scholarly journals Gastrointestinal Cancers: 2021 ASCO Annual Meeting Highlights for the Advanced Practitioner

2021 ◽  
Vol 12 (6) ◽  
Author(s):  
Nina N. Grenon, DNP, AGCNP-BC, AOCN
Keyword(s):  
Colorectal Cancer ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Gastroesophageal Junction ◽  
Standard Of Care ◽  
Gastrointestinal Cancers ◽  
Tract Cancer ◽  
Gastroesophageal Junction Cancer ◽  
Dana Farber Cancer Institute ◽  
Advanced Practitioner

Nina N. Grenon, DNP, AGCNP-BC, AOCN®, of Dana-Farber Cancer Institute, evaluates data on single and dual immunotherapy for advanced esophageal squamous cell carcinoma; maintenance therapy for metastatic colorectal cancer; a HER2-targeted therapy for colorectal cancer; adjuvant therapy for resected esophageal cancer and gastroesophageal junction cancer; and standard of care for patients with advanced biliary tract cancer.

scholarly journals CA 72-4 Compared with Cea and CA 19-9 as a Marker of Some Gastrointestinal Malignancies

1999 ◽  
Vol 14 (3) ◽  
pp. 172-177 ◽  
Author(s):  
J.B. Lopez ◽  
G.P Royan ◽  
M.N. Lakhwani ◽  
M. Mahadaven ◽  
J. Timor
Keyword(s):  
Colorectal Cancer ◽  
Esophageal Cancer ◽  
Colorectal Carcinoma ◽  
Gastrointestinal Cancer ◽  
Gastrointestinal Diseases ◽  
Gastrointestinal Cancers ◽  
Gastrointestinal Malignancies ◽  
Single Marker ◽  
The Individual ◽  
Esophageal Carcinomas

The objective of this study was to compare CA 72-4 with CEA and CA 19-9 in gastrointestinal malignancies. CA 72-4 was assayed by radioimmunoassay and CEA and CA 19-9 with the Abbott IMx analyser. The study included 52 patients with gastrointestinal cancer and 20 controls with benign gastrointestinal diseases. The 52 cases showed marker sensitivities of 39%, 49% and 35% for CA 72-4, CEA and CA 19-9, respectively, and 64% when the markers were combined. Marker expression in serum was highest in colorectal carcinoma followed by gastric and esophageal carcinoma. The sensitivities of the individual markers in colorectal, gastric and esophageal carcinomas, respectively, were: CA 72-4, 56%, 32% and 18%; CEA, 83%, 33% and 18%; CA 19-9, 53%, 25% and 18%. The sensitivity of the three markers in combination was 89%, 50% and 46% in colorectal, gastric and esophageal cancer, respectively. The specificity of CA72-4, CEA and CA 19-9 was 100%, 72% and 86%, respectively. However, CA 72-4 is not a useful a marker for gastrointestinal cancers because of its poor sensitivity. CEA, which had the best overall sensitivity and a reasonable specificity, was the most useful single marker, especially for colorectal cancer. Whereas the single markers were not useful in gastric and esophageal cancer, the combination of the three may be.

Trastuzumab (TRA) in combination with different first-line chemotherapies for treatment of HER2-positive metastatic gastric or gastroesophageal junction cancer (MGC): Findings from the German noninterventional observational study HerMES.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4065-4065 ◽  
Author(s):  
Susanna Hegewisch-Becker ◽  
Enno Moorahrend ◽  
Hendrik Kröning ◽  
Volker Petersen ◽  
Carla Hannig ◽  
...  
Keyword(s):  
Observational Study ◽  
Gastroesophageal Junction ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Observation Time ◽  
Phase Iii ◽  
Her2 Positive ◽  
Gastroesophageal Junction Cancer ◽  
Few Data ◽  
Eortc Qlq

4065 Background: The international phase III study ToGA has recently shown that TRA is effective in prolonging survival in HER2-positive MGC. However, few data are available for TRA as part of routine clinical practice. Methods: This non-interventional observational study was conducted to evaluate the efficacy, safety and feasibility of TRA in previously untreated pts with HER2-positive MGC. Results: Between Apr 2010 and Jan 2012, data from 110 pts were collected. All pts were evaluable for safety. Baseline pt characteristics were as follows: median age 63 yrs (range 29–88); gender (male 70%; female 29%); ECOG PS (0: 25%; 1: 50%; 2: 15%; 3: 5%); distant mets (91%); liver mets (54%), lymph node mets (35%); peritoneal carcinomatosis (23%). The median duration of TRA treatment was 4.4 months (0–17.1). According to the schedule of chemotherapy TRA was administered every 2–3 wks in a median dose of 4–6 mg/kg BW. Only 28% of pts received TRA according to the label in combination with cisplatin and 5-FU or capecitabine. The remainder received: cisplatin, 5-FU and leucovorin (17%); 5-FU, leucovorin, oxaliplatin and docetaxel (8%); 5-FU, leucovorin and oxaliplatin (7%); capecitabine (6%); other combinations (25%); TRA monotherapy (7%). Although most pts didn’t receive cisplatin-based therapy, preliminary median progression-free survival was 6.8 months, thus comparable to the ToGA data. Most common adverse events (AEs, all grades) were diarrhoea (7%), vomiting (5%) and nausea (5%). Most common grade 3/4 AEs were vomiting (3%), nausea (2%) and fatigue (2%). Health-related quality of life as assessed by EORTC QLQ-C30 and QLQ-STO22 remained stable during observation time. An updated analysis of approx. 200 pts will be presented at the meeting. Conclusions: TRA combined with diverse chemotherapies is safe and effective in the routine treatment of MGC. Cisplatin-free less toxic regimens are feasible and equally effective. The results are in line with those from the ToGA trial and suggest that treatment with TRA should be regarded as standard of care for pts with HER2-positive MGC.

P127 TRENDS IN CLINICOPATHOLOGICAL DATA OF ESOPHAGEAL CANCER IN GREECE. A SINGLE CENTER’S EXPERIENCE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Duran Moreno Jose ◽  
Koumarianou Anna ◽  
Liakea Aliki ◽  
Foukas Periklis ◽  
Kefalidi Eirini ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Gastroesophageal Junction ◽  
National Level ◽  
Progression Free Survival ◽  
Greek Population ◽  
Common Location

Abstract Aim The aim of this analysis is to describe the clinicopathological characteristics of patients (pts) with esophageal cancer diagnosed in our unit. Background and methods Esophageal cancer (EC) is the eighth most common malignancy. Updated data indicate that rates of adenocarcinoma are increasing while the incidence of squamous-cell carcinoma is decreasing in industrialized countries. Epidemiologic data from Greek population are scarce. We analyzed the data of pts diagnosed with EC and treated in our unit from 2009 to 2019. Results Thirty-one pts were diagnosed with EC in our unit, 29 males and 2 females (ratio 14.5:1). Mean age of diagnosis was 62.90±11.19 (39-82) years. Eighteen pts were diagnosed with adenocarcinoma, representing the 58.1% of the sample. Seven pts (22.6%) had squamous-cell carcinoma and 6 pts (19.4%) were classified as “other”. Lower esophagus and gastroesophageal junction were the most common location (20 pts). Four pts had tumors located in the upper esophagus and 3 pts in the medium esophagus. Eleven pts had a previous diagnosis of Barret’s esophagus, of which 7 developed adenocarcinoma, 1 squamous-cell carcinoma and 2 neuroendocrine tumors. Four pts (12.9%) presented with metastases at diagnosis. Thirteen pts were treated in peripheral hospitals after diagnosis, so treatment and follow-up data are available for 18 pts. Of them, 4 pts underwent neoadjuvant chemotherapy and 2 pts received neoadjuvant chemoradiation. Downstaging was achieved in 3 pts (2 complete responses and 1 partial response). Most common treatments applied included radical radiotherapy with chemotherapy followed by surgery in some cases. Nine pts (55.5%) presented relapse with a mean time of progression-free survival of 10.44±9.18(2-29) months. With a mean follow-up of 13.48±14.08 (1-56) months, 4 pts are alive without disease, 8 pts are alive with disease and 6 pts deceased. Mean overall survival was 15.83±11.65(4-36) months. Conclusions EC is a heterogeneous disease with a changing epidemiologic trend. Data from our unit are superimposable to those described worldwide and may be representative of Greek population with EC. However, prospective data at national level are needed.

Adjuvant chemoradiotherapy with carboplatin and a fluoropyrimidine for resectable gastric and gastroesophageal junction cancer: A retrospective review of the Stanford experience

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15674-e15674
Author(s):  
M. A. de Bruin ◽  
P. L. Kunz ◽  
V. B. Sharma ◽  
J. A. Norton ◽  
J. Bastidas ◽  
...  
Keyword(s):  
Retrospective Review ◽  
External Beam Radiotherapy ◽  
Gastroesophageal Junction ◽  
Stage Iv ◽  
Standard Of Care ◽  
Adjuvant Chemoradiotherapy ◽  
Cancer Center ◽  
Curative Intent ◽  
Gastroesophageal Junction Cancer ◽  
Grade 3

e15674 Background: The standard of care for the adjuvant treatment of resected gastric or gastroesophageal junction (GEJ) adenocarcinoma in the U.S. is post-operative 5FU and radiotherapy per the MacDonald regimen. At Stanford Cancer Center (SCC) we have adopted a modified regimen of chemoradiotherapy using carboplatin and a fluoropyrimidine. Methods: A retrospective review was performed of patients at SCC with T2-T4 or node positive gastric or GEJ cancer who underwent surgery with curative intent, and then received the following treatment. Carboplatin (AUC 6) was administered on days 1 and 22. Patients also received either 5FU at 200 mg/m2/day (via continuous infusion) plus leucovorin for six weeks, or capecitabine at 1,000 mg/po BID for 14 days, repeated every 21 days for 2 cycles. At week 8, infusional 5FU or capecitabine was combined with external beam radiotherapy to the gastric bed for five weeks (total 4,500 cGy). At week 14, patients repeated an additional 2 cycles of carboplatin and fluoropyrimidine as tolerated. Results: Forty-nine patients were identified. The majority (76%) were male. Median age at diagnosis was 57 years. Thirty-nine had gastric and 10 had GEJ cancers. With a mean follow up of 35 months, twenty-one patients (43%) have died; median disease free and overall survival have not been reached. Eighteen patients (37%) have recurred. The percentage of patients alive by stage was 100% (4/4) for stage IB, 62% (8/13) for stage 2, 53% (9/17) for stage IIIA, 33% (2/6) for stage IIIB and 22% (2/9) for stage IV. Grade 3 or 4 toxicities occurred in 27 patients (55%); most common were neutropenia (16), thrombocytopenia (11) and gastrointestinal toxicity in (8). Conclusions: Adjuvant chemoradiotherapy with carboplatin and a fluoropyrimidine after curative resection of gastric and GEJ cancer was well tolerated and yielded survival results similar to historical data. No significant financial relationships to disclose.

scholarly journals Obesity Is Associated with Early Onset of Gastrointestinal Cancers in California

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Yen-Yi Juo ◽  
Melinda A. Maggard Gibbons ◽  
Erik Dutson ◽  
Anne Y. Lin ◽  
Jane Yanagawa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Gastric Cancer ◽  
Pancreatic Cancer ◽  
Morbid Obesity ◽  
Esophageal Cancer ◽  
Onset Age ◽  
Gastrointestinal Cancers ◽  
Cross Sectional ◽  
Gi Cancer ◽  
Cancer Types

Background. Although it is well known that obesity is a risk factor for gastrointestinal (GI) cancer, it is not well established if obesity can cause earlier GI cancer onset. Methods. A cross-sectional study examining the linked 2004–2008 California Cancer Registry Patient Discharge Database was performed to evaluate the association between obesity and onset age among four gastrointestinal cancers, including esophageal, gastric, pancreatic, and colorectal cancers. Regression models were constructed to adjust for other carcinogenic factors. Results. The diagnosis of obesity (BMI > 30) was associated with a reduction in diagnosis age across all four cancer types: 3.25 ± 0.53 years for gastric cancer, 4.56 ± 0.18 years for colorectal cancer, 4.73 ± 0.73 years for esophageal cancer, and 5.35 ± 0.72 for pancreatic cancer. The diagnosis of morbid obesity (BMI > 40) was associated with a more pronounced reduction in the age of diagnosis: 5.48 ± 0.96 years for gastric cancer, 7.75 ± 0.30 years for colorectal cancer, 7.67 ± 1.26 years for esophageal cancer, and 8.19 ± 1.25 years for pancreatic cancer. Both morbid obesity and obesity remained strongly associated with earlier cancer diagnosis for all four cancer types even after adjusting for other available cancer risk factors. Conclusions. The diagnosis of obesity, especially morbid obesity, was associated with a significantly earlier gastrointestinal cancer onset in California. Further research with prospective cohort data may be required to establish the causal relationship between obesity and cancer onset age.

Selection of induction chemotherapy (CT) in esophageal and gastroesophageal junction cancer by positron emission tomography (PET)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14041-14041
Author(s):  
A. Irigoyen ◽  
J. Delgado ◽  
A. Rodriguez ◽  
J. Ferron ◽  
R. Luque ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Gastroesophageal Junction ◽  
Squamous Carcinoma ◽  
Stage Ii ◽  
Swallowing Function ◽  
Gastroesophageal Junction Cancer ◽  
Positron Emission ◽  
Esophagogastric Cancer ◽  
Preoperative Ct ◽  
Upper Thoracic

14041 Background: Preoperative CT improves survival in esophageal cancer. 50% of patients (pts) do not respond to cisplatin+5-FU (C+F). The reduction of fluorodeoxyglucose uptake after 14 days (d) of CT predicts clinical response (rsp). Our objective was to measure the rsp (rsp) rate after CT adjusted according to PET rsp. Methods: Eligible pts were ≥ stage II esophageal cancer and able to tolerate CT. By adjusting CT according to PET rsp, we expected an increase of rsp rate by 25%. Taking into account a confidence level of 90%, an error β of 20% and a minimal error of 15% (even with such a high error rate the data will exceed the standard results), we calculated a sample size of 23 pts. All underwent esophagoscopy, computed tomography and PET scan prior to C (100mg/m2 d1) +5-FU (1,000mg/m2 d1–5). If PET rsp after first cycle (uptake decreased ≥ 35%), we continued up to third C+F cycle, then if endoscopy rsp: C+F + concurrent radiation only if stage II or III. If no endoscopy rsp, surgery only if stage II or III. On the other hand, if the pts had no rsp in PET after first C+F cycle they continued with 2 cycles of docetaxel (35mg/m2 d 1 & 8) and irinotecan (50mg/m2 d 1 & 8) (D+I) every 21 d and then if endoscopy rsp: radiation + docetaxel only if stage II or III. If no endoscopy rsp, surgery. Results: Since 2/04, 23 pts have been enrolled. Location: 2 cervical, 4 upper thoracic, 7 mid-thoracic, 10 GE junction. PET stage: 7 IIA, 6 IIB, 2 III, 2 IVA, 6 IVB. Up-staging with PET in 6 pts, down-staging in 4 pts. Histology: 10 Adenocarcinoma, 13 squamous carcinoma. Improved swallowing function: from a total of 12 PET responders, 9 had a clinical rsp after C+F, 3 did not. From 11 PET non-responders, 7 had a clinical rsp after D+I, 4 did not. Global clinical rsp = 16/23 (70%). Endoscopy rsp (frequent inaccuracy by overstaging): from a total of 12 PET responders, 6 had a clinical rsp after C+F, 6 did not. From 11 PET non-responders, 7 had a clinical rsp after D+I, 4 did not. Global clinical rsp = 13/23 (57%). Conclusion: Our results suggest that it is possible to significantly increase the percentage of pts who respond to induction CT adjusted according to PET in esophagogastric cancer before concurrent chemoradiotherapy or esophagectomy, or both. No significant financial relationships to disclose.

Tumor platinum concentrations and pathological responses following preoperative cisplatin-containing chemotherapy in gastric or gastroesophageal junction cancer patients.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 76-76 ◽  
Author(s):  
Yanshuo Cao ◽  
Qing Chang ◽  
Michael Cabanero ◽  
Wenjiang Zhang ◽  
Sara Hafezi-Bakhtiari ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Preoperative Chemotherapy ◽  
High Performance ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Collagen Content ◽  
Normal Tissues ◽  
Gastroesophageal Junction Cancer ◽  
Wide Range

76 Background: Perioperative chemotherapy plus surgical resection is a standard of care for locally advanced gastric or gastroesophageal junction (GEJ) cancers. There is a wide range in tumor response following cisplatin-containing preoperative chemotherapy. We investigated the relationship between tumor platinum levels and pathological tumor responses in gastric or GEJ cancer patients following preoperative chemotherapy. Methods: Tumor and adjacent normal tissues were retrieved. Pathological responses were assessed per standard criteria. Tissue platinum concentrations were determined with high-performance liquid chromatography mass spectrometry. Platinum distribution in tissue components was evaluated with imaging mass cytometry. Tissue collagen content was evaluated using trichrome staining. Results: Ten patients were enrolled in this study. Nine patients received 3 cycles of preoperative chemotherapy and 1 received 2 cycles. The median cumulative cisplatin dose was 166.8 mg/m2 (range: 95.9–181.1 mg/m2). Surgery was performed at a median time of 49 days (range: 28–72 days) after the last cycle of chemotherapy. The mean platinum level in tumor tissue in patients with any response was 893 ± 460 pg, significantly higher than in those with no response [38.8 ± 8.8 pg (p = 0.007)]. The collagen content was significantly higher in patients with any response than in those with no response (37.4 ± 6.8% vs. 11.5 ± 8.6%, p < 0.05). Platinum preferentially bound to collagen. Conclusions: Platinum was detectable in surgical specimens up to 72 days after preoperative chemotherapy. Higher tumor platinum concentration correlated with improved pathological response. Collagen binding potentially explained the high interpatient variability in tumor platinum concentrations.

Survival of chemotherapy (chemo) refractory gastric or gastroesophageal junction cancer (GC/GEJC) patients from Flatiron Health (FH): Matched clinical characteristics to ATTRACTION-2 and CHECKMATE-032.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 51-51 ◽  
Author(s):  
Yelena Yuriy Janjigian ◽  
Dung T Le ◽  
Patrick Alexander Ott ◽  
Beata Korytowsky ◽  
Hannah Le ◽  
...  
Keyword(s):  
Performance Status ◽  
Univariate Analysis ◽  
Gastroesophageal Junction ◽  
Standard Of Care ◽  
Ecog Performance Status ◽  
Frequency Matching ◽  
Asian Patients ◽  
Gastroesophageal Junction Cancer ◽  
Matching Process ◽  
Kaplan Meier

51 Background: Treatments for advanced/metastatic (adv/met) GC/GEJC after failure of second-line (2L) chemo are limited. Nivolumab (NIVO) demonstrated encouraging anti-tumor activity and long-term OS in adv/met GC/GEJC Asian patients (pts) in ATTRACTION-2 compared with placebo (12-month OS rate, 26% vs 11%; HR, 0.63; P < .0001) and in CHECKMATE-032 (CM-032) in Western pts (12-months OS rate, 45%). This study explored outcomes in US GC/GEJC pts by establishing real world (RW) standard of care (SOC) comparators, against placebo in Asian pts and NIVO in Western pts. Methods: Data were captured from FH electronic health record database. Median OS, estimated by Kaplan-Meier, was calculated from last treatment for adv/met GC/GEJC to death. To create a US RW SOC arm to the ATTRACTION-2 placebo pts, a 2-step matching process was applied: (1) similar inclusion/exclusion (I/E) criteria (2) frequency matching based on significant differences in baseline characteristics associated with survival, identified by univariate analysis. A similar approach was used to create a US RW SOC arm to NIVO treated pts in CM-032. Results: 742 adv/met GC/GEJC pts with ≥ 2 prior lines of therapy were identified in FH from Jan11-Apr17. Two-step matching resulted in 90 US RW SOC vs. 163 ATTRACTION-2 placebo pts, and 100 US RW SOC vs. 42 CM-032 pts. All pts had ECOG performance status (PS) of 0 or 1. Median OS of US RW SOC arm was similar to matched placebo in ATTRACTION-2. Comparison of RW SOC to NIVO-treated pts in CM-032 showed a favorable median OS with NIVO therapy (Table). Conclusions: These analyses highlight the grave outcomes in US adv/met GC/GEJC pts in FH and signal a need for more effective treatments. The data also suggest favorable outcomes with NIVO vs. SOC in both Asian and Western pts with 3L adv/met GC/GEJC. [Table: see text]

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