Long term experience of patients with unresectable or metastatic KIT positive gastrointestinal stromal tumours

A retrospective analysis of consecutive patients (183 in total, of which 105 were males and 78 females) with gastrointestinal stromal tumour (GIST) was performed. The mean age was 61 years, median age 64 years. The most frequent localization of the tumour was stomach in 74 patients (40.4 %) and the small intestine in 46 patients (25.1 %). Two or more different synchronous or metachronous cancers occurred in 34 (18.6 %) patients with histologically confirmed GIST. Ninety-six patients were treated with imatinib mesylate in palliative setting during the course of their disease. The therapy was finished in 60 patients and 36 patients have been treated so far. The median progression-free survival reached 32.9 months in the group of 96 patients treated with imatinib. The median overall survival in the group of 96 patients treated for metastatic disease reached 77 months. Two-year and 5-year survival was 85.2 % and 63.1 %, respectively. The second-line therapy with sunitinib malate was administered in 37 patients, of which 31 finished and 6 continued in the therapy. The median progression free survival and median survival since the sunitinib therapy initiation reached 8.4 and 22.1 months, respectively (Tab. 2, Fig. 2, Ref. 16).

Significant overexpression of Hsp110 gene during colorectal cancer progression

Colorectal cancer (CRC) is one of the most frequent malignant diseases in the world. Metastatic spread of the cancer to the lymph nodes is a crucial factor for progression and therapeutic management of the disease. We analysed gene expression profiles of CRC patiens by low-density cancer-focused oligonucleotide microarrays to identify new predictive markers of the extent of the disease and for better understanding of CRC progression. Relative expression levels of 440 genes known to be involved in cancer biology were obtained by low-density oligonucleotide microarrays from 20 tumor samples. Statistical analysis of gene expression data identified 3 genes (HSP110, HYOU1 and TCTP) significantly up-regulated in primary tumors of patients who developed lymph node metastasis. We have shown, for the first time, that up-regulation HSP110 and HYOU1 expression is associated with lymph node involvement in CRC. We validated the differences in HSP110 expression in an independent group of 30 patients of all clinical stages by real-time PCR. We identified significant up-regulation of HSP110 expression in colorectal tumors compared to adjacent non-tumoral tissue (p<0.0003). We observed significant differences of HSP110 gene expression between metastatic and localized disease (p=0.031) and negative trend of HSP110 gene expression and overall survival of CRC patients. We suggest that HSP110 gene is a promising molecular predictor in CRC.

Micro-RNAs miR125b and miR137 are frequently upregulated in response to capecitabine chemoradiotherapy of rectal cancer

There is increasing evidence that some microRNAs change their levels in reaction to xenobiotic challenge. The aim of this study was to test the possible involvement of micro-RNAs in response to standard anticancer treatment. Tumor biopsies from 35 patients with rectal cancer before therapy and parallel tumor biopsies from 31 patients two weeks after starting preoperative capecitabine chemoradiotherapy were taken. The expression levels of single miRNA species were measured using TaqMan Micro-RNA assays after reverse transcription from isolated total RNAs. Many micro-RNAs (miR10a, miR21, miR145, miR212, miR339, miR361) responded to chemoradiotherapy in individual tumor samples, but there was profound intertumoral variability. However, other two micro-RNAs miR125b, miR137 showed a significant increase in median expression levels after starting therapy in most samples. Moreover, our results for the first time show that higher induced levels of miR125b and miR137 are associated with worse response to the therapy.

Preoperative radiotherapy and concomitant capecitabine treatment induce thymidylate synthase and thymidine phosphorylase mRNAs in rectal carcinoma

This work is intended to study the effect of preoperative capecitabine and radiotherapy treatment on the levels of thymidylate synthase (TS), thymidine phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD) mRNAs in rectal carcinoma. 55 patients with locally advanced rectal carcinoma (cT3-4, N0, M0 or cT2-4,N+, M0) were treated with capecitabine 825 mg/m2 twice a day and pelvic radiotherapy 1,8 Gy daily up to cumulative dose of 45 Gy, boosting up to 50,4 Gy. Patients underwent surgery 6th week after the completion of chemoradiotherapy. Biopsies of rectal carcinoma were taken before starting therapy and 14 days after its cesation. Biopsies were examined for TS, DPD and TP mRNA levels. CEA in serum was examined to monitor relapses. Both TP and TS mRNA increase two weeks after starting therapy (p<0,001). TP mRNA median levels were elevated 2,3x after starting therapy. Moreover responders exhibit 1,5x higher induction than non-responders both before and after starting therapy, but difference is significant before therapy only (p=0,017). Non-responders have most frequent TS induction. Complete remission was observed in 17% and substantial responses with microscopic residuum only in additional 19% of cases were achieved. The pathologic downstaging rate was 76%. Our data show that TS and TP mRNA are induced by preoperative chemoradiotherapy in both responders and nonresponders. TP induction is in accordance with the expected role of TP in the activation of capecitabine and the known promoting role of TP in tissue fibrosis frequently associated with tumor regression.

Phase I/II study of capecitabine plus irinotecan (XELIRI) in combination with bevacizumab as first-line therapy in metastatic colorectal cancer

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Background: First-line treatment of metastatic colorectal cancer (MCRC) is based on regimens combining oxaliplatin or irinotecan with intravenous 5-fluorouracil (5-FU) and leucovorin (FOLFOX or FOLFIRI/IFL). A few phase II studies of capecitabine with irinotecan (XELIRI) proved to be comparable to FOLFIRI. Methods: A phase I/II study was conducted to assess the efficacy and tolerability of XELIRI + bevacizumab in MCRC. Indication for the therapy: histologically confirmed colorectal adenocarcinoma, metastatic inoperable disease, no prior systematic therapy for metastases, performance status 0–1, normal hematological, biochemical parameters, no other malignity. Therapy consisted of capecitabine 1000mg/m2 bid on days 2–15 and intravenous irinotecan 250mg/m2 on day 1, bevacizumab 7.5mg/kg on day 1, q 21 days. The response was evaluated after 2 or 3 cycles by RECIST criteria. Results: From March 2005 to December 2005 14 patients (pts) 9 males, 5 females with median age 53 years (range 39–67) have been included. 9 pts were initially disseminated, 5 pts relapsed after adjuvant therapy. Liver metastases were in 12 pts, number of metastatic sites was from 1 to 4, median 2. The overall number of cycles was 96, range 2–13, median 7 cycles. 13 pts have been evaluable for response. The CR occurred in 1 (7%) patient, PR in 10 (77%) pts, SD in 2 pts. During therapy CEA and Ca19–9 declined in all pts. Pretreatment level of CEA: median 32 μg/l, range: 2.4 - 9 265 μg/l. CEA at the response evaluation: median 5.3 μg/l, range: 1.2 - 573 μg/l. Pretreatment level of Ca19–9: median 119,7 kU/l, range: 0 - 4 692. kU/l. Ca19–9 at the response evaluation: median 17.4 kU/l, range: 0–666 kU/l. The toxicity: epistaxis in 1 patient, proteinuria < 1 gram / day in 2 pts and granulocytopenia G3 in 1 patient. No other hematologic toxicity > G2 has occurred. The therapy has been continued in all pts so far with median time of therapy 6 months. The time to disease progression and overall survival has not been reached yet. Conclusions: Irinotecan / capecitabine + bevacizumab has shown high efficacy with response rate 84% and low toxicity. The regimen seems to be appropriate for using in further phase II studies.

No significant financial relationships to disclose.