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da Silva Rocha LS, Moniz CMV, Mingueti E Silva MP, de Freitas GF, Souza E Silva V, Hoff PMG, Riechelmann RP. Effects of Palliative Chemotherapy in Unresectable or Metastatic Colorectal Cancer Patients With Poor Performance Status. Clin Colorectal Cancer 2023; 22:291-297. [PMID: 37336705 DOI: 10.1016/j.clcc.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Colorectal cancer is the second most common cancer in both genders and often presents as a metastatic, unresectable, or recurrent disease in early follow-up. It is uncertain the benefit of oxaliplatin-based palliative chemotherapy (CT) in the first line of treatment in patients with compromised performance status (PS), Eastern Cooperative Oncology Group (ECOG) 3 and 4. These patients are systematically excluded from clinical trials but may be treated in clinical practice. METHODS We conducted a prospective observational cohort whose primary outcome was improving at least 2 points in the worst symptom in the Edmonton Symptom Assessment System Scale (ESAS-r), without grade 3 to 4 toxicity, comparing baseline and fourth week of treatment. Secondary endpoints included quality of life using the European Quality of Life-5 dimensions questionnaire, toxicity, response rate, clinical improvement of ECOG PS, and overall survival (OS). RESULTS We included 28 patients, and 12 (42.8%) achieved the primary endpoint. Median overall survival was 86 days, 46% of patients did not respond to the fourth-week reevaluation due to clinical deterioration, and 17.8% presented toxicity grade ≥3, with 5 patients dying from toxicity. In addition, ECOG PS 4 or cholestasis had poorer overall survival. Finally, 25% and 53.6% of patients received these treatments in the last 14 and 30 days of life, respectively. CONCLUSION In the present study, palliative multiagent chemotherapy in poor performance status patients with non-molecularly selected colorectal cancer tended to impact tumor symptoms control; however, there is no benefit in OS and a considerable risk of toxicity and treatment-related death.
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Affiliation(s)
- Lucila Soares da Silva Rocha
- Department of Postgraduate Education in Clinical Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Oncology Clinical Research Department, Instituto D'Or de Pesquisa e Ensino, São Paulo-SP, Brazil.
| | - Camila Motta Venchiarutti Moniz
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, Brazil; Department of Postgraduate Education in Clinical Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Oncology Clinical Research Department, Instituto D'Or de Pesquisa e Ensino, São Paulo-SP, Brazil
| | - Marilia Polo Mingueti E Silva
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, Brazil
| | - Guilherme Fialho de Freitas
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, Brazil
| | | | - Paulo Marcelo Gehm Hoff
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, Brazil; Department of Postgraduate Education in Clinical Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Oncology Clinical Research Department, Instituto D'Or de Pesquisa e Ensino, São Paulo-SP, Brazil
| | - Rachel P Riechelmann
- Department of Postgraduate Education in Clinical Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Clinical Oncology, AC Camargo Cancer Center, São Paulo, Brazil
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Souza E Silva V, Silva MMRL, Silva JDAP, Brito ABC, Silva MLGOBO, Mello CL, Aguiar S. Updated analysis of a prospective, randomized, controlled trial on the impact on clinical outcomes of fish oil supplementation during neoadjuvant chemoradiation for rectal cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e15594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15594 Background: The intake of nutritional supplements, such as fish oil, can modulate the inflammatory response and thus interfere with therapeutic results. Methods: Patients clinically staged as T3,4 and / or N + rectal adenocarcinoma were randomized 1:1 to receive oral ingestion four capsules, totaling 4g of concentrated fish oil (each gram of fish oil concentrate contained 1448 mg of Eicosapentaenoic acid (EPA) + 964 mg of docosahexaenoic acid (DHA)) throughout neoadjuvant conventional chemoradiation (intervention group – IG) or chemoradiation without supplement (control group – CG). All patients were operated about 8 weeks after chemoradiation. Correlation of inflammatory response - Glasgow Prognostic Score (GPS) with disease-free survival (DFS) was the primary outcome; measurements were collected at 4 moments: M1: at diagnosis; M2: at the end of chemoradiation; M3: at 4 weeks after end of chemoradiotherapy; and M4: preoperatively. Results: From January, 2015 and July, 2017, a total of 111 patients with cT3, 4 and / or N (+) rectal adenocarcinoma were accrued and randomized; 105 were randomized (IG: 51 and CG: 54). Mean age were 60 years, ranging from 30-86 years. There was no difference between groups in M1. In M2 and M3 there were differences between the IG and the CG in systemic inflammatory response measured by GPS (M2: p = 0.001; M3: p = 0.027). After neoadjuvant therapy, 49 patients in the CG and 46 patients in the IG were submitted to surgery; complete pathological response (pCR) was present in 15 patients in the CG and in 10 patients in the IG; there was no association of pCR and fish oil supplementation (P = 0.34). Median follow-up time was 45 months (range: 2-72). With a median follow up time of 24 months, DFS was shorter in patients with KPS < 90% (47.0% vs 80.1%, P = 0.01), high risk (T4 or N+) rectal cancer (67.4% vs 89.7%, P = 0.01) and patients who did not achieve pCR after neoadjuvant CRT (65.5% vs 95.8%, P = 0.003). Also, shorter DFS was observed in patients with GPS 1 or 2 in M2 (69.1% vs 76.7%, p = 0.01) and M4 (38.9% vs 75.3%, p = 0.04) compared to patients with GPS 0 (reduced inflammatory response). In multivariate analysis, patients with high risk rectal cancer and GPS 1 or 2 in M2 had 3.07 and 2.11-fold greater risk of disease relapse; patients who achieved pCR had 84% reduction risk of DFS. KPS and GPS in M4 were not independent prognostic biomarkers for DFS. Conclusions: The oil fish supplementation during neoadjuvant chemoradiotherapy for rectal cancer was able to reduce the systemic inflammation syndrome (GPS = 0) associated with cancer. This reduction during treatment, especially in the preoperative moment was associated with better DFS. Thus, this intervention proposed in our study, as it is easily accessible and low cost, may be a viable strategy in this population and this finding should be better evaluate in future trials. Clinical trial information: NCT02534389.
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Karani A, Felismino TC, Diniz L, Macedo MP, Silva VSE, Mello CA. Is there a role for rechallenge and reintroduction of anti-EGFR plus chemotherapy in later lines of therapy for metastatic colorectal carcinoma? A retrospective analysis. Ecancermedicalscience 2020; 14:1069. [PMID: 32728385 PMCID: PMC7373642 DOI: 10.3332/ecancer.2020.1069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Indexed: 12/22/2022] Open
Abstract
Background Mechanisms of resistance have been described during disease progression (PD) for patients under treatment with anti-EGFR plus chemotherapy (CT). The aim of our study was to evaluate efficacy of anti-EGFR rechallenge (ReCH) and reintroduction (ReIn) in metastatic colorectal cancer (mCRC). Materials and methods This is a retrospective analysis of patients with mCRC that previously received anti-EGFR + CT and interrupted therapy due to PD in the ReCH group and other reasons in the ReIn group. We aimed to describe progression-free survival (PFS), overall survival (OS) and response rate (RR) after re-exposure and to evaluate prognostic factors associated with PFS. Results Sixty-eight patients met the inclusion criteria. The median follow-up after re-exposure was 39.3 months. ReCH was adopted in 25% and ReIn in 75%. The median anti-EGFR free interval was at 10.5 months. At re-exposure, the main CT regimen was FOLFIRI in 58.8%. Cetuximab and Panitumumab were used in 59 and 9 patients, respectively. mPFS for ReCH and ReIn was 3.3 × 8.4 months, respectively (p 0.001). The objective response rate for ReCH and ReIn was 18% and 52%, respectively. In univariate analysis, adverse prognostic factors related to PFS were: stable disease or PD at first anti-EGFR exposure (HR: 2.12, CI:1.20-3.74; p = 0.009); ReCH (HR: 3.44, CI:1.88-6.29, p < 0.0001); rechallenge at fourth or later lines (HR: 2.51, CI:1.49-4.23, p = 0.001); panitumumab use (HR: 2.26 CI:1.18-5.54, p = 0.017). In the multivariate model, only ReCH remained statistically significant (HR = 2.63, CI: 1.14-6.03, p = 0.022). Conclusion In our analysis, ReCH resulted in short PFS and low RR. However, reintroduction of anti-EGFR plus CT before complete resistance arose resulted in prolonged PFS. These data could be clinically useful to guide a treatment break due to side effects or patient decisions. Our data should be confirmed by larger and prospective trials.
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Affiliation(s)
- Amanda Karani
- Department of Medical Oncology, AC Camargo Cancer Center, Sao Paulo 01509-000, Brazil
| | | | - Lara Diniz
- Department of Medical Oncology, AC Camargo Cancer Center, Sao Paulo 01509-000, Brazil
| | | | | | - Celso Abdon Mello
- Department of Medical Oncology, AC Camargo Cancer Center, Sao Paulo 01509-000, Brazil.,https://orcid.org/0000-0002-8315-1562
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Souza E Silva V, Abdallah EA, Mello CALD, Tariki MS, Calsavara VF, Chinen LT. Prospective study with circulating tumor cells as potential prognosis biomarker in metastatic colorectal cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
203 Background: Colorectal cancer (CRC) is one of the most common cancer worldwide. Around 30% present metastatic disease at diagnosis and 50%–60% of patients develop metastasis. New prognostic markers are needed and circulating tumor cells (CTCs) are a promising tool. Methods: Prospective study conducted by blood collection from 75 patients (pts) with metastatic CRC (mCRC), twice, with 2 months interval, together with image exams for therapeutic response evaluation. CTCs were detected by ISET and identified by immunocytochemistry. Results: The mean age was 57.3 years old (24-81). RAS mutations in primary tumor was found in 38% (19/50) of patients (pts) and left colon topography in 41.3% (31/75). Comparing the baseline CTC level (CTC1) with the level at first follow-up (CTC 2), pts with CTC2 – CTC1 > 5.5 per ml demonstrated poor progression-free survival (PFS) (3.2 months) when compared to CTC 2 – CTC1 ≤ 5.5 (9.1 months) (p= 0.005). The median overall survival (OS) was 24.5 months for pts with CTC 1 > 1.5 per ml and 34.2 months for those with CTC1 ≤ 1.5 per (HR=1.89, 95% CI, 1.01 to 3.52; p= 0.041). Patients with RAS mutation (P= 0.001), primary tumor in the right colon (p= 0.014) and expression of Multidrug Resistance Protein 1 in CTCs (p= 0.044) had worse OS. By multivariable analyses, CTC 1 > 1.5/mL (p= 0.025) was an independent prognostic factor. Conclusions: This prospective study confirmed that counts of CTCs at baseline (CTC1) is an important prognostic marker for monitoring mCRC and correlates with other established prognostic factors. Clinical trial information: NCT02979470.
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Silva VSE, De Brot L, Riechelmann RP. Testing microsatellite instability in solid tumors: the ideal versus what is real. Ann Transl Med 2019; 7:600. [PMID: 32047761 DOI: 10.21037/atm.2019.09.124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Louise De Brot
- Department of Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
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Souza E Silva V, Flores BT, Abdallah EA, Mello CL, Aguiar S, Takahashi R, Tariki MS, Mendes GG, Silva MLG, da Silva Alves V, Chinen LT. Molecular analysis of thymidylate synthase in circulating tumor cells as a potential marker of response to therapy in locally advanced rectal cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e24059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Braun AC, de Mello CAL, Corassa M, Abdallah EA, Urvanegia AC, Alves VS, Flores BCTCP, Díaz M, Nicolau UR, Silva VSE, Calsavara V, Paterlini-Brechót P, Chinen LTD. EGFR expression in circulating tumor cells from high-grade metastatic soft tissue sarcomas. Cancer Biol Ther 2018; 19:454-460. [PMID: 29394136 DOI: 10.1080/15384047.2018.1433498] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Soft tissue Sarcomas (STS) are rare malignances, with high mortality rates. Half of patients develop metastasis. The presence of isolated Circulating Tumor Cells (CTCs) and Circulating Tumor Microemboli (CTM) in the blood may be early markers of tumor invasion. Epidermal Growth Factor (EGF) family receptors can also influence this process. OBJECTIVES to quantify CTCs and identify CTM as well as the EGF Receptor (EGFR) protein expression in these cells and correlate with clinical outcome in metastatic STS. MATERIALS AND METHODS Approximately 8mL of blood was prospectively collected from patients with different types of high-grade STS, before the beginning of chemotherapy. The samples were processed and filtered by ISET (Rarecells, France) for the isolation and quantification of CTCs and CTMs. EGFR expression was analyzed by immunocytochemistry (ICC) on CTCs/ CTMs. RESULTS We analyzed 18 patients with median age of 49 years (18-77 y). The positivity for EGFR protein expression in CTCs was observed in 93.75% of the patients. This result shows that targeting EGFR positive CTCs from STS origen can be translated in clinical benefit for some patients. In addition, if target therapy is chosen, the EGFR expression in CTCs can be used in follow-up to measure treatment effectiveness. CONCLUSIONS This is the first study to demonstrate the expression of EGFR protein in CTCs from sarcoma patients. It may open an area for future investigations. The next step is to characterize CTCs in a larger cohort of patients to better understand the role of EGFR in sustaining tumor metastasis in sarcomas.
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Affiliation(s)
- Alexcia Camila Braun
- a International Research Center; A. C. Camargo Cancer Center , São Paulo , SP , Brazil
| | | | - Marcelo Corassa
- b Department of Clinical Oncology , A. C. Camargo Cancer Center , São Paulo , SP , Brazil
| | - Emne Ali Abdallah
- a International Research Center; A. C. Camargo Cancer Center , São Paulo , SP , Brazil
| | - Ana Cláudia Urvanegia
- b Department of Clinical Oncology , A. C. Camargo Cancer Center , São Paulo , SP , Brazil
| | - Vanessa Silva Alves
- a International Research Center; A. C. Camargo Cancer Center , São Paulo , SP , Brazil
| | - Bianca C T C P Flores
- a International Research Center; A. C. Camargo Cancer Center , São Paulo , SP , Brazil
| | - Mônica Díaz
- a International Research Center; A. C. Camargo Cancer Center , São Paulo , SP , Brazil
| | | | - Virgilio Souza E Silva
- b Department of Clinical Oncology , A. C. Camargo Cancer Center , São Paulo , SP , Brazil
| | - Vinicius Calsavara
- a International Research Center; A. C. Camargo Cancer Center , São Paulo , SP , Brazil
| | | | - Ludmilla Thomé Domingos Chinen
- a International Research Center; A. C. Camargo Cancer Center , São Paulo , SP , Brazil.,d National Institute for Science and Technology in Oncogenomics and Therapeutic Innovation
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