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Prognostic Role of a New Index Tested in European and Korean Advanced Biliary Tract Cancer Patients: the PECS Index. J Gastrointest Cancer 2021; 53:289-298. [DOI: 10.1007/s12029-021-00596-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 12/13/2022]
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2
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Continuum of care for advanced biliary tract cancers. Clin Res Hepatol Gastroenterol 2020; 44:810-824. [PMID: 32586782 DOI: 10.1016/j.clinre.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023]
Abstract
Biliary tract cancers (BTC) are a heterogeneous group of epithelial neoplasms, with a poor prognosis. Advanced BTC remains a challenging, non-curable disease. In this review, we provide an overview of the medical treatment options in advanced BTC and new strategies under development. Gemcitabine plus platinum chemotherapy is the standard first-line therapy in this setting. Recently, 5-fluorouracil, folinic acid plus oxaliplatin (FOLFOX) regimen became the only second-line therapy to be prospectively validated beyond failure of gemcitabine plus cisplatin combination in a phase III study, even though chemotherapy yielded modest survival improvement over best supportive care. Anti-epidermal growth factor receptor and antiangiogenic antibodies have not demonstrated any survival benefit in unselected patient populations. In recent years, knowledge about the molecular heterogeneity of BTC has considerably increased with the advent of large-scale genomic and transcriptomic analyses, opening up new perspectives for so-called personalised targeted therapies. Patients with BTC may be particularly good candidates for biomarker-driven strategies in clinical practice. Among current developments, the targeting of fibroblast growth factor receptor and isocitrate dehydrogenase gene alterations are the most promising avenues, and combination immunotherapies are under investigation.
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3
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Pape UF, Kasper S, Meiler J, Sinn M, Vogel A, Müller L, Burkhard O, Caca K, Heeg S, Büchner-Steudel P, Rodriguez-Laval V, Kühl AA, Arsenic R, Jansen H, Treasure P, Utku N. Efficacy and Safety of CAP7.1 as Second-Line Treatment for Advanced Biliary Tract Cancers: Data from a Randomised Phase II Study. Cancers (Basel) 2020; 12:cancers12113149. [PMID: 33121007 PMCID: PMC7692271 DOI: 10.3390/cancers12113149] [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: 08/21/2020] [Revised: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Advanced biliary tract cancer is difficult to treat, and 5-year survival is less than 5% for tumours that cannot be removed by surgery. CAP7.1 is a drug being investigated for biliary tract cancer. This study assessed treatment with CAP7.1 in patients with advanced biliary tract cancer whose disease had progressed despite receiving other treatments. One group of patients received CAP7.1 together with best supportive care (BSC) and another group received BSC from their physician. The patients receiving BSC were subsequently given CAP7.1 if their disease was seen to progress. Disease control in those receiving CAP7.1 was better than that observed in patients who received BSC, with an associated greater time to disease progression. Side effects were as expected for this type of anti-cancer drug, related to dose of CAP7.1, and manageable. CAP7.1 may offer a new treatment option for biliary tract cancer and should undergo further clinical investigation. Abstract CAP7.1 is a novel topoisomerase II inhibitor, converted to active etoposide via carboxylesterase 2 (CES2), with signals of efficacy in treatment-refractory solid tumours. In a Phase II trial, 27 patients with advanced biliary tract cancers (BTC) were randomised 1:1 to CAP7.1 plus best supportive care (BSC), or BSC alone, with crossover to CAP7.1 upon disease progression. The primary objective was disease control rate (DCR) following 28-day cycles of CAP7.1 (200/150 mg/m2; iv), or BSC until progression. Secondary objectives included progression-free survival (PFS), time-to-treatment failure (TTF), overall survival (OS) and safety. Fourteen patients received CAP7.1 and 13 BSC. DCR favoured CAP7.1 vs. BSC (50% vs. 20%; treatment difference: 30%, 95%CI −18.44, 69.22, full analysis set [FAS]), with disease progression in 40% vs. 70%, respectively. Significantly longer median PFS was achieved for CAP7.1 vs. BSC: 66 vs. 39 days, respectively (hazard ratio [HR] 0.31; 95%CI 0.11, 0.86; p = 0.009; FAS). Similar trends were observed for TTF and OS. CES2-positive patients had longer median PFS (158 vs. 56 days) and OS (228 vs. 82 days) vs. CES2-negative patients. Adverse events were predictable, dose-dependent and consistent with those previously observed with etoposide. These efficacy and safety findings in second-line BTC warrant further clinical investigation of CAP7.1.
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Affiliation(s)
- Ulrich-Frank Pape
- Department of Hepatology and Gastroenterology, Campus Charité Mitte and Virchow Klinikum, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
- Germany and Department of Internal Medicine and Gastroenterology, Asklepios Klinik St. Georg, Asklepios Tumorzentrum, Hamburg ATZHH, 20099 Hamburg, Germany
- Correspondence: (U.-F.P.); (N.U.)
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, 45147 Essen, Germany; (S.K.); (J.M.)
| | - Johannes Meiler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, 45147 Essen, Germany; (S.K.); (J.M.)
| | - Marianne Sinn
- Department of Medical Oncology, Universitäts Klinikum Hamburg-Eppendorf, 20251 Hamburg, Germany;
- Department of Gastroenterology, Campus Charité Mitte and Virchow Klinikum, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany;
| | - Lothar Müller
- Onkologische Schwerpunktpraxis Leer-Emden-Papenburg, 26789 Leer, Germany;
| | | | - Karel Caca
- Klinikum Ludwigsburg, 71640 Ludwigsburg, Germany;
| | - Steffen Heeg
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 70085 Freiburg, Germany;
| | - Petra Büchner-Steudel
- Martin-Luther-University Halle Wittenberg, Medizinische Fakultät, Universitätsklinik und Poliklinik für Innere Medizin I, 06120 Halle (Saale), Germany;
| | | | - Anja A Kühl
- iPATH.Berlin, Core Unit of the Charité, Hindenburgdamm, 12203 Berlin, Germany;
| | - Ruza Arsenic
- Instituts für Histologische und Zytologische Diagnostik AG, 5000 Aarau, Switzerland;
| | - Holger Jansen
- Institute for Medical Immunology, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Peter Treasure
- Peter Treasure Statistical Services Ltd., Stow Bridge PE34 3NR, UK;
| | - Nalân Utku
- Instituts für Histologische und Zytologische Diagnostik AG, 5000 Aarau, Switzerland;
- CellAct Pharma, 44137 Dortmund, Germany
- Correspondence: (U.-F.P.); (N.U.)
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Yoon J, Kang SY, Lee KH, Cheon GJ, Oh DY. Targeting Hypoxia Using Evofosfamide and Companion Hypoxia Imaging of FMISO-PET in Advanced Biliary Tract Cancer. Cancer Res Treat 2020; 53:471-479. [PMID: 33091966 PMCID: PMC8053876 DOI: 10.4143/crt.2020.577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/21/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose Hypoxia is widely known as one of the mechanisms of chemoresistance and as an environmental condition which triggers invasion and metastasis of cancer. Evofosfamide is a hypoxia-activated prodrug of the cytotoxin bromo-isophosphoramide mustard conjugated with 2-nitroimidazole. Biliary tract cancer (BTC) is known to contain large hypoxic area. This study evaluated the efficacy and safety of evofosfamide as a second-line treatment of advanced BTC. Materials and Methods Patients received evofosfamide at a dose of 340 mg/m2 on days 1, 8, and 15 of every 28-day cycle. Primary end-point was progression-free survival (PFS) rate at 4-months (4m-PFSR). Secondary end-points included overall survival (OS), PFS, disease control rate (DCR), metabolic response by 18F-fluorodeoxyglucose positron emission tomography (PET), hypoxic parameters evaluated by 18F-fluoromisonidazole (FMISO) PET and toxicity. Results Twenty patients were treated with evofosfamide, with 16 response-evaluable patients. There was no objective response; stable disease was observed in nine patients, with a DCR of 56.25%. 4m-PFSR was 40.6%. Median PFS was 3.60 months (95% confidence interval [CI], 1.68 to 5.52). Median OS was 6.37 months (95% CI, 3.94 to 8.79). Reduction of tumor metabolic activity was observed in eight of 15 patients (53.3%). High baseline hypoxic parameters were associated with poor PFS. Change of hypoxic parameters between pretreatment and post-treatment reflected hypoxic-activated drug response. There was no treatment-related death. Conclusion Evofosfamide as second-line treatment of advanced BTC showed acceptable safety and comparable efficacy to other agents. Changes in volumetric parameters measured with FMISO PET, showing the degree of tumor hypoxia, reflected the response to evofosfamide based on the mode of action.
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Affiliation(s)
- Jeesun Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seo Young Kang
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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5
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Kim ST, Oh SY, Lee J, Kang JH, Lee HW, Lee MA, Sohn BS, Hong JH, Park YS, Park JO, Lim HY. Capecitabine plus Oxaliplatin as a Second-Line Therapy for Advanced Biliary Tract Cancers: A Multicenter, Open-Label, Phase II Trial. J Cancer 2019; 10:6185-6190. [PMID: 31772650 PMCID: PMC6856733 DOI: 10.7150/jca.37610] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/14/2019] [Indexed: 12/27/2022] Open
Abstract
Background: Although biliary tract cancer (BTC) has a very aggressive nature, some patients maintain a relatively good performance status after failure with first-line treatment of gemcitabine plus cisplatin (GC). Thus, tolerable, feasible, and useful second-line treatments are needed for these patients. We investigated the efficacy of capecitabine plus oxaliplatin (XELOX) as a second-line therapy for patients with advanced BTC who failed first-line GC treatment. Methods: In this prospective, phase II trial, we investigated XELOX (capecitabine 1,000 mg/m2 twice daily on days 1-14 and oxaliplatin 130 mg/m2 on day 1) as a second-line treatment, given every 3 weeks, totaling 8 cycles in patients with metastatic BTC who failed first-line GC treatment. The primary outcome was progression-free survival (PFS). Results: From December 2015 to November 2016, 50 patients with metastatic intrahepatic or extrahepatic cholangiocarcinoma or gall bladder (GB) cancer were enrolled. The regimen was well tolerated. Toxicities mainly consisted of grade 1 or 2 events, and thrombocytopenia and neuropathy had the highest incidence. In intent-to-treat analysis, one complete response (CR) and six partial responses (PRs) were recorded with XELOX treatment. The overall response rate and the disease control rate from the intent-to-treat analysis were 14% and 52%, respectively. With a median follow-up of 15.6 months, PFS after XELOX was a median of 15.4 weeks (95% CI, 8.5-22.3). This PFS value supported the statistical hypothesis of this study. The median overall survival was 32.7 weeks (95% CI, 21.4-43.9). Conclusion: This phase II trial showed that XELOX treatment was efficacious and had a tolerable toxicity profile in patients with advanced BTC who failed first-line treatment of gemcitabine and cisplatin.
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Affiliation(s)
- Seung Tae Kim
- Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Centre, Seoul, South Korea
| | - Sung Yong Oh
- Department of Medicine, Dong-A University School of Medicine, Busan, South Korea
| | - Jeeyun Lee
- Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Centre, Seoul, South Korea
| | - Jung Hun Kang
- Department of Medicine, Gyeongsang National University Hospital, Jinju, South Korea
| | - Hyun Woo Lee
- Department of Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Myung Ah Lee
- Department of Medicine, Seoul St Mary's Hospital, Catholic University, Seoul, South Korea
| | - Byeong Seok Sohn
- Department of Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Ji Hyong Hong
- Department of Medicine, Incheon St Mary's Hospital, Catholic University, Incheon, South Korea
| | - Young Suk Park
- Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Centre, Seoul, South Korea
| | - Joon Oh Park
- Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Centre, Seoul, South Korea
| | - Ho Yeong Lim
- Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Centre, Seoul, South Korea
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Ikeda M, Ioka T, Fukutomi A, Morizane C, Kasuga A, Takahashi H, Todaka A, Okusaka T, Creasy CL, Gorman S, Felitsky DJ, Kobayashi M, Zhang F, Furuse J. Efficacy and safety of trametinib in Japanese patients with advanced biliary tract cancers refractory to gemcitabine. Cancer Sci 2017; 109:215-224. [PMID: 29121415 PMCID: PMC5765304 DOI: 10.1111/cas.13438] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/29/2017] [Accepted: 11/02/2017] [Indexed: 12/13/2022] Open
Abstract
Gemcitabine‐based therapy remains the mainstay of treatment for patients with biliary tract cancers (BTCs) with no second‐line treatment(s) established yet. Aberrant activation of the MAPK pathway in patients with BTC indicates its importance in BTC. Trametinib is a potent, highly selective, allosteric non‐competitive inhibitor of MEK1/MEK2. In this phase IIa open‐label, single‐arm study, we investigated the efficacy and safety of trametinib in Japanese patients with advanced BTC refractory to gemcitabine‐based therapy. All patients received oral trametinib 2 mg once daily until progressive disease (PD), death, or unacceptable toxicity. The primary objective was to determine the 12‐week non‐PD rate. Secondary assessments included safety, progression‐free survival (PFS), overall survival, and overall response rate. Targeted exome sequencing was used to identify biomarkers for sensitivity or resistance to trametinib monotherapy. Twenty patients (median age, 61.5 years) with carcinoma of gall bladder (40%), intrahepatic (25%) or extrahepatic (30%) bile duct, and ampulla of Vater (5%) were enrolled. The non‐PD rate at week 12 was 10% (95% confidence interval, 1.2‐31.7); it did not reach the threshold rate of 25%. Median PFS was 10.6 weeks (95% confidence interval, 4.6‐12.1) and 1‐year overall survival was 20.0%. Stable disease and PD were observed in 13 (65%) and seven (35%) patients, respectively. No new safety signals were reported. Although the primary end‐point was not met, prolonged PFS was observed in one patient having six somatic variants including synonymous NF1 exon 12 splice variant and a loss‐of‐function variant in ARID1A. Efforts to understand responsive mutations and sensitivity to targeted therapies are warranted. This trial was registered with ClinicalTrials.gov: NCT01943864.
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Affiliation(s)
- Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tatsuya Ioka
- Osaka International Cancer Institute, Osaka, Japan
| | | | | | - Akiyoshi Kasuga
- Department of Medical Oncology, Kyorin University, Tokyo, Japan
| | - Hideaki Takahashi
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | | | | | | | | | | | | | - Junji Furuse
- Department of Medical Oncology, Kyorin University, Tokyo, Japan
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7
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Kim BJ, Yoo C, Kim KP, Hyung J, Park SJ, Ryoo BY, Chang HM. Efficacy of fluoropyrimidine-based chemotherapy in patients with advanced biliary tract cancer after failure of gemcitabine plus cisplatin: retrospective analysis of 321 patients. Br J Cancer 2017; 116:561-567. [PMID: 28081540 PMCID: PMC5344285 DOI: 10.1038/bjc.2016.446] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/18/2016] [Accepted: 12/19/2016] [Indexed: 12/19/2022] Open
Abstract
Background: We aimed to assess the efficacy of second-line fluoropyrimidine-based chemotherapy in patients with advanced biliary tract cancer (BTC) after failure of gemcitabine plus cisplatin (GEMCIS). Methods: We retrospectively examined patients with histologically documented advanced BTC who received first-line GEMCIS between December 2010 and June 2015. Among 748 patients treated with first-line GEMCIS, 321 (43%) subsequently received fluoropyrimidine-based second-line systemic chemotherapy. Results: Fluoropyrimidine monotherapy and fluoropyrimidine–platinum combination were used in 255 and 66 patients, respectively. In patients with measurable disease, the overall response rate (ORR) was 3% and disease control rate was 47%. After a median follow-up of 27.6 months (range, 0.9–70.4 months), the median progression-free survival (PFS) and overall survival (OS) were 1.9 months (95% confidence interval (CI), 1.6–2.2) and 6.5 months (95% CI, 5.9–7.0), respectively. The ORR was significantly higher in patients who received fluoropyrimidine–platinum combination compared with those who received fluoropyrimidine alone (8 vs 1%, P=0.009), although the PFS (P=0.43) and OS (P=0.88) did not significantly differ between these groups. Conclusions: Fluoropyrimidine-based chemotherapy was modestly effective as a second-line chemotherapy for advanced BTC patients after failure of GEMCIS. Fluoropyrimidine–platinum combination therapy was not associated with improved survival outcomes, as compared with fluoropyrimidine monotherapy.
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Affiliation(s)
- Bum Jun Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Changhoon Yoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyu-Pyo Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jaewon Hyung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong Joon Park
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Baek-Yeol Ryoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Heung-Moon Chang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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8
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Venturini M, Sallemi C, Agostini G, Marra P, Cereda S, Reni M, Aldrighetti L, De Cobelli F, Del Maschio A. Chemoembolization with drug eluting beads preloaded with irinotecan (DEBIRI) vs doxorubicin (DEBDOX) as a second line treatment for liver metastases from cholangiocarcinoma: a preliminary study. Br J Radiol 2016; 89:20160247. [PMID: 27558984 DOI: 10.1259/bjr.20160247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The aim of our preliminary study was to compare the efficacy of drug-eluting beads preloaded with irinotecan (DEBIRI) vs drug-eluting beads preloaded with doxorubicin (DEBDOX) as second-line treatment of unresectable liver metastases from cholangiocarcinoma (CCA). METHODS In 2013, 10 patients affected by multiple liver metastases from CCA, resistant to the first-line chemotherapy regimen, were enrolled: 5 patients were submitted to lobar/segmental transarterial chemoembolization (TACE) with DEBIRI (100-mg irinotecan/1 vial) and 5 patients with DEBDOX (50-mg doxorubicin/1 vial), performed every 3 weeks. Patients treated with DEBIRI received antipain premedication consisting of 30-mg of morphine and 3-4 ml of intra-arterial lidocaine. Complications and efficacy were assessed (response evaluation criteria in solid tumour 1.1). RESULTS A total of 32 TACE were performed (mean: 3.2 TACE/patient), all well tolerated, with only 1 case of asymptomatic cholecystitis spontaneously recovered. Response rates of patients treated with DEBDOX and DEBIRI were: 4/5 progressive disease and 1/5 partial response vs 2/5 partial response, 2/5 stable disease and 1/5 progressive disease, respectively, with the appearance of variable necrosis percentage. Progression-free survival from the first procedure and progressive disease were 12.67 weeks for DEBIRI and 15.78 weeks for DEBDOX, respectively. Overall survival from time of primary diagnosis was 176 weeks for DEBIRI and 125 weeks for DEBDOX, respectively. CONCLUSION In our preliminary experience, DEBIRI was more effective than DEBDOX as a second-line treatment for hepatic metastases from CCA. Antipain drug administration and the use of the microcatheter led to a good treatment tolerability and a low complication rate. Advances in knowledge: In our preliminary experience, DEBIRI was more effective than DEBDOX as a second-line treatment of hepatic metastases from CCA; further studies involving a larger cohort of patients are needed.
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Affiliation(s)
- Massimo Venturini
- 1 Department of di Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Sallemi
- 1 Department of di Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Agostini
- 1 Department of di Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Marra
- 1 Department of di Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Cereda
- 2 Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Michele Reni
- 2 Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Aldrighetti
- 3 Department of Hepatobiliary Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- 1 Department of di Radiology, San Raffaele Scientific Institute, Milan, Italy.,4 Vita-Salute University, San Raffaele Hospital, Milan, Italy
| | - Alessandro Del Maschio
- 1 Department of di Radiology, San Raffaele Scientific Institute, Milan, Italy.,4 Vita-Salute University, San Raffaele Hospital, Milan, Italy
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9
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Sirohi B, Rastogi S, Singh A, Sheth V, Dawood S, Talole S, Ramadwar M, Kulkarni S, Shrikhande SV. Use of gemcitabine-platinum in Indian patients with advanced gall bladder cancer. Future Oncol 2016; 11:1191-200. [PMID: 25832876 DOI: 10.2217/fon.14.295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Gemcitabine-platinum (Gem-P) is the current standard for patients with advanced gall bladder cancer. MATERIALS & METHODS This is retrospective analysis of a prospectively maintained database of 210 patients with advanced gall bladder cancer treated with Gem-P between January 2012 and September 2013. RESULTS Median age was 53 years, 65.2% females. In total,158 patients had metastatic and 52 had locoregional disease. Median number of cycles was 5 (1-12). At a median follow-up of 10 months, median overall survival/progression-free survival was 10/5 months, respectively. On multivariate analysis, patients who underwent prior surgery for primary and locoregional disease had a significantly better progression-free survival and those with locoregional disease had a significantly better overall survival. A total of 45.7% received second-line chemotherapy. CONCLUSION Use of Gem-P in Indian patients leads to slightly worse outcomes suggesting an aggressive biology.
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Affiliation(s)
- Bhawna Sirohi
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, India
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10
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Fornaro L, Vivaldi C, Cereda S, Leone F, Aprile G, Lonardi S, Silvestris N, Santini D, Milella M, Caparello C, Musettini G, Pasquini G, Falcone A, Brandi G, Sperduti I, Vasile E. Second-line chemotherapy in advanced biliary cancer progressed to first-line platinum-gemcitabine combination: a multicenter survey and pooled analysis with published data. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2015; 34:156. [PMID: 26693938 PMCID: PMC4689003 DOI: 10.1186/s13046-015-0267-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/07/2015] [Indexed: 02/09/2023]
Abstract
Background After progression to a standard first-line platinum and gemcitabine combination (GP), there is no established second-line therapy for patients with advanced biliary tract cancers (aBTC). Indeed, literature data suggest limited activity of most second-line agents evaluated so far. Methods We collected a large retrospective series of aBTC patients treated with second-line chemotherapy after progression to a first-line GP regimen at different Italian institutions. We then pooled the data with those reported in previous studies, which were identified with a Medline search and the on-line abstract datasets of major international oncology meetings. Results A total of 174 patients were included in the multicenter survey: response rate (RR) with second-line chemotherapy was low (3.4 %), with median PFS and OS of 3.0 months and 6.6 months, respectively. At multivariate analysis, preserved performance status, low CA19.9 levels and absence of distant metastases were favorable prognostic factors. Data from other five presented or published series were identified, for a total of 499 patients included in the pooled analysis. The results confirmed marginal activity of second-line chemotherapy (RR: 10.2 %), with limited efficacy in unselected patient populations (median PFS: 3.1 months; median OS: 6.3 months). Conclusions The current analysis highlights the limited value of second-line chemotherapy after a first-line GP combination in aBTC. While waiting for effective biologic agents in this setting, ongoing randomized trials will identify the optimal second-line chemotherapy regimen and validate prognostic factors for individual patient management.
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Affiliation(s)
- Lorenzo Fornaro
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy.
| | - Caterina Vivaldi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy.
| | - Stefano Cereda
- Department of Medical Oncology, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Francesco Leone
- Unit of Medical Oncology, Institute for Cancer Research and Treatment IRCCS, Strada provinciale 142, 10060, Candiolo, Italy.
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, P.le S. Maria della Misericordia 15, 33100, Udine, Italy.
| | - Sara Lonardi
- Unit of Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Via Gattamelata 64, 35138, Padova, Italy.
| | - Nicola Silvestris
- Unit of Medical Oncology, National Cancer Institute Giovanni Paolo II, V.le Orazio Flacco 65, 70124, Bari, Italy.
| | - Daniele Santini
- Department of Medical Oncology, University Campus Bio-Medico, via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - Michele Milella
- Medical Oncology A, Regina Elena National Cancer Institute, Via E. Chianesi 53, 00144, Rome, Italy.
| | - Chiara Caparello
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy.
| | - Gianna Musettini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy.
| | - Giulia Pasquini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy.
| | - Alfredo Falcone
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy.
| | - Giovanni Brandi
- Unit of Medical Oncology, Sant'Orsola Malpighi Hospital, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy.
| | - Isabella Sperduti
- Biostatistical Unit, Regina Elena National Cancer Institute, Via E. Chianesi 53, 00144, Rome, Italy.
| | - Enrico Vasile
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy.
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11
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Cereda S, Milella M, Cordio S, Leone F, Aprile G, Galiano A, Mosconi S, Vasile E, Santini D, Belli C, Auriemma A, Novarino A, Vaccaro V, Martines C, Marino D, Lutrino SE, Palazzo V, Reinach B, Aldrighetti L, Reni M. Capecitabine with/without mitomycin C: results of a randomized phase II trial of second-line therapy in advanced biliary tract adenocarcinoma. Cancer Chemother Pharmacol 2015; 77:109-14. [PMID: 26659366 DOI: 10.1007/s00280-015-2919-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Advanced biliary tract adenocarcinoma (BTA) is a rare tumor with a poor prognosis. Since no standard salvage chemotherapy regimen exists, we explored the activity of capecitabine alone or combined with mitomycin C. METHODS Patients aged 18-75 years and with KPS >50, with pathological diagnosis of BTA stratified based on site and stage of disease, were randomized to receive capecitabine 2000 mg/m(2) day 1-14 alone (ARM A) or in combination with mitomycin C 6 mg/m(2) day 1 (ARM B) as second-line therapy. Cycles were repeated in both arms every 3 weeks. Tumor assessment was performed every 2 months. The primary endpoint was the probability of being progression free at 6 months (PFS-6) from treatment start. According to the Fleming design, the study aimed to enroll 26 pts per arm. An exploratory endpoint was to assess thymidylate synthase (TS) and thymidine phosphorylase (TP) expression, as biomarkers predictive for clinical outcomes of capecitabine treatment. RESULTS Between October 2011 and 2013, 57 metastatic pts were enrolled: ARM A/B 28/29. Accordingly, 55 (26/29) pts were assessable for the primary endpoint: 2 (8%) ARM A and 3 (10%) ARM B pts were PFS-6. Main G3-4 toxicities were: hand-foot syndrome and transaminitis in 4/0%, and thrombocytopenia, diarrhea and fatigue in 0/3% of pts. No statistically significant correlation was found between TS or TP expression and pts' outcome. CONCLUSIONS Since capecitabine yielded a disappointing outcome and the addition of mitomycin C did not improve the results, new therapeutic strategies need to be explored to improve survival in this disease setting.
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Affiliation(s)
- S Cereda
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - M Milella
- Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - S Cordio
- Struttura Complessa di Oncologia Medica Ospedale Garibaldi, Catania, Italy
| | - F Leone
- Candiolo Cancer Institute - FPO, IRCCS, Università degli Studi di Torino, Turin, Italy
| | - G Aprile
- A.O.U. Santa Maria della Misericordia, Udine, Italy
| | - A Galiano
- Istituto Oncologico Veneto - IRCCS, Padua, Italy
| | - S Mosconi
- A.O. Papa Giovanni XXIII, Bergamo, Italy
| | - E Vasile
- A.O. Universitaria Pisana, Pisa, Italy
| | - D Santini
- Università Campus Bio-Medico, Rome, Italy
| | - C Belli
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - A Auriemma
- A.O. Universitaria Integrata, Verona, Italy
| | - A Novarino
- A.O. Città della Salute e della Scienza, Turin, Italy
| | - V Vaccaro
- Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - C Martines
- Struttura Complessa di Oncologia Medica Ospedale Garibaldi, Catania, Italy
| | - D Marino
- Candiolo Cancer Institute - FPO, IRCCS, Università degli Studi di Torino, Turin, Italy
| | - S E Lutrino
- A.O.U. Santa Maria della Misericordia, Udine, Italy
| | - V Palazzo
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | | | - L Aldrighetti
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - M Reni
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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12
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Yang C, Liu Y, Xi WQ, Zhou CF, Jiang JL, Ma T, Ye ZB, Zhang J, Zhu ZG. Relationship between UGT1A1*6/*28 polymorphisms and severe toxicities in Chinese patients with pancreatic or biliary tract cancer treated with irinotecan-containing regimens. Drug Des Devel Ther 2015; 9:3677-83. [PMID: 26229432 PMCID: PMC4514347 DOI: 10.2147/dddt.s86750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The aim of this retrospective study was to investigate the relationship between UGT1A1 polymorphisms and toxicities in Chinese patients with pancreatic or biliary tract cancer receiving irinotecan-containing regimens as the second- or third-line chemotherapy. PATIENTS AND METHODS A total of 36 patients with unresectable pancreatic cancer and 12 patients with unresectable biliary tract cancer were included. Approximately 33 patients were treated with FOLFIRI regimen, a chemotherapy regimen, where FOL stands for folinic acid, F for fluorouracil, and IRI for irinotecan (irinotecan 180 mg/m(2) at day 1, CF 200 mg/m(2) at day 1-2, 5-FU 400 mg/m(2) at day 1-2, followed by continuous infusion of 5-FU 600 mg/m(2) for 22 hours at day 1-2, every 2 weeks). The other 15 patients were treated with irinotecan monotherapy (180 mg/m(2), every 2 weeks). UGT1A1*6/*28 polymorphisms were detected by direct sequencing. RESULTS The frequencies of GG, GA, AA genotypes for UGT1A1*6 were 70.8% (n=34), 25.0% (n=12), and 4.2% (n=2), respectively. And those of TA6/TA6, TA6/TA7, TA7/TA7 for UGT1A1*28 were 79.2% (n=38), 18.8% (n=9), and 2.0% (n=1), respectively. A total of 22 patients (45.8%) had grade III-IV neutropenia, and six patients (12.5%) experienced grade III-IV diarrhea. The incidence of grade III-IV neutropenia in patients with UGT1A1*6 GA or AA genotype was 71.4%, which was significantly higher than that with GG genotype (35.3%, P=0.022). No relationship was found between grade III-IV neutropenia and UGT1A1*28 polymorphism. The statistical analysis between grade III-IV diarrhea and UGT1A1*6/*28 polymorphisms was not conducted in view of the limited number of patients. CONCLUSION In Chinese patients with pancreatic or biliary tract cancer administered irinotecan-containing regimens, those with UGT1A1*6 variant may have a high risk of severe neutropenia.
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Affiliation(s)
- Chen Yang
- Department of Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Ying Liu
- Department of Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Wen-qi Xi
- Department of Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Chen-fei Zhou
- Department of Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Jin-ling Jiang
- Department of Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Tao Ma
- Department of Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Zheng-bao Ye
- Department of Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Jun Zhang
- Department of Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Zheng-gang Zhu
- Department of Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
- Department of Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
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13
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Brieau B, Dahan L, De Rycke Y, Boussaha T, Vasseur P, Tougeron D, Lecomte T, Coriat R, Bachet JB, Claudez P, Zaanan A, Soibinet P, Desrame J, Thirot-Bidault A, Trouilloud I, Mary F, Marthey L, Taieb J, Cacheux W, Lièvre A. Second-line chemotherapy for advanced biliary tract cancer after failure of the gemcitabine-platinum combination: A large multicenter study by the Association des Gastro-Entérologues Oncologues. Cancer 2015; 121:3290-7. [PMID: 26052689 DOI: 10.1002/cncr.29471] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/07/2015] [Accepted: 04/30/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few data are available on second-line chemotherapy (CT2) for advanced biliary tract cancer (ABTC). The aim of this multicenter study was to describe the CT2 regimens used, the response rates, and the outcomes of patients treated with various CT2 regimens. METHODS Patients who received CT2 for ABTC at 17 French institutions after the failure of the gemcitabine-platinum combination were retrospectively studied. Progression-free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Meier method. Cox models were used for multivariate analyses. RESULTS Among 603 patients who received first-line chemotherapy (CT1) for ABTC, 196 received CT2: 5-fluorouracil (5-FU) and irinotecan (n = 64), 5-FU and oxaliplatin (n = 21), 5-FU and cisplatin (n = 38), 5-FU or capecitabine (n = 40), sunitinib (n = 10), or other various regimens (n = 23). Among the 186 assessable patients, there were 22 partial responses and 70 stabilizations. After a median follow-up of 26.4 months, the median PFS and OS were 3.2 and 6.7 months, respectively. There was no significant difference in PFS or OS between CT2 regimens. Fluoropyrimidine-based doublet chemotherapy was not superior to fluoropyrimidine alone in terms of OS and PFS. In a multivariate analysis, a performance status of 0 to 1, disease control with CT1, and a carbohydrate antigen 19-9 (CA 19-9) level ≤ 400 IU/mL were significantly associated with longer PFS and OS. Grade 3 to 4 toxicity occurred in 32% of the patients. CONCLUSIONS CT2 might provide disease control for selected patients with ABTC after the failure of gemcitabine-platinum, but the prognosis remains poor. No particular regimen seems superior to others, and this calls for new treatments. A good performance status, disease control with CT1, and a low level of CA 19-9 were associated with longer survival.
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Affiliation(s)
- Bertrand Brieau
- Gastroenterology and Digestive Oncology Unit, Cochin Teaching Hospital, Paris, France
| | - Laetitia Dahan
- Digestive Oncology Unit, La Timone Hospital, Marseille, France.,Faculty of Medicine-Timone, Aix-Marseille University, Marseille, France
| | - Yann De Rycke
- Public Health Department, Curie Institute, Paris, France
| | - Tarek Boussaha
- Gastroenterology Unit, Saint Antoine Hospital, Paris, France
| | - Philippe Vasseur
- Gastroenterology Unit, Poitiers Teaching Hospital, Poitiers, France.,Laboratory of Inflammation, Epithelial Tissues, and Cytokines (EA 4331), Poitiers University, Poitiers, France
| | - David Tougeron
- Gastroenterology Unit, Poitiers Teaching Hospital, Poitiers, France.,Laboratory of Inflammation, Epithelial Tissues, and Cytokines (EA 4331), Poitiers University, Poitiers, France
| | - Thierry Lecomte
- Gastroenterology Unit, Tours Teaching Hospital, Tours, France.,Faculty of Medicine, Francois Rabelais University, Tours, France
| | - Romain Coriat
- Gastroenterology and Digestive Oncology Unit, Cochin Teaching Hospital, Paris, France.,Cochin-Port Royal Faculty of Medicine, Paris Descartes University, Paris, France
| | - Jean-Baptiste Bachet
- Gastroenterology Unit, La Pitié Salpêtrière Hospital, Paris, France.,Faculty of Medicine, Pierre and Marie Curie University, Paris, France
| | - Pierre Claudez
- Gastroenterology and Hepatology Unit, Saint Etienne Teaching Hospital, North Hospital, Saint-Priest-en-Jarez, France
| | - Aziz Zaanan
- Gastroenterology and Digestive Unit, Georges Pompidou European Hospital, Paris, France.,Paris Descartes University-Sorbonne Paris Cité, Paris, France
| | | | - Jérome Desrame
- Gastroenterology Unit, Jean Mermoz Hospital, Lyon, France
| | | | | | - Florence Mary
- Gastroenterology Unit, Avicenne Hospital, Bobigny, France
| | - Lysiane Marthey
- Gastroenterology Unit, Antoine Béclère Hospital, Clamart, France
| | - Julien Taieb
- Gastroenterology and Digestive Unit, Georges Pompidou European Hospital, Paris, France.,Paris Descartes University-Sorbonne Paris Cité, Paris, France
| | - Wulfran Cacheux
- Department of Medical Oncology, Curie Institute Hospital, Paris, France
| | - Astrid Lièvre
- Department of Medical Oncology, René Huguenin Hospital, Curie Institute, Saint-Cloud, France.,Faculty of Health Sciences, Versailles Saint-Quentin-en-Yvelines University, Montigny-Le-Bretonneux, France
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14
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Guion-Dusserre JF, Lorgis V, Vincent J, Bengrine L, Ghiringhelli F. FOLFIRI plus bevacizumab as a second-line therapy for metastatic intrahepatic cholangiocarcinoma. World J Gastroenterol 2015; 21:2096-101. [PMID: 25717243 PMCID: PMC4326145 DOI: 10.3748/wjg.v21.i7.2096] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 07/29/2014] [Accepted: 11/07/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the efficacy and tolerance of FOLFIRI plus bevacizumab treatment outcome as second-line treatment for metastatic intrahepatic cholangiocarcinoma. METHODS Thirteen consecutive patients with metastatic intrahepatic cholangiocarcinoma who were refractory to first-line therapy consisting of gemcitabine plus oxaliplatin-based first-line chemotherapy given intravenously via intra-arterial infusion were treated with FOLFIRI [irinotecan (180 mg/m² i.v. over 90 min) concurrently with folinic acid (400 mg/m² i.v. over 120 min) followed by fluorouracil (400 mg/m² i.v. bolus) then fluorouracil 2400 mg/m² intravenous infusion over 46 h] and bevacizumab (5 mg/kg) every 2 wk. Tumor response was evaluated by computed tomography scan every 4 cycles. RESULTS The best tumor responses using response evaluation criteria in solid tumor criteria were: complete response for 1 patient, partial response for 4 patients, and stable disease for 6 patients after 6 mo of follow-up. The response rate was 38.4% (95%CI: 12.5-89) and the disease control rate was 84.5% (95%CI: 42-100). Seven deaths occurred at the time of analysis, progression free survival was 8 mo (95%CI: 7-16), and median overall survival was 20 mo (95%CI: 8-48). No grade 4 toxic events were observed. Four grade 3 hematological toxicities and one grade 3 digestive toxicity occurred. An adaptive reduction in chemotherapy dosage was required in 2 patients due to hematological toxicity, and a delay in chemotherapy cycles was required for 3 patients. CONCLUSION FOLFIRI plus bevacizumab combination treatment showed promising efficacy and safety as second-line treatment for metastatic intrahepatic cholangiocarcinoma after failure of the first-line treatment of gemcitabine plus oxaliplatin chemotherapy.
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15
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Reports from the International Liver Cancer Association (ILCA) congress 2014. J Hepatol 2015; 62:477-82. [PMID: 25463542 DOI: 10.1016/j.jhep.2014.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/08/2014] [Accepted: 11/12/2014] [Indexed: 01/07/2023]
Abstract
The International Liver Cancer Association (ILCA) congress took place in Kyoto, Japan, from September 4 to 7, 2014 and ranged from basic to clinical studies in the area of primary liver cancer, including hepatocellular carcinoma (HCC), but also cholangiocarcinoma. In the field of basic and translational research, several studies attempted to refine our knowledge of biological events involved in liver carcinogenesis and sought to identify new therapeutic targets for improving clinical care in the future, Fig. 1. In the present work, a subjective selection of studies among the large number of abstract available at the ILCA meeting is presented and placed into context.
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16
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Ulahannan SV, Rahma OE, Duffy AG, Makarova-Rusher OV, Kurtoglu M, Liewehr DJ, Steinberg SM, Greten TF. Identification of active chemotherapy regimens in advanced biliary tract carcinoma: a review of chemotherapy trials in the past two decades. Hepat Oncol 2015; 2:39-50. [PMID: 25685318 PMCID: PMC4326054 DOI: 10.2217/hep.14.36] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Biliary tract carcinoma is a rare malignancy. We performed a comprehensive analysis of published prospective clinical trials in advanced biliary tract carcinoma in an attempt to identify active regimens in this setting. We searched PubMed and abstracts presented at the American Society of Clinical Oncology, Gastrointestinal Cancer Symposium, European Society of Medical Oncology and European Cancer Organization conferences for clinical trials in this disease. We found 83 trials. The effect of gemcitabine on overall survival benefit showed a strong trend (p = 0.014) and an improvement in progression-free survival (p = 0.003). Gemcitabine-based regimens containing 5-fluorouracil showed a trend toward an improved overall survival (p = 0.047) relative to platinum agents. Our findings support gemcitabine as the chemotherapy backbone for the treatment of patients with cholangiocarcinoma. Gemcitabine plus 5-fluorouracil combinations warrant further investigations.
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Affiliation(s)
- Susanna V Ulahannan
- Gastrointestinal Malignancies Section, Thoracic & GI-Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Osama E Rahma
- Division of Hematology/Oncology, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Austin G Duffy
- Gastrointestinal Malignancies Section, Thoracic & GI-Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Oxana V Makarova-Rusher
- Gastrointestinal Malignancies Section, Thoracic & GI-Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Metin Kurtoglu
- Gastrointestinal Malignancies Section, Thoracic & GI-Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - David J Liewehr
- Biostatistics & Data Management Section, National Cancer Institute, Rockville, MD, USA
| | - Seth M Steinberg
- Biostatistics & Data Management Section, National Cancer Institute, Rockville, MD, USA
| | - Tim F Greten
- Gastrointestinal Malignancies Section, Thoracic & GI-Oncology Branch, National Cancer Institute, Bethesda, MD, USA
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17
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Multivariate prognostic factors analysis for second-line chemotherapy in advanced biliary tract cancer. Br J Cancer 2014; 110:2165-9. [PMID: 24714745 PMCID: PMC4007244 DOI: 10.1038/bjc.2014.190] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 03/09/2014] [Accepted: 03/17/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The role of second-line chemotherapy (CT) is not established in advanced biliary tract cancer (aBTC). We investigated the outcome of aBTC patients treated with second-line CT and devised a prognostic model. METHODS Baseline clinical and laboratory data of 300 consecutive aBTC patients were collected and association with overall survival (OS) was investigated by multivariable Cox models. RESULTS The following parameters resulted independently associated with longer OS: Eastern Cooperative Oncology Group performance status of 0 (P<0.001; hazard ratio (HR), 0.348; 95% confidence interval (CI) 0.215-0.562), CA19.9 lower than median (P=0.013; HR, 0.574; 95% CI 0.370-0.891), progression-free survival after first-line CT ≥ 6 months (P=0.027; HR, 0.633; 95% CI 0.422-0.949) and previous surgery on primary tumour (P=0.027; HR, 0.609; 95% CI 0.392-0.945). We grouped the 249 patients with complete data available into three categories according to the number of fulfilled risk factors: median OS times for good-risk (zero to one factors), intermediate-risk (two factors) and poor-risk (three to four factors) groups were 13.1, 6.6 and 3.7 months, respectively (P<0.001). CONCLUSIONS Easily available clinical and laboratory factors predict prognosis of aBTC patients undergoing second-line CT. This model allows individual patient-risk stratification and may help in treatment decision and trial design.
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