EGFR expresion in liver metastases in patients with colorectal cancer EGFR negative primary tumour and response to systemic chemotherapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 20104-20104
Author(s):  
Z. Petrovic ◽  
D. Tarabar ◽  
R. Doder
Keyword(s):  
Colorectal Carcinoma ◽  
Liver Metastases ◽  
Primary Tumor ◽  
Systemic Chemotherapy ◽  
Chemotherapy Regimen ◽  
Primary Tumour ◽  
Synchronous Liver Metastasis ◽  
Response To Chemotherapy ◽  
Metastatic Sites

20104 Background: To evaluate expresion of EGFR in liver metastases in patients with colorectal carcinoma EGFR immunohistochemistry (IHC) negative primary tumor and to evaluate response to systemic chemotherapy in this group of patients. Methods: A group of 19 patients with IHC negative EGFR in primary tumor with synchronous liver metastasis were analysed. All patients received irinotecan and/or oxaliplatin based chemotherapy regimen in combination with oral fluoropyrimidines - capecitabine. Results: 10 pts. had EGFR IHC positive expresion in liver metastases. EGFR IHC negative liver metastases were present in 9 pts. In patients with EGFR IHC negative liver metastases 2 pts. had PR, 1 pts. had SD and 6 pts. had PD after chemotherapy. In patients with EGFR IHC positive liver metastases 3 pts. had PR, 2 pts. had SD and 5 pts. had PD after chemotherapy. All pts. with PR were underwent to surgery and/or RFA. Pts. with SD and PD received cetuximab with previous systemic chemotherapy. PFS in this group of pts. is 4,1 month. Conclusions: This study is ongoing. At this moment the results do not support routine determination of EGFR status on distant metastatic sites in patients with colorectal carcinoma and for response to chemotherapy. No significant financial relationships to disclose.

Inoperable stage IV colorectal cancer with intact primary tumor in patients receiving palliative chemotherapy: Does the response to chemotherapy correlate between primary and metastatic sites? An Irish cancer center experience.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 136-136
Author(s):  
Ruba Hamed ◽  
Ronan Andrew McLaughlin ◽  
Hatim Ibrahim ◽  
Greg Korpanty ◽  
Nemer Osman
Keyword(s):  
Stable Disease ◽  
Primary Tumour ◽  
Stage Iv ◽  
Primary Site ◽  
First Line ◽  
Tumour Site ◽  
Response To Chemotherapy ◽  
Stage 4 ◽  
Metastatic Sites ◽  
Line Chemotherapy

136 Background: Colorectal cancer (CRC) is the 3rd most common malignancy in Ireland with over 2700 cases annually. Approximately 20% are diagnosed with stage IV disease. The aim of this study is to evaluate the response to chemotherapy at primary and metastatic sites and review the frequency of intervention required to palliate the intact primary tumour in patients with stage 4 inoperable CRC in an Irish tertiary referral centre. Methods: A retrospective review of medical records was completed, identifying stage 4 CRC patients with primary tumour in situ diagnosed between January 2014 and December 2019, treated with chemotherapy (oxaliplatin or irinotecan based +/- bevacizumab or EGFR monoclonal antibody). Data and survival analysis were obtained using Kaplan-Meier methods. Results: 50 eligible patients were identified; 60% male, 40% female with a median age of 62 years. 2% had a transverse colonic primary, 32% right and 44% left sided and 22% had a rectal primary. 36% presented with liver metastasis only, 4% lung metastasis alone and 20% both. 48% were KRAS, 4% NRAS and 4% BRAF mutation positive while 1 patient was identified as having microsatellite instability. All patient received first-line chemotherapy either oxaliplatin or irinotecan based, 18% with the addition of Bevacizumab and 24% with EGFR monoclonal antibody. Overall response to first-line chemotherapy at the primary site and metastatic sites was assessed radiologically; 42% displaying a partial response, 36% had stable disease while 18% had progression at primary site. At the metastatic sites 50% responded, 10% stable disease and 40% progressed. Complication at primary tumour site included: obstruction 12%, with perforation in 6%, bleeding 10%, pain at tumour site in 6%, and one patient developed an abscess. Overall, after chemotherapy 76% of all patients did not require further intervention to manage primary site. 6% underwent curative surgery with resection of primary and metastatic lesions. Of those who had palliative intervention; 10% underwent palliative colostomy/ileostomy, 12% palliative radiotherapy, and 2% both. Overall survival was 14 months. At time of analysis 14% were alive, 10% receiving treatment and 4% on radiological surveillance. Conclusions: This retrospective study confirms that palliative chemotherapy +/- targeted therapy is effective in controlling the primary tumour in stage 4 inoperable CRC. In addition, it reveals a nearly 80% partial response or stable disease radiologically at the primary site after first-line chemotherapy. Furthermore, progression was significantly lower at primary site compared to distant metastasis (18% vs 40%). Almost 75% did not require palliative intervention for their primary tumour. Overall survival in our centre is higher compared to internationally observed data.

scholarly journals Updates of colorectal cancer liver metastases therapy: review on DEBIRI

2020 ◽  
Vol 7 (1) ◽  
pp. HEP16 ◽  
Author(s):  
Giammaria Fiorentini ◽  
Donatella Sarti ◽  
Roberto Nani ◽  
Camillo Aliberti ◽  
Caterina Fiorentini ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Systemic Chemotherapy ◽  
Tumor Response ◽  
Public Health Issue ◽  
Advanced Stage ◽  
Stage At Diagnosis ◽  
Colorectal Cancer Liver Metastases ◽  
Safety And Efficacy ◽  
Metastatic Sites

Colorectal cancer is a worldwide public health issue, presenting an advanced stage at diagnosis in more than 20% of patients. Liver metastases are the most common metastatic sites and are not indicated for resection in 80% of cases. Unresectable colorectal cancer liver metastases that are refractory to systemic chemotherapy may benefit from transarterial chembolization with irinotecan-loaded beads (DEBIRI). Several studies show the safety and efficacy of DEBIRI for the treatment of colorectal cancer liver metastases. The development of transarterial chembolization and the introduction of new embolics have contributed to better outcomes of DEBIRI. This article reviews the current literature on DEBIRI reporting its use, efficacy in terms of tumor response and survival and side effects.

Neoadjuvant Chemotherapy Before Liver Resection for Patients With Unresectable Liver Metastases From Colorectal Carcinoma

2005 ◽  
Vol 23 (9) ◽  
pp. 2038-2048 ◽  
Author(s):  
Gregory D. Leonard ◽  
Baruch Brenner ◽  
Nancy E. Kemeny
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Colorectal Carcinoma ◽  
Liver Metastases ◽  
Systemic Chemotherapy ◽  
Hepatic Arterial Infusion ◽  
Current Data ◽  
Prognostic Scores ◽  
Unresectable Liver Metastases ◽  
Long Term Survivors

Colorectal carcinoma is one of the most common cancers in the world, and more than 50% of these patients develop liver metastases. Despite recent advances, systemic chemotherapy for metastatic disease without the use of surgery is considered palliative, as there are rarely long-term survivors. However, patients who are candidates for surgical resection of their liver metastases can have a prolonged survival or possibly a cure. Consensus guidelines on criteria for resection and prognostic scores help facilitate patient selection, yet only 25% of patients with liver metastases are considered to have resectable metastases. Neoadjuvant chemotherapy has been explored in an attempt to render more patients candidates for resection. First reports using neoadjuvant systemic chemotherapy in patients with unresectable disease found that 13% to 16% of patients could be rendered resectable. Efforts to increase response rates using hepatic arterial infusion or biologic agents may increase resection rates. This review summarizes the current data on neoadjuvant chemotherapy, the rationale for this approach, potential complications, and future prospects.

scholarly journals Case Report: Molecular Characterization of Aggressive Malignant Retroperitoneal Solitary Fibrous Tumor: A Case Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Haruna Nonaka ◽  
Shuya Kandori ◽  
Satoshi Nitta ◽  
Masanobu Shiga ◽  
Yoshiyuki Nagumo ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Primary Tumor ◽  
Fusion Gene ◽  
Gene Mutations ◽  
Transcriptional Level ◽  
Tp53 Mutations ◽  
Mesenchymal Neoplasms ◽  
Target Dna ◽  
Fibrous Tumor ◽  
Metastatic Sites

Solitary fibrous tumors (SFT) are mesenchymal neoplasms with a favorable prognosis usually originating from the visceral pleura. Rarely, they may occur at various extrapleural sites and show malignant behavior coupled with dedifferentiation. NAB2-STAT6 fusion gene and STAT6 nuclear expression are biomarkers for diagnosis of SFT in addition to CD34, Bcl-2, and CD99. Furthermore, several reports have shown specific NAB2-STAT6 fusion variants and loss of STAT6 protein expression are associated with malignancy. We report a rare case of retroperitoneal SFT which rapidly progressed to death within 35 days after admission. Autopsy found a primary tumor containing both benign and malignant histologies, with multiple metastatic sites similar to the malignant, dedifferentiated tumor. STAT6 was detected in the primary differentiated tumor but not in the primary dedifferentiated tumor or lung/liver metastases. However, the NAB2-STAT6 fusion gene (NAB2ex6/STAT6ex16 variant) was detected in the primary tumor and lung/liver metastases. Intriguingly, fusion gene expression at the transcriptional level was downregulated in the dedifferentiated tumors compared to the differentiated tumor. We further performed target DNA sequencing and found gene mutations in TP53, FLT3, and AR in the dedifferentiated tumors, with TP53 mutations especially found among them. We demonstrate that downregulation of NAB2-STAT6 fusion gene at the transcriptional level is associated with malignant SFT for the first time. Moreover, the present study supports the idea that TP53 mutations promote malignancy in SFTs.

LiverMetSurvey: Analysis of clinicopathologic factors associated with the efficacy of preoperative chemotherapy in 2,122 patients with colorectal liver metastases

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 3521-3521 ◽  
Author(s):  
R. Adam ◽  
T. Aloia ◽  
J. Figueras ◽  
L. Capussotti ◽  
G. Poston ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Preoperative Chemotherapy ◽  
Primary Tumor ◽  
Colorectal Liver Metastases ◽  
Systemic Chemotherapy ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Multimodality Treatment ◽  
Primary Tumor Site ◽  
Number Of Patients

3521 Background: LiverMetSurvey is an international, internet-based registry designed to assess the efficacy of multimodality treatment options for colorectal liver metastases (CLM) by analyzing outcomes following hepatic resection (HR) in a large number of patients. Methods: Data were analyzed for the 2,122 patients entered into LiverMetSurvey by six hepatobiliary centers from inception to August 2004 (HR: 1974 to 2004; 1,306 men: 816 women; mean age: 61 years). The distributions of potential prognostic factors including age, sex, primary tumor site, timing of metastasis diagnosis, tumor number, diameter of the largest metastasis, bilaterality, and treatment with chemotherapy were compared to survivals using univariate and multivariate statistics. Results: Metastases originated in the colon in 69% of patients and were synchronous (diagnosed within 3 mo of primary tumor treatment) in 49% of patients. 34% of patients had ≥ 3 metastases and tumors were distributed bilaterally in 43% of cases. The mean size of the largest metastasis was 41.8 mm. 55% of patients were treated with preoperative systemic chemotherapy. Following resection, 60-day mortality was 1.2% and median, 5-year, and 10-year overall survivals (OS) were 46 mo, 42%, and 26%, respectively. Variables independently associated with poor prognosis included number of metastases > 3 (p<0.0001), bilateral metastases (p=0.0002), and size of the largest metastasis > 5 cm (p=0.03). Preoperative chemotherapy (PC) did not appear to benefit patients with solitary CLM (5-yr OS: PC 45% vs. no PC 58%), but was associated with improved survival in patients with > 5 metastases (5-yr OS: PC 22% vs. no PC 12%). Conclusions: Assessment of outcomes for the first 2,122 registrants to LiverMetSurvey not only confirms the prognostic importance of intrahepatic tumor burden, but also indicates that the ability of preoperative systemic chemotherapy to improve survivals is limited to patients with multiple (> 5) metastases. In addition, this analysis demonstrates the potential for LiverMetSurvey, which is now prospectively enrolling patients from over 40 centers, to determine the therapeutic value of current and future treatment strategies. No significant financial relationships to disclose.

Outcome of patients with colorectal liver metastasis: Analysis of 1,613 consecutive cases.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14000-e14000
Author(s):  
Jianmin Xu ◽  
Dexiang Zhu ◽  
Li Ren ◽  
Ye Wei ◽  
Yunshi Zhong
Keyword(s):  
Survival Rate ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Median Survival ◽  
Colorectal Liver Metastasis ◽  
Primary Tumor ◽  
Systemic Chemotherapy ◽  
Term Survival ◽  
Different Types ◽  
Hepatic Arterial Chemotherapy

e14000 Background: To evaluate the long-time outcome of patients with colorectal liver metastasis (CRLM) undergoing different types of therapy and identify factors associated with prognosis. Methods: From 2000 to 2010, a total of 1,613 patients with CRLM were identified in Zhongshan Hospital. Clinicopathological and outcome data were collected and analyzed by univariate and multivariate analyses. Results: Of 1,613 patients the median survival was 23.1 months and the five-year survival rate was 23%. Synchronous liver metastasis (SLM), female, grade III-IV, T4 and N + of primary tumor, bilobar disease, number of liver metastases ≥ 4, size of largest liver metastases ≥ 5 cm, CEA ≥5 ng/ml and CA19-9 ≥ 37u/ml were the predictors of adverse outcome using univariate analysis. The median survival and five-year survival rate for patients after resection of liver metastases was 49.8 months and 47%, compared with 22.2 months and 19% for those after systemic chemotherapy alone, 19.0 months and 13% for those after hepatic arterial chemotherapy alone, 22.8 months and 10% for those after systemic chemotherapy combined with hepatic arterial chemotherapy, and 28.5 months and 6% for those after local regional treatment alone (p< 0.010). In addition, patients without treatment had the poorest survival rate (9.6 months and 0%). 64 initially unresectable patients underwent surgery after convertible therapy and had a median survival of 36.9 months and a five-year survival of 30%, which was better than that of unresectable patients who did not undergo surgery (18.2 months and 10%). By multivariate analysis, SLM, poorly differentiated primary tumor, number of liver metastases ≥ 4, size of largest liver metastases ≥ 5 cm, and no surgical treatment of liver metastases were found to be independent predictors of poor survival. Conclusions: Patients with CRLM could get long-term survival benefit from different types of therapy, and resection of resectable and initially unresectable liver metastases was the optimal strategy. The disease-free interval from primary to liver metastases, the differentiation of the primary tumor, the number and size of liver metastases and the types of therapy used to treat liver metastases were independent prognostic factors.

The impact of metastatic sites in metastatic colorectal cancer at initial diagnosis (MCCID)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14536-14536
Author(s):  
B. A. Leone ◽  
J. A. Lacava ◽  
A. O. Zwenger ◽  
J. Iturbe ◽  
J. E. Perez ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Primary Tumor ◽  
Liver Involvement ◽  
Rank Test ◽  
Biochemical Modulation ◽  
Metastatic Site ◽  
Group A ◽  
Group B ◽  
Metastatic Sites ◽  
The Impact

14536 Background: The role of metastatic site in MCCID is unclear. The goal of this study is to evaluate if metastatic site influence survival in this setting of patients (P). Methods: Analyses were based on individual data of 300 P with MCCID treated with biochemical modulation of 5- Fluorouracil by Methotrexate regimens in different prospective trials conducted at GOCS Institutions since May 1984 to Aug 2000. P with surgical resection of liver metastases were not included in the analyses. 38 P were excluded for incomplete data. P were grouped according to metastatic sites into group A= Liver metastases only (n=161), group B= Liver and other metastatic sites (n=61) and group C= Non liver metastases (n=40) (lung, peritoneal, others). Different prognostic variables were considered: age, sex, PS, weight loss, size of liver metastases, unilateral or bilateral liver involvement, number of liver metastases, histologic differentiation of primary tumor, location of primary tumor, lactate dehydrogenase, alkaline phosphatase, ALT, AST and hemoglobin. Overall survival (OS) was analyzed since date of diagnosis by means of Kaplan-Meier and the Log-rank test was used to assess the differences. Results: The average follow-up time was 14.4 months (0–73.4). Clinical, laboratory and tumor characteristics were similar among groups A, B and C respectively. However P in group A had bigger size of liver metastases, higher number of them and more bilateral liver involvement respect to group B (p=0.02, p=0.03, p=0.05 respectively). Median OS in group A=21.0 months, group B=13.1 months and group C=15 months (p= 0.02). Statistical difference in OS was observed between group A and group B (p= 0.015). No difference was observed between groups A plus B vs the heterogeneous group C (p= 0.83) Conclusions: P with liver only metastatic site had better prognosis respect to those with other coexisting site of metastases despite presenting higher tumor burden in the liver. No factors analysed in the study explaine this difference. The subset of P with liver only metastatic site would be considered as a distinctive group and deserve further molecular studies. No significant financial relationships to disclose.

Resection of liver metastases from breast cancer: Effect of timing of surgery and estrogen receptor status on outcome.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 288-288
Author(s):  
D. E. Abbott ◽  
A. Brouquet ◽  
F. Meric-Bernstam ◽  
V. Valero ◽  
M. C. Green ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Liver Metastases ◽  
Cancer Patients ◽  
Primary Tumor ◽  
Timing Of Surgery ◽  
Breast Cancer Patients ◽  
Primary Tumors ◽  
Best Response ◽  
Response To Chemotherapy

288 Background: The oncologic benefit of resecting liver metastases (LM) in breast cancer patients is unclear. Identifying predictors of improved outcome would be useful in selecting appropriate candidates for surgery. Methods: From 1997 to 2010, 86 breast cancer patients underwent LM resection. RECIST criteria were used to define the best response to chemotherapy as the optimal response at any time during the course of metastatic disease and the preoperative response to chemotherapy as the response immediately before LM resection. Univariate and multivariate analyses were used to identify predictors of survival. Results: Sixty-four patients (74%) had primary tumors that were either estrogen receptor (ER) or progesterone receptor (PR) positive. Fifty-three patients (62%) had solitary LM, and 73 patients (85%) had LM smaller than 5 cm. Sixty-five patients (76%) received preoperative chemotherapy, and 10 patients (12%) received 2 or more chemotherapy regimens before LM resection. Only 2 patients (3%) had progressive disease (PD) as a best response to chemotherapy, whereas 19 patients (29%) had PD as preoperative response to chemotherapy (p < 0.001). No perioperative mortality was observed. At a median follow-up of 62 months, the median durations of overall and disease-free survival were 57 and 14 months. Univariate analysis revealed that ER and PR primary tumor status, best response to chemotherapy, and preoperative response to chemotherapy were associated with overall survival after LM resection. On multivariate analysis, an ER-negative primary tumor (p=.009, hazard ratio [HR] = 3.3, 95% confidence interval [CI] =1.4-8.2) and preoperative disease progression (p=.003, HR = 3.8, 95% CI = 1.6-9.2) were independently associated with worse survival after LM resection. Conclusions: Resection of liver metastases in breast cancer patients with ER positive disease that is responsive to chemotherapy is associated with prolonged survival. Timing of surgery is critical and resection before progression is associated with better outcome. No significant financial relationships to disclose.

Strategy for cStage4 colorectal cancer: Chemotherapy or resection of primary tumor?

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 779-779
Author(s):  
Shigeyoshi Iwamoto ◽  
Madoka Hamada ◽  
Masaharu Oishi ◽  
Tatsuma Sakaguchi ◽  
Taku Michiura ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Tumor ◽  
Systemic Chemotherapy ◽  
Tumor Resection ◽  
Primary Lesion ◽  
Pathological Response ◽  
Primary Tumor Resection ◽  
R0 Resection ◽  
Chemotherapy Response ◽  
Metastatic Sites

779 Background: It is controversial that the primary tumor must be removed prior chemotherapy in cStage4 colorectal cancer, because some cases prognostic factor were metastatic sites. We report cases of cStage4 colorectal cancer which were underwent intrensive chemotherapy prior the primary tumor resection. Methods: 190 cases of metastatic colorectal cancer were treated by L-OHP based chemotherapy plus bevacizumab/cetuximab/panitumumab in September 2007 to June 2012. 56 cases were treated by intensive chemotherapy prior primary tumor resection, and 44 cases were underwent surgical resection of primary tumor after evaluation of chemotherapy response. Results: 38/10/8 cases were treated by bevacizumab/cetuximab/panitumumab with L-OHP combined therapy as intensive treatment. 30 patient with obstructed primary lesion were underwent stoma surgery (53.6%). Evaluable lesions except primary lesion were liver (50.0%), lung (12.5%), LNs (33.9%). Response rate of chemotherapy were 67.9% (PR/NC/PD: 38/14/4), and 44 cases were performed resection of primary lesion in PR and SD cases. Pathological G2 and G3 response in resected primary lesion were 18.4% (G1a/G1b/G2/G3:17/18/8/2). A GI perforation and bowel obstruction in chemotherapy and 3 cases of anastomotic leakage and 6 cases of SSI in perioperable period were observed respectively. Conclusions: It is seemed to contribute improvement of QOL and local control that start with systemic chemotherapy prior primary lesion resection, therefore some cStage4 cases were difficult to R0 resection also primary lesion and systemic chemotherapy could be reduced symptom with metastatic sites. Only 18.4% of the resected primary tumor were G2/3 pathological response by systemic chemotherapy, on the other hand preoperative chemo-radiation in rectal cancer accomplished 67.3% of G2/3 pathological response (in house data). The end-point of therapy in stage 4 colorectal cancer patient are QOL and prolong survival, and should be selected treatments depending on the patient condition.

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