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Spiliopoulou P, Kazmi F, Aroldi F, Holmes T, Thompson D, Griffiths L, Qi C, Parkes M, Lord S, Veal GJ, Harrison DJ, Coyle VM, Graham J, Jeffry Evans TR, Blagden SP. A phase I open-label, dose-escalation study of NUC-3373, a targeted thymidylate synthase inhibitor, in patients with advanced cancer (NuTide:301). J Exp Clin Cancer Res 2024; 43:100. [PMID: 38566164 PMCID: PMC10986017 DOI: 10.1186/s13046-024-03010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
PURPOSE 5-fluorouracil (5-FU) is inefficiently converted to the active anti-cancer metabolite, fluorodeoxyuridine-monophosphate (FUDR-MP), is associated with dose-limiting toxicities and challenging administration schedules. NUC-3373 is a phosphoramidate nucleotide analog of fluorodeoxyuridine (FUDR) designed to overcome these limitations and replace fluoropyrimidines such as 5-FU. PATIENTS AND METHODS NUC-3373 was administered as monotherapy to patients with advanced solid tumors refractory to standard therapy via intravenous infusion either on Days 1, 8, 15 and 22 (Part 1) or on Days 1 and 15 (Part 2) of 28-day cycles until disease progression or unacceptable toxicity. Primary objectives were maximum tolerated dose (MTD) and recommended Phase II dose (RP2D) and schedule of NUC-3373. Secondary objectives included pharmacokinetics (PK), and anti-tumor activity. RESULTS Fifty-nine patients received weekly NUC-3373 in 9 cohorts in Part 1 (n = 43) and 3 alternate-weekly dosing cohorts in Part 2 (n = 16). They had received a median of 3 prior lines of treatment (range: 0-11) and 74% were exposed to prior fluoropyrimidines. Four experienced dose-limiting toxicities: two Grade (G) 3 transaminitis; one G2 headache; and one G3 transient hypotension. Commonest treatment-related G3 adverse event of raised transaminases occurred in < 10% of patients. NUC-3373 showed a favorable PK profile, with dose-proportionality and a prolonged half-life compared to 5-FU. A best overall response of stable disease was observed, with prolonged progression-free survival. CONCLUSION NUC-3373 was well-tolerated in a heavily pre-treated solid tumor patient population, including those who had relapsed on prior 5-FU. The MTD and RP2D was defined as 2500 mg/m2 NUC-3373 weekly. NUC-3373 is currently in combination treatment studies. TRIAL REGISTRATION Clinicaltrials.gov registry number NCT02723240. Trial registered on 8th December 2015. https://clinicaltrials.gov/study/NCT02723240 .
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Affiliation(s)
- Pavlina Spiliopoulou
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Farasat Kazmi
- Early Phase Clinical Trials Unit, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - Francesca Aroldi
- Early Phase Clinical Trials Unit, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - Thomas Holmes
- Department of Oncology, Oncology Clinical Trials Office, University of Oxford, Oxford, UK
| | - David Thompson
- Department of Oncology, Oncology Clinical Trials Office, University of Oxford, Oxford, UK
| | - Lucinda Griffiths
- Department of Oncology, Oncology Clinical Trials Office, University of Oxford, Oxford, UK
| | - Cathy Qi
- Centre for Statistics in Medicine and Oxford Clinical Trials Research Unit (OCTRU), Oxford, UK
| | - Matthew Parkes
- Centre for Statistics in Medicine and Oxford Clinical Trials Research Unit (OCTRU), Oxford, UK
| | - Simon Lord
- Early Phase Clinical Trials Unit, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - Gareth J Veal
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - David J Harrison
- School of Medicine, University of St Andrews, St Andrews, UK
- NuCana plc, 3 Lochside Way, Edinburgh, UK
| | - Vicky M Coyle
- Patrick G. Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK
| | - Jill Graham
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Thomas R Jeffry Evans
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Sarah P Blagden
- Early Phase Clinical Trials Unit, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
- Department of Oncology, Oncology Clinical Trials Office, University of Oxford, Oxford, UK.
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK.
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Rao D, Ellis CS, Kemeny N, Cercek A. Case-Based Clinical Guidance on Dosing and Management of the Hepatic Artery Infusion Chemotherapy Pump. JCO Oncol Pract 2024; 20:187-194. [PMID: 37883732 DOI: 10.1200/op.23.00374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 10/28/2023] Open
Abstract
Hepatic artery infusion (HAI) delivers localized high-dose floxuridine directly to liver tumors through an implanted pump. While patients are undergoing active treatment, the pump is refilled with chemotherapy alternating with saline every 2 weeks using a specialized noncoring needle. Numerous clinical scenarios influence the dosing of floxuridine, which do not conform to the usual dose modification schema for systemic chemotherapy. This article aims to provide practical clinical management solutions to overcome the common challenges faced by oncologists in the real-world management of HAI pump therapy.
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Affiliation(s)
- Devika Rao
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Nancy Kemeny
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Cercek
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Clinical Oncology Pharmacy, College of Pharmacy, University of Kentucky, Lexington, KY
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Lumish M, Thackray J, Do RKG, Caudle KE, Amstutz U, Schwab M, Diasio RB, Jarnagin WR, Cercek A. Precision Management of a Patient With Dihydropyrimidine Dehydrogenase Deficiency and Liver-Predominant Metastatic Rectal Cancer Using Hepatic Arterial Floxuridine. JCO Precis Oncol 2023; 7:e2200442. [PMID: 36848609 PMCID: PMC10166539 DOI: 10.1200/po.22.00442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/30/2022] [Accepted: 12/09/2022] [Indexed: 03/01/2023] Open
Affiliation(s)
- Melissa Lumish
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jennifer Thackray
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Kelly E. Caudle
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital Memphis, TN
| | - Ursula Amstutz
- Department of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Matthias Schwab
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
- Department of Clinical Pharmacology, University Hospital, Tübingen, Germany
- Departments of Clinical Pharmacology, and of Biochemistry and Pharmacy, University Hospital, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180), “Image-Guided and Functionally Instructed Tumor Therapies,” University of Tuebingen, Tuebingen, Germany
| | - Robert B. Diasio
- Department of Molecular Pharmacology and Experimental Therapeutics and Mayo Clinic Cancer Center, Mayo Clinic, Rochester, MN
| | | | - Andrea Cercek
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Franssen S, Soares KC, Jolissaint JS, Tsilimigras DI, Buettner S, Alexandrescu S, Marques H, Lamelas J, Aldrighetti L, Gamblin TC, Maithel SK, Pulitano C, Margonis GA, Weiss MJ, Bauer TW, Shen F, Poultsides GA, Marsh JW, Cercek A, Kemeny N, Kingham TP, D’Angelica M, Pawlik TM, Jarnagin WR, Koerkamp BG. Comparison of Hepatic Arterial Infusion Pump Chemotherapy vs Resection for Patients With Multifocal Intrahepatic Cholangiocarcinoma. JAMA Surg 2022; 157:590-596. [PMID: 35544131 PMCID: PMC9096688 DOI: 10.1001/jamasurg.2022.1298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/09/2022] [Indexed: 12/14/2022]
Abstract
Importance Intrahepatic cholangiocarcinoma (iCCA) is often multifocal (ie, satellites or intrahepatic metastases) at presentation. Objective To compare the overall survival (OS) of patients with multifocal iCCA after hepatic arterial infusion pump (HAIP) floxuridine chemotherapy vs resection. Design, Setting, and Participants In this cohort study, patients with histologically confirmed, multifocal iCCA were eligible. The HAIP group consisted of consecutive patients from a single center who underwent HAIP floxuridine chemotherapy for unresectable multifocal iCCA between January 1, 2001, and December 31, 2018. The resection group consisted of consecutive patients from 12 centers who underwent a curative-intent resection for multifocal iCCA between January 1, 1990, and December 31, 2017. Resectable metastatic disease to regional lymph nodes and previous systemic therapy were permitted. Patients with distant metastatic disease (ie, stage IV), those who underwent resection before starting HAIP floxuridine chemotherapy, and those who received a liver transplant were excluded. Data were analyzed on September 1, 2021. Main Outcomes and Measures Overall survival in the 2 treatment groups was compared using the Kaplan-Meier method and log-rank test. Results A total of 319 patients with multifocal iCCA were included: 141 in the HAIP group (median [IQR] age, 62 [53-70] years; 79 [56.0%] women) and 178 in the resection group (median [IQR] age, 60 [50-69] years; 91 [51.1%] men). The HAIP group was characterized by a higher percentage of bilobar disease (88.0% [n = 124] vs 34.3% [n = 61]), larger tumors (median, 8.4 cm vs 7.0 cm), and a higher proportion of patients with 4 or more lesions (66.7% [94] vs 24.2% [43]). Postoperative mortality after 30 days was 0.8% (95% CI, 0.0%-2.1%) in the HAIP group vs 6.2% (95% CI, 2.3%-9.7%) in the resection group (P = .01). The median OS for HAIP was 20.3 months vs 18.9 months for resection (P = .32). Five-year OS in patients with 2 or 3 lesions was 23.7% (95% CI, 12.3%-45.7%) in the HAIP group vs 25.7% (95% CI, 17.9%-37.0%) in the resection group. Five-year OS in patients with 4 or more lesions was 5.0% (95% CI, 1.7%-14.3%) in the HAIP group vs 6.8% (95% CI, 1.8%-25.3%) in the resection group. After adjustment for tumor diameter, number of tumors, and lymph node metastases, the hazard ratio of HAIP vs resection was 0.75 (95% CI, 0.55-1.03; P = .07). Conclusions and Relevance This cohort study found that patients with multifocal iCCA had similar OS after HAIP floxuridine chemotherapy vs resection. Resection of multifocal intrahepatic cholangiocarcinoma needs to be considered carefully given the complication rate of major liver resection; HAIP floxuridine chemotherapy may be an effective alternative option.
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Affiliation(s)
- Stijn Franssen
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Kevin C. Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Stefan Buettner
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - Hugo Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - Jorge Lamelas
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | | | | | - Shishir K. Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Carlo Pulitano
- Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Georgios A. Margonis
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew J. Weiss
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Todd W. Bauer
- Department of Surgery, University of Virginia, Charlottesville
| | - Feng Shen
- Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | | | - James Wallis Marsh
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael D’Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - William R. Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Wang WX, Jiang WL, Mao GJ, Tan ZK, Tan M, Li CY. A novel near-infrared theranostic probe for accurate cancer chemotherapy in vivo by a dual activation strategy. Chem Commun (Camb) 2021; 57:13768-13771. [PMID: 34859797 DOI: 10.1039/d1cc05864a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A novel theranostic probe called CX-B-DF is constructed for precise chemotherapy guided by near-infrared (NIR) fluorescence imaging. Moreover, the theranostic probe shows high cytotoxicity to cancer cells under dual activation (H2O2 and TP), which causes the accuracy of drug release to be improved and the toxic side effects to be reduced.
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Affiliation(s)
- Wen-Xin Wang
- Key Laboratory for Green Organic Synthesis and Application of Hunan Province, Key Laboratory of Environmentally Friendly Chemistry and Applications of Ministry of Education, College of Chemistry, Xiangtan University, Xiangtan, 411105, P. R. China.
| | - Wen-Li Jiang
- Key Laboratory for Green Organic Synthesis and Application of Hunan Province, Key Laboratory of Environmentally Friendly Chemistry and Applications of Ministry of Education, College of Chemistry, Xiangtan University, Xiangtan, 411105, P. R. China.
| | - Guo-Jiang Mao
- Henan Key Laboratory of Organic Functional Molecule and Drug Innovation, Collaborative Innovation Center of Henan Province for Green Manufacturing of Fine Chemicals, Key Laboratory of Green Chemical Media and Reactions, Ministry of Education, School of Chemistry and Chemical Engineering, Henan Normal University, Xinxiang, 453007, P. R. China.
| | - Zhi-Ke Tan
- Key Laboratory for Green Organic Synthesis and Application of Hunan Province, Key Laboratory of Environmentally Friendly Chemistry and Applications of Ministry of Education, College of Chemistry, Xiangtan University, Xiangtan, 411105, P. R. China.
| | - Min Tan
- Key Laboratory for Green Organic Synthesis and Application of Hunan Province, Key Laboratory of Environmentally Friendly Chemistry and Applications of Ministry of Education, College of Chemistry, Xiangtan University, Xiangtan, 411105, P. R. China.
| | - Chun-Yan Li
- Key Laboratory for Green Organic Synthesis and Application of Hunan Province, Key Laboratory of Environmentally Friendly Chemistry and Applications of Ministry of Education, College of Chemistry, Xiangtan University, Xiangtan, 411105, P. R. China.
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Abstract
Floxuridine oligomers are anticancer oligonucleotide drugs composed of a number of floxuridine residues. They show enhanced cytotoxicity per floxuridine monomer because the nuclease degradation of floxuridine oligomers directly releases highly active floxuridine monophosphate in cells. However, their clinical use is limited by the low selectivity against cancer cells. To address this limitation, we herein report floxuridine oligomer prodrugs that are active under hypoxia conditions, which is one of the distinguishing features of the microenvironment of all solid tumors. We designed and synthesized two types of floxuridine oligomer prodrugs that possess hypoxia-responsive moieties on nucleobases. The floxuridine oligomer prodrugs showed lower cytotoxicity under normoxia conditions (O2 = 20%), while the parent floxuridine oligomer showed similar anticancer effects under hypoxia conditions (O2 = 1%). The floxuridine oligomer prodrug enabled tumor growth suppression in live mice. This would be the first example demonstrating the conditional control of the medicinal efficacy of oligomerized nucleoside anticancer drugs.
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Affiliation(s)
- Kunihiko Morihiro
- Department of Chemistry and Biotechnology, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Takuro Ishinabe
- Department of Chemistry and Biotechnology, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Masako Takatsu
- Research Center for Advanced Science and Technology (RCAST), The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8904, Japan
| | - Hiraki Osumi
- Department of Chemistry and Biotechnology, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Tsuyoshi Osawa
- Department of Chemistry and Biotechnology, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
- Research Center for Advanced Science and Technology (RCAST), The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8904, Japan
| | - Akimitsu Okamoto
- Department of Chemistry and Biotechnology, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
- Research Center for Advanced Science and Technology (RCAST), The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8904, Japan
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7
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Sato A, Hiramoto A, Kim HS, Wataya Y. Anticancer Strategy Targeting Cell Death Regulators: Switching the Mechanism of Anticancer Floxuridine-Induced Cell Death from Necrosis to Apoptosis. Int J Mol Sci 2020; 21:ijms21165876. [PMID: 32824286 PMCID: PMC7461588 DOI: 10.3390/ijms21165876] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 01/14/2023] Open
Abstract
Cell death can be broadly characterized as either necrosis or apoptosis, depending on the morphological and biochemical features of the cell itself. We have previously reported that the treatment of mouse mammary carcinoma FM3A cells with the anticancer drug floxuridine (FUdR) induces necrosis in the original clone F28-7 but apoptosis in the variant F28-7-A. We have identified regulators, including heat shock protein 90, lamin-B1, cytokeratin-19, and activating transcription factor 3, of cell death mechanisms by using comprehensive gene and protein expression analyses and a phenotype-screening approach. We also observed that the individual inhibition or knockdown of the identified regulators in F28-7 results in a shift from necrotic to apoptotic morphology. Furthermore, we investigated microRNA (miRNA, miR) expression profiles in sister cell strains F28-7 and F28-7-A using miRNA microarray analyses. We found that several unique miRNAs, miR-351-5p and miR-743a-3p, were expressed at higher levels in F28-7-A than in F28-7. Higher expression of these miRNAs in F28-7 induced by transfecting miR mimics resulted in a switch in the mode of cell death from necrosis to apoptosis. Our findings suggest that the identified cell death regulators may play key roles in the decision of cell death mechanism: necrosis or apoptosis.
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Affiliation(s)
- Akira Sato
- Department of Biochemistry and Molecular Biology, Faculty of Pharmaceutical Sciences, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba 278-8510, Japan
- Correspondence: ; Tel.: +81-4-7121-3620
| | - Akiko Hiramoto
- Division of International Infectious Disease Control, Faculty of Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushima-naka, Kita-ku, Okayama 700-8530, Japan; (A.H.); (H.-S.K.); (Y.W.)
| | - Hye-Sook Kim
- Division of International Infectious Disease Control, Faculty of Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushima-naka, Kita-ku, Okayama 700-8530, Japan; (A.H.); (H.-S.K.); (Y.W.)
| | - Yusuke Wataya
- Division of International Infectious Disease Control, Faculty of Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushima-naka, Kita-ku, Okayama 700-8530, Japan; (A.H.); (H.-S.K.); (Y.W.)
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Colleoni M, Bajetta E, de Braud F, Zilembo N, Nolè F, Nelli P. Reversal of Resistance to Doxifluridine and Fluorouracil in Metastatic Colorectal Cancer: The Role of High-Dose Folinic Acid. Tumori 2018; 78:258-61. [PMID: 1466082 DOI: 10.1177/030089169207800409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The benefits from medical treatment in colorectal cancer are limited. Fluorouracil remains the only recognized drug, and how to treat unresponsive patients is still debated. To evaluate the role of folinic acid (FA) in circumvence resistance in colorectal cancer, 28 patients pretreated with fluoropyrimidine were candidated to receive one of the following schedules: fluorouracil (600 mg/m2) associated with FA (500 mg/m2) weekly for 6 weeks (Regimen A: 21 cases), or fluorouracil (370 mg/m2) plus FA (200 mg/m2) dally for 5 days every 4 weeks (Regimen B: 7 cases). Fourteen patients were pretreated with doxifluridlne, a new fluoropyrimldine derivative with a peculiar mechanism of action, and the remaining 14 patients with fluorouracil. All but 2 patients were unresponsive to first-line treatments. When the treatment began, the median age of the patients was 60 years (range, 30-68). The performance status (ECOG) was 0/1 in 25 of them, and the primary tumor was in the colon and rectum in 19 and 9 patients, respectively. Sites of disease were liver (64 %), lung (35 %), local recurrence (10 %) and peritoneum (10 %). A median of 3 cycles (range, 1-7) was delivered, and no objective response was observed in the group of patients pretreated with doxlfluridine or in the group pretreated with fluorouracil. In 5 cases a significant decrease in baseline CEA values was observed. Therapy was well tolerated, and no grade 4 toxicity was encountered. Severe toxicity was limited and included diarrhea (7 patients), stomatitis (1 patient) and nausea/vomiting (1 patient). High-dose FA has no role in reversing resistance to fluoropyrimidine, and other mechanisms of refractoriness are surely involved. FA should be associated with fluoropyrimidine as first-line therapy together with other biochemical modulators. Further rescue therapies need to be developed.
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Affiliation(s)
- M Colleoni
- Division of Medical Oncology B, Istituto Nazionale Tumori, Milan, Italy
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Abstract
Aims and background Colorectal cancer represents an increasing problem and is responsible for about 16,000 deaths per year in Italy. Fluorouracil represents the most widely used agent, but therapeutic responses have remained consistently discouraging. The overall response rates for fluorouracil as a single agent range from 5% to 15%, and the addition of biochemical modulators, although able to improve response rate, has not been shown conclusively to prolong survival. Methods In recent years, several new compounds characterized by a high therapeutic index, optimal absorption through the gastrointestinal tract when administered orally and selective hepatic metabolization have been synthesised. In this review we analyzed published data on new fluoropyrimidines in an attempt to better define their role and to evaluate any significant improvement over fluorouracil. Results Athough no sure advantage over fluorouracil has been detected, interesting results have been reported for fluorouracil analogs with alternative routes of administration such as oral or intra-arterial chemotherapy. Conclusions Further studies, possibly randomized, should also measure quality of life and treatment-related costs in order to define their real advantage over fluorouracil in the palliation of advanced colorectal cancer.
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Affiliation(s)
- M Colleoni
- Division of Medical Oncology, City Hospital, Castelfranco Veneto, Italy
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Spagnesi S, Ducci F, Laddaga M, Falcone A, Conte PF, Pandolfi A, Stampino CG. A Phase III Study of Oral Doxifluridine plus Radiotherapy in Radiosensitive Tumors of the Pelvic Region. Tumori 2018; 79:250-3. [PMID: 8249177 DOI: 10.1177/030089169307900404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and backround Fluoropyrimidines have shown synergic effects in combination with radiotherapy in several tumor types. Doxifluridine is a novel 5-fluorouracil (5-FU) prodrug which is transformed into 5-FU in neoplastic tissue. This would imply enhancement of radiotherapy by 5-FU in neoplastic tissue, where the drug is concentrated higher than in surrounding healthy tissues. Methods A phase I-II study was carried out on 10 patients with radiosensitive tumors of the pelvic area (4 uterine carcinomas). Escalating doses of oral doxifluridine were administered in combination with standard radiotherapy to assess the efficacy and toxicity profile of the combined treatment. The 9 evaluable patients (3 groups of 3 patients each) received oral doxifluridine, at daily doses of 500, 750, or 1000 mg, for 6 consecutive weeks in combination with a standard (1.8-2.0 Gy) dose of radiotherapy. Assessment of physical and laboratory parameters was made at baseline, then weekly up to the end of the treatment and at follow-up. Results At the final evaluation, one patient with a diagnosis of uterine carcinoma showed a complete response that lasted 10 weeks. One patient had a partial response, and 7 patients had no change. The most frequent adverse events were gastrointestinal: 27 episodes of mild to moderate nausea/vomiting and diarrhea. Three patients complained of severe diarrhea of 5-7 days duration: all patients spontaneously recovered. There were no significant changes in laboratory or clinical parameters, and no serious toxicity requiring reduction or interruption of the radiotherapy. Conclusions The maximum tolerated dose of oral doxifluridine in combination with standard radiotherapy was assessed at 1000 mg/patient/day (equivalent to 36-38 g monthly, previously reported as mTD in phase I studies).
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Affiliation(s)
- S Spagnesi
- Unità di Radioterapia, Ospedale S. Chiara, Pisa, Italy
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11
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Di Bartolomeo M, Bajetta E, Buzzoni R, Bozzetti F, Artale S, Valvo F. Integrated Treatment with Doxifluridine and Radiotherapy in Recurrent or Primary Unresectable Rectal Cancer. A Feasibility Study. Tumori 2018; 85:211-3. [PMID: 10426135 DOI: 10.1177/030089169908500313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background When combined with radiotherapy, fluoropyrimidines have been shown to have synergistic effects on various tumor types. Doxifluridine (5-dFUR) is a 5-fluorouracil (5-FU) prodrug that is transformed into 5-FU in neoplastic tissue, which suggests that it may improve the activity of radiotherapy. The aims of this study were to evaluate the feasibility and efficacy of the combination of radiotherapy and oral 5-dFUR plus I-leucovorin in terms of pathologically complete remissions in locally advanced rectal cancer. Methods Eleven patients with locally recurrent (n = 7) or primary unresectable rectal cancer (n = 4) were treated with three cycles of oral I-leucovorin 25 mg/dose followed by 5-dFUR 750 mg/m2 twice daily for four days every 12, in combination with pelvic radiation at a standard dose of 45 Gy over five weeks. The tumor burden was assessed by means of CT and endoscopic ultrasound at baseline and at least four weeks after the end of the treatment and before surgery. Results Four patients achieved an objective response, 6 disease stabilization and 1 had progressive disease. After a median time of five weeks from the end of treatment 8 patients underwent radical resection and a pathologically complete remission was documented in 2. Seven of these patients are still alive and disease free after a median follow-up of 18 months. The major side effects were grade 3 diarrhea in one case, and grade 1-2 nausea and vomiting in three cases. No significant hematological toxicity was observed. Conclusions This combination of radiation and 5-dFUR plus I-leucovorin led to an interesting rate of resectability, with pathological downstaging being documented in two cases. These preliminary results show an encouraging local control of an otherwise unresectable disease. Combined preoperative therapy with oral fluoropyrimidine plus I-leucovorin together with radiation may be an attractive approach in patients with operable rectal cancer.
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Affiliation(s)
- M Di Bartolomeo
- Division of Medical Oncology B, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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12
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Chirio D, Peira E, Battaglia L, Ferrara B, Barge A, Sapino S, Giordano S, Dianzani C, Gallarate M. Lipophilic Prodrug of Floxuridine Loaded into Solid Lipid Nanoparticles: In Vitro Cytotoxicity Studies on Different Human Cancer Cell Lines. J Nanosci Nanotechnol 2018; 18:556-563. [PMID: 29768881 DOI: 10.1166/jnn.2018.13964] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Floxuridine is a very effective drug with high potency in the treatment of various tumors but its utility is limited by its low efficiency of cellular uptake. In order to improve the floxuridine efficiency of cellular uptake, lipophilic prodrug of floxuridine (3',5'-distearoyl-5-fluoro-2'-deoxyuridine) was synthetized and loaded into behenic acid nanoparticles produced by fatty acid coacervation technique. Generally, spherical shaped SLN with mean diameters below 300 nm were obtained. Distearoyl-floxuridine was loaded in SLN with high entrapment efficiency (from 70.8 to 82.8%). In Vitro cytotoxicity studies on different human cancer cell lines (M14, HT-29 and MDA-MB231) were performed in order to test the ability of distearoyl-floxuridine-SLN to inhibit the cancer cell growth. In MTT test distearoyl floxuridine SLN showed a greater efficacy than floxuridine on all cancer cell lines revealing an efficiency about 100 times higher. Also clonogenic assay showed a higher cytotoxicity of distearoyl-floxuridine-SLN compared to floxuridine but the difference between the formulations was only about 10 times. In conclusion, SLN proved to be a promising vehicle to increase the floxuridine efficacy in cancer therapy.
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Affiliation(s)
- Daniela Chirio
- Università degli Studi di Torino - Dipartimento di Scienza e Tecnologia del Farmaco, via Giuria 9, 10125 Torino, Italy
| | - Elena Peira
- Università degli Studi di Torino - Dipartimento di Scienza e Tecnologia del Farmaco, via Giuria 9, 10125 Torino, Italy
| | - Luigi Battaglia
- Università degli Studi di Torino - Dipartimento di Scienza e Tecnologia del Farmaco, via Giuria 9, 10125 Torino, Italy
| | - Benedetta Ferrara
- Università degli Studi di Torino - Dipartimento di Scienza e Tecnologia del Farmaco, via Giuria 9, 10125 Torino, Italy
| | - Alessandro Barge
- Università degli Studi di Torino - Dipartimento di Scienza e Tecnologia del Farmaco, via Giuria 9, 10125 Torino, Italy
| | - Simona Sapino
- Università degli Studi di Torino - Dipartimento di Scienza e Tecnologia del Farmaco, via Giuria 9, 10125 Torino, Italy
| | - Susanna Giordano
- Università degli Studi di Torino - Dipartimento di Scienza e Tecnologia del Farmaco, via Giuria 9, 10125 Torino, Italy
| | - Chiara Dianzani
- Università degli Studi di Torino - Dipartimento di Scienza e Tecnologia del Farmaco, via Giuria 9, 10125 Torino, Italy
| | - Marina Gallarate
- Università degli Studi di Torino - Dipartimento di Scienza e Tecnologia del Farmaco, via Giuria 9, 10125 Torino, Italy
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Kang MH, Lee WS, Go SI, Kim MJ, Lee US, Choi HJ, Kim DC, Lee JH, Kim HG, Bae KS, Cho JM. Can thymidine phosphorylase be a predictive marker for gemcitabine and doxifluridine combination chemotherapy in cholangiocarcinoma?: case series. Medicine (Baltimore) 2014; 93:e305. [PMID: 25526478 PMCID: PMC4603134 DOI: 10.1097/md.0000000000000305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Unresectable cholangiocarcinoma is poorly responded to chemotherapy, especially for the case refractory to gemcitabine and cisplatin. Here, we tested whether high expression of thymidine phosphorylase (TP) can be a predictive biomarker for the indicator for gemcitabine and doxifluridine combination chemotherapy in the cholangiocarcinoma refractory to gemcitabine and cisplatin. Immunohistochemical staining for TP was performed with a biopsy specimen. We accepted the result as positive when more than 10% of cancer cells were stained with moderate intensity. Here, we report 2 cases of TP-positive cholangiocarcinoma well controlled with gemcitabine and doxifluridine combination chemotherapy, which had been refractory to the first line treatment with gemcitabine and cisplatin combination chemotherapy.
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Affiliation(s)
- Myoung Hee Kang
- From the Department of Internal Medicine (MHK, WSL, S-IG, MJK, USL, HJC, H-GK); Department of Pathology (DCK, J-HL); and Department of Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, South Korea (KSB, JMC)
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Kanekiyo S, Hazama S, Kondo H, Nagashima A, Eto R, Yoshida S, Shimizu R, Araki A, Yamamoto T, Uchiyama T, Yoshino S, Okayama N, Hinoda Y, Oka M. UDP-glucuronosyltransferase (UGT) 1A1*28 polymorphism-directed phase II study of irinotecan with 5'-deoxy-5-fluorouridine (5'-DFUR) for metastatic colorectal cancer. Anticancer Res 2013; 33:3423-3430. [PMID: 23898114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM We performed a phase II study of irinotecan with 5'-deoxy-5-fluorouridine (5'-DFUR) for metastatic colorectal cancer based on UDP-glucuronosyltransferase (UGT) 1A1 polymorphism. PATIENTS AND METHODS A total of 28 patients were enrolled. The dose of irinotecan was 150 mg/m(2) for patients with the *1/*1 wild-type genotype, and 70 mg/m(2) for those with the *1/*28 mutated genotype. The primary end-point was the response rate (RR); secondary end-points were safety, time to treatment failure (TTF), and overall survival (OS). RESULTS In 28 patients total, genotype was wild-type in 22 and mutated in six. The RR was *1/*1 (22.7%; wild-type) vs. *1/*28 (16.7%; mutated); the median TTF was 5 months vs. 4.5 months, and the median OS was 13 months vs. 17.5 months, respectively. None of these differences were significant. Toxicities of grade 3 or higher were neutropenia (9.0% vs. 0%, respectively) and diarrhea (13.6% vs. 0%, respectively). CONCLUSION This genotype-oriented therapy was effective and safe, and thus appears useful for patients who have complications or advanced age.
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Affiliation(s)
- Shinsuke Kanekiyo
- Department of Digestive Surgery and Surgical Oncology (Surgery II), Yamaguchi University Graduate School of Medicine,1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
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15
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Yoshino S, Furuya T, Shimizu R, Ozasa H, Nishimura T, Fukuda S, Kawaoka T, Hazama S, Oka M. Combination phase II study of weekly paclitaxel and 5'-DFUR for unresectable or recurrent gastric cancer. Anticancer Res 2013; 33:2629-2633. [PMID: 23749919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Paclitaxel and 5'-deoxy-5-fluorouridine (5'-DFUR) have single-agent activity in gastric cancer and have distinct mechanisms of action and no overlap of key toxicities. To evaluate the efficacy and safety of their combination, we conducted a combination phase II study of paclitaxel and 5'-DFUR in patients with unresectable or recurrent gastric cancer who had received up to one prior chemotherapy. PATIENTS AND METHODS Treatment included paclitaxel at 70 mg/m(2) i.v. on days 1, 8 and 15 every four weeks, and 5'-DFUR at 600 mg p.o. every day. The primary end-point was the response rate (RR) and secondary end-points were overall survival (OS), progression-free survival (PFS), time-to-treatment failure (TTF) and rate of adverse events. RESULTS In 42 eligible patients, the RR was 40.5%. OS, PFS and TTF were 371 days, 170 days, and 147 days, respectively. Adverse events were relatively mild. Commonly observed grade 3/4 adverse events were neutropenia (26.2%), anorexia (4.8%), neuropathy (4.8%) and fatigue (4.8%). CONCLUSION The combination of weekly paclitaxel and 5'-DFUR chemotherapy is active and well-tolerated.
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Affiliation(s)
- Shigefumi Yoshino
- Department of Digestive Surgery and Surgical Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Japan.
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Jiang H, Lu J, Jiang J, Hu P. Important Role of the Dihydrouracil/Uracil Ratio in Marked Interpatient Variations of Fluoropyrimidine Pharmacokinetics and Pharmacodynamics. J Clin Pharmacol 2013; 44:1260-72. [PMID: 15496644 DOI: 10.1177/0091270004268911] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Dihydropyrimidine dehydrogenase (DPD) deficiency in patients causes severe toxicities in 5-fluorouracil/floxuridine (5-FU/FUDR) treatments. To determine the plasma dihydrouracil/uracil ratio (DUUR) as a potential index for setting 5-FU/FUDR doses, the authors conducted a prospective study on the relationships of the DUUR with 5-FU/FUDR pharmacokinetic and pharmacodynamic parameters. Forty gestational trophoblastic tumor (GTT) patients were treated with 30 mg/kg of 5-FU or prodrug FUDR during a 10-day cycle. The pretreatment DUURs of the patients were determined prior to the treatments, and plasma 5-FU and FUDR concentrations on day 1 of the test cycle were measured to calculate the corresponding pharmacokinetic parameters. The absolute neutrophil count (ANC) and human chorionic gonadotrophins (HCG/beta-HCG) were recorded as the efficacy indexes. The correlation of the DUUR with pharmacokinetic parameters and efficacy indexes was analyzed to look for a relationship between individual doses (in milligrams) and the varied DUUR. Pretreatment DUUR was significantly correlated with the corresponding plasma AUC (r > 0.80, P < .01), the plasma drug clearance (r > 0.78, P < .01), the ANC (r > 0.76, P < 0.01), and the decrease of HCG/beta-HCG levels (r > 0.5, P < 0.01). In addition, the charts for setting 5-FU/FUDR doses were designed for further validation in clinical trials. These findings indicate the important roles of the DUUR in remarkable interpatient variations of fluoropyrimidine pharmacokinetics and pharmacodynamics and propose a better index for setting individual 5-FU/FUDR doses based on interpatient variations in DPD levels.
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Affiliation(s)
- Hao Jiang
- Clinical Pharmacology Research Center, Peking Union Medical University Hospital, Beijing, China
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Jiang J, Zheng X, Xu X, Zhou Q, Yan H, Zhang X, Lu B, Wu C, Ju J. Prognostic significance of miR-181b and miR-21 in gastric cancer patients treated with S-1/Oxaliplatin or Doxifluridine/Oxaliplatin. PLoS One 2011; 6:e23271. [PMID: 21876743 PMCID: PMC3158077 DOI: 10.1371/journal.pone.0023271] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 07/10/2011] [Indexed: 12/12/2022] Open
Abstract
Background The goal of this study is to evaluate the effectiveness of S-1/Oxaliplatin vs. Doxifluridine/Oxaliplatin regimen and to identify miRNAs as potential prognostic biomarkers in gastric cancer patients. The expression of candidate miRNAs was quantified from fifty-five late stage gastric cancer FFPE specimens. Experimental Design Gastric cancer patients with KPS>70 were recruited for the trial. The control group was treated with 400 mg/twice/day Doxifluridine plus i.v. with Oxaliplatin at 130 mg/m2/first day/4 week cycle. The testing group was treated with S-1 at 40 mg/twice/day/4 week cycle plus i.v. with Oxaliplatin at 130 mg/m2/first day/4 week cycle. Total RNAs were extracted from normal and gastric tumor specimens. The levels of miRNAs were quantified using real time qRT-PCR expression analysis. Results The overall objective response rate (CR+PR) of patients treated with S-1/Oxaliplatin was 33.3% (CR+PR) vs. 17.6% (CR+PR) with Doxifluridine/Oxaliplatin for advanced stage gastric cancer patients. The average overall survival for patients treated with S-1/Oxaliplatin was 7.80 month vs. 7.30 month with patients treated with Doxifluridine/Oxaliplatin. The expression of miR-181b (P = 0.022) and miR-21 (P = 0.0029) was significantly overexpressed in gastric tumors compared to normal gastric tissues. Kaplan-Meier survival analysis revealed that low levels of miR-21 expression (Log rank test, hazard ratio: 0.17, CI = 0.06–0.45; P = 0.0004) and miR-181b (Log rank test, hazard ratio: 0.37, CI = 0.16–0.87; P = 0.018) are closely associated with better patient's overall survival for both S-1 and Doxifluridine based regimens. Conclusion Patients treated with S-1/Oxaliplatin had a better response than those treated with Doxifluridine/Oxaliplatin. miR-21 and miR-181b hold great potential as prognostic biomarkers in late stage gastric cancer.
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Affiliation(s)
- Jingting Jiang
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, People‘s Republic of China
| | - Xiao Zheng
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, People‘s Republic of China
| | - Xiao Xu
- Department of Pathology, Stony Brook University, Stony Brook, New York, United States of America
| | - Qi Zhou
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, People‘s Republic of China
| | - Haijiao Yan
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, People‘s Republic of China
| | - Xueguang Zhang
- Key Laboratory of Stem Cell of Jiangsu Province, Key Laboratory of Clinical Immunology of Jiangsu Province, Soochow University, Suzhou, Jiangsu Province, People‘s Republic of China
| | - Binfeng Lu
- Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Changping Wu
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, People‘s Republic of China
- * E-mail: (CW); (JJ)
| | - Jingfang Ju
- Department of Pathology, Stony Brook University, Stony Brook, New York, United States of America
- * E-mail: (CW); (JJ)
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Toya H, Takeyoshi I, Arakawa K, Sunose Y, Yoshinari D, Totsuka O, Ogawa H, Hirai K. [A case of gastric cancer with lung, Virchow and para-aortic lymph node metastases treated successfully using PTX/5'-DFUR]. Gan To Kagaku Ryoho 2011; 38:659-662. [PMID: 21499000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 6 3-year-old male presented with dysphagia. Gastrointestinal endoscopic examination showed advanced gastric cancer type 3, which was diagnosed as well-differentiated adenocarcinoma. Computed tomography(CT)showed bilateral lung tumors, hugely enlarged Virchow and para-aortic lymph nodes. He was treated with combination chemotherapy of weekly paclitaxel(PTX)and doxifluridine(5'-DFUR). PTX was administered at a dose of 80mg/m2 on day 1, 8 and 15, and 5'- DFUR was orally administered at a dose of 533mg/m / 2day for 5 days followed by withdrawal for 2 days. After four courses of treatment, CT showed an almost complete disappearance of the lung and lymph node metastases. After 13 courses of treatment, total gastrectomy and lymph node dissection were performed. One year postoperatively, the patient died of a recur- rence.
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Affiliation(s)
- Hiroyuki Toya
- Dept. of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Japan
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19
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Nukaya H, Kajino S, Tokuda H, Tanaka Y, Hasegawa I, Kato A, Joh T. [Bi-weekly docetaxel and doxifluridine combination therapy in pretreated patients with unresectable and/or advanced gastric cancer]. Gan To Kagaku Ryoho 2010; 37:1713-1717. [PMID: 20841933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We report an investigation of the therapeutic efficacy and safety of combination chemotherapy with docetaxel (DOC) and doxifluridine (5'-DFUR) administered as second-line or third-line chemotherapy in 23 cases of unresectable and/or advanced gastric cancer. Treatment consisted of intravenous DOC (40mg/m/2) on day 1 and 15, and oral 5'-DFUR (600mg/body) on days 1 to 28 every 4 weeks. The response rate for its antitumor efficacy was 17.4 %, with partial response in 4 cases, no change in 6 cases, progressive disease in 12 cases, and one case not evaluable. By site, the response rate was 11. 8% for primary tumors (2/17), 33.3% for lymph nodes (3/9) , and 26.9% for liver metastasis (1/7). Median time to treatment failure was 2.6 months, median overall survival was 4.6 months. The one-year survival rate was 26.1 %, and the two-year survival rate was 13.0%. The most common grade 3 to 4 toxicities were neutropenia( 4.3%), fatigue (8.7%), stomatitis (8.7%), anorexia(4.3% ), and rash (4.3%). Our data suggest that the combination of docetaxel and 5'-DFUR has a promising therapeutic index in patients with unresectable advanced gastric cancer as second-line or third-line chemotherapy.
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Affiliation(s)
- Haruhiko Nukaya
- Dept. of Gastroenterology, Nagoya Midori Municipal Hospital, Japan
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Nakayama T, Noguchi S. Therapeutic usefulness of postoperative adjuvant chemotherapy with Tegafur-Uracil (UFT) in patients with breast cancer: focus on the results of clinical studies in Japan. Oncologist 2010; 15:26-36. [PMID: 20080863 PMCID: PMC3227888 DOI: 10.1634/theoncologist.2009-0255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 10/20/2009] [Accepted: 12/08/2009] [Indexed: 11/17/2022] Open
Abstract
In Japan, the history of postoperative chemotherapy for breast cancer started with 5-fluorouracil (5-FU), launched in the 1980s. Currently, oral fluoropyrimidine-based regimens indicated for the treatment of breast cancer in Japan include tegafur plus uracil (UFT); tegafur, gimeracil, and oteracil (TS-1); doxifluridine; and capecitabine. In particular, UFT represents an important option for long-term treatment because of minimal adverse events and the potential for long-term maintenance of effective plasma concentrations of 5-FU to inhibit micrometastasis after surgery. Therefore, various clinical studies of postoperative adjuvant chemotherapy with UFT have been conducted in patients with completely resected tumors. Recent studies have shown that UFT prolongs survival after tumor resection in patients with gastric cancer, colorectal cancer, and lung cancer. In patients with breast cancer, large clinical trials of UFT-based postoperative chemotherapy conducted in Japan have shown that UFT is useful for the treatment of intermediate-risk patients with no lymph node metastasis. This paper reviews the results of clinical studies of UFT conducted in Japan to assess the therapeutic usefulness of this oral 5-FU. The types of patients most likely to benefit from UFT are discussed on the basis of currently available evidence and a global consensus of treatment recommendations. The optimal timing of endocrine therapy and strategies for postoperative adjuvant chemotherapy with UFT in patients with breast cancer are also discussed.
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Affiliation(s)
- Takahiro Nakayama
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2-E10, Yamadaoka, Suita, Osaka, Japan 565-0871.
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Abstract
BACKGROUND Liver metastases are often the dominant site of metastatic disease in colorectal cancer. Selective internal radiation therapy (SIRT) involves embolising radiolabeled spheres (SIR-Spheres) into the arterial supply of the liver with the aim of improving the control of liver metastases. OBJECTIVES To assess the effectiveness and toxicity of SIRT in the treatment of metastatic colorectal cancer liver metastasis when given alone or with systemic or regional hepatic artery chemotherapy. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane library 2008 issue 2, MEDLINE (1966 to October 2008), EMBASE (1980 to October 2008), and Pubmed (October 2008). The proceedings of ASCO (1985 to 2008) and ASCO GI (2004 to 2008) were also searched. The manufacturers of SIR-Spheres were contacted and asked whether they were aware of any other unpublished studies. SELECTION CRITERIA Randomised controlled trials comparing SIRT and chemotherapy (systemic and/or regional) with chemotherapy alone, or comparing SIRT alone with best supportive care in patients with metastatic colorectal cancer. DATA COLLECTION AND ANALYSIS Two authors (AT/TP) extracted data and assessed the trial quality. The study authors were contacted and individual patient data was obtained. Results were analysed separately for patients with and without extra-hepatic disease. MAIN RESULTS A single study of 21 patients compared SIRT and systemic chemotherapy (fluorouracil and leucovorin) with chemotherapy alone. There was a significant improvement in progression free survival and median survival associated with SIRT, both for the total studied population and for those disease limited to the liver. There was an increase in toxicity with the use of SIRT. A second study of 63 eligible patients compared SIRT and regional chemotherapy (floxuridine) with regional chemotherapy alone. There was no significant difference in progression free survival and median survival seen with SIRT, in either the total patient group or in the 22 patients with disease limited to the liver. There was no significant increase in toxicity with the addition of SIRT to regional chemotherapy. There were no randomised studies comparing SIRT with best supportive care in patients with refractory disease, and no randomised studies assessing the effect of SIRT in patients with resectable liver metastases. AUTHORS' CONCLUSIONS There is a need for well designed, adequately powered phase III trials assessing the effect of SIRT when used with modern combination chemotherapy regimens. Further studies are also needed for patients with refractory disease with a particular focus on the impact on quality of life.
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Affiliation(s)
- Amanda Townsend
- The Queen Elizabeth Hospital28 Woodville Road,WoodvilleSAAustralia5011
| | - Timothy Price
- The Queen Elizabeth HospitalMedical Oncology28 Woodville RoadWoodvilleSouth AustraliaAustralia5011
| | - Christos Karapetis
- Flinders Medical CentreMedical OncologyFlinders DriveBedford ParkSAAustralia5042
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Saito Y, Suzuki Y, Tokuda Y. Combination therapy by trastuzumab with 5'-deoxy-5-fluorouridine and cyclophosphamide in patients with metastatic breast cancer. Tokai J Exp Clin Med 2009; 34:106-111. [PMID: 21319009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 07/21/2009] [Indexed: 05/30/2023]
Abstract
BACKGROUND Trastuzumab (Herceptin®) was clinically introduced in Japan in 2001 to treat metastatic breast cancer patients who show an over-expression of human epidermal growth factor receptor 2 (HER2). Since that time, this anticancer drug has played an important role in the treatment of cancer. In the present retrospective study, trastuzumab was administered in combination with 5'-deoxy-5-fluorouridine (5'-DFUR) and cyclophosphamide (CPM) as the third- to sixth- line therapy in 25 patients whose HER2-positive metastatic breast cancers did not respond but showed recurrence after treatment with several chemotherapeutic regimens, namely, trastuzumab alone, and trastuzumab combined with taxane or other anticancer drugs. METHODS Trastuzumab was administered at a dose of 2 mg/kg (at a loading dose of 4 mg/kg) once weekly; 5'-DFUR, at an oral daily dose of 800-1200 mg/body; and CPM, at an oral daily dose of 100 mg/body for 2 weeks followed by one week discontinuation of the drug. RESULTS The response rate to the combination therapy was 32% (95% confidence interval, 17-52%). Grade 3 adverse effects, according to National Cancer Institute-Clinical Therapeutic Conference version 2.0. (NCI-CTC ver. 2.0), included: neutropenia in 7 patients, anemia in one, and elevation of alkaline phosphatase (ALP) in one. Other adverse events of grade 1 or 2 in accordance with NCI-CTC included general fatigue, nausea, vomiting, thrombocytopenia, increased transaminase, and decreased serum albumin. All adverse events were easily controllable and reversible after discontinuation of the drug. CONCLUSIONS Combination therapy with trastuzumab, 5'-DFUR and CPM is effective and well tolerated as the third- to six line treatment option for patients with HER2-overexpressing metastatic breast cancer. MINI-ABSTRACT Combination therapy by trastuzumab with 5'-DFUR and cyclophosphamide can be safely administered on an outpatient basis and is useful to treat patients with HER2-overexpressing metastatic breast cancer.
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Affiliation(s)
- Yuki Saito
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Matsuyama H, Baba Y, Shimabukuro T, Uchiyama K, Aoki A, Suga A, Jojima K, Suyama KI, Yamamoto N, Naito K. Novel prophylactic effect of doxifluridine in superficial bladder cancer. ACTA ACUST UNITED AC 2009; 38:366-72. [PMID: 15764246 DOI: 10.1080/00365590410033425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The prophylactic effect of 5'-deoxy-5-fluorouridine (5'-DFUR) has not been fully studied in superficial bladder cancer. The aims of this work were to investigate the prophylactic effects of 5'-DFUR in terms of tumor recurrence after transurethral resection of bladder tumor (TURBT) and to study whether thymidine phosphorylase (TdRPase) immunostaining predicts tumor recurrence. MATERIAL AND METHODS A total of 112 patients with pTa or pT1 bladder cancer were eligible for the analysis and were allocated to either an adjuvant group (TURBT+5'-DFUR; n = 47; initial 23 months) or a control group (TURBT alone; n = 65, final 23 months). Tumor specimens were studied immunohistochemically using anti-TdRPase antibody. RESULTS Tumor recurrence was observed in 54 of the patients (48%) after a median follow-up period of 26.8 months. No significant clinico-pathologic bias was observed between the two groups. Although patients in the adjuvant group had a significantly higher recurrence-free survival rate than those in the control group when considering 78 patients with pathological T1 tumors (p = 0.0272) and 65 patients who did not recur within 12 months (p = 0.001), overall there was no significant difference between the two groups. Multivariate analysis revealed that 5'-DFUR administration was the strongest predictor of late tumor recurrence, which was defined as development of recurrence 12 months after TURBT (hazard ratio 5.744; 95% CI 1.495-30.45; p = 0.0094). Immunostaining did not predict prophylactic effects of 5'-DFUR. Mild, reversible toxicity was found in 9/58 (15.5%) of the cases evaluated. CONCLUSIONS Oral administration of 5'-DFUR after TURBT did not prevent tumor recurrence in the overall cohort, although this novel drug may have a prophylactic effect in patients belonging to several subgroups.
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MESH Headings
- Administration, Oral
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/mortality
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/surgery
- Cystectomy/methods
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Female
- Floxuridine/therapeutic use
- Follow-Up Studies
- Humans
- Immunohistochemistry
- Male
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm Staging
- Probability
- Proportional Hazards Models
- Prospective Studies
- Reference Values
- Risk Assessment
- Survival Analysis
- Treatment Outcome
- Urinary Bladder Neoplasms/drug therapy
- Urinary Bladder Neoplasms/mortality
- Urinary Bladder Neoplasms/pathology
- Urinary Bladder Neoplasms/surgery
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Affiliation(s)
- Hideyasu Matsuyama
- Department of Urology, Yamaguchi University School of Medicine, Yamaguchi, Japan.
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Kitajima Y, Yakabe T, Ohtsuka T, Tanaka M, Sato S, Nakafusa Y, Miyazaki K. [Complete response obtained with first-line therapy as S-1, followed by second-line 5'-DFUR plus paclitaxel therapy in a patient with multiple liver and lymph node metastases from gastric cancer]. Gan To Kagaku Ryoho 2009; 36:851-854. [PMID: 19461193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A 82-year-old man with advanced gastric cancer underwent distal gastrectomy in January 2006. The histological diagnosis was poorly-differentiated adenocarcinoma, T2(MP), pN2, sH0, sP0, CY0; fStage III A. Three months after the operation, two metastatic nodules were noticed on the liver. The patient was treated with S-1 in April 2006. After the 8 courses of S-1 treatment, a complete response was achieved. However, a lymph node metastasis was newly found adjacent to the remnant stomach 2 months after the complete response to S-1. 5'-DFUR+paclitaxel combination therapy was then performed. After the 2 courses, the metastatic lymph node completely disappeared. We continued a total of 18 courses of the 5'-DFUR+paclitaxel therapy approximately for 1 year without critical drug toxicity. The patient has been alive without any recurrent site. Thus 5'-DFUR+paclitaxel as a second-line therapy following S-1 should be recommended for a gastric cancer patient with a recurrent tumor.
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Okabe T, Ohya T, Matsumoto H, Tago KI, Totsuka O, Numaga Y, Higuchi T, Iesato H, Yokomori T, Kawate S, Takeyoshi I. [A case of complete response for advanced gastric cancer with liver metastasis treated with combination chemotherapy of weekly paclitaxel and doxifluridine]. Gan To Kagaku Ryoho 2009; 36:115-118. [PMID: 19151575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A 68-year-old man underwent total gastrectomy for Type 3 gastric cancer with liver metastasis. The final finding was T3(SE), N1, H1, P0, CY0(class IV), Stage IV, Cur C. After surgery, he was treated with combination chemotherapy of weekly paclitaxel(PTX)/doxifluridine(5'-DFUR). Paclitaxel was administered at a dose of 80 mg/m(2) on day 1, 8 and 15, and doxifluridine was orally administered at a dose of 533 mg/m(2) day for five days followed by withdrawal for two days. This regimen was repeated every four weeks. After 2 courses, the tumor marker level normalized, and the size of the liver metastasis was remarkably decreased. After 5 courses, a CT scan revealed the liver metastasis had disappeared, and he has now survived without recurrence after the disappearance of the liver metastasis. No severe adverse reactions were observed, and the man can be treated as an outpatient. This therapy may thus be effective in the treatment of advanced gastric cancer following non-curative operation.
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Hirata K, Nakahara S, Shimokobe T, Imamura T, Sakamoto Y, Hirano T, Abe R, Kuroki N, Konomi K, Kato H, Fujiwara H, Fukuyama N, Hotokezaka M, Miyazaki Y, Terasaka R, Shiraishi M, Miyazaki R, Iwashita A, Nakano S, Ito H. [A randomized controlled trial of postoperative adjuvant chemotherapy for colorectal cancer-optimal duration of the treatment]. Gan To Kagaku Ryoho 2009; 36:77-82. [PMID: 19151567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
METHODS Subjects were 239 patients with colorectal cancer who underwent curative resection surgery from December 1994 to March 1997(Stage I-III b). The patients were given 5'-DFUR for postoperative 10 months as scheduled. They had been allocated into either a 1-year group or a 3-year group by dynamic randomization. 5'-DFUR was administered by an intermittent regimen such as 1,200 mg/body/day for five days followed by two days rest. All patients were followed for five years at least. RESULTS 239 patients were enrolled in the study. Favorable prognoses in both groups were observed. Although no statistically significant differences in overall survival curves of full analysis set based on the drug administration durations, were detected(log-rank test, p=0.734), a better prognosis was found in the 3-year group(5-year OS: 92.0%; 1- year group, 91.4%; 3-year group). Adverse drug reactions resulted in low rates such as 14.8% in the 1-year group and 19.5% in the 3-year group. Grade 3 was found in either group. CONCLUSIONS Due to a result in the present study that 5-year survival rates in both groups were far higher than anticipated, we could not finally clarify the optimal administration duration of 5'-DFUR. However, the results of the present study indicate that 5'-DFUR results in a good prognosis for colorectal cancer patients and is safe over a long / administration period.
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Affiliation(s)
- Keiji Hirata
- First Dept. of Surgery, University of Occupational and Environmental Health, Japan
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27
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Sakurai T, Umemura T, Jinta E, Suzuma T, Yoshimura G, Shimizu S, Sakurai T. [Doxifluridine, medroxyprogesterone acetate and cyclophosphamide (DMpC) combination therapy is effective against recurrent triple negative breast cancer--a case report]. Gan To Kagaku Ryoho 2008; 35:2433-2435. [PMID: 19098418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report a postmenopausal recurrent breast cancer patient with triple negative disease who presented with right recurrent nerve palsy. Nine years previously, she had undergone a mastectomy. FDG-PET scan revealed neck lymph node metastases from the breast cancer. The recurrent nerve palsy was thus considered to have been caused by the lymph node metastases. The patient was orally administered DMpC (doxifluridine, medroxyprogesterone acetate and cyclophosphamide) combination therapy. This resulted in a remarkable response after five months, with the recurrent nerve palsy completely disappearing at six months. No side effects from the treatment were observed. The patient was well and the treatment was being continued without relapse at nine months. Oral anti-cancer treatments such as DMpC appear to have few side effects and might be an effective treatment option for recurrent breast cancer patients with triple negative disease.
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Affiliation(s)
- Teruhisa Sakurai
- Dept. of Surgery, Wakayama Medical University Kihoku Hospital, Japan
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Ishizu K, Sunose N, Yamazaki K, Tsuruo T, Sadahiro S, Makuuchi H, Yamori T. Development and characterization of a model of liver metastasis using human colon cancer HCT-116 cells. Biol Pharm Bull 2007; 30:1779-83. [PMID: 17827739 DOI: 10.1248/bpb.30.1779] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In order to develop a model of liver metastasis of human gastrointestinal cancer cells, we examined the potential of 10 human colon and stomach cancer cell lines (HT-29, WiDr, HCT-116, HCT-15, HCC-2998, MKN7, MKN28, MKN45, MKN74 and St-4) to form liver metastases in nude mice. Among the cell lines, HCT-116 cells consistently formed gross liver metastases when injected into the spleens of nude mice. In contrast, other human colon and stomach cancer cells produced little or no liver metastasis. In order to analyze the high metastatic potential of HCT-116 cells, the adhesion potential was compared between HCT-116 cells and the other colon cancer cell lines. HCT-116 cells showed more efficient adhesion to fibronectin (FN) than other cells. Furthermore, FN enhanced haptotaxis of HCT-116 cells, but not of other colon cancer cells. The high adhesion potential to FN and enhanced haptotaxis may contribute, at least in part, to the high metastatic potential of HCT-116. To assess the value of this newly developed model of liver metastasis, we compared the ability of four anticancer drugs (fluorouracil, doxifluridine, paclitaxel and irinotecan) to inhibit the formation of liver metastases. Paclitaxel and irinotecan showed strong inhibition of liver metastasis but fluorouracil and doxifluridine showed only slight inhibition. Therefore, this model of metastasis may be useful for screening anti-liver metastatic reagents. These results indicate that the HCT-116 liver-metastasis model should be useful for analyzing the molecular mechanism of liver metastasis and for evaluating new anti-liver metastatic drugs.
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Affiliation(s)
- Kazuhiro Ishizu
- Division of Molecular Pharmacology, Cancer Chemotherapy Center, Japanese Foundation for Cancer Research, Koto-ku, Tokyo 135-8550, Japan
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Nagata Y, Masuda A. Bladder tumor associated with phenacetin abuse: a case report and a review of the literature. Tokai J Exp Clin Med 2007; 32:86-89. [PMID: 21318943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 07/03/2007] [Indexed: 05/30/2023]
Abstract
We herein report the case of a bladder tumor in an 85-year-old man who had been engaged in phenacetin abuse. He had been taking phenacetin owing to migraine headaches since he was 45 year of age. His total intake of phenacetin was approximately 7.3 to 11.5 kg over a period of years. He visited the Department of Urology in our hospital due to gross hematuria and pain on urination. IVP and a pelvic CT scan revealed a tumor mass on the right lateral wall of the urinary bladder. TUR-BT was performed. A histopathological examination of the resected specimen was diagnosed as urotherial carcinoma, grade 2∼3, pT2N0M0. To our acknowledge, only 24 cases of urotherial tumors owing to phenacetin abuse have been previously reported in the Japanese literature, making this the 25 th such case to be reported in Japan.
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30
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Nishioka M, Miyamoto H, Kurita N, Higashijima J, Yoshikawa K, Miyatani T, Shimada M. Pyrimidine nucleoside phosphorylase and dihydropyrimidine dihydrogenase activities as predictive factors for the efficacy of doxifluridine together with mitomycin C as adjuvant chemotherapy in primary colorectal cancer. Hepatogastroenterology 2007; 54:1089-93. [PMID: 17629045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND/AIMS Pyrimidine Nucleoside Phosphorylase (PyNPase) converts 5'-deoxy-5-fluorouridine (5'-DFUR, doxifluridine) to 5-fluorouracil (5-FU). While this reaction is taking place Dihydropyrimidine Dihydrogenase (DPD) catalyzes 5-FU to inactive molecules. Mitomycin C (MMC) elevates the PyNPase level in tumor cells. METHODOLOGY We investigated 17 colorectal cancer patients' PyNPase and DPD activities in tumor and normal tissues using an enzyme-linked immunosorbent assay (ELISA) to assess their clinical significance as indicators for selecting colorectal cancer patients for 5'-DFUR together with MMC as adjuvant chemotherapy. RESULTS Six of 17 patients developed experienced a recurrence. Tumor DPD activity of the 6 patients who had a recurrence were higher than those of the 11 patients with no recurrence (p = 0.047). On the other hand, there were no significant differences in both the PyNPase and the PyNPase/DPD (P/D) ratio between the group with recurrence and the group without recurrence. For survival analyses, we designed the cut-off value of tumor PyNPase, DPD and P/D ratio as their median value and classified patients into a higher group and a lower group, but there were no significant differences between the groups. CONCLUSIONS The DPD activity in the tumor may be a useful indicator for selecting patients likely respond to 5'-DFUR together with MMC as adjuvant chemotherapy. If tumor DPD is high, we had better select a different anticancer drug.
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Affiliation(s)
- Masanori Nishioka
- Department of Digestive and Pediatric Surgery, Institute of Health Biosciences The University of Tokushima Graduate School, Tokushima, Japan.
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31
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Strasser S, Maier S, Leisser C, Saiko P, Madlener S, Bader Y, Bernhaus A, Gueorguieva M, Richter S, Mader RM, Wesierska-Gadek J, Schott H, Szekeres T, Fritzer-Szekeres M, Krupitza G. 5-FdUrd-araC heterodinucleoside re-establishes sensitivity in 5-FdUrd- and AraC-resistant MCF-7 breast cancer cells overexpressing ErbB2. Differentiation 2007; 74:488-98. [PMID: 17177846 DOI: 10.1111/j.1432-0436.2006.00082.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ErbB2 overexpressing breast tumors have a poor prognosis and a high risk to develop chemoresistance to therapeutic treatment. "Chemoresistance" is a response of cells to toxic stress, and, although it is a common phenomenon, it is still poorly defined. However, a detailed understanding is required to target desensitized pathways and mechanisms for successful reactivation as part of a tailored therapy. To gain insight, which malfunctions contribute to chemoresistance, two mechanisms relevant for tissue homeostasis, the regulation of the cell cycle and of apoptosis, were investigated. Maternal MCF-7- and ErbB2-overexpressing MCF-7(erbB2) breast cancer cells were long term pretreated with 2'-deoxy-5-fluorodeoxyuridine (5-FdUrd) or 1-beta-d-arabinofuranosylcytosine (AraC) and the acquisition of drug-insensitivity was analyzed. A phosphate-conjugated heterodinucleoside consisting of one 5-FdUrd- and one AraC-moiety (5-fluoro-2'-desoxyuridylyl-(3'-->5')-Arabinocytidine) was utilized as a tool to assess the type of acquired resistances. ErbB2-overexpression disrupted proper cell cycle regulation and furthermore facilitated the development of an apoptosis-refractory phenotype upon exposure to 5-FdUrd. Experiments with dimer 5-FdUrd-araC in ErbB2-overexpressing MCF-7(erbB2) cells, and also with nucleoside 5-FdUrd in maternal MCF-7 cells, evidenced that the phenotypes of resistance to cell cycle inhibition and to apoptosis induction were differently affected. The expression profile of cyclin D1 (but not that of p53, p21, or p27) correlated with the proliferative phenotypes and nuclear accumulation of apoptosis inducing factor (but not activation of caspase 7) with apoptotic phenotypes. Dimer 5-FdUrd-araC overrode acquired chemoresistances, whereas combined application of 5-FdUrd and AraC exhibited significantly less activity. Dimer 5-FdUrd-araC remained active in MCF-7 clones most likely by circumventing the prerequisite of first-step phosphorylation. The acquisition of chemoresistance encompassed the affection of apoptosis- and cell-cycle regulation to, respectively, different extents. Thus, drug-induced cell cycle arrest and apoptosis induction are independent of each other.
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Affiliation(s)
- Stephen Strasser
- Institute of Clinical Pathology, Medical University of Vienna, A-1090 Vienna, Austria
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32
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Abstract
The Hollow Fibre Assay (HFA) is usually applied as an early in vivo model for anti-cancer drug screening, but is potentially an excellent model for short-term in vivo pharmacodynamic studies. We used the model to study the in vivo role of thymidine phosphorylase/platelet-derived endothelial cell growth factor (TP/PD-ECGF) in the cytotoxicity and pharmacodynamics of TAS-102 in colon cancer cells. TAS-102 is a new oral drug formulation, which is composed of trifluorothymidine (TFT) and thymidine phosphorylase inhibitor (TPI), which prevents TFT degradation. We compared the activity with Xeloda (capecitabine), which is activated by TP into 5FU. Hollow fibres filled with human Colo320 or Colo320TP1 colorectal cancer cells with deficient or high TP expression, respectively, were implanted subcutaneously (s.c.) at both flanks of BALB/c mice. The mice were treated orally over 5 days with TAS-102, TFT alone, 5′DFUR±TPI or capecitabine at their maximum tolerated dose (MTD). The cells were retrieved from the fibres and assayed for growth (MTT assay), cell cycle distribution (flow cytometry) and apoptosis induction (FragEL method). TAS-102 induced considerable growth inhibition (50%, P<0.01) to both cell lines, which was completely abolished in the absence of TPI. Capecitabine and its metabolite 5′DFUR reduced proliferation of Colo320TP1 cells in the fibres significantly (down to 25–40%), but much less in Colo320 cells, whereas addition of TPI reduced the effect of 5′DFUR, although not completely. These differences in cytotoxic effects were reflected in the pharmacodynamic evaluation. TAS-102 induced a G2M-phase arrest (from 25 to 40%) and apoptosis (>8-fold), which was more pronounced in Colo320 than in Colo320TP1. Again, omission of TPI neutralised the effect of TAS-102. Similarly, 5′DFUR and capecitabine induced a significant G2M-phase arrest (up to 45%) in the Colo320TP1 cell line, but less pronounced in the parental Colo320. Addition of TPI to 5′DFUR reduced this effect to control levels. Also induction of apoptosis was reduced in the presence of TPI. The data demonstrated that the HFA is excellently suited for studying short-term pharmacodynamic effects of fluoropyrimidines in vivo. TAS-102 is only effective in inducing cytotoxicity when systemic TPI is present, but acts against both low and high TP expressing colon cancer cells, while 5′DFUR needs cellular TP to exert significant activity.
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Affiliation(s)
- O H Temmink
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - H-J Prins
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - E van Gelderop
- Clinical and Experimental Animal Laboratory, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
| | - G J Peters
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, PO box 7057, 1007 MB Amsterdam, The Netherlands. E-mail:
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Roybal JJ, Feliberti EC, Rouse L, Wagman LD. Pump removal in infected patients with hepatic chemotherapy pumps: when is it necessary? Am Surg 2006; 72:880-4. [PMID: 17058726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Hepatic chemotherapy pumps have been shown to be an effective and well-tolerated treatment for metastatic colorectal cancer confined to the liver. The importance of completing chemotherapy in long-term outcome makes it desirable to salvage hepatic pumps where possible. Concerns of persistent and systemic infection have resulted in premature removal of pumps in patients with infection. We report our experience in this clinical scenario. We placed 75 hepatic chemotherapy pumps from January 1998 to August 2005 for treatment of colorectal liver metastases. Information was collected on the patients' courses of treatment, complications, and demographics via chart review. The rate of infection was 22.7% (n = 17), including eight infections localized to the abdomen (entailing five wound infections, three hepatic abscesses, and two pump pocket infections). Of these, two pumps had to be removed because of pump pocket infection, and these patients received more cycles of chemotherapy compared with the four removed for noninfectious complications (12.3 vs 3.2, P = 0.0349). Time to infection was found to be significantly higher in these patients (12.5 months) than in the patients with infections overall (4.87 months, P = 0.029), and age was found to be lower (42.5 vs 57.6 years, P = 0.0068).
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Abstract
It is time to challenge the current orthodoxy that frowns upon surgical and nonsurgical methods of tumor reduction for patients with metastatic colon cancer. Although the studies conducted with radiofrequency ablation, chemoembolization, and radiation therapy in patients with metastatic colon cancer have tended to be small and may have been subject to selection bias, they have produced survival data that require careful consideration. At the very least, it is clear that locoregional approaches to debulking tumors are feasible and that their combination with systemic chemotherapy should be investigated.
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Affiliation(s)
- David P Ryan
- Tucker Gosnell Gastrointestinal Cancer Center, Massachusetts General Hospital Cancer Center, Boston, Massachusetts 02114, USA.
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Abstract
Uridine phosphorylase (UPase) is an enzyme that converts the pyrimidine nucleoside uridine into uracil. Upon availability of ribose-1-phosphate, UPase can also catalyze the formation of nucleosides from uracil as well as from 5-fluorouracil, therefore involved in fluoropyrimidine metabolism. UPase gene expression is strictly controlled at the promoter level by oncogenes, tumor suppressor genes, and cytokines. UPase activity is usually elevated in various tumor tissues, including breast cancer, compared to matched normal tissues and this induction appears to contribute to the therapeutic efficacy of fluoropyrimidines in cancer patients. In this review, we will discuss in detail the role of UPase in the activation of fluoropyrimidines and its effect on the prognosis of breast cancer patients.
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Affiliation(s)
- Ruilan Yan
- Department of Medical Microbiology, Immunology, and Cell Biology, Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL 62702, USA
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Fischel JL, Ciccolini J, Formento P, Ferrero JM, Milano G. Synergistic cytotoxic interaction in hormone-refractory prostate cancer with the triple combination docetaxel–erlotinib and 5-fluoro-5′-deoxyuridine. Anticancer Drugs 2006; 17:807-13. [PMID: 16926630 DOI: 10.1097/01.cad.0000224444.23953.90] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The current reference treatment of hormone-refractory prostate cancer consists mainly of chemotherapy with docetaxel. To improve the management of advanced prostate cancer, one should examine the benefits of adding other agents to docetaxel. We examined the growth inhibitory effects of a triple combination, including the anti-epidermal growth factor receptor drug erlotinib, docetaxel and 5-fluoro-5'-deoxyuridine (the main intermediary metabolite of capecitabine), on the human prostate cancer cell lines PC3 and DU145, which are both devoid of androgen receptors. Marked synergistic cytotoxic effects were observed with the application of the double combination of erlotinib-5-fluoro-5'-deoxyuridine for both cell lines and to a lesser magnitude with the triple combination. For PC3 cells, all conditions resulted in synergistic interactions. The combination between erlotinib and docetaxel resulted in an approximately 50% reduction in thymidylate synthase activity (the molecular target of 5-fluorodeoxyuridine monophosphate, the active capecitabine anabolite) with an higher impact observed with DU145 cells than with PC3 cells. Neither erlotinib nor docetaxel alone displayed marked effects on thymidine phosphorylase activity (the enzyme that governs at the cellular level the final and crucial step in the activation cascade of capecitabine), in contrast to their combination that resulted in a strong increase in thymidine phosphorylase activity in PC3 cells. These data may serve as a rational basis for setting up clinical trials in advanced prostate cancer combining epidermal growth factor receptor-targeting agents like erlotinib together with docetaxel and capecitabine.
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Affiliation(s)
- Jean-Louis Fischel
- Centre Antoine-Lacassagne, Department of Oncopharmacology, Nice Cedex, France
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Gore ME, Escudier B. Emerging efficacy endpoints for targeted therapies in advanced renal cell carcinoma. Oncology (Williston Park) 2006; 20:19-24. [PMID: 16773841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Several novel targeted agents are being tested for the treatment of advanced renal cell carcinoma (RCC), and results of phase I and II trials have been encouraging. A recently completed phase III, placebo-controlled study showed that median progression-free survival doubled from 12 weeks to 24 weeks in patients treated with the multi-kinase inhibitor sorafenib (Nexavar) (hazard ratio [HR], 0.44; P < .00001), and approximately three-quarters of patients had some degree of tumor regression. Furthermore, interim analysis showed an estimated 39% improvement in overall survival in sorafenib-treated patients (HR, 0.72; P = .018) and an investigator-assessed response rate of 10%, indicating that many more patients had clinical benefit than had tumor regression qualifying as response by traditional criteria. These data and others have added to the evidence of lack of correlation between response rate and clinical benefit in RCC patients (as well as in other tumor types) treated with targeted therapies. Issues surrounding study endpoints and biologic efficacy markers for molecular targeted agents in RCC are discussed in this article, with a focus on results of the Treatment Approaches in Renal Cancer Global Evaluation Trial (TARGETs).
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Affiliation(s)
- Martin E Gore
- Department of Medicine, The Royal Marsden Hospital (NHS Trust), London, England.
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Abstract
BACKGROUND Hepatic arterial infusion of fluoropyrimidines has been widely used for the treatment of hepatic metastasis from colorectal cancer. One major complication of such treatment is biliary sclerosis resembling primary sclerosing cholangitis, which has an incidence ranging from 8% to 26%. AIM We evaluated the efficacy and long-term outcome of endoscopic therapy in the management of chemotherapy-induced sclerosing cholangitis (CISC). METHODS With the use of an endoscopic retrograde cholangiopancreatography (ERCP) database, all patients with a diagnosis of CISC who had endoscopic therapy between March 1995 and March 2005 were identified. The indications, findings, therapies, and complications for all patients undergoing ERCP were recorded in this database. Additional information was obtained by review of medical records. RESULTS Eleven patients (six men and five women) were identified. The mean age at presentation was 59.5 years (range, 36-76 years). Cholangiogram findings revealed stricture confined to the common hepatic duct in two patients, involving the hilum in seven patients, involving the right and/or left main hepatic ducts in nine patients, and extending to the intrahepatic radicals in two patients. All patients had successful endoscopic therapy to alleviate the presenting symptom. The grade and extent of biliary strictures did not change in five patients, improved in one patient, recurred in two patients, and progressed in two patients over the follow-up period of 28.2 months (range, 4-60 months). CONCLUSION Although long-term follow-up of patients with CISC is limited by the dismal prognosis of the underlying malignancy, CISC has a recalcitrant pattern that rarely improves with endoscopic therapy. However, endoscopic therapy seems to be an effective method of palliation.
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Affiliation(s)
- Waleed M Alazmi
- Indiana University Medical Center, 550 N. University Blvd, Indianapolis, 46202, USA
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Zhao WH, Wang SF, Ding W, Sheng JM, Ma ZM, Teng LS, Wang M, Wu FS, Luo B. Apoptosis induced by preoperative oral 5’-DFUR administration in gastric adenocarcinoma and its mechanism of action. World J Gastroenterol 2006; 12:1356-61. [PMID: 16552801 PMCID: PMC4124310 DOI: 10.3748/wjg.v12.i9.1356] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the apoptosis induced by preoperative oral 5’-DFUR administration in gastric adenocarcinoma and its mechanism of action.
METHODS: Sixty gastric cancer patients were divided randomly into three groups (20 each group) before operation: group one: 5’-DFUR oral administration at the dose of 800-1200mg/d for 3 - 5 d, group two: 500mg 5-FU + 200 mg/d CF by venous drip for 3 - 5 d, group three (control group). One or two days after chemotherapy, the patients were operated. Fas/FasL, PD-ECGF and PCNA were examined by immunohistochemistry and apoptotic tumor cells were detected by in situ TUNEL method. Fifty-four patients received gastrectomy, including 12 palliative resections and 42 radical resections. Six patients were excluded. Finally 18 cases in 5’-DFUR group, 16 cases in CF + 5-FU group, and 20 cases in control group were analyzed.
RESULTS: There was no significant difference in patient mean age, gender, white blood cell count, haematoglobin (HB), thromboplastin, perioperative complication incidence, radical or palliation resection, invasion depth (T), lymphonode involvement (N), metastasis (M) and TNM staging among the three groups. However, the PCNA index (PI) in 5’-DFUR group (40.51 ± 12.62) and 5-FU + CF group (41.12 ± 15.26) was significantly lower than that in control group (58.33 ± 15.69) (F = 9.083, P = 0.000). The apoptotic index (AI) in 5’-DFUR group (14.39 ± 9.49) and 5-FU + CF group (14.11±9.68) was significantly higher than that in control group (6.88 ± 7.37) (F = 4.409, P = 0.017). The expression rates of Fas and FasL in group one and group three were 66.7% (12/18) and 50% (9/18), 43.8% (7/16) and 81.3% (13/16), 45.0% (9/20) and 85% (17/20), respectively. The expression rate of FasL in 5’-DFUR group was significantly lower than that in the other two groups (χ2=6.708, P = 0.035). Meanwhile, the expression rate of PD-ECGF was significantly lower in 5’-DFUR group (4/18,28.6%) than in CF + 5-FU group(9/16,56.3%)and control group (13/20,65.0%) (χ2 = 7.542, P = 0.023). The frequency of Fas expression was significantly correlated with palliative or radical resection (χ2 = 7.651, P = 0.006), invasion depth (χ2 = 8.927, P = 0.003), lymphatic spread (χ2 = 4.488, P = 0.034) and UICC stages (χ2 = 8.063, P = 0.045) respectively. By the end of March 2005, 45 patients were followed up. The 0.5-, 1-, 2-, 3-year survival rates were 96%,73%,60%,48%, respectively, which were related with T, N, M and Fas expression, but not with PD-ECGF and FasL expression.
CONCLUSION: Preoperative oral 5’-DFUR administration may induce apoptosis of gastric carcinoma cells and decrease tumor cell proliferation index, but cannot improve the prognosis of patients with gastric cancer. Down-regulation of FasL and PD-ECGF expression mediated by 5’-DFUR may be one of its anti-cancer mechanisms. Fas expression correlates with the progression of gastric carcinoma and may be an effective prognostic factor.
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Affiliation(s)
- Wen-He Zhao
- Department of Oncological Surgery, the First Affiliated Hospital of Medical College, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
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Ben-Josef E, Normolle D, Ensminger WD, Walker S, Tatro D, Ten Haken RK, Knol J, Dawson LA, Pan C, Lawrence TS. Phase II trial of high-dose conformal radiation therapy with concurrent hepatic artery floxuridine for unresectable intrahepatic malignancies. J Clin Oncol 2006; 23:8739-47. [PMID: 16314634 DOI: 10.1200/jco.2005.01.5354] [Citation(s) in RCA: 234] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE A phase II trial was conducted to determine if high-dose radiation with concurrent hepatic arterial floxuridine would improve survival in patients with unresectable intrahepatic malignancies. PATIENTS AND METHODS Three-dimensional conformal high-dose radiation therapy was delivered concurrently with hepatic arterial floxuridine in 128 patients. The radiation dose was based on a normal-tissue complication probability model and subjected the patient to an estimated maximum risk of radiation-induced liver disease of 10% to 15%. The study design provided more than 80% power to detect a two-fold increase in median survival compared with historical controls at a 5% significance level. RESULTS The median radiation dose delivered was 60.75 Gy (1.5-Gy fractions bid). At a median follow-up time of 16 months (26 months in patients who were alive) the median survival was 15.8 months (95% CI, 12.6 to 18.3 months), significantly longer than in the historical control. The actuarial 3-year survival was 17%. The total dose was the only significant predictor of survival. Primary hepatobiliary tumors had a significantly greater tendency to remain confined to the liver than did colorectal cancer metastases. Overall toxicity was acceptable, with 27 patients (21%) and 11 patients (9%) developing grade 3 and 4 toxicity, respectively, and one treatment-related death. CONCLUSION The results suggest that, compared with historical controls, high-dose focal liver irradiation with hepatic artery floxuridine prolongs survival in patients with unresectable chemotherapy-refractory metastatic colorectal cancer and primary hepatobiliary tumors. This provides a rationale for intensification of local therapy for unresectable hepatobiliary cancers and integration of this regimen with newer systemic therapy for patients with colorectal cancer.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antimetabolites, Antineoplastic/adverse effects
- Antimetabolites, Antineoplastic/therapeutic use
- Bile Duct Neoplasms/secondary
- Bile Duct Neoplasms/therapy
- Bile Ducts, Intrahepatic/drug effects
- Bile Ducts, Intrahepatic/pathology
- Bile Ducts, Intrahepatic/radiation effects
- Carcinoma, Hepatocellular/secondary
- Carcinoma, Hepatocellular/therapy
- Cholangiocarcinoma/secondary
- Cholangiocarcinoma/therapy
- Colorectal Neoplasms/pathology
- Colorectal Neoplasms/therapy
- Combined Modality Therapy
- Digestive System Surgical Procedures
- Dose-Response Relationship, Radiation
- Female
- Floxuridine/adverse effects
- Floxuridine/therapeutic use
- Follow-Up Studies
- Hepatic Artery
- Humans
- Infusions, Intra-Arterial
- Liver Neoplasms/secondary
- Liver Neoplasms/therapy
- Male
- Middle Aged
- Prospective Studies
- Radiotherapy Dosage
- Radiotherapy, Conformal/adverse effects
- Radiotherapy, Conformal/methods
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Edgar Ben-Josef
- Department of Radiation Oncology, Division of Hematology Oncology, University of Michigan, UH-B2C490, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0010, USA.
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Phongkitkarun S, Kobayashi S, Varavithya V, Huang X, Curley SA, Charnsangavej C. Bile duct complications of hepatic arterial infusion chemotherapy evaluated by helical CT. Clin Radiol 2005; 60:700-9. [PMID: 16038698 DOI: 10.1016/j.crad.2005.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2004] [Revised: 12/21/2004] [Accepted: 01/12/2005] [Indexed: 10/25/2022]
Abstract
AIM To describe the imaging findings of bile duct complications of hepatic arterial infusion chemotherapy (HAIC) using helical CT, to set diagnostic criteria, to develop a CT grading system, and to correlate these with clinical findings and laboratory data. METHODS Follow-up helical CT of the abdomen was performed every 3 months for 60 patients receiving HAIC. Three radiologists reviewed all CT studies before and after treatment, using either the picture archiving and communication system or hard copies. The findings of bile duct abnormalities were correlated with findings from other imaging techniques, clinical symptoms and laboratory data. RESULTS Bile duct abnormalities developed in 34 (57%) of cases either during HAIC or 1 to 12 months after treatment. In 14 (41%) of these 34 patients, enhancement of the hepatic parenchyma along the dilated bile duct or in the segmental or lobar distribution was observed. In 43 cases (72%), normal or abnormal alkaline phosphatase levels were consistent with normal or abnormal CT findings, respectively. Increasing alkaline phosphatase and bilirubin levels were related to CT grade. CONCLUSION Imaging findings of bile duct complications of HAIC are similar to those of primary sclerosing cholangitis, and correlate well with abnormal clinical and laboratory data. In the presence of such clinical abnormalities, thin-section helical CT with careful review of the imaging studies helps to determine the correct diagnosis, monitor the changes and guide appropriate treatment.
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Affiliation(s)
- S Phongkitkarun
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
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Tagaya N, Nakagawa A, Mori S, Tachibana M, Kakihara Y, Hamada K, Suzuki N, Kubota K. [Experience with capecitabine in patients with anthracycline and/or taxane-resistant recurrent breast cancer]. Gan To Kagaku Ryoho 2005; 32:1135-8. [PMID: 16121915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We evaluated the safety and efficacy of capecitabine in 12 patients with anthracycline and/or taxane-resistant metastatic breast cancer on an outpatient basis. Their mean age was 57 years, and they previously received chemotherapy consisting of anthracycline in 7 cases, taxane in 12 and doxifluridine in 8. Their mean disease-free interval was 28.5 months, HER 2/neu and ER and/or PgR-positive was shown in 2 and 8 cases, respectively. The recurrent sites were lymph node in 9 cases, lung in 6, skin in 5, pleural effusion in 4, liver, bone and pleura in 3, brain and CBS in 2, and thyroid, ascites and pericardial effusion in one, respectively. The administration dose was 2,400 mg/day in 11 cases and 3,000 mg/day in one. Capecitabine was administered orally for 21 consecutive days followed by a one-week rest. The mean follow-up period was 6.5 months. The overall response rate was 18.2% in 11 cases, including 2 partial responses, 4 stable diseases and 5 progressive diseases. Clinical benefit was 36.4% including two long stable diseases. The mean time to treatment failure was 6.5 months. Adverse events included Hand-Foot Syndrome in 5 cases, nausea in 3, diarrhea, appetite loss and high fever in one, respectively. In two of them administration was discontinued due to adverse events. Capecitabine had satisfactory effects with tolerable adverse events for anthracycline- and/or taxane-resistant metastatic breast cancer.
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Affiliation(s)
- Nobumi Tagaya
- Dept of Surgery II, Dokkyo University School of Medicine
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Faynsod M, Wagman LD, Longmate J, Carroll M, Leong LA. Improved Hepatic Toxicity Profile of Portal Vein Adjuvant Hepatic Infusional Chemotherapy. J Clin Oncol 2005; 23:4876-80. [PMID: 16009960 DOI: 10.1200/jco.2005.01.515] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine whether floxuridine (FUDR) can be delivered with low hepatic toxicity through the portal vein (PV) as an adjuvant to surgically treated colorectal metastases. Patients and Methods Fifty-one patients undergoing complete resection and/or ablation for colorectal hepatic metastases were prospectively enrolled at a National Cancer Institute–designated comprehensive cancer center. Two sequential phase II trials were performed. Each trial included complete surgical treatment followed by sequential, alternating (22 patients) or concurrent (29 patients) regional PV FUDR and systemic fluorouracil (FU) with leucovorin chemotherapy. Results Fifty percent of patients were male. The mean age at diagnosis was 57 years. The mean number of lesions resected was three (range, one to 11 lesions). The stage at diagnosis was II, III, and IV in 16.9%, 52.8%, and 28.3% of patients, respectively. One- and 3-year overall survival rates were 92.7% and 41.8%, respectively. The 1- and 3-year disease-free survival rates were 64.5% and 19%, respectively. The site of first recurrence was hepatic in 35.9% of patients. Treatment was terminated early in 24 patients (17 patients progressed, two refused treatment, and five had nonhepatic toxicities). Fifty-five percent of patients received 75% to 100% of the planned FUDR courses, and 72% received greater than 50% of the planned FUDR dose. Only four patients required dose reductions of FUDR because of grade 3 hepatic toxicity. No patient required biliary stenting or had discontinuation of PV infusion because of hepatic toxicity. Conclusion The delivery of PV FUDR and FU with leucovorin can be performed with a high percentage of expected drug delivery and a low drug-induced hepatic toxicity rate, while achieving acceptable overall and disease-free survival.
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Affiliation(s)
- Moshe Faynsod
- City of Hope National Medical Center, Division of Surgery, Duarte, CA 91010-3000, USA
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Zheng JF, Wang HD. 5-Fluorouracil concentration in blood, liver and tumor tissues and apoptosis of tumor cells after preoperative oral 5’-deoxy-5-fluorouridine in patients with hepatocellular carcinoma. World J Gastroenterol 2005; 11:3944-7. [PMID: 15991299 PMCID: PMC4504902 DOI: 10.3748/wjg.v11.i25.3944] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the levels of 5-fluorouracail (5-FU) in plasma, liver and tumor in patients with hepatocellular carcinoma after oral administration of 5’-deoxy-5-fluorouridine (5’-DFUR).
METHODS: Thirty-nine patients with hepatocellular carcinoma were treated with oral 5’-DFUR for more than 4 d before operation. The contents of 5-FU in plasma, liver and tumor were measured by high performance liquid chromatography (HPLC) and apoptosis of tumor cells was evaluated by in-situ TUNEL after resection of tumor.
RESULTS: The concentrations of 5-FU were 1.1 μg/mL, 5.6, 5.9, and 10.5 μg/g in plasma, the liver tissue, the center of tumor and the periphery of tumor, respectively. 5-FU concentration was significantly higher in the periphery of tumor than that in the liver tissue and the center of tumor (10.5 ± 1.6 μg/g vs 5.6 ± 0.8 μg/g, t = 21.38, P < 0.05; 10.5 ± 1.6 μg/g vs 5.9 ± 0.9 μg/g, t = 20.07, P < 0.05). 5-FU level was significantly lower in plasma than that in the liver and the tumor (1.1 ± 0.3 μg/mL vs 5.6 ± 0.8 μg/g, t = 19.63, P < 0.05; 1.1 ± 0.3 μg/mL vs 10.5 ± 1.6 μg/g, t = 41.01, P < 0.05). Apoptosis of tumor cells was significantly increased after oral 5’-DFUR compared to the control group without 5’-DFUR treatment.
CONCLUSION: There is a higher concentration of 5-FU distributed in the tumor compared with liver tissue and apoptosis of tumor cells is increased following oral 5’-DFUR compared with the control group. The results indicate that 5’-DFUR is hopeful as neo-adjuvant chemotherapy to prevent recurrence after resection of hepatocellular carcinoma.
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Affiliation(s)
- Jin-Fang Zheng
- Department of Hepatobiliary Surgery, Hainan Provincial People's Hospital, Haikou 570311, Hainan Province, China.
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Miyake K, Hayakawa K, Nishino M, Morimoto T, Mukaihara S. Effects of oral 5-fluorouracil drugs on hepatic fat content in patients with colon cancer. Acad Radiol 2005; 12:722-7. [PMID: 15935970 DOI: 10.1016/j.acra.2005.02.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2005] [Revised: 02/16/2005] [Accepted: 02/16/2005] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES The association between hepatic steatosis and oral 5-fluorouracil (5-FU) agents is clinically recognized but has not been systematically studied. The aim of this study was to determine the effects of 5-FU on hepatic fat content in patients undergoing oral 5-FU therapy and to compare the effects in three subgroups of 5-FU drugs. MATERIALS AND METHODS Fifty-one patients with postoperative colon cancer (mean 61.1 years) were retrospectively studied. Forty-three patients were given adjuvant oral 5-FU therapy for a mean 3.3 years (5-FU group), and eight patients were not (control group). All patients underwent preoperative and postoperative abdominal computed tomography (CT) studies. The liver/spleen ratio was calculated from the CT attenuation values for the liver and spleen. We also compared the effects on hepatic appearance under CT of three 5-FU drugs: fluorouracil (n = 13), doxifluridine (n = 14), or UFT (a mixture of tegafur and uracil; n = 9). RESULTS In the 5-FU group, the mean CT values for the liver were significantly reduced relative to values before therapy (P < .01) and to those of the control group (P < .0001). Fifteen of 43 patients (34.9%) developed steatosis. Of the three 5-FU drugs, fluorouracil and doxifluridine caused a significant decrease in hepatic CT values. CONCLUSION 5-FU caused a significant decrease in CT attenuation, indicating an increase in hepatic fat content, and was associated with very frequent hepatic steatosis. UFT seemed less likely to cause hepatic fatty infiltration. CT examination was useful for early detection of drug-induced side effects on liver even before lab abnormality or clinical manifestation is observed.
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Affiliation(s)
- Kanae Miyake
- Department of Radiology, Kyoto City Hospital, 1-2 Higashi-takada-cho, Mibu, Nakagyo-ku, Kyoto 604-8845, Japan.
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Hasegawa S, Seike K, Koda K, Takiguchi N, Oda K, Hasegawa R, Miyazaki M. Thymidine phosphorylase expression and efficacy of adjuvant doxifluridine in advanced colorectal cancer patients. Oncol Rep 2005; 13:621-6. [PMID: 15756433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
To clarify the correlation between the expression level of thymidine phosphorylase (TP) and efficacy of doxifluridine (5'-DFUR) and 5-fluorouracil (5-FU), samples from 177 colorectal cancer patients who underwent curative resection were evaluated by immunohistochemical staining using a newly developed monoclonal antibody 1C6-203. Patients were randomly given either oral 5'-DFUR or 5-FU as postoperative adjuvant chemotherapy. In Dukes' C staged colon cancer patients treated with 5'-DFUR, better survival was observed in the high TP patients than the low TP patients (P=0.025 by the log-rank test). The observed 5-year survival rates were 91.2 and 74.8%, respectively. No correlation between TP expression and patient prognosis was detected in the 5-FU group. In Dukes' C stage colon patients with high TP expression, the 5'-DFUR group had slightly better survival than the 5-FU group. These findings suggest that TP may be a chemosensitive marker for 5'-DFUR as postoperative adjuvant chemotherapy for advanced colon cancer patients.
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Affiliation(s)
- Shiro Hasegawa
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8677, Japan
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Bareggi C, Paleari D, Garassino MC, Mora M, Salamina S, Senecione M, Ghidini A, Pancera G. Localized Hand-Foot Syndrome after Intra-Arterial Hepatic Chemotherapy with Floxuridine: A Clinical Case. Tumori 2005; 91:193-6. [PMID: 15948551 DOI: 10.1177/030089160509100217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hand-foot syndrome is a toxic effect of some chemotherapy agents such as 5-fluorouracil (5-FU), capecitabine and liposomal doxorubicin. The symptoms and signs are localized erythema and paresthesia. Floxuridine (FUDR) is an analogue of 5-FU, used for arterial hepatic infusion in patients affected by liver metastases from colorectal cancer. A patient who was treated for colorectal cancer with liver metastases underwent locoregional chemotherapy with FUDR and systemic chemotherapy with FOLFOX4. After three cycles he developed severe painful dermatitis of the right leg. Abdominal X-ray showed displacement of the catheter to the right common iliac artery. Treatment was discontinued and the patient had a rapid recovery.
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