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Arias-Martinez A, Martínez de Castro E, Gallego J, Arrazubi V, Custodio A, Fernández Montes A, Diez M, Hernandez R, Limón ML, Cano JM, Vidal-Tocino R, Macias I, Visa L, Martin Richard M, Sauri T, Hierro C, Gil M, Cerda P, Martínez Moreno E, Martínez Lago N, Mérida-García AJ, Gómez González L, García Navalón FJ, Ruiz Martín M, Marín G, López-López F, Ruperez Blanco AB, Fernández AF, Jimenez-Fonseca P, Carmona-Bayonas A, Alvarez-Manceñido F. Is there a preferred platinum and fluoropyrimidine regimen for advanced HER2-negative esophagogastric adenocarcinoma? Insights from 1293 patients in AGAMENON-SEOM registry. Clin Transl Oncol 2024; 26:1674-1686. [PMID: 38361134 PMCID: PMC11178610 DOI: 10.1007/s12094-024-03388-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/06/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND The optimal chemotherapy backbone for HER2-negative advanced esophagogastric cancer, either in combination with targeted therapies or as a comparator in clinical trials, is uncertain. The subtle yet crucial differences in platinum-based regimens' safety and synergy with combination treatments need consideration. METHODS We analyzed cases from the AGAMENON-SEOM Spanish registry of HER2-negative advanced esophagogastric adenocarcinoma treated with platinum and fluoropyrimidine from 2008 to 2021. This study focused exclusively on patients receiving one of the four regimens: FOLFOX (5-FU and oxaliplatin), CAPOX (capecitabine and oxaliplatin), CP (capecitabine and cisplatin) and FP (5-FU and cisplatin). The aim was to determine the most effective and tolerable platinum and fluoropyrimidine-based chemotherapy regimen and to identify any prognostic factors. RESULTS Among 1293 patients, 36% received either FOLFOX (n = 468) or CAPOX (n = 466), 20% CP (n = 252), and 8% FP (n = 107). FOLFOX significantly increased PFS (progression free survival) compared to CP, with a hazard ratio of 0.73 (95% CI 0.58-0.92, p = 0.009). The duration of treatment was similar across all groups. Survival outcomes among regimens were similar, but analysis revealed worse ECOG-PS (Eastern Cooperative Oncology Group-Performance Status), > 2 metastatic sites, bone metastases, hypoalbuminemia, higher NLR (neutrophil-to-lymphocyte ratio), and CP regimen as predictors of poor PFS. Fatigue was common in all treatments, with the highest incidence in FOLFOX (77%), followed by FP (72%), CAPOX (68%), and CP (60%). Other notable toxicities included neuropathy (FOLFOX 69%, CAPOX 62%), neutropenia (FOLFOX 52%, FP 55%), hand-foot syndrome in CP (46%), and thromboembolic events (FP 12%, CP 11%). CONCLUSIONS FOLFOX shown better PFS than CP. Adverse effects varied: neuropathy was more common with oxaliplatin, while thromboembolism was more frequent with cisplatin.
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Affiliation(s)
- Aranzazu Arias-Martinez
- Doctoral Program in Pharmacy, Universidad de Granada, Barrio Verxeles n°13 2°, CP 27850, Granada, Viveiro, Spain.
| | - Eva Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
| | - Virginia Arrazubi
- Medical Oncology Department, Hospital Universitario de Navarra, IdiSNA, Pamplona, Spain
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC, CB16/12/00398, Madrid, Spain
| | - Ana Fernández Montes
- Medical Oncology Department, Complejo Hospitalario Universitario de Orense, Orense, Spain
| | - Marc Diez
- Medical Oncology Department, Hospital Universitario Vall d'Hebron, VHIO, Barcelona, Spain
| | - Raquel Hernandez
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - María Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Rosario Vidal-Tocino
- Medical Oncology Department, Complejo Asistencial Universitario de Salamanca - IBSAL, Salamanca, Spain
| | - Ismael Macias
- Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - Marta Martin Richard
- Medical Oncology Department, Instituto Catalán de Oncología (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Tamara Sauri
- Medical Oncology Department, Hospital Clinic, Barcelona, Spain
| | - Cinta Hierro
- Medical Oncology Department, Instituto Catalán de Oncología (ICO)-Badalona, Barcelona; Badalona-Applied Research Group in Oncology (B-ARGO), Badalona, Spain
| | - Mireia Gil
- Medical Oncology Department, Hospital General Universitario de Valencia-Ciberonc CB16/12/0035, Valencia, Spain
| | - Paula Cerda
- Medical Oncology Department, Hospital Universitario Santa Creu y Sant Pau, Barcelona, Spain
| | - Elia Martínez Moreno
- Medical Oncology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Nieves Martínez Lago
- Medical Oncology Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | | | - Lucía Gómez González
- Medical Oncology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Maribel Ruiz Martín
- Medical Oncology Department, Complejo Asistencial Universitario de Palencia, Palencia, Spain
| | - Gema Marín
- Medical Oncology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Flora López-López
- Medical Oncology Department, Hospital Universitario del Sureste, Madrid, Spain
| | | | | | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
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Cho M, Kim HS, Jung M, Hyung WJ. Perioperative intraperitoneal plus systemic chemotherapy and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for gastric cancer: phase Ib/II single-arm prospective study. J Gastrointest Surg 2024; 28:1095-1103. [PMID: 38705369 DOI: 10.1016/j.gassur.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/13/2024] [Accepted: 04/27/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND In gastric cancer, peritoneal metastasis is the most common form of metastasis and leads to dismal prognosis. We aimed to evaluate the safety and efficacy of combining perioperative intraperitoneal (IP) plus systemic chemotherapy, cytoreductive surgery (CRS), and hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with gastric cancer with limited peritoneal metastasis or even after reducing peritoneal tumor burden by upfront IP chemotherapy. METHOD Patients were enrolled in phase Ib in a 3 + 3 dose escalation of IP paclitaxel plus a fixed dose of IP cisplatin and oral S-1. In phase II, patients were managed according to the peritoneal cancer index (PCI) by diagnostic laparoscopy. For patients with a PCI of >12, upfront IP and systemic chemotherapy were given. Patients with a PCI of ≤12 or reduced to ≤12 after upfront chemotherapy underwent CRS with HIPEC. The primary endpoints were safety and the recommended phase II dose (RP2D) confirmation for phase Ib and the 1-year overall survival rate for phase II. RESULTS The RP2D was defined as IP 175 mg/m2 paclitaxel and 60 mg/m2 cisplatin and oral 70 mg/m2/day S-1 for 14 days. A total of 22 patients were included. After CRS with HIPEC, there were no grade 3 or higher complications. The median hospital stay was 7 days (range, 6-11). The median overall and progression-free survival were 27.3 months (95% CI, 14.4 to not estimable) and 12.6 months (95% CI, 7.7-14.5), respectively. One-year overall and progression-free survival rates were 81.0% (95% CI, 65.8-99.6) and 54.5% (95% CI, 37.2-79.9), respectively. CONCLUSION A combination of IP plus systemic chemotherapy, CRS, and HIPEC was safe and resulted in good survival outcomes.
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Affiliation(s)
- Minah Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea; Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyo Song Kim
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea; Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minkyu Jung
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea; Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea; Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea.
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3
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Porschen R, Fischbach W, Gockel I, Hollerbach S, Hölscher A, Jansen PL, Miehlke S, Pech O, Stahl M, Vanhoefer U, Ebert MPA. Updated German guideline on diagnosis and treatment of squamous cell carcinoma and adenocarcinoma of the esophagus. United European Gastroenterol J 2024; 12:399-411. [PMID: 38284661 PMCID: PMC11017771 DOI: 10.1002/ueg2.12523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/21/2023] [Indexed: 01/30/2024] Open
Abstract
Diagnosis and therapy of esophageal carcinoma is challenging and requires a multidisciplinary approach. The purpose of the updated German guideline "Diagnosis and Treatment of Squamous Cell Carcinoma and Adenocarcinoma of the Esophagus-version 3.1" is to provide practical and evidence-based advice for the management of patients with esophageal cancer. Recommendations were developed by a multidisciplinary expert panel based on an extensive and systematic evaluation of the published medical literature and the application of well-established methodologies (e.g. Oxford evidence grading scheme, grading of recommendations). Accurate diagnostic evaluation of the primary tumor as well as lymph node and distant metastases is required in order to guide patients to a stage-appropriate therapy after the initial diagnosis of esophageal cancer. In high-grade intraepithelial neoplasia or mucosal carcinoma endoscopic resection shall be performed. Whether endoscopic resection is the definitive therapeutic measure depends on the histopathological evaluation of the resection specimen. Esophagectomy should be performed minimally invasive or in combination with open procedures (hybrid technique). Because the prognosis in locally advanced esophageal carcinoma is poor with surgery alone, multimodality therapy is recommended. In locally advanced adenocarcinomas of the esophagus or esophagogastric junction, perioperative chemotherapy or preoperative radiochemotherapy should be administered. In locally advanced squamous cell carcinomas of the esophagus, preoperative radiochemotherapy followed by complete resection or definitive radiochemotherapy without surgery should be performed. In the case of residual tumor in the resection specimen after neoadjuvant radiochemotherapy and R0 resection of squamous cell carcinoma or adenocarcinoma, adjuvant immunotherapy with nivolumab should be given. Systemic palliative treatment options (chemotherapy, chemotherapy plus immunotherapy, immunotherapy alone) in unresectable or metastastic esophageal cancer depend on histology and are stratified according to PD-L1 and/or Her2 expression.
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Affiliation(s)
- Rainer Porschen
- Gastroenterologische Praxis am Kreiskrankenhaus OsterholzOsterholz‐ScharmbeckGermany
| | - Wolfgang Fischbach
- Deutsche Gesellschaft zur Bekämpfung der Krankheiten von MagenDarm und Leber sowie von Störungen des Stoffwechsels und der Ernährung (Gastro‐Liga) e. V.GiessenGermany
| | - Ines Gockel
- Klinik für Viszeral‐, Transplantations‐, Thorax‐ und GefäßchirurgieLeipzigGermany
| | | | - Arnulf Hölscher
- Contilia Zentrum für SpeiseröhrenerkrankungenElisabeth Krankenhaus EssenEssenGermany
| | - Petra Lynen Jansen
- Deutsche Gesellschaft für GastroenterologieVerdauungs‐ und StoffwechselkrankheitenBerlinGermany
| | | | - Oliver Pech
- Klinik für Gastroenterologie und Interventionelle EndoskopieKrankenhaus Barmherzige BrüderRegensburgGermany
| | - Michael Stahl
- Klinik für Internistische Onkologie & Onkologische PalliativmedizinEvang. Kliniken Essen‐MitteEssenGermany
| | - Udo Vanhoefer
- Klinik für Hämatologie und OnkologieKath. MarienkrankenhausHamburgGermany
| | - Matthias P. A. Ebert
- Medizinische Fakultät MannheimII. Medizinische KlinikUniversitätsmedizinUniversität HeidelbergMannheimGermany
- DKFZ‐Hector Krebsinstitut an der Universitätsmedizin MannheimMannheimGermany
- Molecular Medicine Partnership UnitEMBLHeidelbergGermany
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Ebert MP, Fischbach W, Hollerbach S, Höppner J, Lorenz D, Stahl M, Stuschke M, Pech O, Vanhoefer U, Porschen R. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:535-642. [PMID: 38599580 DOI: 10.1055/a-2239-9802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Matthias P Ebert
- II. Medizinische Klinik, Medizinische Fakultät Mannheim, Universitätsmedizin, Universität Heidelberg, Mannheim
- DKFZ-Hector Krebsinstitut an der Universitätsmedizin Mannheim, Mannheim
- Molecular Medicine Partnership Unit, EMBL, Heidelberg
| | - Wolfgang Fischbach
- Deutsche Gesellschaft zur Bekämpfung der Krankheiten von Magen, Darm und Leber sowie von Störungen des Stoffwechsels und der Ernährung (Gastro-Liga) e. V., Giessen
| | | | - Jens Höppner
- Klinik für Allgemeine Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
| | - Dietmar Lorenz
- Chirurgische Klinik I, Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Darmstadt, Darmstadt
| | - Michael Stahl
- Klinik für Internistische Onkologie und onkologische Palliativmedizin, Evang. Huyssensstiftung, Evang. Kliniken Essen-Mitte, Essen
| | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Oliver Pech
- Klinik für Gastroenterologie und Interventionelle Endoskopie, Krankenhaus Barmherzige Brüder, Regensburg
| | - Udo Vanhoefer
- Klinik für Hämatologie und Onkologie, Katholisches Marienkrankenhaus, Hamburg
| | - Rainer Porschen
- Gastroenterologische Praxis am Kreiskrankenhaus Osterholz, Osterholz-Scharmbeck
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Wang SF, Chang YL, Liu TY, Huang KH, Fang WL, Li AFY, Yeh TS, Hung GY, Lee HC. Mitochondrial dysfunction decreases cisplatin sensitivity in gastric cancer cells through upregulation of integrated stress response and mitokine GDF15. FEBS J 2024; 291:1131-1150. [PMID: 37935441 DOI: 10.1111/febs.16992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/18/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
Gastric neoplasm is a high-mortality cancer worldwide. Chemoresistance is the obstacle against gastric cancer treatment. Mitochondrial dysfunction has been observed to promote malignant progression. However, the underlying mechanism is still unclear. The mitokine growth differentiation factor 15 (GDF15) is a significant biomarker for mitochondrial disorder and is activated by the integrated stress response (ISR) pathway. The serum level of GDF15 was found to be correlated with the poor prognosis of gastric cancer patients. In this study, we found that high GDF15 protein expression might increase disease recurrence in adjuvant chemotherapy-treated gastric cancer patients. Moreover, treatment with mitochondrial inhibitors, especially oligomycin (a complex V inhibitor) and salubrinal (an ISR activator), respectively, was found to upregulate GDF15 and enhance cisplatin insensitivity of human gastric cancer cells. Mechanistically, it was found that the activating transcription factor 4-C/EBP homologous protein pathway has a crucial function in the heightened manifestation of GDF15. In addition, reactive oxygen species-activated general control nonderepressible 2 mediates the oligomycin-induced ISR, and upregulates GDF15. The GDF15-glial cell-derived neurotrophic factor family receptor a-like-ISR-cystine/glutamate transporter-enhanced glutathione production was found to be involved in cisplatin resistance. These results suggest that mitochondrial dysfunction might enhance cisplatin insensitivity through GDF15 upregulation, and targeting mitokine GDF15-ISR regulation might be a strategy against cisplatin resistance of gastric cancer.
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Affiliation(s)
- Sheng-Fan Wang
- Department of Pharmacy, Taipei Veterans General Hospital, Taiwan
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taiwan
- Department and Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biopharmaceutical Sciences, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuh-Lih Chang
- Department of Pharmacy, Taipei Veterans General Hospital, Taiwan
- Department and Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ting-Yu Liu
- Department and Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuo-Hung Huang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan
- Department of Surgery, Gastric Cancer Medical Center, Taipei Veterans General Hospital, Taiwan
| | - Wen-Liang Fang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan
- Department of Surgery, Gastric Cancer Medical Center, Taipei Veterans General Hospital, Taiwan
| | - Anna Fen-Yau Li
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anatomical Pathology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Tien-Shun Yeh
- Institute of Anatomy and Cell Biology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Giun-Yi Hung
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taiwan
| | - Hsin-Chen Lee
- Department and Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Feng WJ, Zhao XY, He YF, Huang MZ, Chen ZY, Wang YS, Zhu XD, Guo WJ. Multivariate prognostic index and triplet regimen efficacy predictive index in locally advanced and metastatic gastric cancer: pooled analysis from three clinical trials using individual patient data. Ther Adv Med Oncol 2024; 16:17588359241233982. [PMID: 38420603 PMCID: PMC10901054 DOI: 10.1177/17588359241233982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Background To construct an effective prognostic index to predict overall survival (OS) and triplet regimen efficacy for advanced gastric cancer (AGC) patients treated with platinum-based and fluorouracil-based chemotherapy. Objectives Between 2011 and 2021, 679 patients from two randomized phase III trials and one phase II trial were enrolled. Designs We collected 11 baseline clinicopathological and 14 hematological parameters to establish a prognostic index. Methods Univariate and multivariate Cox analyses were used to screen prognostic factors, and a prognostic index nomogram was conducted. Results Seven prognostic factors were identified: primary tumor site in the non-proximal gastric area, signet-ring cell carcinoma (SRCC)/mucinous carcinoma, peritoneal metastasis, neutrophil count higher than the upper limit of normal value (ULN), lymphocyte count lower than the lower limit of normal value, lactate dehydrogenase level higher than the ULN, and alkaline phosphatase level higher than the ULN as significant for prognosis. A prognostic nomogram named the Fudan advanced gastric cancer prognostic risk score (FARS) index was constructed, and patients in the high-risk group had significantly shorter OS than those in the low-risk group (median OS, 15.5 versus 8.0 months, p < 0.001). The areas under the curve of the FARS index for 1-, 2-, and 3-year OS were 0.70, 0.72, and 0.77, respectively. A validation and external cohort verified the prognostic value of the FARS index. Moreover, three triplet regimen efficacy parameters were identified: SRCC/mucinous adenocarcinoma, primary tumor location in the non-proximal gastric area, and peripheral neutrophil count higher than the ULN; a TRIS index was subsequently conducted. In patients with any two of the three parameters, the triplet regimen showed significantly longer OS than the doublet regimen (p = 0.018). Conclusion The constructed FARS index to predict the OS of AGC patients and the TRIS index to screen out the dominant population for triplet regimens can be used to aid clinical decision-making and individual risk stratification.
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Affiliation(s)
- Wan-Jing Feng
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, P. R. China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P. R. China
| | - Xiao-Ying Zhao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, P. R. China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P. R. China
| | - Yi-Fu He
- Department of Medical Oncology, The First Affiliated Hospital, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, P. R. China
| | - Ming-Zhu Huang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, P. R. China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P. R. China
| | - Zhi-Yu Chen
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, P. R. China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P. R. China
| | - Yu-Sheng Wang
- Department of Gastroenterology, Shanxi Cancer Hospital, Taiyuan, Shanxi 030013, P. R. China
| | - Xiao-Dong Zhu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P. R. China
- Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’An Road, Shanghai 200032, P. R. China
| | - Wei-Jian Guo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P. R. China
- Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’An Road, Shanghai 200032, P. R. China
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Forouhari A, Moghaddas A, Darakhshandeh A. Outcome evaluation of ECF, DCF, FOLFOX, and FLOT chemotherapy regimens as perioperative treatment in elderly patients with resectable gastric cancer; A retrospective comparative study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2023; 28:79. [PMID: 38292337 PMCID: PMC10826847 DOI: 10.4103/jrms.jrms_417_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/18/2023] [Accepted: 08/07/2023] [Indexed: 02/01/2024]
Abstract
Background The incidence of gastric cancer is known to be high in the elderly population. Identification of the best perioperative chemotherapy regimen is challenging in patients with resectable gastric cancer. In this study, we aimed to evaluate and compare the outcomes and safety of epirubicin, cisplatin, and 5-fluorouracil (ECF), docetaxel, cisplatin, and 5-fluorouracil (DCF), oxaliplatin plus 5-Fluorouracil and leucovorin (FOLFOX), and docetaxel, oxaliplatin, leucovorin, and 5-Fluorouracil (FLOT) chemotherapy regimens to identify the most appropriate treatment option for elderly patients with resectable gastric cancer. Materials and Methods In this retrospective observational cohort study, data were extracted from the medical archives (2017-2021) of Omid Hospital, which is a tertiary oncology referral hospital in Isfahan, Iran. Patients with resectable gastric cancer, above 60 years of age, who were perioperatively treated with one of the mentioned chemotherapy regimens and met the inclusion criteria, were enrolled in this study. The survival parameters and safety profile of the regimens were evaluated and compared in this population. Results A total of 63 patients were included in this study. The median follow-up period of the patients was 24 months (range, 7-51 months). The results of survival analysis revealed that the FLOT and DCF regimens were significantly associated with longer overall survival (OS) as compared to the other regimens (median OS: 38 and 33 months, respectively). Based on the results, the progression-free survival was longer in the DCF regimen (median: 24 months) compared to the other regimens; however, only the difference with the ECF regimen (median: 14 months) was significant. The results of Cox regression analysis showed no significant difference in the overall adjusted hazard ratio of mortality between the FLOT and DCF regimens (P = 0.802). The DCF and FOLFOX regimens accounted for the highest and lowest rates of adverse events (e.g., neutropenia and mucositis), respectively. Conclusion Considering the higher rate of adverse events in the DCF group, besides the significant improvement of OS and the acceptable adverse event profile of patients treated with the FLOT regimen, it can be proposed that this chemotherapy regimen is the most appropriate treatment option for elderly patients with resectable gastric cancer.
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Affiliation(s)
- Ali Forouhari
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azadeh Moghaddas
- Department of Clinical Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Darakhshandeh
- Department of Medical Oncology and Hematology, Isfahan University of Medical Sciences, Isfahan, Iran
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Takayama T, Tsuji Y. Updated Adjuvant Chemotherapy for Gastric Cancer. J Clin Med 2023; 12:6727. [PMID: 37959193 PMCID: PMC10648766 DOI: 10.3390/jcm12216727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023] Open
Abstract
Surgical resection is currently the best curative approach for gastric cancer (GC); however, the prognosis of patients with advanced GC remains poor even with curative resection. For this reason, perioperative chemotherapy has been combined with surgery to reduce the risk of postoperative recurrence. Standard perioperative chemotherapy for resectable advanced GC varies from region to region. Postoperative S-1 therapy was standardized via the ACTS-GC study in East Asia, perioperative ECF (Epirubicin + Cisplatin + Fluorouracil) was standardized via the MAGIC study in Europe, and postoperative chemoradiotherapy was standardized via the US intergroup study in North America. Since then, more intensive regimens have been developed. In recent years, perioperative therapy using novel agents, such as molecular-targeted drugs and immune checkpoint inhibitors (ICIs), has also been tested and evaluated in the three major regions (East Asia, Europe, and North America) with promising results. Perioperative chemotherapy has become an integral part of many treatment strategies and requires continued research and evaluation.
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Affiliation(s)
- Toshizo Takayama
- Department of Medical Oncology, Tonan Hospital, Sapporo 060-0004, Japan
- Department of Medical Oncology, Daido Hospital, Nagoya 457-8511, Japan
| | - Yasushi Tsuji
- Department of Medical Oncology, Tonan Hospital, Sapporo 060-0004, Japan
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Funk-Debleds P, Rossi J, Bernard L, Galan A, Kepenekian V, Glehen O, Chambrier C. Post-operative weight loss affects 3-year survival in patients with gastric adenocarcinoma after gastrectomy and hyperthermic intraperitoneal chemotherapy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106895. [PMID: 37012111 DOI: 10.1016/j.ejso.2023.03.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 02/09/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Patients with advanced gastric adenocarcinoma are at high risk of malnutrition. Some patients benefit from total gastrectomy associated with hyperthermic intraperitoneal chemotherapy (HIPEC) with or without cytoreduction surgery (CR) as a curative strategy. The aim of this study was to describe pre- and post-operative nutritional assessments and their impact on survival in these patients. MATERIALS AND METHODS All patients with advanced gastric adenocarcinoma treated with gastrectomy and HIPEC with or without CR at Lyon University Hospital were retrospectively included from April 2012 to August 2017. Carcinologic data, history of weight, anthropometric measures, nutritional biological markers and CT-scan body composition were collected. RESULTS 54 patients were included. Malnutrition affected 48.1% before and 64.8% after surgery, and severe malnutrition respectively 11.1% and 20.3%. Pre-operative sarcopenia diagnosed by CT scan was found in 40.7% of the patients while 81.1% of the sarcopenic patients had a normal or high body mass index. A loss of ⩾ 20% of usual weight on discharge was a pejorative factor of survival at 3 years of follow-up (p = 0.0470). Only 14.8% of the patients continued artificial nutrition following discharge but artificial nutrition was resumed in 30.4% of the patients within 4 months after discharge owing to weight loss. CONCLUSIONS Patients with advanced gastric adenocarcinoma undergoing gastrectomy and HIPEC with or without CR are at high risk of malnutrition. Post-operative weight loss has a pejorative impact on outcome. These patients should be systematically screened for malnutrition with early interventionist nutritional care and close nutritional follow-up.
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Affiliation(s)
- Pamela Funk-Debleds
- Département de Soins de Support, Centre de Lutte Contre le Cancer Léon Bérard, Lyon, France.
| | - Julien Rossi
- Département de Radiologie, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France
| | - Lorraine Bernard
- Service de Biostatistique et Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; 4 CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
| | - Alexandre Galan
- Département de Radiologie, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France
| | - Vahan Kepenekian
- Département de Chirurgie Viscérale, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France
| | - Olivier Glehen
- Département de Chirurgie Viscérale, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France; Equipe Accueil CICLY, Université Lyon 1, Lyon, France
| | - Cécile Chambrier
- Unité de Nutrition Clinique Intensive, Hospices Civil de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France
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10
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S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:701-745. [PMID: 37285870 DOI: 10.1055/a-1771-7087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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11
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S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:e209-e307. [PMID: 37285869 DOI: 10.1055/a-1771-6953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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12
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Systematic review and meta-analysis of the outcomes following neoadjuvant therapy in upfront resectable gastric cancers compared to surgery alone in phase III randomised controlled trials. J Gastrointest Surg 2023:10.1007/s11605-023-05641-9. [PMID: 36882627 DOI: 10.1007/s11605-023-05641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/27/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Gastric cancer is the fifth most common malignancy and the fourth most common cause of cancer mortality globally. The role of neoadjuvant chemotherapy in upfront resectable gastric cancer is a subject of ongoing research. In recent meta-analyses, R0 resection rate and superior outcomes were not consistently observed in such regimens. AIM To describe the outcomes following phase III randomised control trials; comparing neoadjuvant therapy followed by surgery against upfront surgery with and without adjuvant therapy in resectable gastric cancers. METHODS The Cochrane Library, CINAHL, EMBASE, PubMed, SCOPUS and Web of Science was searched from January 2002 to September 2022. RESULTS 13 studies were included (3280 participants). R0 resection rates were in neoadjuvant therapy arms as compared to adjuvant therapy with odds ratio (OR) 1.55[95% CI: 1.13, 2.13](p=0.007) and compared to surgery alone OR 2.49[95% CI: 1.56, 3.96](p=0.0001). 3-year and 5-year progression-, event- and disease-free survival in neoadjuvant therapy as compared to adjuvant therapy were not significantly increased, 3-year OR 0.87[0.71, 1.07](p=0.19). Meanwhile, comparing neoadjuvant therapy to adjuvant therapy, 3-year overall survival (OS) hazard ratio was 0.88[95% CI: 0.70, 1.11](p=0.71) while 3- and 5-year OS OR was 1.18[95% CI: 0.90, 1.55], p=0.22 and 1.27[95% CI: 0.67, 2.42](p=0.47) respectively. Surgical complications were also more common with neoadjuvant therapy. CONCLUSION Neoadjuvant therapy yields higher rates of R0 resection. However, improved long-term survival was not seen as compared to adjuvant therapy. Large multi-centred randomised control trials with D2 lymphadenectomy should be performed to better evaluate the treatment modalities.
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13
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Manfredi S, Dior M, Bouche O, Barbier E, Hautefeuille V, Guillet M, Turpin J, Bourgeois V, Helene DO, Desgrippes R, Audemar F, Molin Y, Locher C, Chatellier T, Lecomte T, Baize N, Lecaille C, Spaeth D, Goujon G, Lepage C, Tougeron D. Daily practices in chemotherapy for advanced gastric or gastroesophageal junction adenocarcinoma: METESTOMAC French prospective cohort. Cancer Med 2023; 12:5341-5351. [PMID: 36394147 PMCID: PMC10028027 DOI: 10.1002/cam4.5354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Around 50% of gastric cancers are diagnosed at an advanced stage. Several chemotherapy regimens are now internationally validated. Few data are available on the routine daily management of advanced gastric or gastroesophageal junction cancers. We aimed to describe chemotherapy practices, tolerance, and efficacy overall survival (OS) and Progression free survival (PFS) in a prospective French cohort. METHODS Patients starting palliative chemotherapy were prospectively enrolled in 49 French centres. The primary objective was to report and describe patients' characteristics and treatment strategies. Secondary objectives were OS, PFS, objective response rate, adverse events rate, performance status deterioration during the chemotherapy. RESULTS A total of 182 patients were included; 179 were analysed. Most patients received platinium-based chemotherapy as the first treatment and FOLFIRI as second; 62.0% of patients received a second line, and 32.4% a third line. More than two thirds of Her2-positive patients were first treated with trastuzumab. The FOLFIRI regimen was the most frequently used second-line therapy. Median OS was 13.3 months, similar whatever the chemotherapy or combinations used in the first line. One- and 2-year OS increased with the number of chemotherapy lines received, from respectively 24.7% and 5.7% (1 line), to 46.9% and 12.4% (2 lines) and 88.1% and 29.9% (3 or more lines) (p < 0.0001). CONCLUSION Our study showed that treatment strategies in France are based on a succession of doublets, making it possible to offer a second and third line of treatment more often. This treatment strategy must be taken into account for future trials with immunotherapy combinations.
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Affiliation(s)
- Sylvain Manfredi
- Digestive Cancer Registry of Burgundy, INSERM, LNC UMR1231, University Bourgogne Franche-Comté, Dijon-Bourgogne University Hospital, Dijon, France
| | - Marie Dior
- University Hospital Cochin, Paris, France
| | | | - Emilie Barbier
- CRGA, FFCD, INSERM, LNC UMR1231, University Bourgogne Franche-Comté, Dijon, France
| | | | | | | | | | | | | | | | - Yann Molin
- Private Hospital La Sauvegarde, Lyon, France
| | | | - Thierry Chatellier
- Private Hospital Clinique mutualiste de l'estuaire, Saint Nazaire, France
| | | | | | | | | | | | - Come Lepage
- CRGA, FFCD, INSERM, LNC UMR1231, University 'Bourgogne Franche-Comté', Dijon, France
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14
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Nguyen HT, Do KH, Le NB, Tran T. Treatment Outcome and Safety of the TCX Regimen for Advanced Gastric Cancer: A Prospective Cohort Study. Cancer Manag Res 2022; 14:2825-2837. [PMID: 36164467 PMCID: PMC9507975 DOI: 10.2147/cmar.s384325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/12/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the outcome and safety of the paclitaxel, carboplatin, and capecitabine (TCX) regimen in patients with advanced gastric cancer. Methods Advanced gastric cancer patients received the TCX regimen for up to six cycles, which were 3 weeks apart. Paclitaxel (175 mg/m2) was given over a 3-hour infusion, followed by carboplatin in a 1-hour infusion on day 1. Capecitabine (850 mg/m2) was given orally twice daily from day 1 to day 14. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Results Among 83 patients at stage IVa and IVb, the median PFS was 9.3 months; 6-month, 1-year, and 2-year PFS were 74.6%, 32.5%, and 14.4%, respectively. The median OS was 17.0 months; 6-month, 1-year, and 2-year OS were 97.5%, 68.7%, and 21.7%, respectively. In the multivariable Cox regression model, higher CEA was associated with poor OS. Common adverse events included hand-food syndrome (77.9%), peripheral neuropathy (63.2%), fatigue (68.7%), and nausea (54.2%). Conclusion The TCX regimen provided good survival and a better safety profile. More clinical trials are needed to confirm its treatment efficacy and safety, especially in comparison with other triplet regimens.
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Affiliation(s)
- Hieu Trong Nguyen
- Department of Medical Oncology 2, Hanoi Oncology Hospital, Hanoi, Vietnam
| | - Kien Hung Do
- Department of Medical Oncology 1, National Cancer Hospital of Vietnam, Hanoi, Vietnam
| | | | - Thang Tran
- Department of Medical Oncology 4, National Cancer Hospital of Vietnam, Hanoi, Vietnam
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15
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Awasthi N, Schwarz MA, Zhang C, Klinz SG, Meyer-Losic F, Beaufils B, Thiagalingam A, Schwarz RE. Augmenting Experimental Gastric Cancer Activity of Irinotecan through Liposomal Formulation and Antiangiogenic Combination Therapy. Mol Cancer Ther 2022; 21:1149-1159. [PMID: 35500018 PMCID: PMC9377761 DOI: 10.1158/1535-7163.mct-21-0860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/22/2022] [Accepted: 04/28/2022] [Indexed: 01/07/2023]
Abstract
Gastric adenocarcinoma (GAC) is the third most common cause of cancer-related deaths worldwide. Combination chemotherapy remains the standard treatment for advanced GAC. Liposomal irinotecan (nal-IRI) has improved pharmacokinetics (PK) and drug biodistribution compared with irinotecan (IRI, CPT-11). Angiogenesis plays a crucial role in the progression and metastasis of GAC. We evaluated the antitumor efficacy of nal-IRI in combination with novel antiangiogenic agents in GAC mouse models. Animal survival studies were performed in peritoneal dissemination xenografts. Tumor growth and PK studies were performed in subcutaneous xenografts. Compared with controls, extension in animal survival by nal-IRI and IRI was >156% and >94%, respectively. The addition of nintedanib or DC101 extended nal-IRI response by 13% and 15%, and IRI response by 37% and 31% (MKN-45 xenografts); nal-IRI response by 11% and 3%, and IRI response by 16% and 40% (KATO-III xenografts). Retardation of tumor growth was greater with nal-IRI (92%) than IRI (71%). Nintedanib and DC101 addition tend to augment nal-IRI or IRI response in this model. The addition of antiangiogenic agents enhanced tumor cell proliferation inhibition effects of nal-IRI or IRI. The tumor vasculature was decreased by nintedanib (65%) and DC101 (58%), while nal-IRI and IRI alone showed no effect. PK characterization in GAC xenografts demonstrated that compared with IRI, nal-IRI treatment groups had higher retention, circulation time, and tumor levels of CPT-11 and its active metabolite SN-38. These findings indicate that nal-IRI, alone and in combination with antiangiogenic agents, has the potential for improving clinical GAC therapy.
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Affiliation(s)
- Niranjan Awasthi
- Department of Surgery, Indiana University School of Medicine, South Bend, Indiana.,Harper Cancer Research Institute, University of Notre Dame, South Bend, Indiana.,Corresponding Author: Niranjan Awasthi, Department of Surgery, Indiana University School of Medicine, 1234 N Notre Dame Avenue, South Bend, IN 46617. Phone: 574-631-5780; E-mail:
| | - Margaret A. Schwarz
- Harper Cancer Research Institute, University of Notre Dame, South Bend, Indiana.,Department of Pediatrics, Indiana University School of Medicine, South Bend, Indiana
| | - Changhua Zhang
- Department of Gastrointestinal Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Guangming, Shenzhen, China
| | | | | | | | | | - Roderich E. Schwarz
- Department of Surgery, Indiana University School of Medicine, South Bend, Indiana.,Harper Cancer Research Institute, University of Notre Dame, South Bend, Indiana.,Roswell Park Comprehensive Cancer Center, Buffalo, New York
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16
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Rosati G, Cella CA, Cavanna L, Codecà C, Prisciandaro M, Mosconi S, Luchena G, Silvestris N, Bernardini I, Casaretti R, Zoratto F, Amoroso D, Ciarlo A, Barni S, Cascinu S, Davite C, Di Sanzo A, Casolaro A, Bilancia D, Labianca R. A randomized phase III study of fractionated docetaxel, oxaliplatin, capecitabine (low-tox) vs epirubicin, oxaliplatin and capecitabine (eox) in patients with locally advanced unresectable or metastatic gastric cancer: the lega trial. Gastric Cancer 2022; 25:783-793. [PMID: 35352176 DOI: 10.1007/s10120-022-01292-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/16/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND EOX (epirubicin, oxaliplatin, and capecitabine) is one of the standard regimens for metastatic or locally advanced gastric cancer (GC). A new combination based on fractional docetaxel (low-TOX) has been developed in an attempt to increase the efficacy of EOX and reduce the heavy toxicity of classical docetaxel regimens. METHODS Overall, 169 previously untreated GC patients were randomized between EOX (arm A) and low-TOX (arm B). The primary endpoint was progression-free survival (PFS), while secondary ones were overall survival (OS), overall response rate (ORR), disease control rate (DCR), and tolerability. The study was designed to detect a 35% (80% power at a two-sided 5% significance level) PFS increase with low-TOX and an interim analysis for futility was planned after the first 127 events. RESULTS At the cut-off date of interim analysis, median PFS was 6.3 months [95% confidence interval (CI) 5.0-8.1] in arm A vs 6.3 months (95% CI 5.0-7.8) in arm B, without statistical difference. OS was comparable in the two arms: 12.4 in arm A (95% CI 9.1-19.2) vs 11.5 months in arm B (95% CI 8.6-15.0). ORR was 33% and 24%, while DCR was 68% and 67%, respectively. Treatment modification (91% vs 78%, P = 0.017) and number of patients with CTC grade ≥ 3 adverse events (42 vs 35) were higher in arm B. CONCLUSIONS A triplet regimen based on the fractional dose of docetaxel achieves no improvement over EOX which remains a potential standard treatment in many patients with inoperable, locally advanced or metastatic GC.
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Affiliation(s)
- Gerardo Rosati
- UOC di Oncologia Medica, Azienda Ospedaliera San Carlo, Via P. Petrone 1, 85100, Potenza, Italy.
| | - Chiara Alessandra Cella
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Luigi Cavanna
- Dipartimento di Oncologia-Ematologia, Azienda USL, Ospedale di Piacenza, Piacenza, Italy
| | - Carla Codecà
- U.O. Oncologia Medica, ASST Santi Paolo e Carlo, Presidio Ospedaliero San Paolo, Milan, Italy
| | - Michele Prisciandaro
- Divisione di Oncologia Medica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefania Mosconi
- Dipartimento di Oncologia ed Ematologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Nicola Silvestris
- U.O.C. Oncologia Medica, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | | | - Rossana Casaretti
- Department of Abdominal Oncology, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Napoli, Italy
| | - Federica Zoratto
- U.O.C. Oncologia Medica, Ospedale Santa Maria Goretti, Latina, Italy
| | - Domenico Amoroso
- Ospedale Versilia, Azienda USL Toscana Nordovest (ATNO), Lido di Camaiore, Italy
| | - Andrea Ciarlo
- U.O. Oncologia Medica, AUSL Toscana Centro, Ospedale di Prato, Prato, Italy
| | - Sandro Barni
- U.O. Oncologia Medica, ASST Bergamo Ovest, Ospedale di Treviglio-Caravaggio, Treviglio, BG, Italy
| | - Stefano Cascinu
- Unità di Medicina Oncologica, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristina Davite
- Global Clinical Development, Nerviano Medical Sciences, Nerviano, MI, Italy
| | | | - Alessia Casolaro
- Global Clinical Development, Nerviano Medical Sciences, Nerviano, MI, Italy
| | - Domenico Bilancia
- UOC di Oncologia Medica, Azienda Ospedaliera San Carlo, Via P. Petrone 1, 85100, Potenza, Italy
| | - Roberto Labianca
- Dipartimento di Oncologia ed Ematologia, ASST Papa Giovanni XXIII, Bergamo, Italy
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17
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Möhring C, Timotheou A, Mańczak A, Sadeghlar F, Zhou T, Mahn R, Bartels A, Monin M, Toma M, Feldmann G, Brossart P, Köksal M, Sarria GR, Giordano FA, Lingohr P, Jafari A, Kalff JC, Strassburg CP, Gonzalez-Carmona MA. Efficacy and tolerability of fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) in unselected patients with advanced gastric and gastroesophageal cancer: does age really matter? J Cancer Res Clin Oncol 2022; 149:1849-1862. [PMID: 35763109 DOI: 10.1007/s00432-022-04109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) regimen has shown strong efficacy as perioperative therapy for patients with locally advanced gastric (GC) and gastroesophageal (AEG) carcinoma. In the palliative situation, FLOT is recommended only for young fit patients. Data of efficacy and tolerability of FLOT in elderly patients are scarce and controversial. Thus, this study aimed to provide real-life experience of elderly patients with GC and AEG treated with FLOT as first-line palliative chemotherapy. METHODS Patients with advanced or metastatic GC or AEG and treated with FLOT as first-line palliative therapy between 2010 and 2021 were analyzed. Patients were grouped into < 65 years old (n = 35) and ≥ 65 years old (n = 22) groups. Overall survival (OS), progression-free survival (PFS), feasibility and toxicity were analyzed. RESULTS The median OS was 10.4 months with no significant difference between both groups (HR 0.86; 95% CI 0.48, 1.57; p = 0.632). The ECOG performance status showed powerful influence on OS in the subgroup analysis with median OS of 12.3 months for ECOG = 0 compared to 5.0 months for ECOG ≥ 1 (p = 0.015) as well as in multivariate analysis (HR 2.62; 95% CI 1.36, 5.04; p = 0.004). CONCLUSION In the present study the ECOG performance status showed a stronger prognostic value than patient age in FLOT as first- line therapy in a real-life cohort with advanced and metastatic GC and AEG. The performance status should therefore be considered in the therapeutic decision making of elderly patients with GC and AEG.
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Affiliation(s)
- Christian Möhring
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Aliki Timotheou
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Adrianna Mańczak
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Farsaneh Sadeghlar
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Taotao Zhou
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Robert Mahn
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Alexandra Bartels
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Malte Monin
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Marieta Toma
- Department of Pathology, University Hospital of Bonn, Bonn, Germany
| | - Georg Feldmann
- Department of Internal Medicine III, University Hospital of Bonn, Bonn, Germany
| | - Peter Brossart
- Department of Internal Medicine III, University Hospital of Bonn, Bonn, Germany
| | - Mümtaz Köksal
- Department of Radiation Oncology, University Hospital of Bonn, Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital of Bonn, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital of Bonn, Bonn, Germany
| | - Philipp Lingohr
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Azin Jafari
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Jörg C Kalff
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Christian P Strassburg
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Maria A Gonzalez-Carmona
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
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18
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Xie P, Wang S, He W, Yin M, Li C, Li Z, Li X, Ma Y, Yang G, Wu G. Sequential treatment of severe airway stenosis caused by esophageal cancer by using airway stent implantation and arterial infusion chemotherapy. Sci Rep 2022; 12:6918. [PMID: 35484182 PMCID: PMC9050643 DOI: 10.1038/s41598-022-10888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 03/30/2022] [Indexed: 11/11/2022] Open
Abstract
The purpose of this clinical study was to investigate the efficacy and safety of airway stent implantation and transarterial infusion chemotherapy in the sequential treatment of severe airway stenosis caused by esophageal cancer. Data of patients with advanced esophageal cancer complicated by severe airway stenosis treated with airway stent implantation and transarterial infusion chemotherapy were retrospectively analyzed. Furthermore, dyspnea, clinical efficacy, adverse reactions, and survival of patients were evaluated. 71 patients were included in this study. There were 28 patients with grade III dyspnea and 43 patients with grade IV dyspnea before airway stent implantation, and 34 patients with grade I dyspnea, 35 patients with grade II dyspnea and 2 patients with grade III dyspnea after airway stent implantation. After airway stent implantation and 1–3 courses of transarterial infusion chemotherapy, 11, 41 and 19 patients had complete response, partial response and stable response respectively. Total disease control rate (DCR) and objective response rate (ORR) were 100.0% and 73.2%, respectively. During the follow-up, 32 patients died of organ failure, 24 patients died of tumor-related respiratory failure, and 10 patients died of gastrointestinal bleeding. The median survival time of all patients was 8 months, and the 1-year survival rate was 40.8%. Airway stent implantation combined with arterial infusion chemotherapy is safe and effective for sequential treatment of esophageal cancer with severe airway stenosis.
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Affiliation(s)
- Pengfei Xie
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China
| | - Shuai Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China
| | - Wei He
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Meipan Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China
| | - Chunxia Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China
| | - Zhen Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China
| | - Xiaobing Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China
| | - Yaozhen Ma
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China
| | - Guang Yang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, No. 12, Jiankang Road, Shijiazhuang, 050000, Hebei, China
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China.
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Gürler F, İlhan A, Güven DC, Turhan O, Kurt İnci B, Sütçüoğlu O, Yildiz F, Arik Z, Öksüzoğlu B, Yalçin Ş, Özdemir N, Yazici O, Özet A. Does docetaxel matter in metastatic gastric cancer? FOLFOX versus FLOT regimens as first-line treatment. Anticancer Drugs 2022; 33:e477-e485. [PMID: 34261917 DOI: 10.1097/cad.0000000000001143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We aimed to compare the efficacy and the safety of the FOLFOX and the FLOT regimens in metastatic gastric cancer (mGC) as first-line treatment. It was a retrospective multicenter observational study. The comparisons between groups were conducted in terms of progression-free survival (PFS), overall survival (OS), objective response rate (ORR) and hematologic adverse events. Seventy-nine patients, diagnosed with mGC between March 2012 and December 2019, treated with FOLFOX (n = 43) or FLOT (n = 36) regimens as first-line treatment were included in the study. The mPFS was 10.9 months [95% confidence interval (CI), 5.8-16.1] in the FLOT arm and 7.1 months (95% CI, 5.1-9.1) in the FOLFOX arm (P < 0.001). The ORR was 63.9% in the FLOT arm and 30.2% in the FOLFOX arm (P = 0.003). The mOS was 13.3 months (95% CI, 11.3-15.4) in the FLOT arm and 10.9 months (95% CI, 8.2-13.5) in the FOLFOX arm (P = 0.103). The hematologic adverse events in all grades were 88.4% (n = 38) in the FOLFOX arm compared with 80.6% (n = 29) in the FLOT arm (P = 0.335). The FLOT regimen might be a preferred option in mGC with an improved PFS and ORR compared with the FOLFOX regimen.
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Affiliation(s)
| | - Ayşegül İlhan
- Department of Medical Oncology, HSU Dr Abdurrahman Yurtaslan Oncology Training & Research Hospital
| | - Deniz Can Güven
- Department of Medical Oncology, Hacettepe University Cancer Institute
| | - Okan Turhan
- Department of Internal Medicine, Gazi University, Ankara, Turkey
| | | | | | - Fatih Yildiz
- Department of Medical Oncology, HSU Dr Abdurrahman Yurtaslan Oncology Training & Research Hospital
| | - Zafer Arik
- Department of Medical Oncology, Hacettepe University Cancer Institute
| | - Berna Öksüzoğlu
- Department of Medical Oncology, HSU Dr Abdurrahman Yurtaslan Oncology Training & Research Hospital
| | - Şuayib Yalçin
- Department of Medical Oncology, Hacettepe University Cancer Institute
| | | | - Ozan Yazici
- Department of Medical Oncology, Gazi University
| | - Ahmet Özet
- Department of Medical Oncology, Gazi University
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20
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Moussa O, Bhogal RH, Malietzis G, Fribbens C, Starling N, Gerlinger M, Watkins D, Chau I, Rao S, Cunningham D, Allum WH, Chaudry A, Kumar S. OUP accepted manuscript. BJS Open 2022; 6:6534647. [PMID: 35195263 PMCID: PMC8864466 DOI: 10.1093/bjsopen/zrac003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Osama Moussa
- Division of Surgery & Cancer, Imperial College London, St Mary’s Hospital, London, UK
- Gastrointestinal Unit, The Royal Marsden Hospital, 203 Fulham Road, London, UK
| | - Ricky Harminder Bhogal
- Gastrointestinal Unit, The Royal Marsden Hospital, 203 Fulham Road, London, UK
- Upper GI Surgical Oncology Research Group, Division of Radiotherapy & Imaging, Institute of Cancer Research, London, UK
| | - George Malietzis
- Division of Surgery & Cancer, Imperial College London, St Mary’s Hospital, London, UK
- Gastrointestinal Unit, The Royal Marsden Hospital, 203 Fulham Road, London, UK
| | - Charlotte Fribbens
- Gastrointestinal Unit, The Royal Marsden Hospital, 203 Fulham Road, London, UK
| | - Naureen Starling
- Gastrointestinal Unit, The Royal Marsden Hospital, 203 Fulham Road, London, UK
| | - Marco Gerlinger
- Gastrointestinal Unit, The Royal Marsden Hospital, 203 Fulham Road, London, UK
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - David Watkins
- Gastrointestinal Unit, The Royal Marsden Hospital, 203 Fulham Road, London, UK
| | - Ian Chau
- Gastrointestinal Unit, The Royal Marsden Hospital, 203 Fulham Road, London, UK
| | - Sheela Rao
- Gastrointestinal Unit, The Royal Marsden Hospital, 203 Fulham Road, London, UK
| | - David Cunningham
- Gastrointestinal Unit, The Royal Marsden Hospital, 203 Fulham Road, London, UK
| | - William H. Allum
- Gastrointestinal Unit, The Royal Marsden Hospital, 203 Fulham Road, London, UK
| | - Asif Chaudry
- Gastrointestinal Unit, The Royal Marsden Hospital, 203 Fulham Road, London, UK
| | - Sacheen Kumar
- Gastrointestinal Unit, The Royal Marsden Hospital, 203 Fulham Road, London, UK
- Upper GI Surgical Oncology Research Group, Division of Radiotherapy & Imaging, Institute of Cancer Research, London, UK
- Correspondence to: Sacheen Kumar, The Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK (e-mail: )
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21
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Liu F, Wu Q, Han W, Laster K, Hu Y, Ma F, Chen H, Tian X, Qiao Y, Liu H, Kim DJ, Dong Z, Liu K. Targeting integrin αvβ3 with indomethacin inhibits patient-derived xenograft tumour growth and recurrence in oesophageal squamous cell carcinoma. Clin Transl Med 2021; 11:e548. [PMID: 34709754 PMCID: PMC8552524 DOI: 10.1002/ctm2.548] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE A high risk of post-operative recurrence contributes to the poor prognosis and low survival rate of oesophageal squamous cell carcinoma (ESCC) patients. Increasing experimental evidence suggests that integrin adhesion receptors, in particular integrin αv (ITGAV), are important for cancer cell survival, proliferation and migration. Therefore, targeting ITGAV may be a rational approach for preventing ESCC recurrence. MATERIALS AND METHODS Protein levels of ITGAV were determined in human ESCC tumour tissues using immunohistochemistry. MTT, propidium iodide staining, and annexin V staining were utilized to investigate cell viability, cell cycle progression, and induction of apoptosis, respectively. Computational docking was performed with the Schrödinger Suite software to visualize the interaction between indomethacin and ITGAV. Cell-derived xenograft mouse models, patient-derived xenograft (PDX) mouse models, and a humanized mouse model were employed for in vivo studies. RESULTS ITGAV was upregulated in human ESCC tumour tissues and increased ITGAV protein levels were associated with poor prognosis. ITGAV silencing or knockout suppressed ESCC cell growth and metastatic potential. Interestingly, we identified that indomethacin can bind to ITGAV and enhance synovial apoptosis inhibitor 1 (SYVN1)-mediated degradation of ITGAV. Integrin β3, one of the β subunits of ITGAV, was also decreased at the protein level in the indomethacin treatment group. Importantly, indomethacin treatment suppressed ESCC tumour growth and prevented recurrence in a PDX mouse model. Moreover, indomethacin inhibited the activation of cytokine TGFβ, reduced SMAD2/3 phosphorylation, and increased anti-tumour immune responses in a humanized mouse model. CONCLUSION ITGAV is a promising therapeutic target for ESCC. Indomethacin can attenuate ESCC growth through binding to ITGAV, promoting SYVN1-mediated ubiquitination of ITGAV, and potentiating cytotoxic CD8+ T cell responses.
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Affiliation(s)
- Fangfang Liu
- Department of PathophysiologySchool of Basic Medical SciencesChina‐US (Henan) Hormel Cancer InstituteAMS, College of MedicineZhengzhou UniversityZhengzhouChina
- China‐US (Henan) Hormel Cancer InstituteZhengzhouChina
| | - Qiong Wu
- Department of PathophysiologySchool of Basic Medical SciencesChina‐US (Henan) Hormel Cancer InstituteAMS, College of MedicineZhengzhou UniversityZhengzhouChina
- China‐US (Henan) Hormel Cancer InstituteZhengzhouChina
| | - Wei Han
- China‐US (Henan) Hormel Cancer InstituteZhengzhouChina
| | - Kyle Laster
- China‐US (Henan) Hormel Cancer InstituteZhengzhouChina
| | - Yamei Hu
- Department of PathophysiologySchool of Basic Medical SciencesChina‐US (Henan) Hormel Cancer InstituteAMS, College of MedicineZhengzhou UniversityZhengzhouChina
- China‐US (Henan) Hormel Cancer InstituteZhengzhouChina
| | - Fayang Ma
- Department of PathophysiologySchool of Basic Medical SciencesChina‐US (Henan) Hormel Cancer InstituteAMS, College of MedicineZhengzhou UniversityZhengzhouChina
- China‐US (Henan) Hormel Cancer InstituteZhengzhouChina
| | - Hanyong Chen
- Hormel InstituteUniversity of MinnesotaAustinMinnesotaUSA
| | - Xueli Tian
- Department of PathophysiologySchool of Basic Medical SciencesChina‐US (Henan) Hormel Cancer InstituteAMS, College of MedicineZhengzhou UniversityZhengzhouChina
- China‐US (Henan) Hormel Cancer InstituteZhengzhouChina
| | - Yan Qiao
- Department of PathophysiologySchool of Basic Medical SciencesChina‐US (Henan) Hormel Cancer InstituteAMS, College of MedicineZhengzhou UniversityZhengzhouChina
| | - Hui Liu
- China‐US (Henan) Hormel Cancer InstituteZhengzhouChina
| | - Dong Joon Kim
- China‐US (Henan) Hormel Cancer InstituteZhengzhouChina
| | - Zigang Dong
- Department of PathophysiologySchool of Basic Medical SciencesChina‐US (Henan) Hormel Cancer InstituteAMS, College of MedicineZhengzhou UniversityZhengzhouChina
- China‐US (Henan) Hormel Cancer InstituteZhengzhouChina
- State Key Laboratory of Esophageal Cancer Prevention and TreatmentZhengzhouChina
- Provincial Cooperative Innovation Center for Cancer ChemopreventionZhengzhou UniversityZhengzhouChina
- Cancer Chemoprevention International Collaboration LaboratoryZhengzhouChina
| | - Kangdong Liu
- Department of PathophysiologySchool of Basic Medical SciencesChina‐US (Henan) Hormel Cancer InstituteAMS, College of MedicineZhengzhou UniversityZhengzhouChina
- China‐US (Henan) Hormel Cancer InstituteZhengzhouChina
- State Key Laboratory of Esophageal Cancer Prevention and TreatmentZhengzhouChina
- Provincial Cooperative Innovation Center for Cancer ChemopreventionZhengzhou UniversityZhengzhouChina
- Cancer Chemoprevention International Collaboration LaboratoryZhengzhouChina
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22
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Yamashita K, Hosoda K, Niihara M, Hiki N. History and emerging trends in chemotherapy for gastric cancer. Ann Gastroenterol Surg 2021; 5:446-456. [PMID: 34337293 PMCID: PMC8316740 DOI: 10.1002/ags3.12439] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/29/2020] [Accepted: 01/15/2021] [Indexed: 12/24/2022] Open
Abstract
Chemotherapy is indispensable for gastric cancer. For unresectable and/or recurrent gastric cancer, first-line chemotherapy consists of multidrug regimens including oral 5-FU agents such as S1/Xeloda and platinum preparations, as well as Trastuzumab, which is effective in HER2-positive cases. Second- and third-line chemotherapy regimens include taxanes, Ramucirumab (R-mab), and Nivolumab (N-mab), which have different mechanisms of action from first-line chemotherapy. R-mab is molecularly targeted to vascular endothelial growth factor receptor 2 in the host cells, but its indication is not conditional. For resectable gastric cancer, in Eastern countries, postoperative adjuvant chemotherapy has been successful, including S1, Docetaxel/S1 (DS), and Xeloda/Oxaliplatin (Xelox) regimens, whereas, in Western countries, the 5-FU/Leucovorin/Oxaliplatin/Docetaxel (FLOT) regimen was recently shown to be effective in the perioperative chemotherapy setting. Most recently, however, in Eastern countries, perioperative SOX was demonstrated to be effective in specific advanced gastric cancer. For stage IV gastric cancer, new therapeutic strategies have been proposed such as neoadjuvant chemotherapy and conversion surgery, and cures can be conditionally obtained. Recent genomic understanding of gastric cancer proposed a diversity of molecular targets by molecular profiling. Such optimized chemotherapy regimens, according to the specific clinical situations, have been rigorously established for the best survival of advanced gastric cancer.
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Affiliation(s)
- Keishi Yamashita
- Division of Advanced Surgical Oncology, Research and Development Center for New Medical FrontiersKitasato University School of MedicineSagamiharaJapan
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Kei Hosoda
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Masahiro Niihara
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Naoki Hiki
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
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23
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Abstract
Gastric cancer represents a major global health problem. Approximately half of patients are diagnosed with early stage disease and surgical resection is potentially curative. The addition of combination chemotherapy, with or without radiotherapy, to surgery has been shown to improve outcomes. In metastatic disease, combination chemotherapy in the form of 2- or 3-drug regimens has been used. The aim of this chapter is to summarize currently approved systemic treatment options for gastric cancer and to highlight several promising treatments currently under investigation.
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Affiliation(s)
- Andrew Hsu
- The Warren Alpert Medical School of Brown University, Lifespan Cancer Institute, Rhode Island Hospital/The Miriam Hospital, 164 Summit Avenue, Fain Building, Third Floor, Providence, RI 02906, USA
| | - Alexander G Raufi
- The Warren Alpert Medical School of Brown University, Lifespan Cancer Institute, Rhode Island Hospital/The Miriam Hospital, 164 Summit Avenue, Fain Building, Third Floor, Providence, RI 02906, USA.
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24
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Joshi A, Noronha V, Pandey A, Patil V, Samar A, Mahajan A, Janu A, Prabhash K. Outcomes with Palliative Weekly Paclitaxel in Advanced, Recurrent, and Metastatic Esophageal Cancer - Real World Experience. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_39_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Abstract
Background: In advanced esophageal cancer, combination chemotherapy regimens provide effective palliation but result in substantial toxicity. Aim: The aim of the study was to evaluate outcomes of recurrent and metastatic esophageal carcinoma treated with weekly paclitaxel. Objectives: The objective of the study was to determine the clinical and laboratory factors predicting response and affecting overall survival (OS) in patients receiving palliative chemotherapy for advanced esophageal/gastroesophageal cancer. Materials and Methods: Retrospective analysis of patients with advanced esophageal cancer, not amenable to definitive intent therapy that was treated with intravenous weekly paclitaxel was done. Progression-free survival (PFS) and OS were calculated with Kaplan–Meir analysis while factors affecting outcome were subjected to log rank test and multivariate analysis. Results: Between September 2010 and October 2014, 350 patients were included in analysis. Median follow-up is 8 months. Median age was 55 years, with a male:female ratio of 2.4:1. Nearly 34.5% were mid esophageal and 51% were lower third and gastroesophageal junction tumors. Almost 58% of the tumors had squamous histology. Performance status was >2 in 25.4%. Almost 62% patients had received prior therapy. Median number of cycles of weekly paclitaxel delivered was 12 with median duration of 3 months. Nearly 51% of patients had improvement in dysphagia, with time to symptom improvement of 20 days. In 31% patients, feeding nasogastric tube could be removed. Overall response rate was 32% (complete remission, 2.5% + partial remission, 29.5%). Median PFS was 4.0 months (95% confidence interval [CI]: 3.6–4.3 months) and median OS was 10 months (95% CI: 8.5–11.4 months). Performance status and pretreatment albumin significantly affected OS. Conclusion: Metronomic weekly paclitaxel chemotherapy provides good palliative benefit in advanced unresectable/metastatic esophageal cancer with minimal toxicity. Eastern Cooperative Oncology Group Performance Status (PS 0 and 1) and baseline serum albumin level >3.7 g/dl significantly improved survival.
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Affiliation(s)
- Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Avinash Pandey
- Department of Medical Oncology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Aseem Samar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhishek Mahajan
- Department of Radio-Diagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amit Janu
- Department of Radio-Diagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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25
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Grojean M, Schwarz MA, Schwarz JR, Hassan S, von Holzen U, Zhang C, Schwarz RE, Awasthi N. Targeted dual inhibition of c-Met/VEGFR2 signalling by foretinib improves antitumour effects of nanoparticle paclitaxel in gastric cancer models. J Cell Mol Med 2021; 25:4950-4961. [PMID: 33939252 PMCID: PMC8178268 DOI: 10.1111/jcmm.16362] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/16/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022] Open
Abstract
Elevated expression of multiple growth factors and receptors including c‐Met and VEGFR has been reported in gastric adenocarcinoma (GAC) and thus provides a potentially useful therapeutic target. The therapeutic efficacy of foretinib, a c‐Met/VEGFR2 inhibitor, was determined in combination with nanoparticle paclitaxel (NPT) in GAC. Animal studies were conducted in NOD/SCID mice in subcutaneous and peritoneal dissemination xenografts. The mechanism of action was assessed by Immunohistochemical and Immunoblot analyses. In c‐Met overexpressing MKN‐45 cell‐derived xenografts, NPT and foretinib demonstrated inhibition in tumour growth, while NPT plus foretinib showed additive effects. In c‐Met low‐expressing SNU‐1 or patient‐derived xenografts, the foretinib effect was smaller, while NPT had a similar effect compared with MKN‐45, as NPT plus foretinib still exhibited an additive response. Median mice survival was markedly improved by NPT (83%), foretinib (100%) and NPT plus foretinib (230%) in peritoneal dissemination xenografts. Subcutaneous tumour analyses exhibited that foretinib increased cancer cell death and decreased cancer cell proliferation and tumour vasculature. NPT and foretinib suppressed the proliferation of GAC cells in vitro and had additive effects in combination. Further, foretinib caused a dramatic decrease in phosphorylated forms of c‐Met, ERK, AKT and p38. Foretinib led to a decrease in Bcl‐2, and an increase in p27, Bax, Bim, cleaved PARP‐1 and cleaved caspase‐3. Thus, these findings highlight the antitumour impact of simultaneous suppression of c‐Met and VEGFR2 signalling in GAC and its potential to enhance nanoparticle paclitaxel response. This therapeutic approach might lead to a clinically beneficial combination to increase GAC patients’ survival.
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Affiliation(s)
- Meghan Grojean
- Department of Surgery, Indiana University School of Medicine, South Bend, IN, USA
| | - Margaret A Schwarz
- Department of Pediatrics, Indiana University School of Medicine, South Bend, IN, USA.,Harper Cancer Research Institute, University of Notre Dame, South Bend, IN, USA
| | - Johann R Schwarz
- Department of Surgery, Indiana University School of Medicine, South Bend, IN, USA
| | - Sazzad Hassan
- Department of Surgery, Indiana University School of Medicine, South Bend, IN, USA.,Harper Cancer Research Institute, University of Notre Dame, South Bend, IN, USA
| | - Urs von Holzen
- Department of Surgery, Indiana University School of Medicine, South Bend, IN, USA.,Harper Cancer Research Institute, University of Notre Dame, South Bend, IN, USA.,Goshen Center for Cancer Care, Goshen, IN, USA.,University of Basel, Basel, Switzerland
| | - Changhua Zhang
- Department of Gastrointestinal Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Roderich E Schwarz
- Department of Surgery, Indiana University School of Medicine, South Bend, IN, USA.,Harper Cancer Research Institute, University of Notre Dame, South Bend, IN, USA.,Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.,University of Buffalo, Buffalo, NY, USA
| | - Niranjan Awasthi
- Department of Surgery, Indiana University School of Medicine, South Bend, IN, USA.,Harper Cancer Research Institute, University of Notre Dame, South Bend, IN, USA
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26
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Mamdani H, Jalal SI. Where to Start and What to Do Next: The Sequencing of Treatments in Metastatic Esophagogastric Cancer. Am Soc Clin Oncol Educ Book 2021; 41:1-16. [PMID: 33770461 DOI: 10.1200/edbk_321243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Esophagogastric cancer is associated with rising incidence and high mortality. Nearly 40% of patients have metastatic disease at the time of diagnosis with poor 5-year overall survival. The treatment of squamous cell carcinoma of the esophagus and gastroesophageal adenocarcinoma has started to bifurcate in recent years, owing to the evolving understanding of the biologic and genomic characteristics of these tumors. Incorporation of HER2-directed therapy in the form of monoclonal antibody and antibody-drug conjugate is now standard of care for patients with HER2-positive disease. The addition of immune checkpoint inhibitors to the therapeutic landscape of metastatic esophagogastric cancer is associated with modest improvement in overall survival, and definition of predictive biomarkers of response to checkpoint inhibition remains imprecise. A number of therapeutic targets including FGFR2b, Claudin 18.2, DKK-1, and DNA repair defects are being explored in clinical trials. Similarly, combination immunotherapy and novel HER2-targeting agents, such as bispecific antibody and small-molecule inhibitors, are at various stages of clinical development. Despite the progress made in the field of targeted therapies and checkpoint inhibition, chemotherapy remains an integral part of treatment of metastatic esophagogastric cancer but is associated with considerable toxicity. Clinical trials focusing on minimizing toxicity of currently available therapeutic agents, development of novel biomarker-driven treatment strategies, and overcoming resistance to immune checkpoint inhibition will define the future of this traditionally indelible disease.
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Affiliation(s)
- Hirva Mamdani
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Shadia I Jalal
- Department of Internal Medicine, Division of Hematology/Oncology, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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27
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Demarest CT, Chang AC. The Landmark Series: Multimodal Therapy for Esophageal Cancer. Ann Surg Oncol 2021; 28:3375-3382. [PMID: 33629251 DOI: 10.1245/s10434-020-09565-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 12/18/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Esophagectomy is the mainstay of treatment for patients with resectable esophageal cancer, and chemotherapy and chemoradiation have become essential adjuncts to improve survival. Controversy remains regarding the optimal perioperative therapy. METHODS This review focuses on three landmark, randomized, controlled trials that have greatly influenced esophageal cancer management and established chemotherapy and chemoradiotherapy as standard of care: Medical Research Council Adjuvant Gastric Infusional Chemotherapy Trial (MAGIC); The United Kingdom Medical Research Council Esophageal Cancer Trial (OEO2); and Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS). RESULTS The findings from these landmark studies are reviewed and summarized. CONCLUSION Chemotherapy regimens are heterogeneous but centered around platinum-based therapy and should be included in the management for all appropriate patients. Ongoing and future studies will further delineate the roles of various chemo- and chemoradiotherapy regimens and also will investigate the promising area of immunotherapy in the treatment of esophageal cancer.
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Affiliation(s)
- Caitlin T Demarest
- Section of Thoracic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Andrew C Chang
- Section of Thoracic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA.
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28
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Shrestha R, Tripathi R, Goyal P, Agarwal C, Gupta M, Mehta A, Doval DC. Long-Term Survival in an Esophageal Cancer Patient with Multiple Recurrences. J Gastrointest Cancer 2021; 51:695-697. [PMID: 31989443 DOI: 10.1007/s12029-020-00366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rakshya Shrestha
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Sector-5, Rohini, Delhi, India
| | - Rupal Tripathi
- Department of Research, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Pankaj Goyal
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Sector-5, Rohini, Delhi, India
| | - Chaturbhuj Agarwal
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Sector-5, Rohini, Delhi, India
| | - Manoj Gupta
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Anurag Mehta
- Department of Pathology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Dinesh Chandra Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Sector-5, Rohini, Delhi, India.
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29
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Rivera F, Izquierdo-Manuel M, García-Alfonso P, Martínez de Castro E, Gallego J, Limón ML, Alsina M, López L, Galán M, Falcó E, Manzano JL, González E, Muñoz-Unceta N, López C, Aranda E, Fernández E, Jorge M, Jiménez-Fonseca P. Perioperative trastuzumab, capecitabine and oxaliplatin in patients with HER2-positive resectable gastric or gastro-oesophageal junction adenocarcinoma: NEOHX phase II trial. Eur J Cancer 2021; 145:158-167. [PMID: 33485079 DOI: 10.1016/j.ejca.2020.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Perioperative chemotherapy improves overall survival (OS) and disease-free survival (DFS) compared with surgery alone in patients with resectable gastric adenocarcinoma (GA) or gastro-oesophageal junction adenocarcinoma (GEJA). The addition of trastuzumab to chemotherapy improves outcomes in patients with HER2-positive advanced gastric cancer (GC), and we aimed to explore its role in the perioperative setting. MATERIAL AND METHODS This Spanish, multicentre, open-label phase II trial evaluated the efficacy and toxicity of perioperative capecitabine, oxaliplatin and trastuzumab (XELOX-T) in patients with HER2-positive resectable GA or GEJA. The primary end-point was 18-months DFS; and secondary end-points included pathological complete response (pCR) rate, R0 resection rate, OS and toxicity (NCT01130337). RESULTS Thirty-six patients were included. After three cycles of preoperative treatment, 14 patients (38% of the intention-to-treat population) had partial response and 18 (50%) had stable disease. Surgery was performed in 31 patients: 28 (90%) had R0 resection, three (9.6%) had a pCR and three (9.6%) died due to surgical complications. A total of 24 patients received post-operative XELOX-T, 22 of whom completed trastuzumab maintenance. Main grade III/IV toxicities included diarrhoea (33%), nausea and vomiting (8%). After a median follow-up of 24.1 months, 18-month DFS was 71% (95% confidence interval [CI], 53-83%); and an update after 102 months of follow-up showed a median OS of 79.9 months and a 60-month OS of 58% (95% CI, 40-73%). CONCLUSIONS These data suggest that perioperative XELOX-T in patients with HER2-positive GA and GEJA is feasible and active. Further investigation in randomised studies is warranted.
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Affiliation(s)
- Fernando Rivera
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
| | | | - Pilar García-Alfonso
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Eva Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
| | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain.
| | - María Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - María Alsina
- Medical Oncology Department, Hospital Universitari Vall d'Hebron and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
| | - Luis López
- Medical Oncology Department, Hospital Universitario Virgen de la Salud, Toledo, Spain.
| | - Maica Galán
- Medical Oncology Department, Institut Catala d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Esther Falcó
- Medical Oncology Department, Hospital Universitario Sont Llatzer, Palma de Mallorca, Spain.
| | - José Luis Manzano
- Medical Oncology Department, Institut Catala d'Oncologia (ICO), Hospital Universitario Germans Trias i Pujol, Badalona, Spain.
| | - Encarna González
- Medical Oncology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - Nerea Muñoz-Unceta
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
| | - Carlos López
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
| | - Enrique Aranda
- Medical Oncology Department, Hospital Universitario Reina Sofía, IMIBIC, UCO, Córdoba, Spain.
| | - Eva Fernández
- Medical Oncology Department, Hospital Universitario de Valme, Sevilla, Spain.
| | - Mónica Jorge
- Medical Oncology Department, Hospital Xeral Cies, Vigo, Spain.
| | - Paula Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
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Babu KG, Chaudhuri T, Lakshmaiah KC, Dasappa L, Jacob LA, Suresh Babu MC, Rudresha AH, Lokesh KN, Rajeev LK. Modified Epirubicin, cisplatin, and 5-FU regimen as first-line chemotherapy in metastatic gastric or gastroesophageal junction adenocarcinoma: A Phase II study. South Asian J Cancer 2020; 8:85-87. [PMID: 31069184 PMCID: PMC6498711 DOI: 10.4103/sajc.sajc_146_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Epirubicin, cisplatin, and 5-FU (ECF) is one of the most commonly used first-line chemotherapy regimens in metastatic gastric cancer. However, due to protracted infusion schedule, need for special infusion pumps, and catheter-related complications, the practical utility and acceptability of standard ECF regimen are limited, particularly in resource-constrained settings including India. Materials and Methods In the present study, we have used a more convenient modification of the standard ECF protocol (using 5 days intravenous infusion of 5-FU at a dose of 750 mg/m2/day, given over 6 h through a peripheral venous line), in Indian patients with metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma. The primary endpoint was overall survival (OS). The secondary endpoints were overall response rate (ORR), progression-free survival (PFS), and toxicity profile. Results Between January 2014 and December 2017, 107 patients were assigned and treated with this modified ECF regimen. The median age was 52 years (range, 34-62); 66.3% were males and 36.5% of the patients had ≥ 3 metastatic disease site involvement at baseline. Dose reductions due to toxicity were required in 14.9% of the patients. The ORR was 32.7%; median PFS and OS were 5.9 months (95% confidence interval [CI]: 4.7-6.9) and 10.4 months (95% CI: 8.4-11.8), respectively. Both the hematological and nonhematological toxicities were manageable, and there was no toxicity-related death. The most frequent Grade 3-4 adverse events were neutropenia (18.7%), febrile neutropenia (13.1%), mucositis (5.6%), and diarrhea (5.6%). Conclusions In the present study, the modified ECF regimen demonstrated significant efficacy with an acceptable toxicity profile in Indian patients with metastatic gastric and GEJ adenocarcinoma. The survival outcomes of this modified schedule were comparable with those of the standard ECF regimen, as reported earlier. Clearly, this modified and more convenient ECF protocol should be explored and validated through large prospective randomized trials.
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Affiliation(s)
- K Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Tamojit Chaudhuri
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - K C Lakshmaiah
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Lokanatha Dasappa
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Linu Abraham Jacob
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - M C Suresh Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - A H Rudresha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - K N Lokesh
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - L K Rajeev
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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Sexton RE, Al Hallak MN, Diab M, Azmi AS. Gastric cancer: a comprehensive review of current and future treatment strategies. Cancer Metastasis Rev 2020; 39:1179-1203. [PMID: 32894370 PMCID: PMC7680370 DOI: 10.1007/s10555-020-09925-3] [Citation(s) in RCA: 318] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
Gastric cancer remains a major unmet clinical problem with over 1 million new cases worldwide. It is the fourth most commonly occurring cancer in men and the seventh most commonly occurring cancer in women. A major fraction of gastric cancer has been linked to variety of pathogenic infections including but not limited to Helicobacter pylori (H. pylori) or Epstein Barr virus (EBV). Strategies are being pursued to prevent gastric cancer development such as H. pylori eradication, which has helped to prevent significant proportion of gastric cancer. Today, treatments have helped to manage this disease and the 5-year survival for stage IA and IB tumors treated with surgery are between 60 and 80%. However, patients with stage III tumors undergoing surgery have a dismal 5-year survival rate between 18 and 50% depending on the dataset. These figures indicate the need for more effective molecularly driven treatment strategies. This review discusses the molecular profile of gastric tumors, the success, and challenges with available therapeutic targets along with newer biomarkers and emerging targets.
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Affiliation(s)
- Rachel E Sexton
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R, HWCRC 732, Detroit, MI, 48201, USA
| | - Mohammed Najeeb Al Hallak
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R, HWCRC 732, Detroit, MI, 48201, USA
| | - Maria Diab
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R, HWCRC 732, Detroit, MI, 48201, USA
| | - Asfar S Azmi
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R, HWCRC 732, Detroit, MI, 48201, USA.
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32
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Peixoto RD, Rocha-Filho DR, Weschenfelder RF, Rego JFM, Riechelmann R, Coutinho AK, Fernandes GS, Jacome AA, Andrade AC, Murad AM, Mello CAL, Miguel DSCG, Gomes DBD, Racy DJ, Moraes ED, Akaishi EH, Carvalho ES, Mello ES, Filho FM, Coimbra FJF, Capareli FC, Arruda FF, Vieira FMAC, Takeda FR, Cotti GCC, Pereira GLS, Paulo GA, Ribeiro HSC, Lourenco LG, Crosara M, Toneto MG, Oliveira MB, de Lourdes Oliveira M, Begnami MD, Forones NM, Yagi O, Ashton-Prolla P, Aguillar PB, Amaral PCG, Hoff PM, Araujo RLC, Filho RPDP, Gansl RC, Gil RA, Pfiffer TEF, Souza T, Jr. UR, Jesus VHF, Jr WLC, Prolla G. Brazilian Group of Gastrointestinal Tumours' consensus guidelines for the management of gastric cancer. Ecancermedicalscience 2020; 14:1126. [PMID: 33209117 PMCID: PMC7652540 DOI: 10.3332/ecancer.2020.1126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Indexed: 12/23/2022] Open
Abstract
Gastric cancer is among the ten most common types of cancer worldwide. Most cases and deaths related to the disease occur in developing countries. Local socio-economic, epidemiologic and healthcare particularities led us to create a Brazilian guideline for the management of gastric carcinomas. The Brazilian Group of Gastrointestinal Tumors (GTG) invited 50 physicians with different backgrounds, including radiology, pathology, endoscopy, nuclear medicine, genetics, oncological surgery, radiotherapy and clinical oncology, to collaborate. This document was prepared based on an extensive review of topics related to heredity, diagnosis, staging, pathology, endoscopy, surgery, radiation, systemic therapy and follow-up, which was followed by presentation, discussion, and voting by the panel members. It provides updated evidence-based recommendations to guide clinical management of gastric carcinomas in several scenarios and clinical settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Diogo B D Gomes
- Hospital Israelita Albert Einstein, São Paulo. Brazil, 05652- 900
| | - Douglas J Racy
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil, 01323-001
| | | | - Eduardo H Akaishi
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | | | - Evandro S Mello
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | - Fauze Maluf Filho
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | | | | | | | | | - Flavio R Takeda
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | | | | | - Gustavo A Paulo
- Universidade Federal de São Paulo, São Paulo, Brazil, 04040-003
| | | | | | | | | | - Marcos B Oliveira
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Sâo Paulo, Brazil, 01238-010
| | | | | | - Nora M Forones
- Universidade Federal de São Paulo, São Paulo, Brazil, 04040-003
| | - Osmar Yagi
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | | | | | | | | | | | | | | | | | | | - Tulio Souza
- Hospital Aliança de Salvador, Salvador, Brazil, 41920-900
| | - Ulysses Ribeiro Jr.
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
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Epistola RJ, Chao J. Systemic therapy for advanced gastroesophageal cancers: progress and pitfalls. Transl Gastroenterol Hepatol 2020; 5:53. [PMID: 33073048 PMCID: PMC7530312 DOI: 10.21037/tgh.2020.01.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/15/2020] [Indexed: 01/05/2023] Open
Abstract
Advanced gastroesophageal cancer in which surgical resection is no longer appropriate is an aggressive malignancy with poor prognosis. This review provides an overview of the key trials that have led to the current standard of care, both highlighting progress with systemic cytotoxic and biological therapies, but also calling attention to pitfalls to assist practitioners in optimizing currently available treatments for their patients. This review surveys recent and ongoing trials and biomarker studies regarding the use of anti-HER2 agents, with increased recognition of molecular intratumoral heterogeneity confounding such targeted therapy strategies. We conclude with an overview of recent major trials incorporating immune checkpoint inhibitors among patients with metastatic and locally advanced gastroesophageal cancer and providing a framework for the discriminate application of these new therapies.
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Affiliation(s)
- Raisa J. Epistola
- Department of Internal Medicine, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Joseph Chao
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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Hsu A, Zayac AS, Eturi A, Almhanna K. Treatment for metastatic adenocarcinoma of the stomach and gastroesophageal junction: 2020. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1109. [PMID: 33145328 PMCID: PMC7575962 DOI: 10.21037/atm-20-1159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Gastric and gastroesophageal junction (GEJ) cancer is one of the most common malignancy worldwide. In unresectable or metastatic disease, the prognosis is poor and is generally less than a year. Standard front-line chemotherapy includes two- or three-drug regimens with the addition of trastuzumab in HER2-positive disease. With an increased understanding of the biology of cancer over the past few decades, targeted therapies have made their way into the treatment paradigm of many cancers. They been examined in the first- and second-line settings in the treatment of gastroesophageal cancer though has yielded few viable treatment options. One success is ramucirumab either as monotherapy or in combination with paclitaxel is the preferred choice in second-line therapy. While immunotherapy has been considered a breakthrough in oncology over the past decade, the response rates in gastric and gastroesophageal cancers have been relatively low compared to other cancers, resulting in its limited approval and mostly reserved for second-line therapy or beyond. In this article, we will review the standard first- and second-line treatment regimens. Furthermore, this article will review the use of targeted therapies and immunotherapy in treatment of gastric and gastroesophageal cancers. Lastly, we will touch upon future treatment strategies that are currently under investigation.
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Affiliation(s)
- Andrew Hsu
- Division of Hematology/Oncology, The Warren Alpert Medical School of Brown University, Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI, USA
| | - Adam S Zayac
- Division of Hematology/Oncology, The Warren Alpert Medical School of Brown University, Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI, USA
| | - Aditya Eturi
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Khaldoun Almhanna
- Division of Hematology/Oncology, The Warren Alpert Medical School of Brown University, Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI, USA
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35
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Management of cisplatin-associated toxicities in bladder cancer patients. Curr Opin Support Palliat Care 2020; 14:286-292. [PMID: 32740273 DOI: 10.1097/spc.0000000000000505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Cisplatin remains the treatment cornerstone for bladder cancer, either in neoadjuvant or in metastatic (cisplatin-gemcitabine or dose-dense methotrexate, vinblastine, and doxorubicin). Timely and adequate management of cisplatin's adverse events is important in order to avoid dose reductions, treatment delays, or cessation. Over the last years, several randomized studies and updated guidelines have been published on this subject. RECENT FINDINGS The incidence, physiopathology, risk factors, preventive treatment, and optimal management of such complications will be presented, with special focus on cisplatin-associated nausea and vomiting, acute kidney injury (AKI), hypomagnesemia, neurotoxicity, and ototoxicity. SUMMARY Optimal prevention of cisplatin-associated nausea and vomiting requires an aggressive approach with the use of a four-drug prophylactic regimen (NK1 receptor antagonist, 5-HT3 receptor antagonist, dexamethasone, olanzapine). The use of intensive hydration before and after cisplatin infusion has been the mainstay of AKI prevention. The management of hypomagnesemia and neurotoxicity remains largely symptomatic. In an adult population, no therapy has yet demonstrated benefits in the prevention or treatment of platinum-related ototoxicity.
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Yamada Y. Present status and perspective of chemotherapy for patients with unresectable advanced or metastatic gastric cancer in Japan. Glob Health Med 2020; 2:156-163. [PMID: 33330800 PMCID: PMC7731092 DOI: 10.35772/ghm.2019.01025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 03/28/2020] [Accepted: 04/10/2020] [Indexed: 05/01/2023]
Abstract
Patients with unresectable advanced or recurrent gastric cancer have a poor prognosis with overall survival times increasing by only a few months after anti-cancer drug therapy in the last four decades. The survival times from previous clinical trials for untreated metastatic gastric cancer in Japan are generally better than those reported from trials in European and North or South American countries. Therefore, the proportion of Japanese patients enrolled in recent global trials of novel anti-cancer drugs should be increased in order to identify drugs that specifically prolong the survival of such patients. S-1 plus oxaliplatin (SOX) therapy is the most commonly used standard first-line treatment for advanced gastric cancer in Japan. SOX induces mild nausea and vomiting, even in elderly patients, that can be treated by maintaining oral intake with adequate anti-emetic treatment usually given in an outpatient clinic. Neutropenia, nausea, and vomiting in SOX therapy were more frequently observed in female patients compared with males. Intensive toxic chemotherapy such as triplet therapy never prolonged overall survival or maintained a favorable quality of life. The current strategies used against metastatic gastric cancer need to be modified in regard to innovative treatments with current drugs, keeping in mind each categorized treatment population. In a real world of a diverse society even if the same treatment is performed, the outcome of the individual patient is different. It is important for each society to implement established treatment, knowing that the evidence from global trials aimed at drug approval does not necessarily show external validity.
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Affiliation(s)
- Yasuhide Yamada
- Address correspondence to:Yasuhide Yamada, Comprehensive Cancer Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. E-mail:
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Wang XZ, Zeng ZY, Ye X, Sun J, Zhang ZM, Kang WM. Interpretation of the development of neoadjuvant therapy for gastric cancer based on the vicissitudes of the NCCN guidelines. World J Gastrointest Oncol 2020; 12:37-53. [PMID: 31966912 PMCID: PMC6960069 DOI: 10.4251/wjgo.v12.i1.37] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/09/2019] [Accepted: 09/26/2019] [Indexed: 02/05/2023] Open
Abstract
Gastric cancer is one of the most common digestive system tumors in China, and locally advanced gastric cancer (LAGC) accounts for a high proportion of newly diagnosed cases. Although surgery is the main treatment for gastric cancer, surgical excision alone cannot achieve satisfactory outcomes in LAGC patients. Neoadjuvant therapy (NAT) has gradually become the standard treatment for patients with LAGC, and this treatment can not only achieve tumor downstaging and improve surgical rate and the R0 resection rate, but it also significantly improves the long-term prognosis of patients. Peri/preoperative neoadjuvant chemotherapy and preoperative chemoradiotherapy are both recommended according to a large number of studies, and the regimens have also been evolved in the past decades. Since the NCCN guidelines for gastric cancer are one of the most authoritative evidence-based guidelines worldwide, here, we demonstrate the development course and major breakthroughs of NAT for gastric cancer based on the vicissitudes of the NCCN guidelines from 2007 to 2019, and also discuss the future of NAT.
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Affiliation(s)
- Xian-Ze Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Zi-Yang Zeng
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Juan Sun
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Zi-Mu Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Wei-Ming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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Mehta R, Kommalapati A, Kim RD. The Impact of Ramucirumab Treatment on Survival and Quality of Life in Patients with Gastric Cancer. Cancer Manag Res 2020; 12:51-57. [PMID: 32021422 PMCID: PMC6954857 DOI: 10.2147/cmar.s199827] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/17/2019] [Indexed: 01/26/2023] Open
Abstract
Gastric cancer is the sixth most common cancer and is known to be the fifth-leading cause of cancer-related deaths globally in 2018. Systemic therapy remains the only curative option in advanced gastric carcinoma with the primary goal of improving the Health-related Quality of Life (HRQoL) (including palliation of symptoms such as dysphagia) and prolonging overall survival. Recently, ramucirumab is approved by the United States Food and Drug Administration (US-FDA) as a second-line agent either as monotherapy or in combination with paclitaxel in advanced or metastatic gastric and gastro-esophageal junction adenocarcinoma patients who have progressed on prior treatment with fluoropyrimidine or platinum containing chemotherapy. HRQoL is a subjective term that typically constitutes four components - psychological, social, occupational and physical well being. This has been evaluated as secondary endpoint in the pivotal Phase III trials with ramucirumab. HRQoL measurement can potentially provide additional information for clinical decision making beyond that of traditional medical outcomes. The present work is primarily focused on discussing HRQoL in gastric cancer patients and the impact of ramucirumab on the HRQoL in the patients with advanced gastric cancer. We also summarized the studies that evaluated the benefits of systemic therapies on HRQoL in advanced gastric cancer.
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Affiliation(s)
- Rutika Mehta
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Anuhya Kommalapati
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Richard D Kim
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
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Davidson M, Wagner AD, Kouvelakis K, Nanji H, Starling N, Chau I, Watkins D, Rao S, Peckitt C, Cunningham D. Influence of sex on chemotherapy efficacy and toxicity in oesophagogastric cancer: A pooled analysis of four randomised trials. Eur J Cancer 2019; 121:40-47. [PMID: 31542640 DOI: 10.1016/j.ejca.2019.08.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/23/2019] [Accepted: 08/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sex contributes to interpatient variability of chemotherapy metabolism and dose response, potentially influencing both efficacy and toxicity; however, comparative data on its effect on oesophagogastric cancer are lacking. PATIENTS AND METHODS Data for patients with advanced oesophagogastric cancer randomised to comparable first-line chemotherapy regimens within four United Kingdom prospective trials were pooled, and key demographic and outcome measures were compared between males and females. RESULTS A total of 1654 patients were included: 1328 (80.3%) males and 326 (19.7%) females. Female patients were younger, had a significantly higher proportion of gastric tumours as opposed to junctional or oesophageal tumours and experienced significantly higher rates of a number of toxicities including nausea and vomiting, diarrhoea, stomatitis and alopecia. When adjusting for potential confounding factors, the risk of female patients experiencing grade ≥III gastrointestinal toxicity was greater (adjusted odds ratio = 1.50; 95% confidence interval = 1.07-2.12). Females also had a significantly higher incidence of serious adverse events on treatment and received comparatively less cycles of chemotherapy overall than males. CONCLUSIONS This represents the largest pooled analysis of the effect of sex on chemotherapy outcome and toxicity in advanced oesophagogastric cancer. The differential toxicity and adverse event rates observed suggest that sex may be an important modulator of treatment tolerability and safety in this tumour type.
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Affiliation(s)
- Michael Davidson
- Gastrointestinal Research Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK
| | - Anna Dorothea Wagner
- Department of Medical Oncology, Centre Hospitalier Universitaire Vaudois, Switzerland
| | - Kyriakos Kouvelakis
- Gastrointestinal Research Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK
| | - Henry Nanji
- Gastrointestinal Research Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK
| | - Naureen Starling
- Gastrointestinal Research Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK
| | - Ian Chau
- Gastrointestinal Research Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK
| | - David Watkins
- Gastrointestinal Research Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK
| | - Sheela Rao
- Gastrointestinal Research Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK
| | - Clare Peckitt
- Gastrointestinal Research Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK
| | - David Cunningham
- Gastrointestinal Research Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK.
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Ngai LL, ter Veer E, van den Boorn HG, van Herk EH, van Kleef JJ, van Oijen MGH, van Laarhoven HWM. TOXview: a novel graphical presentation of cancer treatment toxicity profiles. Acta Oncol 2019; 58:1138-1148. [PMID: 31017020 DOI: 10.1080/0284186x.2019.1601256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Toxicity profiles play a crucial role in the choice between specific palliative chemotherapy regimens. To optimize the quality of life for cancer patients, patients should be adequately informed about potential toxicities before undergoing chemotherapy. Therefore, we constructed TOXviews, a novel graphical presentation and overview of toxicity profiles to improve information provision about adverse events. As an example, we analyzed first-line chemotherapy regimens for advanced esophagogastric cancer (AEGC). Methods: We searched PubMed, EMBASE, CENTRAL, ASCO and ESMO for prospective phase II or III randomized controlled trials (RCTs) on palliative first-line systemic treatment for AEGC until February 2017. We extracted proportions of Common Terminology Criteria for Adverse Events grade 1-2 (mild) and 3-4 (severe) adverse events from each chemotherapy arm and pooled these by using single-arm meta-analysis. Toxicity profiles per chemotherapy regimen were visualized in bidirectional bar charts with pooled proportions plus 95% confidence intervals. For comparative analysis, chemotherapy regimens were grouped in singlets, doublets and triplets. Results: We included 92 RCTs with a total of 16,963 patients. TOXviews for 3 fluoropyrimidine singlets, 5 cisplatin-containing doublets (C-doublets), 10 fluoropyrimidine non-cisplatin containing doublets (F-doublets), 4 anthracycline-containing triplets (A-triplets) and 5 taxane-containing triplets (T-triplets) were constructed. C-doublets, A-triplets and T-triplets all showed an increased incidence of grade 3-4 adverse events and clinically relevant grade 1-2 adverse events compared to F-doublets. Conclusion: TOXview provides a new graphical presentation and overview of chemotherapy toxicities. TOXviews can be used to educate physicians about the incidences of AEs of systemic therapy and improve informed decision-making.
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Affiliation(s)
- Lok Lam Ngai
- Department of Medical Oncology, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Emil ter Veer
- Department of Medical Oncology, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Héctor G. van den Boorn
- Department of Medical Oncology, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - E. Hugo van Herk
- Department of Medical Oncology, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jessy Joy van Kleef
- Department of Medical Oncology, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Martijn G. H. van Oijen
- Department of Medical Oncology, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Hanneke W. M. van Laarhoven
- Department of Medical Oncology, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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van Kleef JJ, ter Veer E, van den Boorn HG, Schokker S, Ngai LL, Prins MJ, Mohammad NH, van de Poll-Franse LV, Zwinderman AH, van Oijen MGH, Sprangers MAG, van Laarhoven HWM. Quality of Life During Palliative Systemic Therapy for Esophagogastric Cancer: Systematic Review and Meta-Analysis. J Natl Cancer Inst 2019; 112:12-29. [DOI: 10.1093/jnci/djz133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/09/2019] [Accepted: 06/26/2019] [Indexed: 12/16/2022] Open
Abstract
AbstractBackgroundPalliative systemic therapy can prolong life and reduce tumor-related symptoms for patients with advanced esophagogastric cancer. However, side effects of treatment could negatively affect health-related quality of life (HRQoL). Our aim was to review the literature and conduct a meta-analysis to examine the effect of palliative systemic therapy on HRQoL.MethodsEMBASE, Medline, and Central were searched for phase II/III randomized controlled trials until April 2018 investigating palliative systemic therapy and HRQoL. Meta-analysis was performed on baseline and follow-up summary values of global health status (GHS) and other European Organisation for Research and Treatment of Cancer scales. A clinically relevant change and difference of 10 points (scale 0–100) was set to assess the course of HRQoL over time within treatment arms as well as between arms.ResultsWe included 43 randomized controlled trials (N = 13 727 patients). In the first-line and beyond first-line treatment setting, pooled baseline GHS mean estimates were 54.6 (95% confidence interval = 51.9 to 57.3) and 57.9 (95% confidence interval = 55.7 to 60.1), respectively. Thirty-nine (81.3%) treatment arms showed a stable GHS over the course of time. Anthracycline-based triplets, fluoropyrimidine-based doublets without cisplatin, and the addition of trastuzumab to chemotherapy were found to have favorable HRQoL outcomes. HRQoL benefit was observed for taxane monotherapy and several targeted agents over best supportive care beyond first line.ConclusionsPatients reported impaired GHS at baseline and generally remained stable over time. Anthracycline-based triplets and fluoropyrimidine-based doublets without cisplatin may be preferable first-line treatment options regarding HRQoL for HER2-negative disease. Taxanes and targeted agents could provide HRQoL benefit beyond first line compared with best supportive care.
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Affiliation(s)
| | - Emil ter Veer
- See the Notes section for the full list of authors’ affiliations
| | | | - Sandor Schokker
- See the Notes section for the full list of authors’ affiliations
| | - Lok Lam Ngai
- See the Notes section for the full list of authors’ affiliations
| | - Mariska J Prins
- See the Notes section for the full list of authors’ affiliations
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Sun Z, Zheng H, Yu J, Huang W, Li T, Chen H, Hu Y, Zhao M, Liu H, Jiang Y, Li G. Liver Metastases in Newly Diagnosed Gastric Cancer: A Population-Based Study from SEER. J Cancer 2019; 10:2991-3005. [PMID: 31281476 PMCID: PMC6590027 DOI: 10.7150/jca.30821] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 04/23/2019] [Indexed: 02/07/2023] Open
Abstract
Purpose: Population-based data on the proportion and prognosis of liver metastases at diagnosis of gastric cancer are currently lacking. Besides, the treatment of gastric cancer with liver metastases is still controversial now. Methods: Patients with gastric cancer and liver metastases (GCLM) at the time of diagnosis in advanced gastric cancer were identified using the Surveillance, Epidemiology, and End Result (SEER) database of the National Cancer Institute. Multivariable logistic and Cox regression were performed to identify predictors of the presence of GCLM at diagnosis and factors associated with all-cause mortality. Results: We identified 3507 patients with gastric cancer and liver metastases at the time of diagnosis, representing 16.89% of the entire cohort and 44.12% of the subset with metastatic disease to any distant site. Among entire cohort, multivariable logistic regression identified thirteen factors (age, race, sex, original, tumor location, pathology grade, Lauren classification, T staging, N staging, tumor size, number of extrahepatic metastatic sites to bone, lung, and brain, insurance situation and smoking) as predictors of the presence of liver metastases at diagnosis. Median survival among the entire cohort with GCLM was 4.0 months (interquartile range: 1.0-10.0 mo). Patients receiving comprehensive therapy had longer median overall survival, of which the median survival was 12.0 months (interquartile range: 6.0-31.0 mo). Multivariable Cox model in SEER cohort confirmed nine factors (age, tumor location, Lauren classification, T staging, number of extrahepatic metastatic sites to bone, lung, and brain, surgery, chemotherapy, RSC and marital status) as independent predictors for overall survival. Conclusions: The findings of this study provided population-based estimates of the proportion and prognosis for LM at time of GC diagnosis. These findings provide preventive guidelines for screening and treatment of LM in GC patients.
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Affiliation(s)
- Zepang Sun
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
| | - Huan Zheng
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, 510515 Guangzhou, China
| | - Jiang Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
| | - Weicai Huang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
| | - Tuanjie Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
| | - Hao Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
| | - Yanfeng Hu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
| | - Mingli Zhao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
| | - Yuming Jiang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
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Seo S, Ryu MH, Park YS, Ahn JY, Park Y, Park SR, Ryoo BY, Lee GH, Jung HY, Kang YK. Loss of HER2 positivity after anti-HER2 chemotherapy in HER2-positive gastric cancer patients: results of the GASTric cancer HER2 reassessment study 3 (GASTHER3). Gastric Cancer 2019; 22:527-535. [PMID: 30386954 DOI: 10.1007/s10120-018-0891-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although discordance in HER2 positivity between primary and metastatic lesions is well established, changes in HER2 positivity after anti-HER2 therapy have not been well evaluated in gastric cancer. We aimed to evaluate whether HER2 expression in gastric cancer is affected by trastuzumab therapy. METHODS We enrolled 48 HER2-positive advanced gastric cancer patients treated with trastuzumab-containing first-line chemotherapy and had paired biopsies at baseline and after progression. RESULTS At baseline, HER2 was positive, with immunohistochemistry (IHC) 2+ and in situ hybridization (ISH)+ in five patients, and with IHC 3+ in 43 patients. Fourteen patients (29.1%) exhibited loss of HER2 positivity on post-progression biopsy: 10 with IHC 0 or 1+, and four with IHC 2+/ISH-. HER2 remained positive on second biopsy in 34 patients: four with IHC 2+/ISH+, and 30 with IHC 3+. Median H-scores decreased from 225 to 175 (p = 0.047). HER2 genetic heterogeneity was defined in one of 34 ISH-assessable patients (2.9%) at baseline and seven of 32 (21.9%) at second biopsy. Among 13 patients who received second-line trastuzumab emtansine, three showed HER2-negative conversion; they had no objective response and short progression-free survival (1.2, 1.3, and 3.4 months). Patients with stable HER2 status had a 44% response rate and median progression-free survival of 2.7 (0.4-36.8) months. CONCLUSION A substantial portion of HER2-positive patients showed HER2-negative conversion with increased HER2 genetic heterogeneity after failure of trastuzumab-containing chemotherapy. Loss of HER2 positivity could be predictive of second-line anti-HER2 treatment, suggesting a need to reexamine HER2 status before initiating second-line anti-HER2 therapy.
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Affiliation(s)
- Seyoung Seo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yangsoon Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sook Ryun Park
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Baek-Yeol Ryoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hwoon-Young Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
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Economic Evaluation of Treatments for Patients with Esophageal Cancer: A Systematic Review. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.86631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Arai H, Sunakawa Y, Nakajima TE. Co-operative groups in the development of chemotherapy for gastric cancer. Jpn J Clin Oncol 2019; 49:210-227. [PMID: 30508188 DOI: 10.1093/jjco/hyy176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/14/2018] [Accepted: 11/01/2018] [Indexed: 01/05/2023] Open
Abstract
In the multimodality treatment strategy for gastric cancer, chemotherapy has an important role in conferring survival benefit. For the last three decades, great progress has been achieved in adjuvant and palliative chemotherapy. Powerful combination regimens using doublet or triplet cytotoxic agents have been developed and new molecular targeted drugs, including trastuzumab and ramucirumab, have been introduced in clinical practice. These advances have resulted from the accumulation of many clinical trials. A well-designed phase III trial can change standard treatment; however, such a trial is hard to complete due to its huge cost and need to recruit many patients. Some co-operative groups have actively made efforts at fundraising and patient recruitment, which can make implementation of high-quality and large-scale phase III trials possible. This review summarizes the development of chemotherapy for gastric cancer with focus on co-operative groups around the world, considering effective treatment developments in gastric cancer. We studied 11 active co-operative groups, including six in Europe, two in the United States, and three in Japan, that have completed one or more phase III trials cited in the major guidelines. Each co-operative group had its own characteristics and contributed to the establishment of standard treatment in each region. International collaboration in the development of gastric cancer treatment may be difficult due to regional differences in standards of care, particularly for resectable gastric cancer. Whereas, intergroup collaboration within each region is a reasonable method to effectively develop treatments for resectable and advanced gastric cancer.
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Affiliation(s)
- Hiroyuki Arai
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Yu Sunakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Takako Eguchi Nakajima
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
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Noronha V, Simha V, Patil V, Joshi A, Prabhash K. Role of palliative chemotherapy and targeted therapy in advanced esophageal and gastroesophageal junction cancers. CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_10_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Lee SD, Yu D, Lee DY, Shin HS, Jo JH, Lee YC. Upregulated microRNA-193a-3p is responsible for cisplatin resistance in CD44(+) gastric cancer cells. Cancer Sci 2018; 110:662-673. [PMID: 30485589 PMCID: PMC6361556 DOI: 10.1111/cas.13894] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 12/17/2022] Open
Abstract
Cisplatin is a well‐known anticancer drug used to treat various cancers. However, development of cisplatin resistance has hindered the efficiency of this drug in cancer treatment. Development of chemoresistance is known to involve many signaling pathways. Recent attention has focused on microRNAs (miRNAs) as potentially important upstream regulators in the development of chemoresistance. CD44 is one of the gastric cancer stem cell markers and plays a role in regulating self‐renewal, tumor initiation, metastasis and chemoresistance. The purpose of the present study was to examine the mechanism of miRNA‐mediated chemoresistance to cisplatin in CD44‐positive gastric cancer stem cells. We sorted gastric cancer cells according to level of CD44 expression by FACS and analyzed their miRNA expression profiles by microarray analysis. We found that miR‐193a‐3p was significantly upregulated in CD44(+) cells compared with CD44(−) cells. Moreover, SRSF2 of miR‐193a‐3p target gene was downregulated in CD44(+) cells. We studied the modulation of Bcl‐X and caspase 9 mRNA splicing by SRSF2 and found that more pro‐apoptotic variants of these genes were generated. We also found that downstream anti‐apoptotic genes such as Bcl‐2 were upregulated, whereas pro‐apoptotic genes such as Bax and cytochrome C were downregulated in CD44(+) cells compared to CD44(−) cells. In addition, we found that an elevated level of miR‐193a‐3p triggered the development of cisplatin resistance in CD44(+) cells. Inhibition of miR‐193a‐3p in CD44(+) cells increased SRSF2 expression and also altered the levels of multiple apoptotic genes. Furthermore, inhibition of miR‐193a‐3p reduced cell viability and increased the number of apoptotic cells. Therefore, miR‐193a‐3p may be implicated in the development of cisplatin resistance through regulation of the mitochondrial apoptosis pathway. miR‐193a‐3p could be a promising target for cancer therapy in cisplatin‐resistant gastric cancer.
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Affiliation(s)
- So D Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Dayeon Yu
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Do Y Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun-Soo Shin
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Hyeon Jo
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong C Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Lee S, Cohen DJ. Pharmacotherapy for metastatic esophageal cancer: where do we need to improve? Expert Opin Pharmacother 2018; 20:357-366. [PMID: 30526127 DOI: 10.1080/14656566.2018.1551881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Esophageal cancer is a heterogeneous cancer comprised of differing cells of origin, molecular changes, and immune microenvironments. To date, most advances have been made in chemotherapy regimens where a one-size-fits-all approach is used. As a result, there remains a lack of tailored treatment options for such a heterogeneous cancer. This paper highlights the current standard of care treatment options as well as active areas of clinical research. AREAS COVERED The authors review the key trials that have led to current standard of care treatment including pivotal chemotherapy and targeted therapy trials. The authors then discuss the current approved uses and future directions for immunotherapy. EXPERT OPINION Current treatment options lack tailored treatment strategies based on the tumor's biology. To date, approved targeted approaches only include HER2-directed and anti-VEGFR2 therapies. Furthermore, while immunotherapy treatment response is often durable, few clear predictive biomarkers for response have been identified. Future research should focus on characterizing additional molecular targets for therapeutic intervention and predictive biomarkers for immunotherapy, as well as combination approaches of immunotherapy with other therapeutic modalities to increase response rate. Ultimately, the field should strive to develop personalized treatment options based on a tumor's molecular profile, microenvironment, and neo-antigen expression.
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Affiliation(s)
- Samuel Lee
- a Department of Medicine , Perlmutter Cancer Center, NYU Langone Medical Center , New York , NY , USA
| | - Deirdre J Cohen
- a Department of Medicine , Perlmutter Cancer Center, NYU Langone Medical Center , New York , NY , USA
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Bracken-Clarke D, Farooq AR, Horgan AM. Management of Locally Advanced and Metastatic Esophageal Cancer in the Older Population. Curr Oncol Rep 2018; 20:99. [PMID: 30426245 DOI: 10.1007/s11912-018-0745-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review aims to synthesise the current literature on the management of early-stage and metastatic esophageal cancers, focusing on the older population. In particular, we aim to dissect out the elderly-specific data from the relevant trials and to discuss the issues unique to this population. RECENT FINDINGS While surgery is the curative modality in esophageal malignancies, the CROSS, MAGIC and FLOT trials demonstrate a clear advantage to neoadjuvant therapy (chemotherapy and chemoradiotherapy). These trials, however, included few elderly patients. There is a similar lack of elderly-specific data in the metastatic setting. Esophageal malignancies remain highly lethal with increasing incidence with age. Despite the relative lack of elderly-specific data, the fit older population appear to similarly benefit from multimodal therapy in early-stage and palliative therapy in metastatic disease.
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Affiliation(s)
- Dara Bracken-Clarke
- Medical Oncology Department, University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - Abdul Rehman Farooq
- Medical Oncology Department, University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - Anne M Horgan
- Medical Oncology Department, University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland.
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Hong J, Maacha S, Belkhiri A. Transcriptional upregulation of c-MYC by AXL confers epirubicin resistance in esophageal adenocarcinoma. Mol Oncol 2018; 12:2191-2208. [PMID: 30353671 PMCID: PMC6275285 DOI: 10.1002/1878-0261.12395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/19/2018] [Accepted: 10/10/2018] [Indexed: 01/21/2023] Open
Abstract
AXL receptor tyrosine kinase is overexpressed in esophageal adenocarcinoma (EAC) and several other types of malignancies; hence, it may be a valuable therapeutic target. Herein, we investigated the role of AXL in regulating c‐MYC expression and resistance to the chemotherapeutic agent epirubicin in EAC. Using in vitro EAC cell models, we found that AXL overexpression enhances epirubicin resistance in sensitive cells. Conversely, genetic knockdown or pharmacological inhibition of AXL sensitizes resistant cells to epirubicin. Notably, we showed that inhibition or knockdown of c‐MYC markedly sensitizes AXL‐dependent resistant cells to epirubicin, and our data demonstrated that AXL promotes epirubicin resistance through transcriptional upregulation of c‐MYC. We showed that AXL overexpression significantly increased transcriptional activity, mRNA, and protein levels of c‐MYC. Conversely, AXL knockdown reversed these effects. Mechanistic investigations indicated that AXL upregulates c‐MYC expression through activation of the AKT/β‐catenin signaling pathway. Data from a tumor xenograft mouse model indicated that inhibition of AXL with R428 in combination with epirubicin synergistically suppresses tumor growth and proliferation. Our results demonstrate that AXL promotes epirubicin resistance through transcriptional upregulation of c‐MYC in EAC. Our findings support future clinical trials to assess the therapeutic potential of R428 in epirubicin‐resistant tumors with overexpression of AXL and activation of c‐MYC.
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Affiliation(s)
- Jun Hong
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Selma Maacha
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Abbes Belkhiri
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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