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Prabhu A, Brandl A, Wakama S, Sako S, Ishibashi H, Mizumoto A, Takao N, Ichinose M, Motoi S, Liu Y, Yonemura Y. Effect of oxaliplatin-based chemotherapy on chemosensitivity in patients with peritoneal metastasis from colorectal cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: proof-of-concept study. BJS Open 2021; 5:6220267. [PMID: 33839755 PMCID: PMC8038512 DOI: 10.1093/bjsopen/zraa075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022] Open
Abstract
Background Chemosensitivity testing, including collagen gel droplet‐embedded culture drug sensitivity test, has proven to be a useful tool in therapeutic decision‐making. This retrospective analysis investigated chemosensitivity testing of peritoneal metastases collected during cytoreductive surgery (CRS), and its impact on survival in patients with colorectal cancer. Methods All patients with peritoneal metastasis from colorectal cancer who underwent CRS with or without hyperthermic intraperitoneal chemotherapy (HIPEC) between November 2008 and October 2014 were included. The growth inhibition rate was expressed as the ratio between the image density after treatment (T) and that before treatment (control, C). Tumours with a reduction in T/C ratio of less than 20 per cent were defined as resistant and those with a reduction of 20 per cent or more as sensitive. Groups were compared for overall (OS) and disease‐free (DFS) survival. Results Of 84 eligible patients, 81 received neoadjuvant chemotherapy (NACT), including 56 patients with an oxaliplatin‐based regimen. Mean(s.d.) follow‐up was 23·4(22·9) months. The median overall survival of all patients was 19·0 (i.q.r. 5·7–36·1) months, with a progression‐free survival time of 10·1 (4·5–17·0) months. Patients who received oxaliplatin‐based NACT had significantly altered chemosensitivity to oxaliplatin; only 20 of 51 such patients showed chemosensitivity to oxaliplatin compared with 16 of 24 who did not undergo oxaliplatin‐based NACT (P = 0·046). However, patients who showed chemoresistance to oxaliplatin had similar OS to those with chemosensitivity (18·8 versus 18·1 months; P = 0·835). The choice of HIPEC agents in patients who received oxaliplatin‐based NACT did not significantly influence survival (oxaliplatin versus mitomycin C: median OS 20·6 (10·9–24·8) versus 19·0 (10·5–34·6) months, P = 0·811; DFS 6·6 (2·8–25·7) versus 9·3 (4·1–13·9) months, P = 0·191). Conclusion Patients who had oxaliplatin‐based NACT showed a higher rate of chemoresistance to oxaliplatin at the time of CRS and HIPEC. The impact of chemosensitivity testing on OS remains unclear and needs further investigation.
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Affiliation(s)
- A Prabhu
- Department of Surgical Oncology Thangam Cancer Centre, Namakkal India
| | - A Brandl
- Digestive Unit Champalimaud Foundation, Lisbon, Portugal
| | - S Wakama
- Department of Surgery Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - S Sako
- Non-Profit Organization to Support Peritoneal Surface Malignancy Treatment Japanese/Asian School of Peritoneal Surface Oncology, Kyoto Japan.,Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kishiwada, Tokushukai Hospital Kishiwada Japan
| | - H Ishibashi
- Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kishiwada, Tokushukai Hospital Kishiwada Japan
| | - A Mizumoto
- Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kusatsu General Hospital Shiga Japan
| | - N Takao
- Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kusatsu General Hospital Shiga Japan
| | - M Ichinose
- Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kusatsu General Hospital Shiga Japan
| | - S Motoi
- Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kusatsu General Hospital Shiga Japan
| | - Y Liu
- Non-Profit Organization to Support Peritoneal Surface Malignancy Treatment Japanese/Asian School of Peritoneal Surface Oncology, Kyoto Japan
| | - Y Yonemura
- Non-Profit Organization to Support Peritoneal Surface Malignancy Treatment Japanese/Asian School of Peritoneal Surface Oncology, Kyoto Japan.,Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kishiwada, Tokushukai Hospital Kishiwada Japan.,Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kusatsu General Hospital Shiga Japan
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Akazawa Y, Higashiyama M, Nishino K, Uchida J, Kumagai T, Inoue T, Fujiwara A, Tokunaga T, Okami J, Imamura F, Kodama K, Kobayashi H. Impact of in vitro chemosensitivity test-guided platinum-based adjuvant chemotherapy on the surgical outcomes of patients with p-stage IIIA non-small cell lung cancer that underwent complete resection. Mol Clin Oncol 2017; 7:327-335. [PMID: 28811897 PMCID: PMC5547765 DOI: 10.3892/mco.2017.1340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/22/2017] [Indexed: 12/26/2022] Open
Abstract
The impact of in vitro chemosensitivity test-guided platinum-based adjuvant chemotherapy on the surgical outcomes of patients undergoing complete resection for locally advanced non-small cell lung cancer (NSCLC) has yet to be elucidated. In the present study, the utility of adjuvant chemotherapy based on the collagen gel droplet embedded culture drug sensitivity test (CD-DST) in patients with p (pathology)-stage IIIA NSCLC was retrospectively analyzed. A series of 39 patients that had received platinum-based adjuvant chemotherapy following complete resection between 2007 and 2012 were enrolled. Their surgical specimens were subjected to the CD-DST. The patients were subsequently classified into two groups on the basis of in vitro anti-cancer drug sensitivity data obtained using the CD-DST: The sensitive group (25 patients) were treated with regimens including one or two of the anti-cancer drug(s) that were indicated to be effective by the CD-DST, whereas the non-sensitive group (14 patients) were treated with chemotherapy regimens that did not include any CD-DST-selected anti-cancer drugs. There were no significant differences in the background characteristics of the two groups [including in respect of the pathological TN (tumor-lymph node) stage, tumor histology, epidermal growth factor receptor mutation status, the frequency of each chemotherapy regimen, and the number of administered cycles]. The 5-year disease-free survival (DFS) rate of the sensitive group was 32.3%, whereas that of the non-sensitive group was 14.3% (P=0.037). In contrast, no difference in overall survival (OS) was observed (P=0.76). Multivariate analysis revealed that adjuvant chemotherapy based on the CD-DST had a significant favorable effect on the DFS (P=0.01). Therefore, the present study has demonstrated that CD-DST data obtained from surgical specimens aid the selection of effective platinum-based adjuvant chemotherapy regimens for patients undergoing complete resection for p-stage IIIA NSCLC. The use of CD-DST-guided platinum-based regimens may have a beneficial impact on the DFS of such patients.
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Affiliation(s)
- Yuki Akazawa
- Department of Thoracic Oncology, Osaka International Cancer Institute (formerly, Osaka Medical Center for Cancer and Cardiovascular Diseases), Osaka 541-8567, Japan
- Department of Respiratory Medicine, Osaka General Medical Center, Osaka 558-8585, Japan
| | - Masahiko Higashiyama
- Department of General Thoracic Surgery, Osaka International Cancer Institute (formerly, Osaka Medical Center for Cancer and Cardiovascular Diseases), Osaka 541-8567, Japan
| | - Kazumi Nishino
- Department of Thoracic Oncology, Osaka International Cancer Institute (formerly, Osaka Medical Center for Cancer and Cardiovascular Diseases), Osaka 541-8567, Japan
| | - Jyunji Uchida
- Department of Thoracic Oncology, Osaka International Cancer Institute (formerly, Osaka Medical Center for Cancer and Cardiovascular Diseases), Osaka 541-8567, Japan
| | - Toru Kumagai
- Department of Thoracic Oncology, Osaka International Cancer Institute (formerly, Osaka Medical Center for Cancer and Cardiovascular Diseases), Osaka 541-8567, Japan
| | - Takako Inoue
- Department of Thoracic Oncology, Osaka International Cancer Institute (formerly, Osaka Medical Center for Cancer and Cardiovascular Diseases), Osaka 541-8567, Japan
| | - Ayako Fujiwara
- Department of General Thoracic Surgery, Osaka International Cancer Institute (formerly, Osaka Medical Center for Cancer and Cardiovascular Diseases), Osaka 541-8567, Japan
| | - Toshiteru Tokunaga
- Department of General Thoracic Surgery, Osaka International Cancer Institute (formerly, Osaka Medical Center for Cancer and Cardiovascular Diseases), Osaka 541-8567, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute (formerly, Osaka Medical Center for Cancer and Cardiovascular Diseases), Osaka 541-8567, Japan
| | - Fumio Imamura
- Department of Thoracic Oncology, Osaka International Cancer Institute (formerly, Osaka Medical Center for Cancer and Cardiovascular Diseases), Osaka 541-8567, Japan
| | - Ken Kodama
- Department of Surgery, Yao Municipal Hospital, Osaka 581-0069, Japan
| | - Hisayuki Kobayashi
- Technical Research Laboratory, Kurabo Industries Ltd., Osaka 541-8581, Japan
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Kimura M, Imamura F, Inoue T, Nishino K, Uchida J, Kumagai T, Okami J, Higasiyama M, Kamoshida S. Protein and mRNA expression of folic acid-associated enzymes as biomarkers for the cytotoxicity of the thymidylate synthase-targeted drugs, pemetrexed and S-1, in non-small cell lung cancer. Mol Clin Oncol 2017; 7:15-23. [PMID: 28685068 PMCID: PMC5492704 DOI: 10.3892/mco.2017.1262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 03/15/2017] [Indexed: 11/25/2022] Open
Abstract
The thymidylate synthase (TS)-targeted drugs, pemetrexed and S-1, exert an important role in advanced non-small cell lung cancer (NSCLC) treatment; folic acid-associated enzymes are expected to behave as biomarkers, although their role has yet to be fully elucidated. In the present study, a single-institutional prospective analysis, in which the mRNA and protein expression levels of five folic acid-associated enzymes were evaluated with surgical specimens of NSCLC, was performed. Drug sensitivity was evaluated using a collagen gel droplet-embedded culture drug sensitivity test (CD-DST) in vitro. A total of 50 patients with NSCLC were enrolled, and the mRNA and protein expression levels of five enzymes were assessed in 47 and 46 patients, respectively. A significant association was identified between mRNA and protein expression in TS (r=0.6266), but the correlation between mRNA and protein expression levels for the other four enzymes was poor. TS mRNA expression was significantly higher in poorly differentiated tumors compared with moderately differentiated tumors (P=0.0399). TS protein expression was significantly higher in patients with pleural invasion or lymphatic invasion compared with those lacking them (P=0.027 and 0.030, respectively). CD-DST revealed that none of the tumors that were sensitive to pemetrexed, but not to S-1, were well differentiated, whereas none of the tumors that were sensitive to S-1, but not to pemetrexed, were poorly differentiated. More prominent vascular invasion was observed in the tumors that were sensitive to S-1. The only factors that exhibited the potential to discriminate the cytotoxicity of pemetrexed from S-1 were tumor differentiation grade and vascular invasion.
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Affiliation(s)
- Madoka Kimura
- Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Fumio Imamura
- Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Takako Inoue
- Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Kazumi Nishino
- Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Junji Uchida
- Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Toru Kumagai
- Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Jiro Okami
- Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Masahiko Higasiyama
- Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Shingo Kamoshida
- Laboratory of Pathology, Division of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Hyogo 654-0142, Japan
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Stratified phase II trial to establish the usefulness of the collagen gel droplet embedded culture-drug sensitivity test (CD-DST) for advanced gastric cancer. Gastric Cancer 2014; 17:630-7. [PMID: 24318670 PMCID: PMC4169653 DOI: 10.1007/s10120-013-0320-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 11/24/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND We conducted a multicenter phase II trial to assess the suitability of three types of chemotherapy (docetaxel plus S-1, irinotecan plus S-1, or S-1 alone) for patients with advanced gastric cancer by means of the collagen gel droplet embedded culture-drug sensitivity test (CD-DST). To our knowledge, this is the first multicenter clinical trial that has employed CD-DST to choose anticancer agents for the treatment of advanced gastric cancer. METHODS Subjects (n = 64) were patients with advanced or recurrent gastric cancer. Patients were allocated to one of the treatment regimens on the basis of CD-DST results. Outcome of the patients was compared between the groups deemed chemosensitive or chemoresistant by the CD-DST. RESULTS Thirty-three patients showed high sensitivity (T/C ratio <60 %) to at least one type of anticancer agent (sensitive group), and 31 showed low sensitivity (T/C ratio ≥60 %) to all agents (resistant group). Specifically, the 1-year survival rate was significantly higher in the sensitive group (78.5 %; 95 % CI, 67.2-94.7 %) than in the resistant group (54.7 %; 95 % CI, 38.7-74.3 %; P = 0.019), whereas time to progression (TTP) was significantly longer in the sensitive group (59.8 %; 95 % CI, 48.2-81.7 %) than in the resistant group (30.0 %; 95 % CI 13.6-46.4 %; P = 0.023). Median survival time was also significantly longer in the sensitive group (15.5 months; 95 % CI, 12.8-18.2) than in the resistant group (12.5 months; 95 % CI, 10.2-14.9; P = 0.038). CONCLUSIONS CD-DST predicts the outcome of patients undergoing chemotherapy for advanced gastric cancer, presumably through evaluating chemosensitivity.
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Differences in chemosensitivity between primary and metastatic tumors in colorectal cancer. PLoS One 2013; 8:e73215. [PMID: 24015297 PMCID: PMC3756023 DOI: 10.1371/journal.pone.0073215] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 07/17/2013] [Indexed: 12/27/2022] Open
Abstract
Purpose We retrospectively evaluated the in vitro chemosensitivity of primary site and metastatic site tumors in colorectal cancer. Methods Various resected tumor samples (33 from lymph nodes, 42 from liver, six from lung, and 68 primary tumors) were assessed via a collagen gel droplet-embedded culture drug sensitivity test to determine chemosensitivity to a single agent or a combination of agents. Results Sensitivity to combination chemotherapy was significantly higher than that of monotherapy in the primary site group, lymph node group, and liver group. There was significant difference between chemosensitivity of primary site and that of liver metastasis in each agent (5-FU, p<0.001; SN38, p = 0.045; 5-FU/SN38, p<0.001; OHP, p = 0.037; 5-FU/OHP, p = 0.045). Conclusions Tumors showed greater in vitro chemosensitivity to combination therapy when compared with monotherapy. Further, tumors that had metastasized to the liver were more resistant to chemotherapy when compared with matched primary tumors.
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Higashiyama M, Okami J, Maeda J, Tokunaga T, Fujiwara A, Kodama K, Imamura F, Kobayashi H. Differences in chemosensitivity between primary and paired metastatic lung cancer tissues: In vitro analysis based on the collagen gel droplet embedded culture drug test (CD-DST). J Thorac Dis 2012; 4:40-7. [PMID: 22295166 PMCID: PMC3256540 DOI: 10.3978/j.issn.2072-1439.2011.05.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 05/02/2011] [Indexed: 11/14/2022]
Abstract
BACKGROUND To elucidate the differences in chemosensitivity to anticancer drugs between primary and metastatic lesions in non-small cell lung cancer (NSCLC) patients, we examined the in vitro chemosensitivities of surgically resected NSCLC tissues. METHODS A total of 32 specimens were enrolled: 26 specimens of primary lesions paired with metastases in the lymph node, 3 specimens of primary lesions paired with metastases in the adrenal gland, and 3 specimens of primary lesions paired with metastases in the lung. The collagen gel droplet embedded culture drug test (CD-DST) was applied to examine the sensitivity of the tissues to anticancer drugs, including cisplatin, gemcitabine, vinorelbine, docetaxel and 5-fluorouracil. RESULTS The degree of in vitro sensitivity to each anticancer drug varied between the primary and metastatic lesions. The sensitivity of the paired metastatic lesions was significantly lower than that of the primary lesions only for gemcitabine (P=0.029), vinorelbine (P=0.012), and docetaxel (P=0.009). The incidence of cases diagnosed as CD-DST-sensitive among the paired metastatic lesions was significantly lower than that for the primary lesions for vinorelbine (P=0.035) or docetaxel (P=0.022). The difference in the sensitivity to gemcitabine between the primary and paired non-lymphatic metastases was clearer than that between the primary lesion and paired lymph node metastases. CONCLUSIONS The sensitivities of the paired metastatic lesions to some anticancer drugs were significantly lower than those of the primary lesions. When performing chemotherapy based on CD-DST data using primary tumors from patients with postoperative recurrence, an appropriate regimen can be selected by carefully considering these differences.
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Affiliation(s)
| | | | | | | | | | | | - Fumio Imamura
- Department of Respiratory Medicine, Osaka Medical Center for Cancer and Cardiovascular Diseases 1-3-3, Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan;
| | - Hisayuki Kobayashi
- Bio-Medical Department, Kurabo Industries LTD. (formally, Research Laboratory Division, Nitta Gelatin Inc.), 14-41 Shimokida-cho, Neyagawa City, Osaka, 572-0823, Japan
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Maniwa Y, Yoshimura M, Hashimoto S, Takata M, Nishio W. Chemosensitivity of lung cancer: Differences between the primary lesion and lymph node metastasis. Oncol Lett 2010; 1:345-349. [PMID: 22966306 DOI: 10.3892/ol_00000061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 12/23/2009] [Indexed: 01/10/2023] Open
Abstract
In this study, chemosensitivity tests were performed on both primary lesions (PLs) and lymph node metastases (LMs) from surgically resected non-small cell lung cancer (NSCLC). Differences between the results obtained were evaluated. Operative specimens were obtained from 13 patients with NSCLC [6 with squamous cell carcinoma (SQ) and 7 with adenocarcinoma (AD)] whose lymph nodes were confirmed to be positive for metastasis. Both the PL and LM from the same patient were examined immediately after resection. The collagen gel droplet-embedded culture drug sensitivity test (CD-DST) was used as the chemosensitivity test against six anticancer drugs [5-fluorouracil (5-FU), cisplatin, gemcitabine, docetaxel, vinorelbine and SN-38 (an active metabolite of irinotecan)]. When the growth rate, determined by the T/C ratio (T, signal for viable cells in the treated group and C, signal in the control) was less than 50%, the tumor cells were considered to be sensitive to the drug. Only in 4 cases (2 SQ and 2 AD) was the chemosensitivity of the primary lesion identical to that of LM. In the SQ cases, chemosensitivity of the primary lesions to 5-FU tended to be consistent with that of LMs. In contrast, the primary lesions in 4 of the 7 AD cases were negative for chemosensitivity to 5-FU; however, LMs were sensitive. In many cases, the chemosensitivity of the PLs to each anticancer drug differed from that of the LMs. In conclusion, both primary and metastatic tumors should be examined to ensure maximum clinical efficacy of in vitro drug-sensitivity testing for adjuvant chemotherapy after complete resection of n1 and n2 NSCLC.
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Affiliation(s)
- Yoshimasa Maniwa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe
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