S3447 Gastric Cancer: Epidemiology and Diagnosis in the Asian Population at a Tertiary Medical Center

Introduction: Immunomodulators remain fundamental for the medical treatment of Crohn’s disease (CD). Methotrexate (MTX) is widely used as a second-line immunomodulator; however, there is a lack of recent data on MTX monotherapy among the Asian population with CD. Therefore, in this study, we aimed to investigate the tolerability and clinical outcomes of MTX in Korean patients with CD. Methods: A retrospective chart review was performed for CD patients treated with MTX monotherapy or in combination with 5-aminosalicylic acid (5-ASA), at the Asan Medical Center, Seoul, South Korea. The tolerability of MTX monotherapy within 6 months was assessed and the clinical effectiveness of MTX was evaluated based on the Crohn’s disease activity index (CDAI). Results: In total, 85 patients were included, of which 29 (34.1%) discontinued MTX due to intolerability during the follow-up. Adverse events (AEs) were reported in 41 (48.2%) patients. The most common AE was gastrointestinal disorders (17/41) and only one patient experienced a serious AE, a systemic infection that required hospitalization. Among the 56 patients who tolerated MTX within 6 months, 44 (65.9%) showed a clinical response. Moreover, no factor was significantly associated with intolerability. The administration method was the only factor significantly associated with a response to MTX ( p = 0.041). The adjusted odds ratio of parenteral injection compared to oral administration was 5.68 (95% confidence interval (CI), 1.07–30.08). Conclusion: In this study, one-third of patients were intolerant to MTX; nonetheless, the response rate was as high as 65.9% among tolerant patients. In addition, no significant factors affected intolerability. In terms of the clinical response, parenteral injection could be better than oral administration.

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Gastric Cancer Epidemiology in Korea

Journal of Gastric Cancer ◽

10.5230/jgc.2011.11.3.135 ◽

2011 ◽

Vol 11 (3) ◽

pp. 135 ◽

Cited By ~ 111

Author(s):

Aesun Shin ◽

Jeongseon Kim ◽

Sohee Park

Keyword(s):

Gastric Cancer ◽

Cancer Epidemiology

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Concordance Rate between Clinicians and Watson for Oncology among Patients with Advanced Gastric Cancer: Early, Real-World Experience in Korea

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2019/8072928 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 11

Author(s):

Youn I Choi ◽

Jun-won Chung ◽

Kyoung Oh Kim ◽

Kwang An Kwon ◽

Yoon Jae Kim ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Treatment Option ◽

Clinical Decision Making ◽

Medical Information ◽

Medical Center ◽

Treatment Options ◽

Concordance Rate ◽

Cancer Center ◽

Recommended Level

Backgrounds/Aims. Watson for Oncology (WFO) is a cognitive technology that processes medical information by analyzing the latest evidence and guidelines. However, studies of the concordance rate between WFO and clinicians for advanced gastric cancer (AGC) are lacking.Methods. We retrospectively reviewed 65 patients with AGC who consulted WFO and the Gachon Gil Medical Center multidisciplinary team (GMDT) in 2016 and 2017. The recommendations of WFO were compared with the opinions of the GMDT. WFO provided three treatment options: recommended (first treatment option), for consideration (second treatment option), and not recommended.Results. In total, 65 patients (mean age 61.0 years; 44 males and 21 females) were included in the study. The concordance rate between WFO and the GMDT was 41.5% (27/65) at the recommended level and 87.7% (57/65) at the for consideration level. The main causes of discordance between WFO and the GMDT were as follows. First, WFO did not consider the medical history. Second, WFO recommended the use of agents that are considered outdated in Korea. Third, some patients wanted to be involved in a clinical trial. Fourth, some patients refused to use the biologic agents recommended by WFO for financial reasons as they were not covered by medical insurance.Conclusions. The concordance rate at the recommended level was relatively low but was higher at the for consideration level. Discordances arose mainly from the different medical circumstances at the Gachon Gil Medical Center (GMC) and the Memorial Sloan Kettering Cancer Center (MSKCC), the main WFO consulting center. The utility of WFO as a tool for supporting clinical decision making could be further improved by incorporating regional guidelines.

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Gastric cancer: epidemiology, prevention, and therapy

Helicobacter ◽

10.1111/hel.12518 ◽

2018 ◽

Vol 23 ◽

pp. e12518 ◽

Cited By ~ 52

Author(s):

Marino Venerito ◽

Riccardo Vasapolli ◽

Theodoros Rokkas ◽

Peter Malfertheiner

Keyword(s):

Gastric Cancer ◽

Cancer Epidemiology ◽

Prevention And Therapy

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Late-line treatment in metastatic gastric cancer: today and tomorrow

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835919867522 ◽

2019 ◽

Vol 11 ◽

pp. 175883591986752 ◽

Cited By ~ 11

Author(s):

Elizabeth C. Smyth ◽

Markus Moehler

Keyword(s):

Gastric Cancer ◽

Asian Population ◽

Phase Iii ◽

Response To Treatment ◽

Evidence Based ◽

Line Treatment ◽

Second Line ◽

Specific Patient ◽

Line Therapy ◽

Third Line

Survival for patients with unresectable advanced or recurrent gastric cancer (GC) remains poor and the historical lack of evidence-based therapeutic options after second-line therapy is reflected in current clinical guidelines for this condition. Despite uncertainty about optimal therapeutic strategies, further treatment is appropriate for some patients after failure of second line and may prolong survival. This approach has been reported in clinical trials and is becoming more common in real-world clinical settings. Several prognostic factors may increase the likelihood that a patient will be eligible for treatment in the third-line setting, including geographic location, status at diagnosis and response to treatment. There has been little progress over the last decade until the results from two large phase III randomized controlled trials completed in the last year: the ATTRACTION-2 trial with the programmed cell death-1 (PD-1) inhibitor, nivolumab, in an Asian population; and the TAGS trial with the oral chemotherapy trifluridine/tipiracil in a global population. Both ATTRACTION-2 and TAGS reported positive results in third-line treatment in advanced GC in specific patient groups. A further recently reported study, KEYNOTE-059, which was a single-arm phase II trial of the PD-1 inhibitor pembrolizumab in a mainly non-Asian population, has provided evidence supporting the use of this immunotherapy in patients with advanced GC. As further third-line options become available, more GC patients are expected to benefit from an individualized evidence-based approach to later-line therapy, with a common goal of extending survival and improving outcomes for their refractory disease.

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Unexpected CDH1 Mutations Identified on Multigene Panels Pose Clinical Management Challenges

JCO Precision Oncology ◽

10.1200/po.16.00021 ◽

2017 ◽

pp. 1-12 ◽

Cited By ~ 7

Author(s):

Katrina Lowstuter ◽

Carin R. Espenschied ◽

Duveen Sturgeon ◽

Charité Ricker ◽

Rachid Karam ◽

...

Keyword(s):

Gastric Cancer ◽

Medical Management ◽

Cancer Genetics ◽

Medical Center ◽

Academic Medical Center ◽

Lifetime Risk ◽

Diffuse Gastric Cancer ◽

Mutation Carriers ◽

Cdh1 Mutation ◽

Testing Criteria

Purpose Mutations in the CDH1 gene confer up to an 80% lifetime risk of diffuse gastric cancer and up to a 60% lifetime risk of lobular breast cancer. Testing for CDH1 mutations is recommended for individuals who meet the International Gastric Cancer Linkage Consortium (IGCLC) guidelines. However, the interpretation of unexpected CDH1 mutations identified in patients who do not meet IGCLC criteria or do not have phenotypes suggestive of hereditary diffuse gastric cancer is clinically challenging. This study aims to describe phenotypes of CDH1 mutation carriers identified through multigene panel testing (MGPT) and to offer informed recommendations for medical management. Patients and Methods This cross-sectional prevalence study included all patients who underwent MGPT between March 2012 and September 2014 from a commercial laboratory (n = 26,936) and an academic medical center cancer genetics clinic (n = 318) to estimate CDH1 mutation prevalence and associated clinical phenotypes. CDH1 mutation carriers were classified as IGCLC positive (met criteria), IGCLC partial phenotype, and IGCLC negative. Results In the laboratory cohort, 16 (0.06%) of 26,936 patients were identified as having a pathogenic CDH1 mutation. In the clinic cohort, four (1.26%) of 318 had a pathogenic CDH1 mutation. Overall, 65% of mutation carriers did not meet the revised testing criteria published in 2015. All three CDH1 mutation carriers who had risk-reducing gastrectomy had pathologic evidence of diffuse gastric cancer despite not having met IGCLC criteria. Conclusion The majority of CDH1 mutations identified on MGPT are unexpected and found in individuals who do not fit the accepted diagnostic testing criteria. These test results alter the medical management of CDH1-positive patients and families and provide opportunities for early detection and risk reduction.

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