Mode of progression after radioembolization in patients with colorectal cancer liver metastases

Abstract Background Radioembolization is an established treatment modality in colorectal cancer patients with liver-dominant disease in a salvage setting. Selection of patients who will benefit most is of vital importance. The aim of this study was to assess response (and mode of progression) at 3 months after radioembolization and the impact of baseline characteristics. Methods Three months after radioembolization with either yttrium-90 resin/glass or holmium-166, anatomic response, according to RECIST 1.1, was evaluated in 90 patients. Correlations between baseline characteristics and efficacy were evaluated. For more detailed analysis of progressive disease as a dismal clinical entity, distinction was made between intra- and extrahepatic progression, and between progression of existing metastases and new metastases. Results Forty-two patients (47%) had extrahepatic disease (up to five ≥ 1 cm lung nodules, and ≤ 2 cm lymph nodes) at baseline. No patients showed complete response, 5 (5.5%) patients had partial response, 16 (17.8%) had stable disease, and 69 (76.7%) had progressive disease. Most progressive patients (67/69; 97%) had new metastases (intra-hepatic N = 11, extrahepatic N = 32; or both N = 24). Significantly fewer patients had progressive disease in the group of patients presenting without extrahepatic metastases at baseline (63% versus 93%; p = 0.0016). Median overall survival in patients with extrahepatic disease was 6.5 months, versus 10 months in patients without extrahepatic disease at baseline (hazard ratio 1.79, 95%CI 1.24–2.57). Conclusions Response at 3-month follow-up and survival were heavily influenced by new metastases. Patients with extrahepatic disease at baseline had a worse outcome compared to patients without.

Download Full-text

Predictive value of D-dimer and LDH levels in response to chemotherapy in metastatic colorectal cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.14568 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 14568-14568

Author(s):

O. Er ◽

M. Inanc ◽

M. Ozkan ◽

G. G. Dogu ◽

M. Dikilitas ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Cancer Patients ◽

Predictive Value ◽

Progressive Disease ◽

Complete Response ◽

Chemotherapy Response ◽

Response To Chemotherapy ◽

Colorectal Cancer Patients ◽

D Dimer

14568 Background: Hemostatic activation is known to occur in malignant diseases and this may be associated with tumor progression and angiogenesis. D-dimer levels are elevated in lung, uterine cervix, prostate and colorectal cancer patients. We aimed to evaluate the association and predictive value of LDH and D-Dimer levels with chemotherapy response in metastatic colorectal cancer (MCRC) patients. Patients and Methods: Twenty-five chemotherapy-naive MCRC patients were enrolled into this study. Plasma CEA, CA19–9, D-Dimer and LDH levels were measured before and after 3 cycles of capecitabine + oxaliplatin combination chemotherapy. The comparison between groups were done by Wilcoxon W and Mann-Whitney U tests. Results: Median age was 58 years in 15 female, 10 male patients. All patients received Capecitabine 2,000 mg/m2/day orally on days 1- 14 + Oxaliplatin 130 mg/m2 intravenously on day 1 every 21 days. The chemotherapy response after 3 cycles of treatment were 2 complete response, 7 partial response, 8 stable disease and progressive disease in 8 patients. Plasma CEA, CA19–9, LDH and D-Dimer levels were not significantly different between two groups before chemotherapy (table). Plasma LDH and D-Dimer levels were significantly higher in progressive disease patients than patients with complete, partial or stable response after 3 cycles of chemotherapy, but plasma CEA and CA19–9 were not significantly different between these groups (table). Conclusion: We found that D-dimer and LDH levels dropped in responders while they increased in patients with disease progression. D- Dimer and LDH plasma levels decrease or increase after response and progressive disease, respectively, and can act as a predictive factor of the clinical outcome of the disease. [Table: see text] No significant financial relationships to disclose.

Download Full-text

Nuclear factor kB (NF-kB) may predict efficacy of cetuximab therapy in EGFR-positive colorectal cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.14036 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 14036-14036

Author(s):

M. Scartozzi ◽

I. Bearzi ◽

C. Pierantoni ◽

A. Mandolesi ◽

F. Loupakis ◽

...

Keyword(s):

Colorectal Cancer ◽

Progressive Disease ◽

Response Rate ◽

Complete Response ◽

Time To Progression ◽

The Difference ◽

Colorectal Cancer Patients ◽

Cetuximab Therapy ◽

Downstream Signalling Pathway ◽

Colorectal Tumours

14036 Background: NF-kB is part of the aberrant activation of the EGFR-downstream signalling pathway in colorectal tumours, which is described to be inhibited by anti-EGFR therapies. Methods: We retrospectively analysed nuclear immunoreactivity for NF-kB with the aim to determine a correlation between NF-kB expression and outcome in terms of response rate and time to progression in EGFR-positive advanced colorectal cancer patients receiving cetuximab and irinotecan. Results: To date 67 patients (40 males and 27 females, median age 62, range 38–78) were analysed. Cetuximab and irinotecan were administered as a second-line in 18 cases (27%) and after = 3 lines of chemotherapy in the remaining 49 patients (63%). Among the 56 patients evaluable for response we observed a partial (PR) or a complete response (CR) in 10 and 1 cases respectively for an overall response rate of 20%. Twenty-seven patients (48%) obtained progressive disease, median time to progression (TTP) was 3,6 months, median overall survival was 16 months. NF-kB was positive in 46 cases (69%). All main clinical characteristics resulted well balanced between NF-kB positive and NF-kB negative patients. Response rate was 6% (2 PR) vs 43% (8 PR and 1 CR) (p= 0.001) in NF-kB positive and NF-kB negative tumours respectively whereas progressive disease was observed in 19 (54%) vs 8 (23%) cases in NF-kB positive and NF-kB negative cases respectively. Median TTP in NF- kB positive patients was 2.9 months versus 6.8 months in the remaining NF-kB negative patients (p= 0.01). Conclusions: Both the difference in median TTP and in response rate seem to confirm that NF-kB may play a crucial role in predicting the efficacy of cetuximab therapy in advanced colorectal tumours. The analysis is ongoing and updated results on an expanded number of cases will be presented. No significant financial relationships to disclose.

Download Full-text

The Impact of Physical Exercise on Sleep in Colorectal Cancer Patients During Prehabilitation Period

Case Medical Research ◽

10.31525/ct1-nct04270500 ◽

2020 ◽

Author(s):

Keyword(s):

Colorectal Cancer ◽

Physical Exercise ◽

Cancer Patients ◽

Colorectal Cancer Patients ◽

The Impact

Download Full-text

Liver Immune Microenvironment and Metastasis from Colorectal Cancer-Pathogenesis and Therapeutic Perspectives

Cancers ◽

10.3390/cancers13102418 ◽

2021 ◽

Vol 13 (10) ◽

pp. 2418

Author(s):

Xuezhen Zeng ◽

Simon E. Ward ◽

Jingying Zhou ◽

Alfred S. L. Cheng

Keyword(s):

Colorectal Cancer ◽

Liver Metastasis ◽

Cancer Patients ◽

High Recurrence Rate ◽

Immune Microenvironment ◽

Liver Sinusoidal Endothelial Cells ◽

Premetastatic Niche ◽

Cancer Pathogenesis ◽

Colorectal Cancer Patients ◽

The Impact

A drastic difference exists between the 5-year survival rates of colorectal cancer patients with localized cancer and distal organ metastasis. The liver is the most favorable organ for cancer metastases from the colorectum. Beyond the liver-colon anatomic relationship, emerging evidence highlights the impact of liver immune microenvironment on colorectal liver metastasis. Prior to cancer cell dissemination, hepatocytes secrete multiple factors to recruit or activate immune cells and stromal cells in the liver to form a favorable premetastatic niche. The liver-resident cells including Kupffer cells, hepatic stellate cells, and liver-sinusoidal endothelial cells are co-opted by the recruited cells, such as myeloid-derived suppressor cells and tumor-associated macrophages, to establish an immunosuppressive liver microenvironment suitable for tumor cell colonization and outgrowth. Current treatments including radical surgery, systemic therapy, and localized therapy have only achieved good clinical outcomes in a minority of colorectal cancer patients with liver metastasis, which is further hampered by high recurrence rate. Better understanding of the mechanisms governing the metastasis-prone liver immune microenvironment should open new immuno-oncology avenues for liver metastasis intervention.

Download Full-text

Impact of Extrahepatic Metastases on Overall Survival in Patients with Advanced Liver Dominant Hepatocellular Carcinoma: A Subanalysis of the SORAMIC Trial

Liver Cancer ◽

10.1159/000510798 ◽

2020 ◽

Vol 9 (6) ◽

pp. 771-786

Author(s):

Kerstin Schütte ◽

Regina Schinner ◽

Mathias P. Fabritius ◽

Melina Möller ◽

Christiane Kuhl ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Median Survival ◽

Pulmonary Metastases ◽

Study Entry ◽

Extrahepatic Disease ◽

Advanced Hepatocellular Carcinoma ◽

Significant Difference ◽

Distant Organ ◽

Extrahepatic Metastases ◽

The Impact

Introduction: Extrahepatic spread is reported as a prognostic factor in patients with advanced hepatocellular carcinoma (HCC) receiving systemic therapy. However, clinical studies have reported conflicting results for the clinical impact of the pattern of tumor progression during treatment and the role of new extrahepatic metastases in length of survival. Objective: To evaluate the impact of extrahepatic metastases on survival in patients with HCC treated with sorafenib or with a combination of sorafenib and selective internal radiation treatment (SIRT). Methods: SORAMIC is a randomized, controlled trial comprising diagnostic, local ablation, and palliative cohorts. In the palliative cohort, patients not eligible for transarterial chemoembolization (TACE) were randomized 11:10 to SIRT plus sorafenib (SIRT + sorafenib) or sorafenib alone. This exploratory subanalysis evaluated the impact of extrahepatic metastases on survival. Results: In the intent-to-treat cohort, 216 patients were randomized to SIRT + sorafenib and 208 to sorafenib alone. Seventeen patients with distant organ metastases (bone, n = 11; adrenal glands, n = 5; peritoneum, n = 1) and 262 without distant metastases at study entry were analyzed in this substudy. Patients with (Group A) and without (Group B) distant organ metastases at study entry presented with a median survival of 11.3 and 14.8 months, respectively (p = 0.2807). During follow-up of patients with no organ metastases at baseline, extrahepatic disease progression occurred in 50 patients (19.1%). No statistically significant difference in survival was observed between patients without extrahepatic progression and those with new extrahepatic disease during treatment (14.8 vs. 14.9 months; p = 0.6483). Development of new pulmonary metastases during treatment significantly shortened median survival (7.6 vs. 15.0 months, p = 0.0060). Conclusions: This subanalysis of the SORAMIC trial suggests that in patients with liver-dominant advanced HCC, metastases to distant organs with the exception of pulmonary metastases do not in general exert a negative impact on patient prognosis. The choice of palliative treatment should incorporate a personalized analysis of the pattern of tumor distribution.

Download Full-text

Management of colorectal cancer in the era of COVID-19: Challenges and suggestions

Science Progress ◽

10.1177/00368504211010626 ◽

2021 ◽

Vol 104 (2) ◽

pp. 003685042110106

Author(s):

Walid Alam ◽

Youssef Bouferraa ◽

Yolla Haibe ◽

Deborah Mukherji ◽

Ali Shamseddine

Keyword(s):

Colorectal Cancer ◽

Treatment Protocols ◽

Cancer Management ◽

Increased Risk ◽

Huge Impact ◽

Treatment Plans ◽

Virus Exposure ◽

Risk Of Exposure ◽

Colorectal Cancer Patients ◽

The Impact

The Coronavirus (COVID-19) pandemic had a huge impact on all sectors around the world. In particular, the healthcare system has been subject to an enormous pressure that has surpassed its ability in many instances. Additionally, the pandemic has called for a review of our daily medical practices, including our approach to colorectal cancer management where treatment puts patients at high risk of virus exposure. Given their higher median age, patients are at an increased risk for severe symptoms and complications in cases of infection, especially in the setting of immunosuppression. Therefore, a review of the routine colorectal cancer practices is needed to minimize risk of exposure. Oncologists should weigh risk of exposure versus the patient’s oncologic benefits when approaching management. In addition, treatment protocols should be modified to minimize hospital visits and admissions while maintaining the same treatment efficacy. In this review, we will focus on challenges that colorectal cancer patients face during the pandemic, while highlighting the priority in each case. We will also discuss the evidence for potential modifications to existing treatment plans that could reduce infectious exposure without compromising care. Finally, we will discuss the impact of the socio-economic difficulties faced by Lebanese patients due to a poor economy toppled by an unexpected pandemic.

Download Full-text

The impact of an ostomy on older colorectal cancer patients: a cross-sectional survey

International Journal of Colorectal Disease ◽

10.1007/s00384-016-2665-8 ◽

2016 ◽

Vol 32 (1) ◽

pp. 89-94 ◽

Cited By ~ 13

Author(s):

N. M. Verweij ◽

M. E. Hamaker ◽

D. D. E. Zimmerman ◽

Y. T. van Loon ◽

F. van den Bos ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Colorectal Cancer Patients ◽

The Impact

Download Full-text

The bevacizumab plus oxaliplatin-based chemotherapy regimen is more suitable for metastatic colorectal cancer patients with a history of schistosomiasis

10.21203/rs.2.18346/v1 ◽

2019 ◽

Author(s):

Li-Na Zhou ◽

Li-Qiang Weng ◽

Chun-Xia Feng ◽

Yan Zhang ◽

Ping Li ◽

...

Keyword(s):

Colorectal Cancer ◽

Platelet Count ◽

Liver Fibrosis ◽

Metastatic Colorectal Cancer ◽

Medical Records ◽

Chemotherapy Regimen ◽

Splenic Enlargement ◽

History Of ◽

Colorectal Cancer Patients ◽

The Impact

Abstract Background: People suffer from schistosomiasis, leading to liver fibrosis, splenomegaly and thrombocytopenia. The effects of bevacizumab plus oxaliplatin or irinotecan-based chemotherapy regimens on platelets are different, but have not been determined. We conducted a retrospective analysis in metastatic colorectal cancer (mCRC) patients evaluating the impact of bevacizumab on platelet, in order to find a more suitable plan for mCRC patients with a history of schistosomiasis.Methods: The medical records of all mCRC patients with a history of schistosomiasis who received FOLFOX or FOLFIRI with or without bevacizumab from September 1, 2017 to June 30, 2019 in Kunshan Hospital were reviewed. Platelet counts and spleen sizes were compared from the first cycle until completion of chemotherapy.Results: Evaluable splenic enlargement and thrombocytopenia results were obtained from 73 Bevacizumab-treated patients and 80 non-bevacizumab treated patients. In patients treated with oxaliplatin, the rates of splenic enlargement (19.5% vs. 66.7%, P=0.01) and thrombocytopenia (31.7% vs. 77.2%, P=0.02) were lower in the bevacizumab-treated cohort than that in the nonbevacizumab cohort. When stratified for irinotecan, there were no statistical differences of frequency of splenic enlargement between the two groups, however, the rates of thrombocytopenia were higher in the bevacizumab-treated cohort than that in the nonbevacizumab cohort (59.4% vs. 8.7%, P=0.01 ).Conclusion: The bevacizumab plus oxaliplatin-based chemotherapy regimen is more suitable for mCRC patients with a history of schistosomiasis, especially for lower platelet count patients.

Download Full-text