scholarly journals Recent developments in palliative chemotherapy for locally advanced and metastatic pancreas cancer

2010 ◽  
Vol 16 (6) ◽  
pp. 673 ◽  
Author(s):  
Soley Bayraktar
Keyword(s):  
Pancreas Cancer ◽  
Palliative Chemotherapy ◽  
Locally Advanced ◽  
Recent Developments

IJV thrombophlebitis: be wary of the occult

2021 ◽  
Vol 14 (3) ◽  
pp. e238813
Author(s):  
Pamela Oshinyemi ◽  
Charlotte Lee ◽  
Antony Gough-Palmer ◽  
Iain McKay-Davies
Keyword(s):  
Colorectal Adenocarcinoma ◽  
Palliative Chemotherapy ◽  
Jugular Vein ◽  
Thrombus Formation ◽  
Locally Advanced ◽  
Patients With Cancer ◽  
Occult Malignancy ◽  
Night Sweats ◽  
History Of ◽  
Nose And Throat

A 43-year-old woman was referred to the Ear, Nose and Throat Department with a 3-day history of left-sided neck pain and swelling associated with fevers and night sweats. She also reported a cough, oral thrush and a dental extraction more than a month previously. A CT scan of the neck with contrast revealed left internal jugular vein (IJV) thrombophlebitis and the patient was initially managed for suspected Lemierre’s syndrome. Subsequent investigations revealed a locally advanced metastatic colorectal adenocarcinoma as the cause of her thrombosis, which was deemed inoperable. The patient was referred to oncology and commenced on palliative chemotherapy.The incidence of thrombophlebitis in patients with cancer is high. Although the IJV is a relatively uncommon site of thrombus formation, IJV thrombophlebitis is associated with significant morbidity and mortality. As it may be the first manifestation of an occult malignancy, a neoplastic cause should always be considered.

scholarly journals Intensity modulated radiation therapy reduces gastrointestinal toxicity in locally advanced pancreas cancer

2016 ◽  
Vol 6 (2) ◽  
pp. 78-85 ◽  
Author(s):  
Shreya Prasad ◽  
Lajhem Cambridge ◽  
Florence Huguet ◽  
Joanne F. Chou ◽  
Zhigang Zhang ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Pancreas Cancer ◽  
Locally Advanced ◽  
Intensity Modulated Radiation Therapy ◽  
Gastrointestinal Toxicity ◽  
Intensity Modulated

The Current Status of Combined Radiotherapy and Chemotherapy for Locally Advanced or Resected Pancreas Cancer

2005 ◽  
Vol 3 (5) ◽  
pp. 637-642 ◽  
Author(s):  
Mary F. Mulcahy ◽  
Andrew O. Wahl ◽  
William Small
Keyword(s):  
Quality Of Life ◽  
Clinical Trials ◽  
Surgical Resection ◽  
Primary Tumor ◽  
Pancreas Cancer ◽  
Locally Advanced ◽  
Clinical Situation ◽  
Current Status ◽  
Therapy Goals

Pancreas cancer is the fourth most common cause of cancer deaths. Even for the small percentage of patients who can undergo surgical resection of the primary tumor, the risk of recurrence remains unacceptably high. For patients with localized disease that is not amenable to surgical resection, pain related to the primary tumor can significantly impair quality of life. Attempts to improve the duration and quality of life for these patients have included both chemotherapy and radiotherapy. The addition of chemotherapy to radiation may enhance the local effects of radiation or provide treatment of disease outside the radiation field. The results of clinical trials evaluating the appropriate therapy for locally advanced or resected disease have been inconsistent. In some instances, the methods used in these studies became outdated before the results were available. Hopefully, advances in radiation techniques and systemic drug therapy will provide more durable and clinically relevant results. Meanwhile, treatment decisions should be tailored to the clinical situation, including consideration of treatment toxicity and therapy goals. Recognizing which patients are likely to benefit from combination therapy or systemic therapy alone is a subject of future and ongoing clinical trials.

Recent Developments in Androgen Deprivation Therapy for Locally Advanced Prostate Cancer

2014 ◽  
Vol 10 (02) ◽  
pp. 133
Author(s):  
David A Bader ◽  
Jasmina Z Cerne ◽  
Sean E McGuire ◽  
◽  
◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Trials ◽  
Androgen Deprivation Therapy ◽  
Advanced Prostate Cancer ◽  
Second Generation ◽  
Locally Advanced ◽  
Androgen Deprivation ◽  
External Beam Radiation ◽  
Locally Advanced Prostate Cancer ◽  
Recent Developments

Locally advanced prostate cancer (LAPC) is often managed with a combination of external beam radiation therapy (EBRT) and androgen deprivation therapy (ADT). Clinical protocols combining ADT and EBRT for the treatment of LAPC were developed based on clinical trials that used conventional-dose EBRT (~70 Gy) and luteinizing hormone-releasing hormone (LHRH) analog monotherapy. However, dose-escalated EBRT (>74 Gy) is in widespread clinical use and potent second-generation agents targeting the androgen axis have recently received US Food and Drug Administration (FDA) approval. These and other recent developments challenge the current standard of care for LAPC. Determining the optimal duration and potency of ADT in combination with dose-escalated EBRT in LAPC is an active area of clinical research seeking to balance the side-effect profile of ADT with its well-established therapeutic benefits. Prospective randomized clinical trials incorporating dose-escalated EBRT and second-generation androgen axis inhibitors are necessary to clarify the role of ADT in this new arena. Further, since biochemical response to neoadjuvant ADT predicts for efficacy of EBRT, new trials should seek to achieve maximal androgen suppression prior to EBRT to increase clinical benefit. Last, recent clinical and preclinical research efforts hold significant promise and seek to provide better predictive markers and expand the therapeutic target spectrum in prostate cancer.

Is survival in advanced pancreas cancer (APC) correlated to treatment-related lymphopenia (TRL)?

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 313-313
Author(s):  
Anuradha Jayaram ◽  
MinYuen Teo ◽  
Mohd Syahizul Nuhairy Mohd Sharial ◽  
Felicity McDonnell ◽  
Justin Geoghegan ◽  
...  
Keyword(s):  
Median Overall Survival ◽  
Pancreas Cancer ◽  
Multivariate Analyses ◽  
Locally Advanced ◽  
Descriptive Statistics ◽  
Adjuvant Chemoradiotherapy ◽  
Inclusion Criteria ◽  
Survival Analyses ◽  
Major Reduction ◽  
Existing Data

313 Background: Relationship between TRL and survival has been described in patients (pts) who receive adjuvant chemoradiotherapy. Evidence on TLR in APC treated with chemotherapy (ctx) is limited. We investigate the effect of ctx on TRL and its association with survival. Methods: Pts with APC were identified from two institutional databases. Inclusion criteria were: locally advanced (LA) or metastatic disease (MPC) and receipt of ctx. Baseline clinicopathologic and biochemical details including lymphocyte count at baseline and between day 21 and 28 were collected. Degree of TRL was collected prior to initiation of ctx and graded according to CTCAE v4. Descriptive statistics and survival analyses were performed. Results: Between 2001 and 2012, 97 pts were included. Median age was 64 years (range: 42 – 79), 58% were males. MPC seen in 57% of pts and 46% received doublet ctx. Ca19-9 ≥10,000 was detected in 77% pts. Uni- and multivariate analyses for six variables are described in the table. Major reduction, as defined by a 33% change in TLC, was described as a major reduction, present in 14 pts (15%). A major reduction of TLC was associated with a median overall survival (OS) of 2.5 mths (95%CI=1.2-5.3) versus 7.1 mths in those with no TLC change (95%CI=5.6-9.3) (p=0.0149). When assessed by CTCAE, difference in OS was also noted for G0 (n=47), G1 (n=39), G>=2(n=10) lymphopenia: 95 pts had grade 0-2 TLC 4 weeks post chemotherapy. OS was 9.7, 5.3 and 1.9 mths for grade 0, 1, and 2 lymphopenia. (p=<0.0001) respectively. Conclusions: TRL is an independent prognostic factor for APC. In comparison to existing data where chemo-radiation increases the grade and rates of TRL, APC pts treated with ctx had lower rates of TRL. This raises the question whether TRL is determined by the underlying biology of APC versus radiotherapy related effect. [Table: see text]

Prospective evaluation of metabolic intratumoral heterogeneity using 18F-FDG-PET-CT in patients with advanced gastric cancer receiving palliative chemotherapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 4059-4059
Author(s):  
Shin Hye Yoo ◽  
Seo Young Kang ◽  
Gi Jeong Cheon ◽  
Do-Youn Oh ◽  
Yung-Jue Bang
Keyword(s):  
Gastric Cancer ◽  
Treatment Response ◽  
Fdg Pet ◽  
Palliative Chemotherapy ◽  
Cox Regression ◽  
Objective Response ◽  
Locally Advanced ◽  
Intratumoral Heterogeneity ◽  
Pet Ct ◽  
Fdg Pet Ct

4059 Background: Metabolic intratumoral heterogeneity (ITH) gives important information on treatment response and prognosis. However, temporal changes in metabolic ITH and their associations with treatment outcome have not been reported yet in gastric cancer (GC). We aimed to evaluate the early changes in metabolic ITH and their predictive roles in advanced GC patients receiving palliative chemotherapy. Methods: Unresectable locally advanced or metastatic GC patients were prospectively enrolled before the first-line palliative chemotherapy and underwent 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET-CT) at baseline (T1) and at the first response evaluation follow-up (T2). SUVs (Standardized uptake values), volumetric parameters, and textural features including entropyHisto and contrastGLCM were extracted from the primary gastric tumor at T1, T2, and ΔT (T2-T1) was evaluated. Associations of these parameters with treatment response, progression-free survival (PFS), and overall survival (OS) were analyzed. Results: 87 patients were analyzed. Of 86 evaluable patients, 44 obtained partial response, 33 stable disease, and 8 progressed. The objective response rate was 51.8% (95% confidence interval [CI], 40.7% to 62.7%). The median PFS and OS were 7.3 months (95% CI, 5.4 to 8.2 months) and 11.5 months (95% CI, 10.1 to 14.3 months), respectively. From T1 to T2, metabolic ITH was significantly reduced ( P < 0.01), and the degree of decrease was greater in responders than in non-responders ( P < 0.01). By multiple Cox regression analyses adjusted for clinical variables, low entropyHisto at T2 ( P= 0.001), larger decreases in coefficient of variance ( P= 0.003) and contrastGLCM ( P= 0.017) were associated with better PFS. Low SUVpeak at T2 ( P= 0.001), larger decreases in coefficient of variance ( P= 0.032) and being a responder were associated with better OS. Conclusions: Early reduction in metabolic ITH is useful to predict response to palliative chemotherapy, PFS and OS in advanced GC patients.

Combined chemoradiotherapy and PARP inhibition in pancreatic cancer to induce a synchronous inflammatory cytokine response.

2018 ◽  
Vol 36 (5_suppl) ◽  
pp. 29-29
Author(s):  
Eric Anderson ◽  
Zhenqiu Liu ◽  
Paul Noe ◽  
Yuzu Kubota ◽  
Wensha Yang ◽  
...  
Keyword(s):  
Growth Factor ◽  
Inflammatory Cytokines ◽  
Inflammatory Cytokine ◽  
Pancreas Cancer ◽  
Parp Inhibitor ◽  
Locally Advanced ◽  
Parp Inhibition ◽  
Cytokine Signaling ◽  
Combined Chemoradiotherapy ◽  
The Impact

29 Background: Outcomes remain poor for patients with locally advanced pancreas cancer despite advances in combined modality therapy. Radiation and chemotherapy remain the mainstay of treatment for unresectable locally advanced pancreas cancer, and the addition of various agents is currently being assessed in clinical trials. There is increasing evidence that local inflammation and host immune response play a role in anti-tumor activity. We aimed to assess the impact of combined chemoradiotherapy and PARP inhibition on inflammatory cytokine production in pancreas cancer patients. Methods: A clinical trial of concurrent use of a PARP inhibitor with chemoradiation was performed on a cohort of 34 patients. Serum samples were collected at baseline and weekly during intensity modulated radiotherapy treatment. Concentrations of various inflammatory cytokines were measured in picograms per milliliter using a chemiluminescent assay. Comparisons between average percentage change from baseline to peak change of serum cytokine concentration across all patients was performed using a paired T test. Results: Multiple inflammatory cytokines experienced a statistically significant increase after patient treatment. Peak serum increase occurred within 3-5 weeks after treatment initiation for the majority of cytokines tested. The most significantly increased pro-angiogenic cytokines included placental growth factor (p = 2.21x10-6) and vascular endothelial growth factor (p = 1.19x10-4), which peaked at weeks 4 and 5, respectively. Multiple members of the interleukin family also increased significantly. Both IL-7 (p = 1.89x10-4) and IL-17a (p = 7.26x10-4) peaked at weeks 4. IL-5 (p = 8.84x10-5) and IL-15 (p = 1.26x10-15) peaked at weeks 3 and 4, respectively. Conclusions: Patients receiving combined PARP inhibitor and chemoradiation experience a stereotyped increase in inflammatory cytokine signaling that peaks at approximately 1 month after initiation of treatment. Changes in serum inflammatory cytokines may serve as biomarkers of response to treatment and could underpin future combined treatment modalities including immunomodulating agents.

Surveillance and outcomes after curative resection for gastroesophageal adenocarcinoma (GEAC).

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 162-162
Author(s):  
Di Maria Jiang ◽  
Chihiro Suzuki ◽  
Osvaldo Espin-Garcia ◽  
Melania Pintilie ◽  
Charles Henry Lim ◽  
...  
Keyword(s):  
Salvage Therapy ◽  
Curative Resection ◽  
Palliative Chemotherapy ◽  
Cox Regression ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Cancer Center ◽  
Perioperative Chemotherapy ◽  
Curative Therapy

162 Background: Although commonly performed, the benefit of routine surveillance testing (SvT) following curative resection of GEAC is undefined. We aimed to determine frequency of successful salvage therapy (SST) in patients (pts) with relapsed GEAC who were surveyed post curative therapy. Methods: Between 2011 and 2016, 210 consecutive pts with locally advanced GEAC underwent curative surgery and subsequent surveillance at Princess Margaret Cancer Center. SST was defined as any potentially curative therapy for recurrence which resulted in post-recurrence survival (PRS) two years without further relapse. Time-to-event outcomes were analyzed using Kaplan-Meier and Cox regression methods. Results: Median age was 64.1 years. Esophageal (14%), gastroesophageal junction (41%), and gastric adenocarcinomas (45%) were included. Pts received surgery alone (29%), surgery with perioperative chemotherapy (26%) or perioperative chemoradiation (45%) as primary curative therapy. At median follow-up of 33.6 months (m, range 6.0-122.4), 3- and 5-year overall survival (OS) rates were 68% (95% CI 61-75%) and 59% (95% CI 51-68%) respectively. SvT modalities included imaging (69%), endoscopy (19%), tumor markers (4%), and clinical visits only (9%). Recurrences occurred in 95 (45%) pts, 51% were surveillance-detected (SvDR), and 47% were non-SvDR. Types of recurrences included locoregional only (4%), distant (87%) or both (9%). Salvage therapy was attempted in 14 pts (7%) with SvDR and 1 with non-SvDR. In four pts with SvDR (1.9%) salvage therapy was successful with chemoradiation or surgery perioperative chemotherapy, six were unsuccessful, and 5 had immature follow-up. Compared with pts with non-SvDR, pts with SvDR had longer median OS (34.8 vs. 24.0m, p=0.03) and PRS (14.4 vs. 4.8m, p < 0.001), and similar time-to-relapse (15.6 vs. 12.0m, p = 0.67). Palliative chemotherapy was administered in 25 pts with SvDR and 18 pts with non-SvDR with similar median duration (3.5m vs. 3.3m, p=0.64). Conclusions: Following curative therapy, 96% of relapses were distant. SvT enabled SST in only 1.9% of pts, and did not extend duration of palliative chemotherapy. These data do not support the use of routine SvT in resected GEAC.

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