Clinical colorectal cancer最新文献

{"title":"Impact of Institutional Universal Microsatellite-Instability (MSI) Reflex Testing on Molecular Profiling Differences Between Younger and Older Patients with Colorectal Cancer","authors":"Ellery Altshuler ,&nbsp;Aaron J. Franke ,&nbsp;William Paul Skelton IV ,&nbsp;Michael Feely ,&nbsp;Yu Wang ,&nbsp;Ji-Hyun Lee ,&nbsp;Thomas Read ,&nbsp;Krista Terracina ,&nbsp;Xiang-Yang Lou ,&nbsp;Yunfeng Dai ,&nbsp;Thomas J. George","doi":"10.1016/j.clcc.2022.09.004","DOIUrl":"10.1016/j.clcc.2022.09.004","url":null,"abstract":"<div><h3>Introduction</h3><p>DNA mismatch repair<span> deficient (dMMR) or microsatellite instability-high (MSI-H) colorectal cancer (CRC) is found in about 15% of early-stage diseases<span> and 5% of metastatic diseases. We reviewed a large, single-institutional database after implementation of universal reflex dMMR/MSI-H testing in CRC to compare profiles of younger (≤50) and older (&gt;50) patients.</span></span></p></div><div><h3>Patients and Methods</h3><p>Between 2009 and 2017, all patients diagnosed with CRC at the University of Florida underwent reflex somatic tumor testing for dMMR by immunohistochemistry<span> (MLH1, PMS2, MSH2, MSH6), MSI by PCR<span>, and Next-Generation Sequencing. Statistical analysis was conducted with 2-sample comparison tests and logistic regression models.</span></span></p></div><div><h3>Results</h3><p>There were 375 patients included in the final analysis. Patients were grouped as younger (ages ≤50 years-old; n = 80) or older (&gt;50 years-old; n = 295). Compared to tumors from older patients, tumors from younger patients were less likely to be dMMR/MSI-H (12.5% vs. 21.4%, <em>P</em> = .013) and less likely to have a BRAF mutation (1.5% vs. 16.1%, <em>P</em> = .002). BRAF mutation status was highly associated with MMR status; BRAF-mutated tumors were 29.7 times more likely than BRAF-WT tumors to be dMMR/MSI-H (<em>P</em> = &lt; .001, 95% CI 11.3-78.3).</p></div><div><h3>Conclusions</h3><p>Tumors of younger patients were less likely than tumors of older patients to have a dMMR/MSI-H or BRAF mutation. Universal MMR/MSI testing in our dataset identified a relatively large population of older patients with sporadic CRC who were eligible for immunotherapy.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9151888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GI Symptoms in Pancreatic Cancer","authors":"Victor T. Chang ,&nbsp;Christopher Sandifer ,&nbsp;Fengming Zhong","doi":"10.1016/j.clcc.2022.12.002","DOIUrl":"10.1016/j.clcc.2022.12.002","url":null,"abstract":"<div><p><span>This review will apply a multidisciplinary approach to GI symptoms with attention to symptom assessment (instruments and qualitative aspects), differential diagnosis, and recent findings relevant to management of symptoms and underlying </span>diseases. We conclude that further development of supportive interventions for GI symptoms for both patient and caregivers has the potential to reduce distress from GI symptoms, and anticipate better symptom control with advances in scientific knowledge and improvement of the evidence base.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9152924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Survival Update and Extended RAS Mutational Analysis of the CAIRO2 Trial: Addition of Cetuximab to CAPOX/Bevacizumab in Metastatic Colorectal Cancer","authors":"Sanne ten Hoorn ,&nbsp;Linda Mol ,&nbsp;Dirkje W. Sommeijer ,&nbsp;Lisanne Nijman ,&nbsp;Tom van den Bosch ,&nbsp;Tim R. de Back ,&nbsp;Bauke Ylstra ,&nbsp;Erik van Dijk ,&nbsp;Carel J.M. van Noesel ,&nbsp;Roy J. Reinten ,&nbsp;Iris D. Nagtegaal ,&nbsp;Miriam Koopman ,&nbsp;Cornelis J.A. Punt ,&nbsp;Louis Vermeulen","doi":"10.1016/j.clcc.2022.11.006","DOIUrl":"10.1016/j.clcc.2022.11.006","url":null,"abstract":"<div><h3>Background</h3><p>Here we present updated survival of the CAIRO2 trial and assessed whether the addition of anti-EGFR to anti-VEGF therapy could still be an effective treatment option for patients with extended <em>RAS</em>/<em>BRAF</em> wildtype and left-sided metastatic colorectal cancer (mCRC).</p></div><div><h3>Materials and Methods</h3><p>Retrospective updated survival and extended <em>RAS</em> and <em>BRAF</em> V600E mutational analysis were performed in the CAIRO2 trial, a multicenter, randomized phase III trial on the effect of adding cetuximab to a combination of capecitabine, oxaliplatin (CAPOX), and bevacizumab in mCRC.</p></div><div><h3>Results</h3><p>Updated survival analysis confirmed that the addition of cetuximab did not provide a benefit on either progression free (PFS) or overall survival (OS) in the intention-to-treat population. With the extended mutational analyses 31 <em>KRAS</em>, 31 <em>NRAS</em> and 12 <em>BRAF</em> V600E additional mutations were found. No benefit of the addition of cetuximab was observed within the extended wildtype group, even when selecting only left-sided tumors (PFS HR 0.96, p = 0.7775). However, compared to the original trial an increase of 6.5 months was seen for patients with both extended wildtype and left-sided tumors (median OS 28.6 months).</p></div><div><h3>Conclusion</h3><p>Adding cetuximab to CAPOX and bevacizumab does not provide clinical benefit in patients with mCRC, even in the extended wildtype group with left-sided tumors. However, in the extended wildtype group we did observe clinically relevant higher survival compared to the initial trial report, indicating that it is important to analyze a broader panel of <em>RAS</em> and <em>BRAF</em> variants using more recent sequencing techniques when assessing survival benefit after anti-EGFR therapy.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9153563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancers of the Pancreas Update 2023","authors":"Jordan Berlin","doi":"10.1016/j.clcc.2023.02.002","DOIUrl":"10.1016/j.clcc.2023.02.002","url":null,"abstract":"","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9154484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-guided Radioactive 125I Seed Implantation for Abdominal Incision Metastases of Colorectal Cancer: Safety and Efficacy in 17 Patients","authors":"Hao Wang ,&nbsp;Hong-Bing Shi ,&nbsp;Wei-Guang Qiang,&nbsp;Chao Wang,&nbsp;Bai Sun,&nbsp;Ye Yuan,&nbsp;Wen-Wei Hu","doi":"10.1016/j.clcc.2022.10.004","DOIUrl":"https://doi.org/10.1016/j.clcc.2022.10.004","url":null,"abstract":"<div><h3>Introduction</h3><p><span>To retrospectively evaluate the safety and efficacy of computed tomography (CT)-guided iodine-125 (</span>¹²⁵<span>I) seed implantation for patients with abdominal incision<span> metastases from colorectal cancer.</span></span></p></div><div><h3>Materials and Methods</h3><p>Data of patients with abdominal incision metastases of colorectal cancer from November 2010 to October 2020 were retrospectively reviewed. Each incisional metastasis was percutaneously treated with ¹²⁵I seed implantation under CT guidance. Follow-up contrast-enhanced CT was reviewed, and the outcomes were evaluated in terms of objective response rate, complications, and overall survival.</p></div><div><h3>Results</h3><p>A total of 17 patients were enrolled in this study. The median follow-up was 18 months (range, 2.7-22.1 months). At 3, 6, 12, and 18 months after the treatment, objective response rate was 52.9%, 63.6%, 33.3%, and 0%, respectively. A small amount of local hematoma occurred in two patients and resolved spontaneously without any treatment. Two patients experienced a minor displacement of radioactive seeds with no related symptoms. Severe complications, such as massive bleeding and radiation injury, were not observed. No ≥ grade 3 adverse events were identified. By the end of follow-up, 14 patients died of multiple hematogenous metastases. The one-year overall survival rate was 41.6%, and the median overall survival was 8.6 months.</p></div><div><h3>Conclusion</h3><p>CT-guided ¹²⁵<span>I seed implantation brachytherapy is safe and feasible for patients with abdominal incision metastases from colorectal cancer.</span></p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50194194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Current Role of Radiation in Pancreatic Cancer and Future Directions","authors":"Colin S. Hill ,&nbsp;Joseph M. Herman","doi":"10.1016/j.clcc.2023.01.002","DOIUrl":"10.1016/j.clcc.2023.01.002","url":null,"abstract":"<div><p><span>Survival outcomes for localized pancreatic adenocarcinoma remains poor. Multimodality therapeutic regimens are critical to maximizing survival outcomes for these patients, which includes the use of systemic therapy, surgery, and radiation. In this review, the evolution of radiation techniques are discussed with a focus on modern techniques such as intensity modulated radiation and </span>stereotactic body radiation therapy<span>. However, the current role of radiation within the most common clinical scenarios for pancreatic cancer<span> in the neoadjuvant, definitive, and adjuvant settings continues to be highly debated. The role of radiation in these settings is reviewed in the context of historical and modern clinical studies. In addition, emerging concepts including dose-escalated radiation, magnetic resonance-guided radiation therapy, and particle therapy are discussed to promote an understanding of how such concepts may change the role of radiation in the future.</span></span></p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9148802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Chemotherapy With or Without Hepatic Arterial Infusion Chemotherapy for Liver Metastases From Pancreatic Cancer: A Propensity Score Matching Analysis","authors":"Huaqiang Ouyang ,&nbsp;Weidong Ma ,&nbsp;Tongguo Si ,&nbsp;Donglin Liu ,&nbsp;Ping Chen ,&nbsp;Anna Sandström Gerdtsson ,&nbsp;Jiahong Song ,&nbsp;Yue Ni ,&nbsp;Juanjuan Luo ,&nbsp;Zhuchen Yan","doi":"10.1016/j.clcc.2022.10.007","DOIUrl":"10.1016/j.clcc.2022.10.007","url":null,"abstract":"<div><h3>Background</h3><p>The significance of systemic chemotherapy (SCT) combined with hepatic arterial infusion (HAI) chemotherapy in the treatment of pancreatic ductal adenocarcinoma with liver metastases (PACLM) remains unclear. Based on previous studies, this single-center propensity score matching (PSM) study aimed to explore the efficacy of SCT with or without HAI for PACLM.</p></div><div><h3>Patient and Methods</h3><p>The PSM method was used to screen 661 cases of PACLM who received SCT at Tianjin Medical University Cancer Institute and Hospital from 2001 to 2020. According to the 1:6 ratio with PSM, 385 patients were divided into the SCT+HAI group (n = 55) and the SCT group (n = 330). After a median follow-up of 49 (range 7-153) months, overall survival (OS) and survival-related prognostic factors were analyzed.</p></div><div><h3>Results</h3><p>The main baseline characteristics of the SCT+HAI group and the SCT alone group were matched appropriately (<em>P</em> &gt; .05). After PSM, the median OS for patients in the 2 groups was 10.6 and 7.6 months, respectively (<em>P</em> = .02). Multivariate analysis revealed that peritoneal metastases (<em>P</em> = .03), CA199 ≥ 500U/mL (<em>P</em> = .03), and lactate dehydrogenase (LDH) ≥ 250U/L (<em>P</em> = .03) were prognostic factors of poor survival, modern SCT plus HAI (<em>P</em> = .04) was a protective factor.</p></div><div><h3>Conclusion</h3><p>Our findings indicated that adequate cycles of SCT+HAI result in better survival than SCT alone in patients with PACLM. Patients with peritoneal metastases, markedly elevated CA19-9 and LDH have a poorer prognosis. The conclusion has yet to be validated in randomized controlled clinical trials.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9153510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse Events Associated with Encorafenib Plus Cetuximab in Patients with BRAFV600E-mutant Metastatic Colorectal Cancer: An in-depth Analysis of the BEACON CRC Study","authors":"Julien Taieb ,&nbsp;Sara Lonardi ,&nbsp;Jayesh Desai ,&nbsp;Gunnar Folprecht ,&nbsp;Claire Gallois ,&nbsp;Eduardo Polo Marques ,&nbsp;Sadya Khan ,&nbsp;Claire Castagné ,&nbsp;Harpreet Wasan","doi":"10.1016/j.clcc.2022.12.003","DOIUrl":"10.1016/j.clcc.2022.12.003","url":null,"abstract":"<div><h3>Background</h3><p>The BRAF inhibitor encorafenib in combination with cetuximab was recently approved for patients with <em>BRAF</em>^V600E-mutated (<em>BRAF</em>^V600Emut) metastatic colorectal cancer (mCRC). Approval was based on positive results from the phase 3 BEACON CRC study in <em>BRAF</em>^V600Emut mCRC patients who had progressed after 1–2 previous regimens. This analysis provides a detailed examination of the adverse events (AEs) of interest (AEIs) with encorafenib+cetuximab in the BEACON study to aid gastrointestinal oncologists, given the limited experience with this combination.</p></div><div><h3>Materials and Methods</h3><p>AEIs, including dermatological AEs, arthralgia/myalgia, nausea/vomiting, diarrhea, abdominal pain, fatigue/asthenia and nephrotoxicity, were examined in the doublet therapy group. Clinical characteristics associated with these AEs, AE grade, time to onset and time to resolution were also studied.</p></div><div><h3>Results</h3><p>Safety analysis included 216/220 patients randomized to doublet therapy. The most commonly occurring AEI was dermatological toxicity (75.5%), followed by arthralgia/myalgia (56.0%) and fatigue/asthenia (56.0%). Other than nephrotoxicity (7 patients; 5/7 with Grade 3 or 4), most AEs were Grade 1 or 2. Most AEs were more common in women than men (nausea/vomiting, diarrhea, abdominal pain, dermatological AEs, and arthralgia/myalgia). Nausea/vomiting, abdominal pain and fatigue/asthenia were more common in patients aged ≥70 years. Most AEs developed early, within the first 1–2 months of treatment, and resolved within 1–2 weeks. In addition, survival outcomes were better in patients experiencing arthralgia/myalgia or dermatological toxicities.</p></div><div><h3>Conclusion</h3><p>This analysis indicated that, except for rare cases of nephrotoxicity, encorafenib+cetuximab is well tolerated in most patients, with most AEIs being mild-to-moderate in severity, occurring early and resolving rapidly.</p></div><div><h3>Clinical Trial Registration</h3><p>the BEACON study (ClinicalTrials.gov, NCT02928224; EudraCT, 2015-005805-35)</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9154104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancers of the Pancreas Update 2023.","authors":"J. Berlin","doi":"10.1016/j.cllc.2023.02.004","DOIUrl":"https://doi.org/10.1016/j.cllc.2023.02.004","url":null,"abstract":"","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42484814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second Cancer After Additive Chemotherapy in Patients With Colon Cancer","authors":"Andreas Teufel ,&nbsp;Moying Li ,&nbsp;Michael Gerken ,&nbsp;Matthias P. Ebert ,&nbsp;Hans J Schlitt ,&nbsp;Matthias Evert ,&nbsp;Wolfgang Herr ,&nbsp;Monika Klinkhammer-Schalke","doi":"10.1016/j.clcc.2022.07.002","DOIUrl":"10.1016/j.clcc.2022.07.002","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Additive chemotherapeutic treatment of UICC-stage -III / IV </span>colon cancer<span><span> with fluorouracil, </span>leucovorin and </span></span>oxaliplatin is widely accepted as current standard of treatment after R0-resection. However, as patients.. survival is increasing, long-term side effects of chemotherapeutic agents such as second cancer development are becoming increasingly important.</p></div><div><h3>Patients</h3><p>We therefore investigated a total of 2 856 Patients with UICC-stage III / IV colon cancer, 223 of whom (7.8%) had developed a subsequent second cancer.</p></div><div><h3>Results</h3><p><span>Median follow-up was 73.2 months (range 209.9 months, 95%-CI 69.8-76.9). Most frequent second cancers were prostate cancer<span><span> (18.4%), colon cancer (16.1%), breast cancers (8.1%), lung cancer (8.1%), rectal cancer<span> (4.9%) and uterine cancer (4.9%). However, in comparison to non-treated patients this did not represent a significantly increased risk for subsequent second cancer </span></span>in patients after treatment with additive chemotherapy. Of interest, our data suggest a significantly decreased second cancer rate in patients treated with </span></span>FOLFOX compared to FUFOL for additive treatment.</p></div><div><h3>Conclusions</h3><p>Second cancer development was not increased after additive chemotherapy for colon cancer, which is a novel aspect in the ongoing discussions on reduction of adjuvant treatment to 3 months or treatment of lymph node negative patients.</p><p><strong>Novelty and Impact Statement</strong></p><p>To our knowledge, this is the first population-based study analyzing second cancer development after additive chemotherapy in patients with UICC III-IV colon cancer. The results have an important impact on the surveillance and long-term follow-up of cancer patients.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10663540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}