Incidence of peripheral neuropathy in patients with colorectal cancer receiving oxaliplatin alone vs. radiation therapy and oxaliplatin.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18281-e18281
Author(s):  
Matthew Blake Lockwood ◽  
Krishna Prasad Joshi ◽  
James Mobley ◽  
Suneetha Sampath ◽  
Eric R Siegel ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Radiation Therapy ◽  
Peripheral Neuropathy ◽  
Stage Iv ◽  
Sensory Neuropathy ◽  
Chi Square ◽  
Stage Iv Disease ◽  
Nerve Fibrosis ◽  
Colorectal Cancer Patients

e18281 Background: Peripheral sensory neuropathy (PN) is a known dose limiting toxicity of oxaliplatin, used to treat patients with colorectal cancer. Patients with rectal cancer receive radiation therapy (RT) in addition to oxaliplatin in adjuvant setting. Pelvic radiation causes plexopathy due to demyelination, ischemia due to blood-vessel injury, and nerve fibrosis. To assess if RT increases the incidence of peripheral neuropathy, we conducted an analysis of patients with colorectal cancer treated with oxaliplatin alone vs. oxaliplatin and radiation. Methods: A retrospective analysis of subjects with stages II, III, and IV rectal (R) and colon (C) cancer from 2005 to 2014 was conducted. Only subjects receiving O with or without RT were included. The incidence of PN was compared for increase in subjects receiving both O and RT compared to O alone via one-sided chi-square tests at 5% alpha, both overall and after subgrouping by stage. Results: Out of 261 subjects analyzed, 158 met the study’s criteria. There were 97 C (all received only O) and 61 R (10 received only O; 51 received O+RT). PN occurred in 37% (19/51) of subjects receiving O+RT compared to 22% (24/107) receiving only O ( P= 0.025). In Stage II-III disease, PN occurred at nearly equal rates of 36% (14/39) in subjects receiving O+RT and 33% (16/46) in subjects receiving O only ( P= 0.457). However, in Stage IV disease, PN occurred in 42% (5/12) of subjects receiving O+RT compared to 13% (8/61) of subjects receiving only O ( P= 0.009). Conclusions: In our study, the incidence of PN was higher in subjects receiving both RT and O compared to O alone. Although our study did not show higher PN in stages II and III disease, patients with rectal cancer may have residual neurotoxicity from previous radiation and the subsequent exposure to oxaliplatin may be contributing to the cumulative toxicity. [Table: see text]

Long-term maintenance capecitabine and celecoxib improved clinical outcomes by targeting colorectal cancer micrometastasis

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14513-14513
Author(s):  
M. Zhang ◽  
S. Curley ◽  
C. Ng ◽  
B. Kurland ◽  
S. Krishnan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Stage Iv ◽  
Complete Response ◽  
Kaplan Meier ◽  
Stage Iv Disease ◽  
Disease Site ◽  
Colorectal Cancer Patients

14513 Background: Role of mainteance therapy after achieving complete response (CR) remain undefined for patients with metasatic colorectal cancer. We studied prognostic and treatment factors including maintenance capecitabine and celecoxib (XCEL) in all 19 unresectable metastatic colorectal cancer patients (pts) who had CR from the prior XCEL study. Methods: Event charts are used to summarize the timeline of the various treatments. Kaplan-Meier survival estimates and univariate log-rank tests were used to evaluate RFS and OS as time from CR. Prognostic and treatment factors included: tumor size, metastasis number (9 solitary disease), site (13 being extrahepatic), stage on diagnosis (stage II versus III/IV), disease free interval prior to stage IV disease, surgery (5 R0, 3 R1–2 resections), lactate dehydrogenase levels, first-line irinotecan chemotherapy, radiation (9 pts ≥ 45 Gy, 3 Pts < 45 Gy), and maintenance XCEL (duration 0–50.3 months). Results: Nine of 19 patients experienced recurrence (median 13 months after CR), and 4 died during the follow-up period (median 31 months after CR). The 2-year RFS for the unresected and R1–2 resected patients was 71% versus 20% for the R0 resected patients (p = 0.07). This paradoxical RFS pattern corresponded to a RFS advantage for maintenance XCEL (p = 0.002), but not any other prognostic or treatment factors. All relapses occurred in situ following discontinuation of XCEL except for the surgical cases. Patients undergoing maintenance XCEL also benefited in OS (p = 0.04). The median OS from XCEL and from onset of metastasis reached 51.9 months (95% CI, 45 months- not reached [NR]) and 73.3 months (95% CI, NR-NR months) respectively. Conclusions: Maintenance XCEL targets colorectal micrometastases and produces a paradoxical RFS and OS advantage among the high-risk unresected/R1–2 resected patients than R0 resected patients. Prospective studies are warranted to validate roles of maintenance XCEL in the treatment of colorectal micrometastases. No significant financial relationships to disclose.

Efficacy and tolerability of oxycodone for oxaliplatin-induced peripheral neuropathy and the extension of folfox therapy in colorectal cancer patients.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 196-196
Author(s):  
Makoto Nagashima ◽  
Mitsuru Ooshiro ◽  
Ayako Moriyama ◽  
Kengo Kadoya ◽  
Ayami Sato ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Peripheral Neuropathy ◽  
Medical Center ◽  
Sensory Neuropathy ◽  
Clinical Settings ◽  
Therapeutic Effects ◽  
The Common ◽  
Grade 3 ◽  
Colorectal Cancer Patients ◽  
Experienced Grade

196 Background: The oxaliplatin-based regimen FOLFOX is widely used to treat patients with advanced colorectal cancer (CRC). However, dose-limiting toxicity after continuous oxaliplatin administration can lead to peripheral neuropathy. Several agents, including opioids, that have been employed to treat oxaliplatin-induced peripheral neuropathy (OIPN) have been examined in clinical settings regarding their protective and therapeutic effects. However, the pharmacotherapy of these agents has not yet been established. Therefore, we investigated the efficacy and tolerability of oxycodone for OIPN and subsequently with FOLFOX therapy in CRC patients. Methods: This was a single-center retrospective study of 64 CRC patients who underwent FOLFOX therapy at the Toho University Sakura Medical Center (Sakura, Japan). Controlled-release (CR) oxycodone was concomitantly administered to 29 patients (OXY group), whereas the additional 35 patients (non-OXY group) were not given oxycodone during the FOLFOX treatment course. The incidence and severity of OIPN and the number of FOLFOX cycles were measured and compared between the two groups. Neurological toxicities were assessed according to the Common Terminology Criteria for Advanced Events, version 3.0. Results: All study patients had OIPN. Most patients experienced grade 1 or 2 sensory neuropathy. Grade 3 sensory neuropathy was observed in two patients in the non-OXY group. All patients in the OXY group completed the scheduled FOLFOX therapy, whereas FOLFOX therapy was discontinued in ten patients in the non-OXY group due to severe peripheral neuropathy. The median numbers of FOLFOX cycles in the OXY and non-OXY groups were 13 (range, 6–46) and 7 (range, 2–18), respectively (P < 0.05). The median cumulative oxaliplatin doses were 1072.3 mg/m2 (range, 408.7–3385.3 mg/m2) in the OXY group and 483.0 mg/m2 (range 76.2–1414.1 mg/m2) in the non-OXY group (P < 0.05). Conclusions: Our findings indicate that CR oxycodone might attenuate the severity of OIPN and extend the use of FOLFOX therapy.

Immunomagnetic Enrichment and Detection of Micrometastases in Colorectal Cancer: Correlation With Established Clinical Parameters

2002 ◽  
Vol 20 (21) ◽  
pp. 4338-4343 ◽  
Author(s):  
Martin R. Weihrauch ◽  
Edmund Skibowski ◽  
Thomas C. Koslowsky ◽  
Wilfried Voiss ◽  
Daniel Re ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Bone Marrow ◽  
Cancer Patients ◽  
Stage Iv ◽  
Stage I ◽  
Clinical Parameters ◽  
Uicc Stage ◽  
Detection Rates ◽  
Stage Iv Disease ◽  
Colorectal Cancer Patients

PURPOSE: Micrometastatic disease in bone marrow is of prognostic significance in colorectal cancer patients. However, detection rates of standard immunocytology are relatively low. We used magnetic activated cell sorting (MACS), a highly sensitive method, to increase detection rates and correlated the presence of cytokeratin (CK)-expressing cells with clinical parameters. PATIENTS AND METHODS: Bone marrow was obtained from 51 consecutive patients with newly diagnosed colorectal adenocarcinoma who underwent primary surgery and 18 control subjects. International Union Against Cancer (UICC) stage I disease was diagnosed in 11 patients, stage II disease was diagnosed in 14 patients, stage III disease was diagnosed in 12 patients, and stage IV disease was diagnosed in 14 patients. CK-positive cells were enriched and stained with magnetically labeled CAM 5.2 antibodies directed to CK 7 and 8. RESULTS: CK-positive cells were found in 33 (65%) patients and were absent in 18 (35%). Four of 11 (36%) patients with UICC stage I disease, nine of 14 (64%) with stage II diease, eight of 12 (67%) with stage III disease, and 12 of 14 (86%) with stage IV disease were CK-positive. Epithelial cells were more frequently found in pT3/4 (72%) than in pT1/2 (36%) tumors (P = .026), but there was no difference for lymph node status. CK-positive patients had a higher chance for elevated carcinoembryonic antigen (85% v 15%, P = NS) and CA 19-9 levels (92% v 8%, P = .019). There were no significant differences in CA 72-4, sex, age, tumor grading, or tumor localization regarding the presence of CK-positive cells. All control subjects were CK-negative. CONCLUSION: In searching for micrometastases in colorectal cancer patients, we have achieved high detection rates by using MACS. The presence of these cells correlated significantly with tumor stage, tumor extension, and the tumor marker CA 19-9.

Treatment of colorectal cancer in elder patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19595-19595
Author(s):  
A. Piga ◽  
M. Miscoria ◽  
G. Aprile ◽  
M. Cozzi ◽  
E. Iaiza ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Stage Iv ◽  
Stage Iii ◽  
Treatment Preference ◽  
Chi Square ◽  
Elder Patients ◽  
Therapeutic Decisions ◽  
Clinical Records

19595 Background: Tumor-related mortality is higher in elder patients worldwide. This may be due to comorbidities associated with age but also, at least in part, to a cautious approach by the attending physician(s) which might result in inadequate or even denied treatment. This approach is purportedly justified by scarcity of literature reports on effectiveness, tolerance and side effects of chemotherapy and other treatments on this category of patients. Methods: We have reviewed clinical records of patients of 70 years of age or older with colorectal cancer who came to our first observation between January 2004 and April 2006. We have correlated the appropriateness of therapeutic decisions, based on adherence to clinical standards, to the clinical characteristics of the patients and in particular to number and degree of coexisting morbidities. Chi square test was used for analysing the association between variables. Results: We have reviewed the records of 193 patients with colorectal cancer, to a total of 215 events, including 22 relapses in the same patients, in which a new therapeutic decision was involved. Adjuvant treatment was omitted in 40% of patients with stage III colon cancer, and 38% of patients with stage III rectal cancer. Chemotherapy was also omitted in 34% of patients with stage IV colon cancer and 35% of patients with stage IV rectal cancer. Even when patients received treatment, preference was given to drugs and regimens of low toxicity. Therapeutic decisions appeared in most cases based on age rather than number and severity of comorbidities. On the other hand, once the decision to treat was taken, the treatment was given as programmed, although 21% of patients received drug doses lower than 75% of projected dose; reasons for abandoning the treatment were progression and toxicity in stage IV, and more often patient's refusal in stage III. Conclusions: In a disease where standards of treatment are well defined, elder patients often receive inadequate treatment or no therapy at all. Although the justification for inadequate treatment is or should be poor clinical conditions of patients, this is not apparent from review of clinical records. Efforts should be made to have in elder patients standardised evaluation of physical status and comorbidities on a regular basis. No significant financial relationships to disclose.

scholarly journals Immune status is prognostic for poor survival in colorectal cancer patients and is associated with tumour hypoxia

2020 ◽  
Vol 123 (8) ◽  
pp. 1280-1288 ◽  
Author(s):  
Stephanie G. Craig ◽  
Matthew P. Humphries ◽  
Matthew Alderdice ◽  
Victoria Bingham ◽  
Susan D. Richman ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Stage Iv ◽  
Tumour Hypoxia ◽  
Poor Survival ◽  
Cell Counts ◽  
Tumour Bulk ◽  
Stage Iv Disease ◽  
Colorectal Cancer Patients ◽  
Hypoxia Signature

Abstract Background Immunohistochemical quantification of the immune response is prognostic for colorectal cancer (CRC). Here, we evaluate the suitability of alternative immune classifiers on prognosis and assess whether they relate to biological features amenable to targeted therapy. Methods Overall survival by immune (CD3, CD4, CD8, CD20 and FOXP3) and immune-checkpoint (ICOS, IDO-1 and PD-L1) biomarkers in independent CRC cohorts was evaluated. Matched mutational and transcriptomic data were interrogated to identify associated biology. Results Determination of immune-cold tumours by combined low-density cell counts of CD3, CD4 and CD8 immunohistochemistry constituted the best prognosticator across stage II–IV CRC, particularly in patients with stage IV disease (HR 1.98 [95% CI: 1.47–2.67]). These immune-cold CRCs were associated with tumour hypoxia, confirmed using CAIX immunohistochemistry (P = 0.0009), which may mediate disease progression through common biology (KRAS mutations, CRIS-B subtype and SPP1 mRNA overexpression). Conclusions Given the significantly poorer survival of immune-cold CRC patients, these data illustrate that assessment of CD4-expressing cells complements low CD3 and CD8 immunohistochemical quantification in the tumour bulk, potentially facilitating immunophenotyping of patient biopsies to predict prognosis. In addition, we found immune-cold CRCs to associate with a difficult-to-treat, poor prognosis hypoxia signature, indicating that these patients may benefit from hypoxia-targeting clinical trials.

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