS CT scans of 81 liver metastases from 54 patients with breast cancer were evaluated. Ten most common 3D radiomic features from the histogram and gray level co-occurrence matrix (GLCM) categories were calculated for the hepatic metastases (HM) and compared to normal liver (NL). The effect of size was evaluated by using linear mixed-effects regression models. The effect of size on different radiomic features was analyzed for both liver lesions and background liver. RESULTS Three-dimensional radiomic features from GLCM demonstrate an important size dependence. The texture-feature size dependence was found to be different among feature categories and between the HM and NL, thus demonstrating a discriminatory power for the tissue type. Significant difference in the slope was found for GLCM homogeneity (NL slope = 0.004, slope difference 95% confidence interval [CI] 0.06-0.1, p <0.001), contrast (NL slope = 45, slope difference 95% CI 205-305, p <0.001), correlation (NL slope = 0.04, slope difference 95% CI 0.11-0.21, p <0.001), and dissimilarity (NL slope = 0.7, slope difference 95% CI 3.6-5.4, p <0.001). The GLCM energy (NL slope = 0.002, slope difference 95% CI -0.0005 to -0.0003, p <0.007), and entropy (NL slope = 1.49, slope difference 95% CI 0.07-0.52, p <0.009) exhibited size-dependence for both NL and HM, although demonstrating a difference in the slope between themselves. CONCLUSION Radiomic features of breast cancer hepatic metastasis exhibited significant correlation with tumor size. This finding demonstrates the complex behavior of imaging features and the need to include feature-specific properties into radiomic models.
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Affiliation(s)
- Yuri S Velichko
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Quantitative Imaging Core Lab, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | | | - Tugce Agirlar Trabzonlu
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Zhuoli Zhang
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Quantitative Imaging Core Lab, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alfred W Rademaker
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vahid Yaghmai
- Quantitative Imaging Core Lab, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Azam F, Vazquez A. Trends in Phase II Trials for Cancer Therapies. Cancers (Basel) 2021; 13:E178. [PMID: 33430223 PMCID: PMC7825663 DOI: 10.3390/cancers13020178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 12/27/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Drug combinations are the standard of care in cancer treatment. Identifying effective cancer drug combinations has become more challenging because of the increasing number of drugs. However, a substantial number of cancer drugs stumble at Phase III clinical trials despite exhibiting favourable efficacy in the earlier Phase. Methods: We analysed recent Phase II cancer trials comprising 2165 response rates to uncover trends in cancer therapies and used a null model of non-interacting agents to infer synergistic and antagonistic drug combinations. We compared our latest efficacy dataset with a previous dataset to assess the progress of cancer therapy. Results: Targeted therapies reach higher response rates when used in combination with cytotoxic drugs. We identify four synergistic and 10 antagonistic combinations based on the observed and expected response rates. We demonstrate that recent targeted agents have not significantly increased the response rates. Conclusions: We conclude that either we are not making progress or response rate measured by tumour shrinkage is not a reliable surrogate endpoint for the targeted agents.
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Affiliation(s)
- Faruque Azam
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, UK;
| | - Alexei Vazquez
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, UK;
- Cancer Research UK Beatson Institute, Switchback Road, Bearsden, Glasgow G61 1BD, UK
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Vera R, Gómez ML, Ayuso JR, Figueras J, García-Alfonso P, Martínez V, Lacasta A, Ruiz-Casado A, Safont MJ, Aparicio J, Campos JM, Cámara JC, Martín-Richard M, Montagut C, Pericay C, Vieitez JM, Falcó E, Jorge M, Marín M, Salgado M, Viúdez A. Correlation of RECIST, Computed Tomography Morphological Response, and Pathological Regression in Hepatic Metastasis Secondary to Colorectal Cancer: The AVAMET Study. Cancers (Basel) 2020; 12:cancers12082259. [PMID: 32806731 PMCID: PMC7465835 DOI: 10.3390/cancers12082259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/02/2020] [Accepted: 08/08/2020] [Indexed: 01/03/2023] Open
Abstract
Background: The prospective phase IV AVAMET study was undertaken to correlate response evaluation criteria in solid tumors (RECIST)-defined response rates with computed tomography-based morphological criteria (CTMC) and pathological response after liver resection of colorectal cancer metastases. Methods: Eligible patients were aged ≥18 years, with Eastern Cooperative Oncology Group (ECOG) performance status 0/1 and histologically-confirmed colon or rectal adenocarcinoma with measurable liver metastases. Preoperative treatment was bevacizumab (7.5 mg on day 1) + XELOX (oxaliplatin 130 mg/m2, capecitabine 1000 mg/m2 bid on days 1–14 q3w). After three cycles, response was evaluated by a multidisciplinary team. Patients who were progression-free and metastasectomy candidates received one cycle of XELOX before undergoing surgery 3–5 weeks later, followed by four cycles of bevacizumab + XELOX. Results: A total of 83 patients entered the study; 68 were eligible for RECIST, 67 for CTMC, and 51 for pathological response evaluation. Of these patients, 49% had a complete or partial RECIST response, 91% had an optimal or incomplete CTMC response, and 81% had a complete or major pathological response. CTMC response predicted 37 of 41 pathological responses versus 23 of 41 responses predicted using RECIST (p = 0.008). Kappa coefficients indicated a lack of correlation between the results of RECIST and morphological responses and between morphological and pathological response rates. Conclusion: CTMC may represent a better marker of pathological response to bevacizumab + XELOX than RECIST in patients with potentially-resectable CRC liver metastases.
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Affiliation(s)
- Ruth Vera
- Medical Oncology Department, Complejo Hospitalario de Navarra, Instituto de investigaciones Sanitarias de Navarra (IdISNA), 31008 Pamplona, Spain
| | - María Luisa Gómez
- Pathology Department, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Juan Ramón Ayuso
- Radiology Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Joan Figueras
- General and digestive surgery Department, Hospital Universitario Josep Trueta, 17007 Girona, Spain
| | - Pilar García-Alfonso
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Virginia Martínez
- Medical Oncology Department, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Adelaida Lacasta
- Medical Oncology Department, Hospital Universitario Donostia, 20014 San Sebastian, Spain
| | - Ana Ruiz-Casado
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain
| | - María José Safont
- Medical Oncology Department, Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Jorge Aparicio
- Medical Oncology Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Juan Manuel Campos
- Medical Oncology Department, Hospital Arnau de Vilanova, 46015 Valencia, Spain
| | - Juan Carlos Cámara
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain
| | - Marta Martín-Richard
- Medical Oncology Department, Hospital la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Clara Montagut
- Medical Oncology Department, Hospital de Mar, 08003 Barcelona, Spain
| | - Carles Pericay
- Medical Oncology Department, C.S. Parc Taulí, 08208 Sabadell, Spain
| | - Jose María Vieitez
- Medical Oncology Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Esther Falcó
- Medical Oncology Department, Hospital Universitario Son Llàtzer, 07198 Palma de Mallorca, Spain
| | - Mónica Jorge
- Medical Oncology Department, Hospital Xeral Cíes, 36204 Vigo, Spain
| | - Miguel Marín
- Medical Oncology Department, Hospital Clínico Universitario de la Arrixaca, 30120 Murcia, Spain
| | - Mercedes Salgado
- Medical Oncology Department, Complejo Hospitalario de Ourense, 32005 Ourense, Spain
| | - Antonio Viúdez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Instituto de investigaciones Sanitarias de Navarra (IdISNA), 31008 Pamplona, Spain
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Aykan NF, Özatlı T. Objective response rate assessment in oncology: Current situation and future expectations. World J Clin Oncol 2020; 11:53-73. [PMID: 32133275 PMCID: PMC7046919 DOI: 10.5306/wjco.v11.i2.53] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/05/2019] [Accepted: 11/29/2019] [Indexed: 02/06/2023] Open
Abstract
The tumor objective response rate (ORR) is an important parameter to demonstrate the efficacy of a treatment in oncology. The ORR is valuable for clinical decision making in routine practice and a significant end-point for reporting the results of clinical trials. World Health Organization and Response Evaluation Criteria in Solid Tumors (RECIST) are anatomic response criteria developed mainly for cytotoxic chemotherapy. These criteria are based on the visual assessment of tumor size in morphological images provided by computed tomography (CT) or magnetic resonance imaging. Anatomic response criteria may not be optimal for biologic agents, some disease sites, and some regional therapies. Consequently, modifications of RECIST, Choi criteria and Morphologic response criteria were developed based on the concept of the evaluation of viable tumors. Despite its limitations, RECIST v1.1 is validated in prospective studies, is widely accepted by regulatory agencies and has recently shown good performance for targeted cancer agents. Finally, some alternatives of RECIST were developed as immune-specific response criteria for checkpoint inhibitors. Immune RECIST criteria are based essentially on defining true progressive disease after a confirmatory imaging. Some graphical methods may be useful to show longitudinal change in the tumor burden over time. Tumor tissue is a tridimensional heterogenous mass, and tumor shrinkage is not always symmetrical; thus, metabolic response assessments using positron emission tomography (PET) or PET/CT may reflect the viability of cancer cells or functional changes evolving after anticancer treatments. The metabolic response can show the benefit of a treatment earlier than anatomic shrinkage, possibly preventing delays in drug approval. Computer-assisted automated volumetric assessments, quantitative multimodality imaging in radiology, new tracers in nuclear medicine and finally artificial intelligence have great potential in future evaluations.
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Affiliation(s)
- Nuri Faruk Aykan
- Department of Medical Oncology, Istinye University Medical School, Bahcesehir Liv Hospital, Istanbul 34510, Turkey
| | - Tahsin Özatlı
- Department of Medical Oncology, Istinye University Medical School, Bahcesehir Liv Hospital, Istanbul 34510, Turkey
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Cai Y, Lu X, Zhu X, Ju H, Sun W, Wu W. Histological tumor response assessment in colorectal liver metastases after neoadjuvant chemotherapy: impact of the variation in tumor regression grading and peritumoral lymphocytic infiltration. J Cancer 2019; 10:5852-5861. [PMID: 31737121 PMCID: PMC6843876 DOI: 10.7150/jca.31493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/14/2019] [Indexed: 12/29/2022] Open
Abstract
Background: The objective of this study was to evaluate the prognostic value of the variation in tumor regression grade (TRG) and peritumoral lymphocytic infiltration of colorectal liver metastases (CRLMs) after neoadjuvant chemotherapy (NACT). Methods: A retrospective review was performed in 98 patients with CRLMs who underwent NACT between 2010 and 2016. The TRG scores and counts of TILs at the tumor-normal interface were assessed in all 176 resected liver metastases to determine their association with prognosis. According to the variation in TRG scores, 40 patients with more than one liver metastasis were divided into a decreased TRG group and a stable TRG group. An additional independent cohort of 64 patients with 106 resected liver specimens was established to validate our main findings. Results: In the derivation cohort of 98 patients, 41.8% patients had a favourable pathological response to NACT (TRG 1-3), which were significantly associated with improved prognosis. Seventeen patients (42.5%) showed decreased TRG scores, and the remaining patients had stable scores. The multivariate analysis indicated that patients with decreased TRG scores had a better recurrence-free survival (RFS) compared with those with stable TRG scores (HR=0.42, P=0.034), and a similar trend was observed in the validation cohort (P=0.068). Dense TILs surrounding the metastases were present in 55.1% of the derivation cohort and associated with pathological response (P=0.008). Among patients with a pathological response to NACT, those with dense TILs had a superior RFS compared to those with weak TILs in both cohorts (derivation: HR=0.36, P=0.035; validation: HR=0.34, P=0.016). Conclusions: Variation in TRG scores and peritumoral lymphocytic infiltration may be proposed as secondary pathological parameters to evaluate the pathological response to NACT and predict the risk of recurrence after liver surgery.
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Affiliation(s)
- Yibo Cai
- Department of Colorectal Surgery, Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xingang Lu
- Department of Colorectal Surgery, Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xiu Zhu
- Department of Pathology, Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Haixing Ju
- Department of Colorectal Surgery, Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Wenyong Sun
- Department of Pathology, Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Wei Wu
- Department of Pathology, Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
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Jafari A, Matthaei H, Wehner S, Tonguc T, Kalff JC, Manekeller S. Bevacizumab exacerbates sinusoidal obstruction syndrome (SOS) in the animal model and increases MMP 9 production. Oncotarget 2018; 9:21797-21810. [PMID: 29774103 PMCID: PMC5955173 DOI: 10.18632/oncotarget.25021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/17/2018] [Indexed: 12/25/2022] Open
Abstract
Background Thanks to modern multimodal treatment the ouctome of patients with colorectal cancer has experienced significant improvements. As a downside, agent specific side effects have been observed such as sinusoidal obstruction syndrome (SOS) after oxaliplatin chemotherapy (OX). Bevazicumab targeting VEGF is nowadays comprehensively used in combination protocols with OX but its impact on hepatotoxicity is thus far elusive and focus of the present study. Results After MCT administration 67% of animals developed SOS. GOT serum concentration significantly increased in animals developing SOS (p < 0.001). Subsequent to MCT administration 100% of animals treated with Anti-VEGF developed SOS. In contrast, animals receiving VEGF developed SOS merely in 40% while increasing the VEGF dose led to a further decrease in SOS development to 25%. MMP 9 concentration in animals developing SOS was significantly higher compared to controls (p < 0,001). Additional treatment with Anti-VEGF increased the MMP 9 concentration significantly (p < 0,05). Conclusions Preservation of liver function is a central goal in both curative and palliative treatment phases of patients with CRC. Thus, knowledge about hepatotoxic side effects of chemotherapeutic and biological agents is crucial. From the results it can be concluded that Anti-VEGF exacerbates SOS paralleled by MMP 9 production. Therefore, OX-Bevacizumab combination therapies should be administered with caution, especially if liver parenchyma damage is apparent. Methods Male Sprague-Dawley rats were gavaged Monocrotaline (MCT) to induce SOS. Recombinant VEGF or an Anti-VEGF antibody was administered to MCT-treated rats and the hepatotoxic effect monitored in defined time intervals. MMP 9 expression in the liver was measured by ELISA.
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Affiliation(s)
- Azin Jafari
- Department of Surgery, University Hospital Bonn, Germany
| | - Hanno Matthaei
- Department of Surgery, University Hospital Bonn, Germany
| | - Sven Wehner
- Department of Surgery, University Hospital Bonn, Germany
| | - Tolga Tonguc
- Department of Surgery, University Hospital Bonn, Germany
| | - Jörg C Kalff
- Department of Surgery, University Hospital Bonn, Germany
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Neoadjuvant chemotherapy (NCT) plus targeted agents versus NCT alone in colorectal liver metastases patients: A systematic review and meta-analysis. Oncotarget 2016; 6:44005-18. [PMID: 26515604 PMCID: PMC4791282 DOI: 10.18632/oncotarget.5875] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/27/2015] [Indexed: 12/16/2022] Open
Abstract
Purpose To assess the efficacy of neoadjuvant chemotherapy (NCT) plus targeted agents versus NCT alone for the treatment of colorectal liver metastases (CRLM) patients. Methods Trials published between 1994 and 2015 were identified by an electronic search of public databases (MEDLINE, EMBASE, Cochrane library). All clinical studies were independently identified by two authors for inclusion. Demographic data, treatment regimens, objective response rate (ORR), hepatic resection and R0 hepatic resection rate were extracted and analyzed using Comprehensive MetaAnalysis software (Version 2.0). Results A total of 40 cohorts with 2099 CRLM patients were included: 962 patients were treated with NCT alone, 602 with NCT plus anti-epidermal growth-factor receptor (EGFR)-monoclonal antibodies (MoAbs) and 535 with NCT plus bevacizumab. Pooled ORR was significantly higher for NCT plus bevacizumab or anti-EGFR-MoAbs than NCT alone [relative risk (RR) 1.53, 95% CI 1.30–1.80; p < 0.001; RR 1.53, 95% CI: 1.27–1.83, p < 0.001; respectively]. NCT plus bevacizumab significantly improved R0 hepatic resection rate (RR 1.61, 95% CI: 1.27–2.04, p < 0.001), but not for overall hepatic resection rate (RR 1.26, 95% CI: 0.81–1.94, p = 0.30). While hepatic resection and R0 hepatic resection rate was comparable between NCT plus anti-EGFR-MoAbs and NCT alone (p = 0.42 and p = 0.37, respectively). Conclusions In comparison with NCT alone, NCT plus bevacizumab significantly improve ORR and R0 hepatic resection rate but not for hepatic resection rate. Our findings support the need to compare NCT plus bevacizumab with NCT alone in the neoadjuvant setting in large prospective trials due to its higher hepatic resection rate and R0 hepatic resection rate in CRLM patients.
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Arata R, Itamoto T, Ikeda S, Nakahara H, Oshita A, Shinozaki K, Nishisaka T. Pathological complete response after neoadjuvant chemotherapy for rectal cancer with synchronous multiple liver metastases: a report of an unusual case. Surg Case Rep 2016; 2:106. [PMID: 27686666 PMCID: PMC5042956 DOI: 10.1186/s40792-016-0231-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/20/2016] [Indexed: 01/05/2023] Open
Abstract
Background Systemic chemotherapy for stage IV colorectal cancer has advanced markedly in the recent years. We report an unusual case of 13 synchronous liver metastases for which a pathological complete response was achieved with neoadjuvant chemotherapy (NAC) consisting of a combination of 5-fluorouracil (5-FU), oxaliplatin, leucovorin (mFOLFOX6), and bevacizumab. Case presentation A 44-year-old man was diagnosed with colorectal cancer with synchronous liver metastases. We resected the primary rectal tumor first. Further, after providing NAC for hepatic metastases, lateral segmentectomy and partial resection of the liver were performed. The subsequent result was compatible with a complete pathological response. The postoperative course was uneventful, and the patient is currently alive 5 years after the first surgery without evidence of recurrence and without adjuvant chemotherapy. Conclusions For patients with initially resectable colorectal liver metastases, the survival benefits of NAC are still unclear. We report a rare case of 13 synchronous liver metastatic lesions from rectal cancer with a complete pathological response after neoadjuvant bevacizumab-containing chemotherapy.
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Affiliation(s)
- Ryosuke Arata
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-kanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Toshiyuki Itamoto
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-kanda, Minami-ku, Hiroshima, 734-8530, Japan. .,Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Satoshi Ikeda
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-kanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Hideki Nakahara
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-kanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Akihiko Oshita
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-kanda, Minami-ku, Hiroshima, 734-8530, Japan.,Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Katsunori Shinozaki
- Department of Clinical Oncology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Takashi Nishisaka
- Department of Pathology Clinical Laboratory, Hiroshima Prefectural Hospital, Hiroshima, Japan
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Use of Bevacizumab in the Management of Potentially Resectable Colorectal Liver Metastases: Safety, Pathologic Assessment and Benefit. CURRENT COLORECTAL CANCER REPORTS 2016. [DOI: 10.1007/s11888-016-0326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Lu ZH, Peng JH, Wang FL, Yuan YF, Jiang W, Li YH, Wu XJ, Chen G, Ding PR, Li LR, Kong LH, Lin JZ, Zhang RX, Wan DS, Pan ZZ. Bevacizumab with preoperative chemotherapy versus preoperative chemotherapy alone for colorectal cancer liver metastases: a retrospective cohort study. Medicine (Baltimore) 2016; 95:e4767. [PMID: 27583930 PMCID: PMC5008614 DOI: 10.1097/md.0000000000004767] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study aimed to assess the efficacy and safety of bevacizumab plus preoperative chemotherapy as first-line treatment for liver-only metastatic colorectal cancer in Chinese patients compared with those of preoperative chemotherapy alone.Patients with histologically confirmed liver-only metastatic colorectal cancer were sequentially reviewed, and received either preoperative chemotherapy plus bevacizumab (bevacizumab group, n = 32) or preoperative chemotherapy alone (chemotherapy group, n = 57). Progression-free survival, response rate, liver resection rate, conversion rate, and safety were analyzed.With median follow-up of 28.7 months, progression-free survival was 10.9 months (95% confidence interval: 8.7-13.1 months) in bevacizumab group and 9.9 months (95% confidence interval: 6.8-13.1 months) in chemotherapy group (P = 0.472). Response rates were 59.4% in bevacizumab group and 38.6% in chemotherapy group (P = 0.059). Overall liver resection (R0, R1, and R2) rate was 68.8% in bevacizumab group and 54.4% in chemotherapy group (P = 0.185). Conversion rate was 51.9% in bevacizumab group and 40.4% in chemotherapy group (P = 0.341). No postoperative complication was observed in all patients.Bevacizumab plus preoperative chemotherapy as first-line treatment for liver-only metastatic colorectal cancer tends to achieve better clinical benefit with controllable safety in Chinese patients.
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Affiliation(s)
| | | | | | | | - Wu Jiang
- Department of Colorectal Surgery
| | - Yu-Hong Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
| | | | | | | | | | | | | | | | | | - Zhi-Zhong Pan
- Department of Colorectal Surgery
- Correspondence: Zhi-Zhong Pan, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, PR China (e-mail: )
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Impact of Bevacizumab on parenchymal damage and functional recovery of the liver in patients with colorectal liver metastases. BMC Cancer 2016; 16:84. [PMID: 26864935 PMCID: PMC4750178 DOI: 10.1186/s12885-016-2095-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 01/28/2016] [Indexed: 01/04/2023] Open
Abstract
Background Little is known about the safety of the anti-VEGF antibody bevacizumab in patients undergoing resection for colorectal liver metastases (CLM). This meta-analysis evaluates the impact of bevacizumab on parenchymal damage and functional recovery in patients undergoing resection for CLM. Methods The Medline, Embase and Cochrane Library were systematically searched for studies on preoperative chemotherapy with and without bevacizumab prior to resection of CLM. Studies that reported histological and/or clinical outcomes were eligible for inclusion. Meta-analyses were performed using a random effects model. Results A total of 18 studies with a total sample size of 2430 patients (1050 patients with bevacizumab) were found. Meta-analyses showed a significant reduction in sinusoidal obstruction syndrome (SOS) (Odds ratio 0.50 [95 % confidence interval 0.37, 0.67]; p < 0.001; I2 = 0 %) and hepatic fibrosis (0.61 [0.4, 0.86]; p = 0.004; I2 = 7 %) after preoperative chemotherapy with bevacizumab. The reduced incidence of posthepatectomy liver failure in patients with bevacizumab treatment just failed to reach statistical significance (0.61 [0.34, 1.07]; p = 0.08 I2 = 6 %). While there was no difference in perioperative morbidity and mortality, the incidence of wound complications was significantly increased in patients who received bevacizumab (1.81 [1.12, 2.91]; p = 0.02 I2 = 4 %). Conclusions The combination of bevacizumab with cytotoxic chemotherapy is safe but increases the incidence of wound complications after resection of CLM. The reduction of SOS and hepatic fibrosis warrant further investigation and may explain the inverse association of bevacizumab administration and posthepatectomy liver failure. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2095-6) contains supplementary material, which is available to authorized users.
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Positron Emission Tomography for the Response Evaluation following Treatment with Chemotherapy in Patients Affected by Colorectal Liver Metastases: A Selected Review. Gastroenterol Res Pract 2015; 2015:706808. [PMID: 26078753 PMCID: PMC4442279 DOI: 10.1155/2015/706808] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 02/08/2023] Open
Abstract
The aim of the present paper is to review the scientific literature concerning the usefulness of (18)F-FDG PET/CT in the evaluation of response to chemotherapy in patients affected by liver metastases from colorectal cancer. Material and Methods. Studies were identified by searching PubMed electronic databases. Both prospective and retrospective studies were included. Information regarding the figure of merit of PET for the evaluation of therapy response was extracted and analyzed. Results. Existing data suggests that (18)F-FDG PET/CT may have an outstanding role in evaluating the response. The sensitivity of PET in detecting therapy response seems to be greater than conventional imaging (CT and MRI). PET/CT response is strictly related to better overall survival and progression-free survival. Conclusions. PET/CT is more than a promising technique to assess the response to chemotherapy in colorectal and liver metastases. However, to be fully validated, this examination needs further studies by recruiting more patients.
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Martens MH, Lambregts DMJ, Kluza E, Beets-Tan RGH. Tumor Response to Treatment: Prediction and Assessment. CURRENT RADIOLOGY REPORTS 2014. [DOI: 10.1007/s40134-014-0062-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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