Treatment with standardized mistletoe extract (Viscum album L.) Iscador® as a part of long-term supportive care in patients with primary non-metastatic colorectal carcinoma

490 Background: The exact benefit of preoperative chemotherapy prior to pulmonary metastasectomy for patients with metastatic colorectal carcinoma (CRC) is unknown. Here, we identify outcomes of preop chemo in pts w previously resected primary CRC who then had resectable pulmonary CRC metastases. Methods: We queried a prospectively collected database to identify pts who underwent pulmonary CRC metastasectomy and the specific chemo regimen given prior to but w/i 3 months of surgery. Two multivariate logistic analyses were performed to identify preop regimen as predictors of overall survival (OS) and progression free survival (PFS). Results: From Feb 2000 onwards, 229 pts underwent lung met resection (median age 61, range 24-82). Of those pts, 114 received preop chemo for a median duration of 4months (range 0.1-25.3mos). 41pts receiving 0-3 mos of preop chemo, 37 3-6mos, and 36 >6mos. 38pts received an oxaliplatin-based regimen (23 FOLFOX+bevacizumab [bev], 5 XELOX, 5 FOLFOX alone, 3 FOLFOX+cetuximab, 1 FOLFOX + novel TR-2/DR5 antibody, 1 oxali+irinotecan). 53 pts received an irinotecan-regimen. 29 received a capecitabine therapy. Pts on an oxali-based therapy had an improved OS vs alternate chemo regimen (mean OS 77.6 mos vs 54.2 mos, median OS not reached in oxali-group, p .001). However pts on an irinotecan-based regimen had a lower OS vs alternate chemo (median OS of 49.1mos vs 57.9mos, p .024). 5FU, capecitabine, or bev-based therapies did not significantly impact OS. The type of preop chemo regimen did not significantly affect PFS after lung met resection. Oxali-based regimen moved towards a favorable OS when compared to OS without any preop chemo but not of statistical significance (HR 0.69; 95% CI 0.287 to 1.663, p 0.409) while receiving a non-oxali-based preop regimen was associated with a shorter OS when compared to no preop chemo (HR 2.64; 95% CI 1.634 to 4.275, p <0.001). Conclusions: Preop chemo with an oxaliplatin regimen prior to pulm met resection may improve OS, providing long-term benefit, whereas a preop irinotecan-based therapy appears to result in a shorter OS. Prospective trials on specific preop regimens and criteria for patient selection are planned.

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Long term effects of anti-VEGF agents: patho-physiological perspectives

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v5i1.7834 ◽

2013 ◽

Vol 5 (1) ◽

pp. 100-105

Author(s):

M Gupta ◽

Y Gupta ◽

A Phougat

Keyword(s):

Monoclonal Antibody ◽

Monoclonal Antibodies ◽

Colorectal Carcinoma ◽

Metastatic Colorectal Carcinoma ◽

Long Term Effects ◽

Anti Vegf ◽

Ocular Disorders ◽

The Usa

Monoclonal antibodies directed against different targets have become a new tool for the treatment of various disorders. More than 20 monoclonal antibody-based therapies have been approved in the USA and hundreds more are in development. Some of these therapies are finding applications in ocular disorders. The role of anti-VEGF in the treatment of wet ARMD is now well known. Anti-VEGF, which were initially discovered to treat carcinomas like bevacizumab in metastatic colorectal carcinoma, have now found place in ophthalmology to treat disorders where neovascularization/angiogenesis leads to blindnes. Nepal J Ophthalmol 2013; 5(9):100-105 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7834

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Postoperative treatment with fermented mistletoe (Viscum album L.) extract stratified by therapy regimen in patients with primary non-metastatic colorectal carcinoma

Journal of Clinical Oncology ◽

10.1200/jco.2008.26.15_suppl.20536 ◽

2008 ◽

Vol 26 (15_suppl) ◽

pp. 20536-20536

Author(s):

M. R. Schlaeppi ◽

H. Matthes ◽

W. E. Friedel ◽

P. R. Bock

Keyword(s):

Colorectal Carcinoma ◽

Viscum Album ◽

Postoperative Treatment ◽

Metastatic Colorectal Carcinoma ◽

Therapy Regimen

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Long-term supportive treatment with fermented mistletoe (viscum album L.) extract in primary nonmetastatic colorectal cancer: Best time to start with for optimal effectiveness

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15099 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15099-e15099

Author(s):

H. Matthes ◽

W. E. Friedel ◽

P. R. Bock

Keyword(s):

Colorectal Cancer ◽

Disease Free Survival ◽

Viscum Album ◽

Control Group ◽

Eligibility Criteria ◽

Mistletoe Extract ◽

Beneficial Effects ◽

Anonymized Data

e15099 Background: Safety and efficacy of fermented mistletoe extract (Iscador, ISC) in supportive care of post-surgical patients with primary colorectal cancer as compared to a parallel control group without ISC. Question: Is supportive ISC most effective when started before, during, or after radio- and/or chemotherapy? Methods: In a comparative, multicenter, non-interventional cohort study with parallel groups ISC was applied additionally to conventional adjuvant chemo- and/or radiotherapy (conv-th). The control group was treated with conv-th only. Unselected, standardized, anonymized data from medical records (1993–2002) meeting the eligibility criteria were followed until last visit or death. The pre-specified endpoints were the incidence of adverse drug reactions (ADR) caused by conv-th, and disease-free survival (DFS) in relation to start of ISC therapy before, during or after conv-th. All endpoints were adjusted to confounders. Results: 804 eligible patients (429 ISC and 375 control) from 26 centers were evaluated. ISC started mostly during conv-th (72.9%), and sometimes before (9.0%) or after (18.1%) conv-th. ISC dose was escalated from 0.01mg to 20mg as s.c. injection, 2–3 times weekly. The median follow-up time was 58 (ISC) vs. 51 months and median ISC duration was 52 months. The adjusted relative ADR risk was significantly lower in the ISC groups as compared to control: odds ratio, OR (95% CI) = 0.46 (0.28–0.77), p=0.003. The best results were found in patients where ISC started in parallel to conv-th. Analysis of DFS in the ISC subgroups is presently ongoing. ISC was well tolerated in all subgroups. Conclusions: The results show reliable safety and clinically relevant beneficial effects of ISC treatment, at best if applied in parallel to conv-th. [Table: see text]

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