Perihilar Cholangiocarcinoma

2019 ◽  
Author(s):  
Michele M. Gage ◽  
Matthew J. Weiss
Keyword(s):  
Adjuvant Therapy ◽  
Hilar Cholangiocarcinoma ◽  
Treatment Options ◽  
Treatment Success ◽  
Survival Rates ◽  
Perihilar Cholangiocarcinoma ◽  
Phase Iii ◽  
Major Surgery ◽  
R0 Resection ◽  
Klatskin Tumor

Hilar cholangiocarcinomas (HCs) are a diverse group of aggressive tumors often diagnosed late in disease due to their typically longitudinal spread along the biliary system. Only approximately one-third of HCs are the candidates for resection, which offers the only chance for cure. However, even following resection, recurrence is common, and 5-year survival rates after surgery remain dismal at 20 to 42%. A thorough preoperative work-up and risk stratification for major surgery are critical to treatment success and maximizing the likelihood of an R0 resection. Due to the relatively few large phase III randomized controlled trials for HC, data are lacking on the optimal adjuvant treatment. Recent results of the BILCAP trial are promising for improved survival after surgery with adjuvant therapy, particularly capecitabine. When resection is not an option, prognosis is poor with median survival of less than 12 months. However, there are multiple chemotherapy-based treatment options that have demonstrated prolonging survival, with combined gemcitabine and cisplatin as first-line therapy. Liver transplantation should be considered on protocol for unresectable HC in the absence of metastatic disease. Palliative options, such as photodynamic therapy or radiation, may also be considered in advanced disease. This review contains 2 figures, 5 tables, and 41 references. Key Words: adjuvant therapy in cholangiocarcinoma, hilar cholangiocarcinoma, Klatskin tumor, metastatic cholangiocarcinoma, perihilar cholangiocarcinoma, portal dissection, surgery for hilar cholangiocarcinoma, outcomes in hilar cholangiocarcinoma

Perihilar Cholangiocarcinoma

2019 ◽  
Author(s):  
Michele M. Gage ◽  
Matthew J. Weiss
Keyword(s):  
Adjuvant Therapy ◽  
Hilar Cholangiocarcinoma ◽  
Treatment Options ◽  
Treatment Success ◽  
Survival Rates ◽  
Perihilar Cholangiocarcinoma ◽  
Phase Iii ◽  
Major Surgery ◽  
R0 Resection ◽  
Klatskin Tumor

Hilar cholangiocarcinomas (HCs) are a diverse group of aggressive tumors often diagnosed late in disease due to their typically longitudinal spread along the biliary system. Only approximately one-third of HCs are the candidates for resection, which offers the only chance for cure. However, even following resection, recurrence is common, and 5-year survival rates after surgery remain dismal at 20 to 42%. A thorough preoperative work-up and risk stratification for major surgery are critical to treatment success and maximizing the likelihood of an R0 resection. Due to the relatively few large phase III randomized controlled trials for HC, data are lacking on the optimal adjuvant treatment. Recent results of the BILCAP trial are promising for improved survival after surgery with adjuvant therapy, particularly capecitabine. When resection is not an option, prognosis is poor with median survival of less than 12 months. However, there are multiple chemotherapy-based treatment options that have demonstrated prolonging survival, with combined gemcitabine and cisplatin as first-line therapy. Liver transplantation should be considered on protocol for unresectable HC in the absence of metastatic disease. Palliative options, such as photodynamic therapy or radiation, may also be considered in advanced disease. This review contains 2 figures, 5 tables, and 41 references. Key Words: adjuvant therapy in cholangiocarcinoma, hilar cholangiocarcinoma, Klatskin tumor, metastatic cholangiocarcinoma, perihilar cholangiocarcinoma, portal dissection, surgery for hilar cholangiocarcinoma, outcomes in hilar cholangiocarcinoma

Effect of the addition of algenpantucel-L immunotherapy to standard adjuvant therapy on survival in patients with resected pancreas cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 236-236 ◽  
Author(s):  
J. M. Hardacre ◽  
M. F. Mulcahy ◽  
W. Small ◽  
M. Talamonti ◽  
J. C. Obel ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Therapy ◽  
Treatment Options ◽  
Survival Rates ◽  
Phase Iii ◽  
Human Pancreatic Cancer ◽  
Open Label ◽  
Term Survival ◽  
Major Barrier ◽  
Pancreatic Cancer Cells

236 Background: Pancreatic cancer portends a poor prognosis with ∼4% long-term survival. Among the estimated 20% of patients who have resectable disease, the 1-/3-/5-year survival rates approximate only 70%/30%/18%, even with adjuvant therapy. Better treatment options are needed and addition of algenpantucel-L (HyperAcute-Pancreas) to standard adjuvant therapy is proposed to improve prospects for survival. Algenpantucel-L is composed of irradiated, live, allogeneic human pancreatic cancer cells expressing the enzyme α-1,3 galactosyl transferase (α-GT), which is the major barrier to xenotransplantation from lower mammals to humans (e.g., hyperacute rejection). Up to 2% of circulating human antibodies are directed against the α-GT epitope of algenpantucel-L and are the proposed mechanism of initiating the anti-tumor immune response. Methods: Open-label, single arm, multi-institutional phase II study (NLG0205) to evaluate algenpantucel-L + standard adjuvant therapy (RTOG-9704, JAMA, 2008: gemcitabine + 5-FU-XRT) for pancreatic cancer patients undergoing R0/R1 resection. Disease-free (DFS) and overall survival (OS) are the primary and secondary endpoints, respectively. Results: 73 patients (70 evaluable, 15 month median follow up) received gemcitabine + 5-FU-XRT + algenpantucel-L (mean 12 doses, range 1-14). Demographics and prognostic factors: median age 62 years, 47% female, 81.4% lymph node positive, median tumor size 3.2 cm (range 2-15 cm; 26% > 4cm) and 24% post-operative CA 19-9 > 90. Kaplan-Meier estimated survival rates at 12 and 24 months are 91% and 54%, respectively, comparing favorably to 63% and 32% expected based on the nomogram described by Brennan et al (Ann Surg, 2004). Likewise, the current median DFS of 16 months compares favorably to the 11 months observed in RTOG 9704. OS data continues to mature, with 74% still censored. Algenpantucel-L was well tolerated with no likely/directly attributable grade 3 SAEs. The most common adverse events were injection site pain and induration. Conclusions: Addition of algenpantucel-L to standard adjuvant therapy for resected pancreatic cancer may improve survival. A phase III study began patient enrollment in May 2010. [Table: see text]

Phase III Multicenter Trial of Doxorubicin Plus Cyclophosphamide Followed by Paclitaxel Compared With Doxorubicin Plus Paclitaxel Followed by Weekly Paclitaxel As Adjuvant Therapy for Women With High-Risk Breast Cancer

2010 ◽  
Vol 28 (18) ◽  
pp. 2958-2965 ◽  
Author(s):  
David Loesch ◽  
F. Anthony Greco ◽  
Neil N. Senzer ◽  
Howard A. Burris ◽  
John D. Hainsworth ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Adjuvant Therapy ◽  
Performance Status ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Phase Iii ◽  
High Risk Breast Cancer ◽  
High Risk Breast ◽  
Risk Breast Cancer

Purpose This study compared disease-free survival (DFS) obtained with two different regimens of adjuvant therapy in high-risk breast cancer. Methods Women (who had performance status [PS] of 0 to 1) with operable, histologically confirmed, stage I to III adenocarcinoma of the breast were eligible. Patients had undergone primary surgery with no residual tumor. Treatments were as follows: arm 1 was doxorubicin 60 mg/m2 plus cyclophosphamide 600 mg/m2 every 3 weeks for four cycles followed by paclitaxel 175 mg/m2 every 3 weeks for four cycles (ie, AC-P); and arm 2 was doxorubicin 50 mg/m2 plus paclitaxel 200 mg/m2 every 3 weeks for four cycles followed by paclitaxel 80 mg/m2 weekly for 12 weeks. Results Overall, 1,830 patients were enrolled and 1,801 were treated: arm 1 (n = 906; AC→P) and arm 2 (n = 895; AP-WP). Overall, patients had a PS of 0 (88%), had estrogen receptor and progesterone receptor–positive disease (52%), had one to three positive nodes (46%), and were postmenopausal (57%); the median age was 52 years. Currently, 1,640 patients (90%) are alive. The 6-year DFS was 79% to 80% in both groups. Disease relapse was the cause of death for 83 patients in arm 1 and in 66 patients of arm 2. Overall 6-year survival rates were 82% and 87% in arms 1 and 2, respectively. Reasons for patients being taken off study treatment included toxicity (13% in arm 1 v 20% in arm 2), progressive disease or recurrence (7% v 5%), and consent withdrawn (9% v 8%), respectively. The most frequent toxicities were hematologic, including neutropenia and leukopenia followed by neuropathy, myalgia, nausea, fatigue, headache, arthralgia, and vomiting. Conclusion The results indicate that the AP-WP regimen is an equally effective and tolerable option for the adjuvant treatment of patients with high-risk breast cancer. The substitution of paclitaxel for cyclophosphamide results in comparable effectiveness of the regimen.

scholarly journals Long-term survival of a patient with locally advanced hilar cholangiocarcinoma (Klatskin tumor): A case report and review on high level evidence

2019 ◽  
Vol 25 (2) ◽  
pp. 25-27
Author(s):  
Jalal Vahedian ◽  
Mohammad Babaei ◽  
Ali Mehrjardi ◽  
Ali Almasi ◽  
Seyyed Ahmadi ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Hilar Cholangiocarcinoma ◽  
Locally Advanced ◽  
Surgical Margin ◽  
R0 Resection ◽  
Klatskin Tumor ◽  
Poor Overall Survival ◽  
Term Survival ◽  
High Level

Cholangiocarcinoma, malignant tumor of epithelial cells of bile ducts has poor overall survival and prognosis. We report a case of non-resectable cholangiocarcinoma with a 57-month survival after incomplete R2 surgical margin resection of the tumor. A 52-year old man with generalized itching, jaundice, brownish urine, mild abdominal pain and weight loss of 8 kg in last two months presented. Imaging and surgical workups showed hilar cholangiocarcinoma (Klatskin tumor). Along with incomplete R2 margin resection we performed stent embedding and post-operative adjuvant chemotherapy. Based on current literature data there is no superiority of adjuvant chemotherapy after complete R0 resection compared to incomplete R2 resection. However, it seems that partial resection along with stent embedding and applied adjuvant chemotherapy in cases of locally advanced non-resectable cholangiocarcinoma may increase survival rate.

scholarly journals Modern combined targeted and immunotherapy of metastatic skin melanoma

2020 ◽  
pp. 54-61
Author(s):  
S. A. Protsenko ◽  
E. N. Imyanitov ◽  
A. I. Semenova ◽  
D. Kh. Latipova ◽  
A. V. Novik ◽  
...  
Keyword(s):  
Treatment Options ◽  
Survival Rates ◽  
New Drugs ◽  
Phase Iii ◽  
Immune Checkpoints ◽  
Malignant Neoplasms ◽  
Skin Melanoma ◽  
Clinical Prognosis ◽  
New Treatment

Melanoma of the skin is one of the most aggressive malignant neoplasms. Metastatic skin melanoma has an extremely poor clinical prognosis with a high mortality rate, accounting for 80% of all deaths from skin malignancies. The approaches to the treatment of metastatic skin melanoma have been dynamically developing over the past decade. New drugs and their combinations are becoming more affordable. In connection with the advances in molecular genetics and the development of new targeted drugs, treatment outcomes have significantly improved: first of all, overall survival and the time to progression of the disease, which has set new challenges for continuing research in this area. The development of new treatment options for patients with inoperable and/or metastatic melanoma with a mutation in the BRAFV600 gene is still in high demand. Emerging data from clinical and preclinical studies suggest that synergies can be observed between inhibitors of immune checkpoints and inhibitors of BRAF and MEK. Despite the fact that inhibitors of the BRAF signaling pathway have a high frequency of objective responses, in most cases their duration is short. Inhibitors of immune checkpoints provide a longer lasting effect, but the response rate is relatively low. Combining the two types of therapy can improve survival rates over the long term. This review demonstrates the results of phase III randomized trials that have allowed to determine the current standards in the treatment of metastatic skin melanoma. We also demonstrated our own experience of using a triple combination of targeted therapy with BRAF/MEK inhibitors in combination with PD-1 inhibitors.

Adjuvant Therapy in Operable Pancreatic Cancer

Swiss Surgery ◽  
2002 ◽  
Vol 8 (2) ◽  
pp. 74-80
Author(s):  
Wente ◽  
Büchler ◽  
Friess ◽  
Büchler
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Therapy ◽  
Controlled Trial ◽  
Treatment Options ◽  
Survival Rates ◽  
Surgical Techniques ◽  
Additional Treatment ◽  
Adjuvant Chemoradiotherapy ◽  
European Organization ◽  
Adenocarcinoma Of The Pancreas

Adenocarcinoma of the pancreas remains a highly lethal disease with one of the worst mean survival rates of all solid malignancies. Even with improvements in surgical techniques in the last decades, the five-year survival rate of patients following resection is still under 20 percent. Various additional treatment concepts have been introduced based on encouraging results for adjuvant chemoradiotherapy obtained in a small randomized-controlled trial more than 15 years ago. The purpose of this article is to review the results of several trials investigating adjuvant therapy for pancreatic cancer. We will discuss recent studies of EORTC (European Organization for Research and Treatment of Cancer), ESPAC (European Study Group for Pancreatic Cancer) and others and will also focus on future alternative treatment options for pancreatic cancer.

scholarly journals Adrenocortical Carcinoma: Clinical Update

2006 ◽  
Vol 91 (6) ◽  
pp. 2027-2037 ◽  
Author(s):  
Bruno Allolio ◽  
Martin Fassnacht
Keyword(s):  
Adrenocortical Carcinoma ◽  
Kinase Inhibitors ◽  
Evidence Synthesis ◽  
Treatment Options ◽  
Hormone Secretion ◽  
Disease Free Survival ◽  
Phase Iii ◽  
R0 Resection ◽  
Adrenocortical Cancer ◽  
Prognostic Information

Abstract Context: Adrenocortical carcinoma (ACC) is a rare and heterogeneous malignancy with incompletely understood pathogenesis and poor prognosis. Patients present with hormone excess (e.g. virilization, Cushing’s syndrome) or a local mass effect (median tumor size at diagnosis > 10 cm). This paper reviews current diagnostic and therapeutic strategies in ACC. Evidence Acquisition: Original articles and reviews were identified using a PubMed search strategy (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) covering the time period up until November 2005. The following search terms were used in varying combinations: adrenal, adrenocortical, cancer, carcinoma, tumor, diagnosis, imaging, treatment, radiotherapy, mitotane, cytotoxic, surgery. Evidence synthesis: Tumors typically appear inhomogeneous in both computerized tomography and magnetic resonance imaging with necroses and irregular borders and differ from benign adenomas by their low fat content. Hormonal analysis reveals evidence of steroid hormone secretion by the tumor in the majority of cases, even in seemingly hormonally inactive lesions. Histopathology is crucial for the diagnosis of malignancy and may also provide important prognostic information. In stages I–III open surgery by an expert surgeon aiming at an R0 resection is the treatment of choice. Local recurrence is frequent, particularly after violation of the tumor capsule. Surgery also plays a role in local tumor recurrence and metastatic disease. In patients not amenable to surgery, mitotane (alone or in combination with cytotoxic drugs) remains the treatment of choice. Monitoring of drug levels (therapeutic range 14–20 mg/liter) is mandatory for optimum results. In advanced disease, the most promising therapeutic options (etoposide, doxorubicin, cisplatin plus mitotane, and streptozotocin plus mitotane) are currently being compared in an international phase III trial (www.firm-act.org). Adjuvant treatment options after complete tumor removal (e.g. mitotane, radiotherapy) are urgently needed because postoperative disease-free survival at 5 yr is only around 30%, but options have still not been convincingly established. National registries, international cooperations, and trials provide important new structures for patients but also for researchers aiming at systematic and continuous progress in ACC. However, future advances in the management of ACC will mainly depend on a better understanding of the molecular pathogenesis facilitating the use of modern cancer treatments (e.g. tyrosine kinase inhibitors).

Concurrent chemoradiotherapy for unresectable hilar choloangiocarcinoma: A single-institution experience.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 326-326
Author(s):  
P. Hunag ◽  
Y. Chao ◽  
C. Li ◽  
R. Lee ◽  
L. Wang ◽  
...  
Keyword(s):  
Hilar Cholangiocarcinoma ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Distant Metastases ◽  
Rank Test ◽  
Combined Modality Treatment ◽  
Klatskin Tumor ◽  
Single Institution ◽  
Kaplan Meier ◽  
Rare Malignancy

326 Background: Hilar cholangiocarinoma (Klatskin tumor) is a rare malignancy which is best managed with surgical resection. The majority of patients, however, is unresectable at the time of diagnosis and generally has a poor outcome. The purpose of this study was to retrospectively evaluate the role of chemoradiotherapy (CCRT) for patients with unresectable hilar choloangiocarcinoma at a single institution. Methods: Between 2001 and 2008, a total of 33 patients with unresectable, nonmetastatic hilar cholangiocarcinoma treated at Taipei Veterans General Hospital were reviewed. All patients were to receive 3D-CRT with a median dose of 50.4 Gy (range, 39.6- 60) at 1.8-2 Gy per fraction per day. Sixteen patients also received bolus 5-fluorouracil (5-FU) CCRT (500 mg/m2/d for 3 days repeated every 2 weeks during radiotherapy for 6 weeks). Survivals were estimated by the Kaplan-Meier method and compared by log-rank test. Results: There were 21 males and 12 females, with a median age of 71 years (range, 29 - 81). The median follow-up time was 10.4 months (range, 1 – 42.3) for all patients with the 1- and 2-year survival rates of 45% and 12%, respectively. The median overall survival (OS) and progression-free survival (PFS) were 13.5 months and 10.2 months for the CCRT group, and 10.4 months and 6.5 months for the RT alone group (p = 0.36 and p = 0.28, respectively). Adverse events were similar in thetwo groups with 14 patients (42%) developed grade 1-2 gastrointestinal toxicity during RT. Locoregional progression was observed in 26 patients (79%) and distant metastases in 9 patients (27%). All patients experienced disease progression and had died at time of analysis. Conclusions: The outcome remains poor for unresectable hilar cholangiocarcinoma despite aggressive combined modality treatment. Although not statistically significant, our data showed CCRT provides longer OS and PFS in patients with unresectable hilar cholangiocarcinoma compared to RT alone. Locoregional progression is the main problem for this disease and the efficacy of adding chemotherapy or biologic agents needs to be further investigated. No significant financial relationships to disclose.

Abametapir for the Treatment of Head Lice: A Drug Review

2021 ◽  
pp. 106002802110279
Author(s):  
Alexander D. Woods ◽  
Caroline L. Porter ◽  
Steven R. Feldman
Keyword(s):  
Data Extraction ◽  
Treatment Options ◽  
Treatment Success ◽  
Clinical Importance ◽  
Treated Group ◽  
Phase Iii ◽  
Adult Survival ◽  
Head Lice ◽  
Heavy Metal Cations ◽  
Phase Iii Clinical Trials

Objective This article reviews the pharmacology, safety, efficacy, and clinical importance of abametapir 0.74% (Xeglyze) for the treatment of head lice. Data Sources From 2020 to May 2021, a systematic review of the MEDLINE and EMBASE databases was conducted using the terms abametapir, Xeglyze, Ha44, and head lice. Bibliographies, Food and Drug Administration (FDA) drug package inserts, and ClinicalTrials.gov were searched for further information. Study Selection and Data Extraction All relevant full-text articles in English were considered for inclusion, with a final article date range of 1999 to 2020. Data Synthesis Abametapir chelates heavy metal cations and inhibits metalloproteinases critical to louse ova development, hatching, and adult survival. In phase II, abametapir had direct ovicidal activity inhibiting 100% of treated louse eggs from hatching, compared with 64% in the vehicle-treated group. In two identical phase III clinical trials, subjects treated with a single 10-minute application of abametapir had greater treatment success compared with vehicle-treated subjects, with 81.1% success versus 50.9% in study 1 ( P = 0.001) and 81.8% versus 47.2% in study 2 ( P < 0.001). Abametapir was well tolerated, with only mild adverse effects. Relevance to Patient Care and Clinical Practice Abametapir is a newly FDA-approved, single-application treatment for head lice in patients aged 6 months and older. This review highlights the safety and efficacy of abametapir in the treatment of head lice. Conclusions In the wake of increasing widespread resistance to first-line treatment options, abametapir offers a safe and effective new treatment option for head lice infestations.

scholarly journals Short- and Long-Term Outcomes of Simultaneous Hepatic Artery Resection and Reconstruction for Perihilar Cholangiocarcinoma

2020 ◽  
pp. 1-9
Author(s):  
Yoshitaro Shindo ◽  
Shogo Kobayashi ◽  
Hiroshi Wada ◽  
Yukio Tokumitsu ◽  
Satoshi Matsukuma ◽  
...  
Keyword(s):  
Hepatic Artery ◽  
Locally Advanced ◽  
Survival Rates ◽  
Postoperative Mortality ◽  
University Hospital ◽  
Perihilar Cholangiocarcinoma ◽  
R0 Resection ◽  
Term Survival ◽  
Hospital Deaths

<b><i>Introduction:</i></b> Because surgical resection with simultaneous hepatic artery (HA) resection and reconstruction for perihilar cholangiocarcinoma (PHC) is technically demanding, the surgical indication for this challenging procedure is controversial. Thus, this study aimed to evaluate the efficacy of simultaneous HA resection and reconstruction for PHC. <b><i>Methods:</i></b> Between January 2002 and January 2018, 13 patients with PHC underwent surgical intervention with simultaneous resection and reconstruction of the HA at Yamaguchi University Hospital (Ube, Japan) and Osaka University Hospital (Suita, Japan). <b><i>Results:</i></b> There were 2 cases (15.4%) of 90-day postoperative mortality. Nine patients (69.2%) developed major postoperative complications (Clavien-Dindo classification ≥IIIa). Curative resections (R0) were achieved in 8 cases (61.5%). The median survival time (MST) and 1- and 3-year survival rates after resection (including in-hospital deaths) were 20.9 months and 61.5 and 10.3%, respectively. The MST and 1- and 2-year survival rates of 8 patients who underwent R0 resection were significantly better than those of the other 5 patients (24.2 vs. 10.2 months, 75.0 vs. 40.0%, and 50.0 vs. 0.0%, respectively, <i>p</i> = 0.0228). <b><i>Conclusions:</i></b> Simultaneous HA resection and reconstruction is technically possible and may provide long-term survival in selected patients with locally advanced PHC.

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