Intraabdominal chemotherapy of prevailing forms of colon cancer

The efficacy of intraabdominal chemotherapy in patients with prevailing forms of colon cancer, such as peritoneal carcinomatosis, local disseminated and local recurrent colon cancer was estimated. The comparative analysis showed that the intraabdominal chemotherapy allowed to amend the remote results of the treatment in the cases with carcinomatosis, local disseminated colon cancer and local recurrence.     

Chemoradiation for carcinoma of the cervix: advances and opportunities

Although it is possible to cure many patients with locally advanced cervical cancer using radiation therapy alone, loco-regional relapse continues to be a component of most recurrences. To improve control rates, clinicians have investigated ways of combining chemotherapy and radiation for more than 30 years. Despite encouraging results from phase II trials of neoadjuvant chemotherapy, randomized trials failed to improve on the results with radiation therapy alone. For a number of reasons, early trials of concurrent chemoradiation were inconclusive. However, recent reports of five large prospective randomized trials demonstrated dramatic improvements in survival and local control rates when cisplatin-containing chemotherapy was given during radiation therapy. These results also suggest a number of avenues for future research.     

The Impact of Delayed Chemotherapy on Its Completion and Survival Outcomes in Stage II Colon Cancer Patients

Background

Delayed chemotherapy is associated with inferior survival in stage III colon and stage II/III rectal cancer patients, but similar studies have not been performed in stage II colon cancer patients. We investigate the association between delayed and incomplete chemotherapy, and the association of delayed chemotherapy with survival in stage II colon cancer patients.

Patients and Methods

Patients (age ≥66) diagnosed as stage II colon cancer and received chemotherapy from 1992 to 2005 were identified from the linked SEER–Medicare database. The association between delayed and incomplete chemotherapy was assessed using unconditional and conditional logistic regressions. Survival outcomes were assessed using stratified Cox regression based on propensity score matched samples.

Results

4,209 stage II colon cancer patients were included, of whom 73.0% had chemotherapy initiated timely (≤2 months after surgery), 14.7% had chemotherapy initiated with moderate delay (2–3 months), and 12.3% had delayed chemotherapy (≥3 months). Delayed chemotherapy was associated with not completing chemotherapy (adjusted odds ratio (OR): 1.33 (95% confidence interval: 1.11, 1.59) for moderately delayed group, adjusted OR: 2.60 (2.09, 3.24) for delayed group). Delayed chemotherapy was associated with worse survival outcomes (hazard ratio (HR): 1.75 (1.29, 2.37) for overall survival; HR: 4.23 (2.19, 8.20) for cancer-specific survival).

Conclusion

Although the benefit of chemotherapy is unclear in stage II colon cancer patients, delay in initiation of chemotherapy is associated with an incomplete chemotherapy course and poorer survival, especially cancer-specific survival. Causal inference in the association between delayed initiation of chemotherapy and inferior survival requires further investigation.     

Phase 2 study of canfosfamide in combination with pegylated liposomal doxorubicin in platinum and paclitaxel refractory or resistant epithelial ovarian cancer

We have reviewed the pivotal presentations related to gastrointestinal malignancies from 2009 annual meeting of the American Society of Clinical Oncology with the theme of "personalizing cancer care". We have discussed the scientific findings and the impact on practice guidelines and ongoing clinical trials. Adding trastuzumab to chemotherapy improved the survival of patients with advanced gastric cancer overexpressing human epidermal growth factor receptor 2. Gemcitabine plus cisplatin has become a new standard for first-line treatment of advanced biliary cancer. Octreotide LAR significantly lengthened median time to tumor progression compared with placebo in patients with metastatic neuroendocrine tumors of the midgut. Addition of oxaliplatin to fluoropyrimidines for preoperative chemoradiotherapy in patients with stage II or III rectal cancer did not improve local tumor response but increased toxicities. Bevacizumab did not provide additional benefit to chemotherapy in adjuvant chemotherapy for stage II or III colon cancer. In patients with resected stage II colon cancer, recurrence score estimated by multigene RT-PCR assay has been shown to provide additional risk stratification. In stage IV colorectal cancer, data have supported the routine use of prophylactic skin treatment in patients receiving antibody against epidermal growth factor receptor, and the use of upfront chemotherapy as initial management in patients with synchronous metastasis without obstruction or bleeding from the primary site.     

Chemo-Immunotherapy with Oxaliplatin and Interleukin-7 Inhibits Colon Cancer Metastasis in Mice

Combination of immunotherapy and chemotherapy has shown promise for cancer. Interleukin-7 (IL-7) can potentially enhance immune responses against tumor, while oxaliplatin (OXP), a platinum-based drug, can promote a favorable immune microenvironment and stimulate anticancer immune responses. We evaluated the anti-tumor activity of IL-7 combining OXP against a murine colon carcinoma in vitro and in vivo and studied the tumor immune microenvironment to investigate whether the combined treatment affects on the local immune cell populations. Utilizing lung and abdomen metastasis models by inoculation of CT26 mice colon cancer cells, we evaluated the anti-tumor efficacy of combining IL-7 and OXP in mice models. Tumor immune microenvironment was evaluated by flow cytometric analysis and immunohistochemical staining. Our study showed that the in vivo administration of IL-7 combined with OXP markedly inhibited the growth of tumors in lung and abdomen metastasis models of colon cancer. IL-7 alone had no effect on tumor growth in mice and IL-7 did not alter cell sensitivity to OXP in culture. The antitumor effect of combining IL-7 and OXP correlated with a marked increase in the number of tumor-infiltrating activated CD8+ T cells and a marked decrease in the number of regulatory T (Treg) cells in spleen. Our data suggest that OXP plus IL-7 treatment inhibits tumor cell growth by immunoregulation rather than direct cytotoxicity. Our findings justify further evaluation of combining IL-7 and chemotherapy as a novel experimental cancer therapy.     

Differences in Survival between Colon and Rectal Cancer from SEER Data

Background

Little is known about colorectal cancer or colon and rectal cancer. Are they the same disease or different diseases?

Objectives

The aim of this epidemiology study was to compare the features of colon and rectal cancer by using recent national cancer surveillance data.

Design and setting

Data included colorectal cancer (1995–2008) from the Surveillance, Epidemiology, and End Results Program (SEER) database. Only adenocarcinoma was included for analysis.

Patients

A total of 372,130 patients with a median follow-up of 32 months were analyzed.

Main outcome measures

Mean survival of patients with the same stage of colon and rectal cancer was evaluated.

Results

Around 35% of patients had stage information. Among them, colon cancer patients had better survival than those with rectal cancer, by a margin of 4 months in stage IIB. In stage IIIC and stage IV, rectal cancer patients had better survival than colon cancer patients, by about 3 months. Stage IIB colorectal cancer patients had a poorer prognosis than those with stage IIIA and IIIB colorectal cancer. After adjustment of age, sex and race, colon cancer patients had better survival than rectal cancer of stage IIB, but in stage IIIC and IV, rectal cancer patients had better survival than colon cancer.

Limitations

The study is limited by its retrospective nature.

Conclusion

This was a population-based study. The prognosis of rectal cancer was not worse than that of colon cancer. Local advanced colorectal cancer had a poorer prognosis than local regional lymph node metastasis. Stage IIB might require more aggressive chemotherapy, and no less than that for stage III.     

Evaluation of adjuvant chemotherapy in patients with colorectal cancer in Primorsko-Goranska and Istarska County--a twenty years retrospective study

Colorectal cancer is the second most common malignant disease in developed countries, with about one million new cases worldwide every year, accompanied with high mortality rate. We examined the survival rate and recurrence (occurrence of distant metastases and/or local recurrence) of patients with colorectal cancer in Primorsko-Goranska and Istarska County who received adjuvant chemotherapy, compared to those who did not in the period since 1980. until 1999. This study involves 483 patients with colorectal cancer stages II and III of Primorsko-Goranska and Istarska County, which were underwent curative resections of colorectal cancer at the Clinical Hospital Centre Rijeka, and then treated with chemotherapy (288) or without Chemotherapy (195). We analyzed the five year survival rate and the recurrence of malignant disease in the adjuvant treatment group in comparison with not treated group with chemotherapy, depending on the stage of disease, degree of histological differentiation, patient age and location of cancer (colon or rectum). After follow-up of 60 months died 44.79% (129/288) of patients who received chemotherapy and 53.33% (104/195) of patients who did not receive chemotherapy. The relative risk of death (from any cause) in chemotherapy-treated group versus the group without chemotherapy was 0.82 (p < 0.008). Recurrence of malignant disease in the chemotherapy group was 38.54% (111/288), and in the group without chemotherapy was 46.15% (90/195). The relative risk of recurrence of malignant disease in the chemotherapy group versus the group without chemotherapy was 0.78 (p < 0.001). There was no difference in treatment efficacy regard to the localization of the tumor, but there were differences in efficiency with respect to disease stage, grade and age. Chemotherapy with 5-fluorouracil and leukovorin ameliorate the survival and reduces recurrence and distant metastases in patients with colorectal cancer stages II and III.     

Recent advances in the treatment of colon cancer

Colorectal cancer is one of the leading causes of cancer-related deaths worldwide. Although surgical resection is still the only treatment capable of curing colon cancer, adjuvant therapy continues to play an important role in preventing recurrence and metastasis. In recent years remarkable progress has been made in the treatment of colon cancer. This review discusses recent advances in adjuvant therapy for colon cancer, including chemotherapy, immunotherapy, antiangiogenic therapy and apoptosis induction. In the meantime, molecular therapy is also elucidated in the above methods. All these new advances will provide new promises for patients of colon cancer.     

Multiple tumor marker elevation in androgen ablation-refractory prostate cancer with long-term response to metronomic chemotherapy: a case report

Outcomes in hormone-refractory prostate cancer are very poor. The time from progression to death is only 12-19 months. We present the case of a 69-year-old man with hormone-refractory prostate cancer and bone metastases treated with metronomic chemotherapy (cyclophosphamide based). He had had a colon adenocarcinoma ten years before. The atypical features of this case were an unusually long-lasting response to metronomic chemotherapy and an increase in serum levels of some non-prostate-specific tumor markers (CEA and CA 19-9) that was not related to a relapse of colon cancer. We hypothesize a potential role of hypoxia inducing CA 19-9 and CEA expression in tumor cells, which may predict the development of progressive resistance to antiangiogenic therapies.     

ERCC1蛋白表达与结肠癌FOLFOX方案化疗疗效及预后相关性分析

目的：探讨晚期结肠癌癌组织中核苷酸切除修复交叉互补基因1（excisionrepaircross—complementinggenel,ERCCl）~O表达状况及其与患者临床病理特征、奥沙利铂方案化疗疗效及预后之间的关系。方法：采用免疫组化方法检测晚期结肠癌癌组织中ERCCl蛋白表达状况。结果：晚期结肠癌癌组织中ERCCl表达阳性表达率为45．1％。ERCCl蛋白的表达状况与患者的性别、年龄、肿瘤部位、分化程度及病理类型均无关（P〉0．05）。ERCCl蛋白表达阴性患者奥沙利铂方案化疗有效率为56．O％高于表达阳性患者的34．1％（P。0．037）,并且接受化疗后表达阴性患者中位生存期为19个月高于表达阳性患者的14个月（P=0．016）。结论：ERCCl蛋白表达阴性的晚期结肠癌患者接受奥沙利铂方案化疗有效率较阴性患者高并有生存受益,ERCCl的表达状态可作为晚期结肠癌化疗方案的选择及预后判断的指标。     

Stage IV colon cancer patients without DENND2D expression benefit more from neoadjuvant chemotherapy

According to the EPOC study, chemotherapy could improve 5-year disease-free survival of stage IV colon cancer patients by 8.1%. However, more molecular biomarkers are required to identify patients who need neoadjuvant chemotherapy. DENND2D expression was evaluated by immunohistochemistry in 181 stage IV colon cancer patients. The prognosis was better for patients with DENND2D expression than patients without DENND2D expression (5-year overall survival [OS]: 42% vs. 12%, p = 0.038; 5-year disease-free survival: 20% vs. 10%, p = 0.001). Subgroup analysis of the DENND2D-negative group showed that patients treated with neoadjuvant chemotherapy achieved longer OS than patients without neoadjuvant chemotherapy (RR = 0.179; 95% CI = 0.054–0.598; p = 0.003). DENND2D suppressed CRC proliferation in vitro and in vivo. Downregulation of DENND2D also promoted metastasis to distant organs in vivo. Mechanistically, DENND2D suppressed the MAPK pathway in CRC. Colon cancer patients who were DENND2D negative always showed a worse prognosis and were more likely to benefit from neoadjuvant chemotherapy. DENND2D may be a new prognostic factor and a predictor of the need for neoadjuvant chemotherapy in stage IV colon cancer.Subject terms: Colon cancer, Tumour biomarkers     

结直肠癌患者菌群多样性变化与5-FU联合奥沙利铂化疗诱导的炎症反应的关系

目的 探究结直肠癌患者菌群多样性变化与5-FU联合奥沙利铂化疗诱导的炎症反应的关系。方法 选取2017年1月至2019年1月在泉州市第一医院医院拟行5-FU联合奥沙利铂化疗的结直肠癌患者78例,于化疗前后进行炎症因子及肠道微生物的检测,使用Pearson相关性分析探究各指标的相关性。结果 化疗后患者hs-CRP、TNF-α、IL-6、IL-8水平均显著上升,IL-10水平均显著降低（均P＜0.05）,Pearson相关性分析结果显示,直肠癌患者乳杆菌科相对丰度与hs-CRP呈显著负相关（r=-0.362,P=0.042）,瘤胃菌科相对丰度与TNF-α水平呈显著正相关（r=0.351,P=0.049）;结肠癌患者乳杆菌科相对丰度与TNF-α呈显著负相关（r=-0.410,P=0.015）,乳杆菌属相对丰度与hs-CRP水平呈显著负相关（r=-0.398,P=0.033）,乳杆菌属相对丰度与hs-CRP水平呈显著负相关（r=-0.363,P=0.041）。结论 结直肠癌患者肠道菌群变化与5-FU联合奥沙利铂化疗诱导的炎症具有一定相关性,但仍需进一步研究探讨。     

Recurrence patterns of pancreatic cancer treated with adjuvant intensity modulated radiotherapy

BackgroundThe aim of this study was to investigate the recurrence patterns in pancreatic cancer patients treated with adjuvant intensity modulated radiotherapy (IMRT) and to correlate the sites of locoregional recurrence with radiotherapy target volumes.Materials and methodsThirty-eight patients who had undergone resection and adjuvant chemoradiation for pancreatic cancer were evaluated. Radiotherapy (RT) was started after 1–3 cycles of adjuvant chemotherapy (CHT). Clinical target volume (CTV) was contoured according to the RTOG guideline. All patients were treated with IMRT with a dose of 45–50.4 Gy. Computerized tomography (CT) images at the time of recurrence were correlated with radiotherapy plans. Locoregional recurrences were classified as in-field, out-field and marginal.ResultsMedian overall survival (OS) was 19 months. One- and 2-year OS rates were 73.6% and 37.1%, respectively. Locoregional recurrence and distant metastases were observed in 11 (28.9%) and 23 (60.5%) patients, respectively. For the 11 locoregional recurrences, 7 were in-field, 1 was marginal, and 3 were out-of-field. One patient had isolated local, 2 patients had isolated regional and 15 (57.6%) patients had only distant failures. The first presentations of failures were mostly distant (58%). On multivariate analysis, tumor size ≥ 3 cm (p = 0.011) and positive vascular invasion (p = 0.014) predicted for worse OS rate.ConclusionsThe majority of locoregional recurrences were in the radiation field among pancreatic cancer patients treated with postoperative IMRT. However, failures were predominantly distant, and improvement of systemic control may be of particular interest.     

替吉奥治疗结肠癌的研究

目的：探讨替吉奥治疗结肠癌的疗效。方法：75例经病理组织学确诊的结肠癌患者,分为A、B、C组。A组：替吉奥联合奥沙利铂（艾恒）25例。B组：5-Fu／LV联合奥沙利铂（艾恒）25例。C组：替吉奥单药治疗25例。观察疗效、疾病控制率及不良反应。结果：A组、C组与B组对比,不良反应发生率明显降低。A组有效率48％,疾病控制率88％。B组有效率28％,疾病控制率84％。C组有效率32％,疾病控制率80％。结论：替吉奥是结肠癌辅助化疗联合用药及单药治疗老年结直肠癌较好的治疗药物。     

替吉奥治疗结肠癌的研究

目的:探讨替吉奥治疗结肠癌的疗效。方法:75例经病理组织学确诊的结肠癌患者,分为A、B、C组。A组:替吉奥联合奥沙利铂(艾恒)25例。B组:5-Fu/LV联合奥沙利铂(艾恒)25例。C组:替吉奥单药治疗25例。观察疗效、疾病控制率及不良反应。结果:A组、C组与B组对比,不良反应发生率明显降低。A组有效率48%,疾病控制率88%。B组有效率28%,疾病控制率84%。C组有效率32%,疾病控制率80%。结论:替吉奥是结肠癌辅助化疗联合用药及单药治疗老年结直肠癌较好的治疗药物。     

Making use of the primary tumour

Surgical resection of a primary tumour is often not sufficient to cure a patient. Even when no residual cancer can be detected at time of surgery, metastases may appear in the following years, which indicates that the primary tumour had apparently spread before surgery. Following surgery, systemic chemotherapy may be used to eradicate micro-metastatic disease. Here we present two unconventional strategies that implement new insights into tumour biology and tumour immunology in the treatment of patients with cancer. Both experimental strategies use the individual characteristics of the patient's primary tumour to optimise the control of life-threatening micro-metastases. We aim to modulate the patient's adaptive immune system, targeting it towards the patient's own tumour cells to eradicate residual disease following local treatment. In one approach, this is done by autologous tumour cell vaccinations as adjuvant treatment for colon cancer patients and, in a second approach, by giving chemo-immunotherapy before local treatment to women with locally advanced breast cancer.     

Systemic polychemotherapy in combined treatment of colon cancer]

Seven hundreds and fifty three patients with colon cancer were operated in the Unit of Colon Surgery of the State Scientific Centre of Coloproctology within the period from 1998 to 2003. 352 (46.7%) of them were subjected to systemic chemotherapy. The patients subjected to the surgical and antitumor drug therapy were divided into 3 groups according to the main disease stage: 103 (29.3%) patients with the disease stage T4N0M0 (including those with the tumor local spread), 116 (32.9%) patients with the disease stage T(3-4)N+M0 and 133 (37.8%) patients with the disease stage T(3-4)NxM1. In the patients with the colon serous membrane diffusion and locally spread tumors (total of 103 patients) 3- and 5-year survival was stated in 81.0 +/- 2.8% and 76.5 +/- 3.7% respectively. The control group included 85 patients subjected to the surgical treatment alone. In the latter group 5-year survival was recorded in 68.0 +/- 2.9% of the patients. In the group of the patients with affection of the regional lymph nodes subjected to antitumor drug therapy 3- and 5-year survival was recorded in 64.1 +/- 3.5% and 57.5 +/- 4.2% respectively. In 52 patients not subjected to the systemic chemotherapy the analogous index was equal to 44.5 +/- 3.4%. The systemic chemotherapy was applied to 111 (78.2%) patients with metastases to the liver. In 50 of them cytoreductive operations were performed and in 61 patients palliative resection of the colon was carried out. The average period without clinical manifestations of the disease in the patients subjected to the colon palliative resection and systemic chemotherapy was equal to 8.5 +/- 3.5 months. In the patients with metastases to the liver subjected to the cytoreductive operations the average lifespan after the operations amounted to 24.5 months. The average lifespan of the patients with canceromatosis subjected to the systemic chemotherapy and cytoreductive operations amounted to 13.5 months. When the chemotherapy in such patients was effective the average lifespan was 16 months, while in case of the therapy failure it was 8.5 months.