Chemotherapy (CT) treatment patterns and neutropenia management in gastric cancer patients (pts) receiving myelosuppressive chemotherapy in Europe.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 128-128
Author(s):  
Ewa Kalinka-Warzocha ◽  
Javier Gallego Plazas ◽  
Laurent Mineur ◽  
Tomas Salek ◽  
Alain Hendlisz ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
High Risk ◽  
Risk Estimation ◽  
Primary Prophylaxis ◽  
Myelosuppressive Chemotherapy ◽  
Chemotherapy Administration ◽  
Treatment Naïve ◽  
Drug Regimens ◽  
The Mean ◽  
Gastric Cancer Patients

128 Background: Granulocyte-colony stimulating factor (G-CSF) primary prophylaxis (PP) is recommended for pts undergoing CT who are at overall high risk for febrile neutropenia (FN). No single CT regimen is recognized as standard in gastric cancer and few regimens are represented in G-CSF guidelines. We therefore evaluated neutropenia management in pts receiving CT for gastric cancer. Methods: This was a multicentre prospective observational study that enrolled pts sequentially from 11/2009 to 06/2011. Adult gastric cancer pts (any stage) with ≥3 cycles of myelosuppressive CT scheduled and an investigator-assessed overall FN risk ≥20% were eligible. The primary outcome was the proportion of pts who received PP G-CSF (G-CSF in days 1-7 of cycle 1). Secondary outcomes included FN incidence, chemotherapy administration, and G-CSF use. Posthoc analyses investigated the subgroup who received DCF, including modifications from standard DCF (Van Cutsem. JCO. 2006), and the G-CSF support given up to the first FN (G-CSF prophylaxis given per label in each cycle up to that in which FN occurred). Results: Of 209 pts enrolled, 199 were eligible and their data analyzed. The mean (±SD) age was 62 (±12) years, 76% were male, 17% were ECOG 2 and none ECOG 3-4; 47% were treatment naïve. Planned CT was palliative in 74% of pts; overall, 27 different backbone regimens were planned (10 triplet, 12 doublet, 5 single drug regimens). The most common regimen used was DCF (54 pts, 27%), predominantly given as modified DCF (41 pts). Despite being assessed as high risk for FN, G-CSF PP was administered to only 35% of pts overall (n=70; 54 pegfilgrastim, 16 daily G-CSF) and to 69% of pts who received DCF. FN occurred in 14 pts (10%), 9 of whom received DCF. A large majority of FN pts (12/14, 86%) had not received prophylactic G-CSF per label up to the first FN occurrence; furthermore, 86% of FN pts did not receive G-CSF prophylaxis in the cycle following the FN event. Conclusions: The variety of CT used, frequent modifications to standard CT, and presence of pt risk factors makes FN risk estimation difficult in gastric cancer. Improved risk assessment and appropriate targeting of G-CSF PP to high risk pts is needed.

scholarly journals A Novel Model Based on Deep Convolutional Neural Network Improves Diagnostic Accuracy of Intramucosal Gastric Cancer (With Video)

2021 ◽  
Vol 11 ◽  
Author(s):  
Dehua Tang ◽  
Jie Zhou ◽  
Lei Wang ◽  
Muhan Ni ◽  
Min Chen ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Diagnostic Accuracy ◽  
Diagnostic Performance ◽  
Training Dataset ◽  
Deep Convolutional Neural Networks ◽  
Testing Dataset ◽  
Kappa Value ◽  
The Mean ◽  
Gastric Cancer Patients ◽  
Novel Model

Background and AimsPrediction of intramucosal gastric cancer (GC) is a big challenge. It is not clear whether artificial intelligence could assist endoscopists in the diagnosis.MethodsA deep convolutional neural networks (DCNN) model was developed via retrospectively collected 3407 endoscopic images from 666 gastric cancer patients from two Endoscopy Centers (training dataset). The DCNN model’s performance was tested with 228 images from 62 independent patients (testing dataset). The endoscopists evaluated the image and video testing dataset with or without the DCNN model’s assistance, respectively. Endoscopists’ diagnostic performance was compared with or without the DCNN model’s assistance and investigated the effects of assistance using correlations and linear regression analyses.ResultsThe DCNN model discriminated intramucosal GC from advanced GC with an AUC of 0.942 (95% CI, 0.915–0.970), a sensitivity of 90.5% (95% CI, 84.1%–95.4%), and a specificity of 85.3% (95% CI, 77.1%–90.9%) in the testing dataset. The diagnostic performance of novice endoscopists was comparable to those of expert endoscopists with the DCNN model’s assistance (accuracy: 84.6% vs. 85.5%, sensitivity: 85.7% vs. 87.4%, specificity: 83.3% vs. 83.0%). The mean pairwise kappa value of endoscopists was increased significantly with the DCNN model’s assistance (0.430–0.629 vs. 0.660–0.861). The diagnostic duration reduced considerably with the assistance of the DCNN model from 4.35s to 3.01s. The correlation between the perseverance of effort and diagnostic accuracy of endoscopists was diminished using the DCNN model (r: 0.470 vs. 0.076).ConclusionsAn AI-assisted system was established and found useful for novice endoscopists to achieve comparable diagnostic performance with experts.

scholarly journals Prognostic Autophagy-Related Genes of Gastric Cancer Patients on Chemotherapy

2021 ◽  
Author(s):  
xiaolong Liu ◽  
Zhen Ma ◽  
Lei Zhang ◽  
Yang Yu ◽  
Maswikiti Ewetse Paul ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Regression Models ◽  
Risk Group ◽  
Chemotherapy Resistance ◽  
Estimation Method ◽  
High Risk Group ◽  
Chemotherapy Administration ◽  
Clinical Complications ◽  
Product Limit ◽  
Gastric Cancer Patients

Abstract Background Gastric cancer(GC) treated with fluorouracil and cisplatin can cause chemotherapy resistance, which is one of the most common postoperative clinical complications and leads to in poor prognosis. Methods The purpose of this study is to investigate the susceptibility of patients with GC after postoperative chemotherapy based on autophagy-related genes (ATGs). Under the background of TCGA database, for patients with GC undergoing and during chemotherapy,gene expression data was integrated and analyzed. Prognostic genes were screened based on univariate and various analysis regression models. Subjects were divided into two groups: high-risk group and low-risk group. Univariate and various analytical regression models were used to screen for prognostic genes. Median risk score was used for analysis. OS and DFS were evaluated by the product limit estimation method. Subject curve analysis is used to determine the accuracy of the forecast. We also have performed appropriate analysis and conducted some detailed assessments in our work. The differential expression of ATGs was mainly associated with chemotherapy resistance.Results After chemotherapy administration, we have screened 9 ATGs outcomes in the subjects and DFS and OS were precisely predicted by the model of GEO and TCGA databases.Conclusions 9 genes were established as prognostic markers to predict the relationship between ATGs and GC chemotherapy susceptibility, suggesting a better individualized treatment in clinical practice.

First-degree relatives of early-onset gastric cancer patients show a high risk for gastric cancer: phenotype and genotype profile

2013 ◽  
Vol 463 (3) ◽  
pp. 391-399 ◽  
Author(s):  
Ricardo Marcos-Pinto ◽  
Mário Dinis-Ribeiro ◽  
Fátima Carneiro ◽  
Xiaogang Wen ◽  
Carlos Lopes ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Early Onset ◽  
Genotype Profile ◽  
First Degree Relatives ◽  
Cancer Phenotype ◽  
Gastric Cancer Patients

A Pilot Clinical Trial of Postoperative Adjuvant Intraperitoneal Cisplatin, 5-Fluorouracil, 6S-Leucovorin and Interferon Alpha 2b in Patients with Resected Gastric Cancer

1993 ◽  
Vol 79 (5) ◽  
pp. 331-335 ◽  
Author(s):  
Stefano Cascinu ◽  
Gabriele Valentini ◽  
Giuseppina Catalano
Keyword(s):  
Gastric Cancer ◽  
High Risk ◽  
Interferon Alpha ◽  
Curative Resection ◽  
Interferon Alpha 2B ◽  
Relapse Pattern ◽  
Postoperative Setting ◽  
Gastric Cancer Patients ◽  
Resected Gastric Cancer

Aims and Background The study was performed to assess the toxicity and impact on relapse pattern of postoperative intraperitoneal cisplatin, 5-fluorouracil, leucovorin and interferon therapy as adjuvant treatment for gastric cancer patients who are at high risk for recurrence after potentially curative resection (T2 N1-2; T3-4 N any Mo). Patients and Methods Starting 14 to 21 days after potentially curative resection of primary gastric cancers, 22 patients were given intraperitoneal cisplatin, 60 mg/m2; 5-fluorouracil, 1000 mg/m2; 6S-leucovorin, 250 mg/m2; interferon alpha 2b, 10 MU/m2; every other week for six times. Results After a median follow-up of 24 months, 63 % of patients were alive and free of disease. Eight patients had recurred; five had an intraabdominal component, and 3 had extraabdominal failure. Toxicity was mild: no grade III-IV WHO toxicity was observed. Conclusions Intraperitoneal cisplatin, 5-fluorouracil, 6S-leucovorin and interferon is a tolerable therapy in the postoperative setting for patients with resected gastric cancer. These data make this approach interesting for the development of new programs of adjuvant therapy of high-risk gastric cancer.

TRG as indicator of efficacy of FLOT versus FOLFOX in perioperative chemotherapy for resectable gastric cancer patients (single institution experience).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16061-e16061
Author(s):  
Natalia P. Beliak ◽  
Rashida Orlova ◽  
Svetlana Kutukova ◽  
Natalia V. Zhukova ◽  
Pavel Balashov ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Chemotherapy Regimen ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Similar Efficacy ◽  
Nccn Guidelines ◽  
Locally Advanced Gastric Cancer ◽  
Drug Regimens ◽  
Folfox Chemotherapy ◽  
Gastric Cancer Patients

e16061 Background: Based on results German FLOT-4 study, the FLOT regimen could be considered the new standard chemotherapy regimen for perioperative strategy of resectable GC. Since more and more patients have received neoadjuvant treatment,the efficacy and side effect must be weighted before performing NACT. Two-drug regimens were preferred according to the NCCN guidelines in principle because of their lower toxicity. And three-drug regimens may be applied in medically fit patients with access to frequent evaluation during treatment, to ensure that they can still tolerate surgery after NACT. Methods: We analyzed the data of 79 patients with resectable locally advanced gastric cancer who received the FLOT or FOLFOX regimen as NACT. The group of patients with NAСT FLOT included 44 patients, including 32 men, 12 women. Age in the first group varied from 28 to 80 years, the median age was 59.0 (95% CI 54.1-62.0) The group of patients with the FOLFOX chemotherapy regimen included 35: 17 (48.6%) men and 18 women (51.4%). Age in the second group varied from 60 to 75 years, the median age in the second group was 67.5 (95% CI 62.2-71.0). The second group included significantly older patients U = 137.0; p = 0.0001. Results: The severity of drug pathomorphosis was assessed in a standard way according to the Mandard system, in the first group there were 5 patients - TRG1 (11.4%), 7 patients - TRG2 (15.9%), 9 patients - TRG3 (20.5%), 15 patients TRG4 (34.0%), 5 patients - TRG5 (11.4%), 3 patients it was not evaluated (6.8%). In the second group, 6 patients - TRG1 (17.1%), 2 patients - TRG2 (5.7%), 2 patients - TRG3 (5.7%), 16 patients - TRG4 (45.8 %), 7 patients - TRG5 (20.0%), for 2 patients it was not evaluated (5.7%). Complete pathomorphosis was not statistically different in both groups (p = 0.47). TRG 2 was not statistically different (p = 0.16). The number of registered cases of TRG3 in the first group exceeded (p = 0.06). The frequency of TRG4 and TRG 5 did not differ (p = 0.29). Major pathological regression (TRG1 + TRG2) was 27.3% in the first group and 22.8% (p = 0.65). A decrease in the stage in the first group occurred in 22 patients (50.0%), and in the second group - in 19 patients (54.3%), p = 0.70. yp≤ T2 was diagnosed in 21 out of 79 patients (26.6%), in the first group in 11 patients (25%), in the second group in 10 (28.6%), p = 0.72. Conclusions: the FOLFOX regimen showed similar efficacy in the tumor response grade rate compared to the FLOT regimen, therefore, these two regimes are interchangeable, especially among patients of the older age group or in patients with high risks of a four-component regimen.

Clinical features, treatments and survival of HER2 positive gastric cancer with elevated alpha-fetoprotein: An analysis of 16 cases.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16000-e16000
Author(s):  
Shaohua Ge ◽  
Yi Ba ◽  
Ting Deng ◽  
Yuchong Yang ◽  
Tao Ning ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Immune Checkpoint ◽  
Clinical Characteristics ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Elevated Serum ◽  
Her2 Positive ◽  
The Mean ◽  
Gastric Cancer Patients

e16000 Background: Gastric cancer with elevated alpha-fetoprotein (AFP) is a special type of gastric cancer with elevated serum AFP. It is often misdiagnosed as primary hepatic cancer due to abnormal AFP and liver metastasis. The AFP level is related to the prognosis of these patients in whom there is prone to high HER2 positive rate. Therefore, anti-HER2 treatment is optional, as well as the emerging immunotherapy with immune checkpoint inhibitors. Methods: Gastric cancer patients with HER2 and serum AFP examination were collected in our hospital from May 2017 till now. Serum AFP level over 7 ng/ml was defined as elevated AFP. The clinical characteristics, treatments and survival of the patients with HER2 positive and elevated AFP were picked and analyzed. Results: Among 135 gastric cancer patients with elevated AFP, 16 (11.9%) were HER-2 positive (12 with HER2 3+, 3 with HER2 2+/FISH+ and 1 with HER2 gene amplification in NGS). The mean serum AFP is 201.4± 476.7ng/ml (range: 7.74 -1335). There were 9 males and 7 females. The mean age was 55 years (range: 38-90). The tumors were located in stomach cardia and fundus in 5 cases, body in 5 cases, antrum in 4 cases, body and antrum in 1 case and whole stomach in 1 case. There were 2 patients in stage III and 14 patients in stage IV with metastasis to lymph node metastasis in 15, liver in 9, abdominal cavity in 3 and peritoneum in 3. As for the treatments, three patients underwent surgery, one of whom with exploratory laparotomy (no antitumor treatment after surgery, died from infection). In 13 advanced patients, 12 patients received systemic antitumor therapies (8 with chemotherapy+Trastuzumab+ immunotherapy, 2 with chemotherapy+Trastuzumab, 1 with chemotherapy+ immunotherapy and 1 with chemotherapy). The chemotherapy regimens were XELOX in 5 cases, SOX in 4 cases and FLOT in 2 cases. The response rate was 50% (6 in 12 patients) and the disease control rate was 100%. The median PFS was 7.5 months in first line therapy with six patients without progression disease yet. The longest PFS with PR lasted for 16.5 months with chemotherapy, trastuzumab and immune checkpoint inhibitor. Conclusions: Gastric cancer with HER2 positive and elevated serum AFP is a disease with special clinical characteristics. Patients with advanced diseases can be treated with chemotherapy, trastuzumab +/- immune checkpoint inhibitors. This combination is expected to become a new regimen to improve survival of such special patients.

Different Pathological Features and Prognosis in Gastric Cancer Patients Coming From High-Risk and Low-Risk Areas of Italy

2009 ◽  
Vol 250 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Daniele Marrelli ◽  
Corrado Pedrazzani ◽  
Giovanni Corso ◽  
Alessandro Neri ◽  
Marianna Di Martino ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Low Risk ◽  
Pathological Features ◽  
Risk Areas ◽  
Gastric Cancer Patients

scholarly journals Repeated Combined Chemotherapy with Cisplatin Lowers Carnitine Levels in Gastric Cancer Patients

2017 ◽  
Vol 71 (3-4) ◽  
pp. 261-265 ◽  
Author(s):  
Akimasa Kawai ◽  
Hideo  Matsumoto ◽  
Youko Endou ◽  
Yui Honda ◽  
Hisako Kubota ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Organic Cation ◽  
Organic Cation Transporter ◽  
Combined Chemotherapy ◽  
Carnitine Level ◽  
Upper Gastrointestinal Cancer ◽  
The Mean ◽  
Total Carnitine ◽  
Gastric Cancer Patients ◽  
Upper Gastrointestinal

Background/Aims: Carnitine plays an important role in the metabolism of fatty acids. It has also been reported that the administration of anticancer drugs may lead to reductions in serum carnitine levels due to decreased activity of organic cation transporter novel 2, which plays a role in the reabsorption of carnitine in the tubules of the kidney. We therefore studied the change in carnitine levels when chemotherapy was administered repeatedly to patients with gastric cancer. Methods: Ten patients with upper gastrointestinal cancer were enrolled in this study between December 2014 and August 2015. All patients were administered chemotherapy consisting of TS-1 and cisplatin every 3 weeks: 3 received it as adjuvant therapy post resection, the remaining 7 received it as treatment for unresectable tumors. Before the start of each chemotherapy cycle, serum was collected. Results: The mean total carnitine level was 54.5 ± 13.7 μmol/L prior to commencing chemotherapy; it was 46.7 ± 13.5 and 41.4 ± 14.8 μmol/L at the second and third cycles respectively. The total carnitine level was decreased in a statistically significant manner (p = 0.0039). The serum level of total protein and cholinesterase was also decreased significantly (p = 0.0218 and p = 0.0418). Conclusion: Carnitine levels decreased during repeated chemotherapy in patients with gastric cancer, and they are associated with the nutritional status.

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