Prophylactic oophorectomy in premenopausal women with non-metastatic colon cancer: A decision analysis

6130 Background: There is data to suggest that prophylactic oophorectomy (PO) in premenopausal women with colon cancer may improve survival. However, the potential for improved survival must be balanced against the trade-off of premature menopause and its affect on quality of life (QOL). The objective of this study was to determine the value of PO in premenopausal women undergoing surgical excision of colon cancer. Methods: We constructed a decision-analytic model comparing PO versus no PO for premenopausal women undergoing resection of stage I-III colon cancer. The model included detection of ovarian micrometastases (OMM), adjuvant chemotherapy, development of metachronous ovarian metastases, subsequent risk of ovarian cancer and QOL. Probabilities and utilities were estimated from published data. Life expectancy (LE) and quality adjusted LE (QALE) were calculated using the Declining Exponential Approximation of Life Expectancy. Results: With a baseline OMM incidence of 8%, a 5 yr survival of OMM removed (19%) vs OMM left in situ (11%), there was a gain in LE of 2.8 months with PO. With QOL adjustments for menopause (utility 0.77) and colon cancer (utility 0.37–0.85 ), QALE was 1.7 months less with PO. One-way sensitivity analysis (SA) demonstrated that the utility of menopause had the greatest effect on QALE differences, with a threshold value of 0.86 at which QALE was greater with PO. With increasing OMM incidence and 5-year survival with removed OMM, QALE became greater in the PO cohort. All 1, 2, and 3 way SAs demonstrated that the model was robust through the probable range of variables. Conclusions: Our model demonstrated the significant effect of menopause QOL on overall QALE. Although PO may lead to a small gain in LE, the trade-off of premature menopause must be considered when counseling patients. No significant financial relationships to disclose.

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Hormone Replacement Therapy and Life Expectancy After Prophylactic Oophorectomy in Women With BRCA1/2 Mutations: A Decision Analysis

Journal of Clinical Oncology ◽

10.1200/jco.2004.06.090 ◽

2004 ◽

Vol 22 (6) ◽

pp. 1045-1054 ◽

Cited By ~ 109

Author(s):

Katrina Armstrong ◽

J. Sanford Schwartz ◽

Thomas Randall ◽

Stephen C. Rubin ◽

Barbara Weber

Keyword(s):

Hormone Replacement Therapy ◽

Life Expectancy ◽

Decision Analysis ◽

Replacement Therapy ◽

Prophylactic Mastectomy ◽

Hormone Replacement ◽

Sensitivity Analyses ◽

Decision Analytic Model ◽

Prophylactic Oophorectomy ◽

The Impact

Purpose The decision about prophylactic oophorectomy is difficult for many premenopausal women with BRCA1/2 mutations because of concerns and controversy about the use of hormone replacement therapy (HRT) after oophorectomy. Patients and Methods A Markov decision analytic model used the most current epidemiologic data to assess the expected outcomes of prophylactic oophorectomy with or without HRT (to age 50 years or for life) in cohorts of women with BRCA1/2 mutations. Sensitivity analyses were conducted to assess the impact of alternative assumptions about effects of HRT, effects of prophylactic oophorectomy, and risks of cancer associated with BRCA1/2 mutations. Results In our model, prophylactic oophorectomy lengthened life expectancy in women with BRCA1/2 mutations, irrespective of whether HRT was used after oophorectomy. This gain ranged from 3.34 to 4.65 years, depending on age at oophorectomy. Use of HRT after oophorectomy was associated with relatively small changes in life expectancy (+0.17 to −0.34 years) when HRT was stopped at age 50, but larger decrements in life expectancy if HRT was continued for life (−0.79 to −1.09 years). HRT was associated with a gain in life expectancy of between 0.39 and 0.79 years for mutation carriers undergoing both prophylactic mastectomy and oophorectomy. Conclusion On the basis of the results of this decision analysis, we recommend that women with BRCA1/2 mutations undergo prophylactic oophorectomy after completion of childbearing, decide about short-term HRT after oophorectomy based largely on quality-of-life issues rather than life expectancy, and, if using HRT, consider discontinuing treatment at the time of expected natural menopause, approximately age 50 years.

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Adoptive immunotherapy plus cryotherapy in murine model of metastatic colon cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.2520 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 2520-2520

Author(s):

M. Y. Levy ◽

H. Symons ◽

W. Chowdhury ◽

R. Rodriguez ◽

E. Fuchs

Keyword(s):

Colon Cancer ◽

T Cells ◽

T Cell ◽

Adoptive Immunotherapy ◽

Tumor Antigens ◽

Lung Metastases ◽

Local Treatment ◽

Distant Metastases ◽

Surgical Excision ◽

Metastatic Colon Cancer

2520 Background: Cryotherapy provides a known local treatment effect for cancer. Additionally, many reports suggest that preservation of tumor antigens in the cryoablation (cryo) treatment site may lead to a systemic immune response that may treat remote tumor. However, the capacity of cryo to induce a regression of metastatic lesions may be limited by tumor-induced alterations of the immune system, including tumor-specific T cell tolerance and suppression. One method of awakening dormant anti-tumor immunity is by treating cancer-bearing animals with cyclophosphamide (Cy), to eliminate suppressor T cells, and allogeneic donor lymphocyte infusion (DLI), to provide an exogenous source of CD4+ T cell help for endogenous, tumor-specific CD8+ T cells. We therefore asked whether Cy ± DLI could augment the anti-tumor effect of cryo in a mouse metastatic colon cancer model. Methods: BALB-C mice were inoculated on d0 with the 106 syngeneic CT-26 SQ to generate local tumor and 105 IV via tail vein injection to generate lung metastases. The SQ tumor was then treated on d14 with either surgical excision or cryo, and mice were treated further with nothing, Cy alone (200 mg/kg IP on d13), or Cy plus CD8+ T cell-depleted DLI from allogeneic donors. At d102, surviving animals were re-challenged with 105 CT-26 cells IV. 5 previously untreated BALB-C controls were injected at the same time with 105 CT-26 IV. Results: Our data demonstrates a survival advantage of mice treated with Cy plus cryo (med. survival 100.5 days) compared to animals treated with Cy + surgery (med. survival 33d; p = .002). Furthermore, a significant (p = .0006) effect of the adoptive immunotherapy was seen with a comparison between the surgery +Cy group (med. survival 33d), and the surgery +Cy/DLI group (med. survival 60d). There are currently 6/18 mice alive at d143 that received cryo + Cy±DLI. In the re-challenge experiment, all control animals died of tumor by d19 with a med. survival of d18. 6/7 re-treated animals remain alive and free of tumor 41d after tumor re-challenge (p = .0041). Conclusions: These results suggest a systemic immune effect on distant metastases may occur after local cryo when cryo is coupled with Cy alone and Cy+DLI. The results from this experiment warrant further characterization of the mechanisms for the anti-tumor effects observed. No significant financial relationships to disclose.

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Molecular and biological aspects of forecasting the oncological efficiency of cytoreductive surgery in metastatic colon cancer

Vestnik of Russian military medical Academy ◽

10.17816/brmma73188 ◽

2021 ◽

Vol 23 (3) ◽

pp. 61-66

Author(s):

Aleksey A. Sazonov ◽

Nicolay A. Maistrenko ◽

Pavel N. Romashchenko

Keyword(s):

Stem Cells ◽

Colon Cancer ◽

Surgical Treatment ◽

Cancer Stem Cells ◽

Life Expectancy ◽

Cytoreductive Surgery ◽

Proliferative Activity ◽

Stage Iv ◽

Biological Properties ◽

Metastatic Colon Cancer

Through an immunohistochemical study, the molecular biological properties of adenocarcinoma in patients with stage IV colorectal cancer with synchronous unresectable liver metastases, who underwent cytoreductive interventions for volume removal of the primary tumor, were examined. This study clarified the criteria for selecting patients with stage IV colon cancer with unresectable synchronous metastases in the liver for cytoreductive surgery from the standpoint of the molecular biological properties of the tumor. The prognostic significance of immunohistochemical markers such as the index of proliferative activity of stem cancer cells (ALDH + Ki-67 +) and the receptor for chemokines CXCR4 was established. The level of their expression correlates with the life expectancy of patients who underwent cytoreductive surgery. Thus, the high proliferative activity of cancer stem cells (ALDH + Ki67 + 50%) and the high expression of chemokine receptor (CXCR4 70%) correlate with the rapid disease progression after surgical treatment. A significant inverse relationship was traced between the expression level of the receptor for chemokine CXCR4 as well as the proliferative activity of cancer stem cells and life expectancy of patients with stage IV colon cancer after cytoreductive surgery. The expediency of immunohistochemical studies in patients with metastatic colon cancer has been substantiated. Its implementation provides important information about the potential for tumor aggressiveness, which makes it possible to clarify the indications for performing cytoreductive surgery and improve the results of surgical treatment of this category of patients.

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CHEMOTHERAPY IN THE MANAGEMENT OF LOCALIZED AND METASTATIC COLON CANCER: NEW AND YET UNFORGOTTEN APPROACHES

Medical Council ◽

10.21518/2079-701x-2017-14-67-76 ◽

2017 ◽

pp. 67-76

Author(s):

N. V. Dobrova ◽

O. O. Gordeeva ◽

E. V. Chernoglazova ◽

A. A. Tryakin

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Life Expectancy ◽

Metastatic Colorectal Cancer ◽

Surgical Resection ◽

Targeted Drugs ◽

Metastatic Colon Cancer ◽

The Past ◽

New Approaches

Over the course of the past couple of decades, we have witnessed some significant improvements in the treatment of metastatic colorectal cancer: the emergence of novel targeted drugs and a differentiated approach to their administration, the extension of indications for surgical resection for liver and lungs metastases has resulted in the increased life expectancy among patients in this group. Nevertheless, chemotherapy remains the treatment of choice for colon cancer. In this paper, we discuss new approaches to the use of chemotherapy on stages III and IV of colorectal cancer.

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Treatment cost of metastatic colon cancer in Turkey

Farmeconomia Health economics and therapeutic pathways ◽

10.7175/fe.v14i1.472 ◽

2013 ◽

Vol 14 (1) ◽

pp. 19-25 ◽

Cited By ~ 1

Author(s):

Guvenc Kockaya ◽

Mine Polat ◽

Albert Wertheimer ◽

Ahmet Ozet ◽

Simten Malhan ◽

...

Keyword(s):

Colon Cancer ◽

Life Expectancy ◽

Cancer Treatment ◽

Cost Of Care ◽

University Hospital ◽

Hospital Treatment ◽

Metastatic Colon Cancer ◽

Treatment Protocols ◽

Total Cost ◽

The Cost

OBJECTIVES: Colon cancer is the third most common in the top cancer incidence list in Europe. In Europe 212,000 patients die every year due to colon cancer. In Turkey 120,000-130,000 new cancer patients are diagnosed every year, 7.1% of whom are diagnosed to have developed colon cancer. Metastases will occur in up to 50% of the patients who are newly diagnosed. Survival appears to be further prolonged to more than 20 months with new pharmaceuticals; however, these new pharmaceuticals increase the total cost of care. The aim of this study is to estimate the cost implications of new colon cancer treatment options for Turkey.METHODS: Gazi University Hospital treatment protocols for colon cancer treatment were used. Cost of FUFA (5 FU/LV), FOLFIRI, FOLFOX, bevacizumab/FUFA, bevacizumab/FOLFIRI, bevacizumab/FOLFOX, irinotecan and irinotecan/cetixumab protocols were calculated. The cost of combination of protocols were calculated depending on a Markov analysis. The exchange rate was US$ 1 for TL 1.5.RESULTS: Depending on the life expectancy the lowest total cost was established by FUVA (US$ 5,359). It was followed by FOLFIRI then FOLFOX and FOLFOX, US$ 14,144 and US$ 16,553, respectively. The lowest cost for each week of life expectancy was established by FUVA with US$ 98.CONCLUSIONS: Only FUFA, FOLFIRI followed by FOLFIX, FOLFIRI/bevacizumab then FOLFOX then cetuximab, FOLFOX/bevacizumab then irinotecan then cetuximab/irinotecan and FOLFIRI/bevacizumab then FOLFOX then cetuximab/irinotecan were under the cost effectiveness curve. In addition no treatments ICER was under the WHO`s threshold for Turkey, except FOLFIRI then FOLFOX compared with FUVA.

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