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Lorenzen S, Schwarz A, Pauligk C, Goekkurt E, Stocker G, Knorrenschild JR, Illerhaus G, Dechow T, Moehler M, Moulin JC, Pink D, Stahl M, Schaaf M, Goetze TO, Al-Batran SE. Ramucirumab plus irinotecan / leucovorin / 5-FU versus ramucirumab plus paclitaxel in patients with advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction, who failed one prior line of palliative chemotherapy: the phase II/III RAMIRIS study (AIO-STO-0415). BMC Cancer 2023; 23:561. [PMID: 37337155 DOI: 10.1186/s12885-023-11004-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/23/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Paclitaxel in combination with ramucirumab is the standard of care second-line therapy in gastro-esophageal adenocarcinoma (GEA). As the number of taxane pretreated patients in the perioperative or first-line setting is increasing, it is unknown whether these patients benefit from re-applying a taxane in using the combination of paclitaxel and ramucirumab. Furthermore, the rates of neurotoxicity with first-line FOLFOX or FLOT range from 30%-70%, making second-line taxane-containing therapy less suitable to a meaningful portion of patients. This patient group is likely to benefit from a taxane-free second-line chemotherapy regimen, such as FOLFIRI and ramucirumab (FOLFIRI-Ram). Therefore, the RAMIRIS phase III trial evaluates the effects of the regimen of FOLFIRI-Ram in the second-line treatment after a taxane-based chemotherapy in patients with advanced GEA. METHODS The RAMIRIS trial is a randomized, open-label, multicenter phase II/III study comparing treatment of FOLFIRI-Ram (arm A) with paclitaxel and ramucirumab (arm B). The Phase II is already closed with 111 enrolled patients. In the phase III, 318 taxane-pretreated patients with advanced GEA will be recruited and randomized 1:1 to FOLFIRI (5-FU 2400 mg/m2 over 46 h i.v., irinotecan 180 mg/m2 i.v.; 5-FU 400 mg/m2 bolus; leucovorin 400 mg/m2 i.v.; on day 1 and 15, q28) with ramucirumab 8 mg/kg every two weeks (Arm A) or paclitaxel 80 mg/m2 (days 1, 8, 15, q28) with ramucirumab 8 mg/kg every two weeks (Arm B). The primary endpoints are overall survival (OS) and objective overall response rate (ORR). Secondary endpoints are progression-free survival (PFS), disease control rate and safety and quality of life as assessed by EORTC-QLQ-C30 questionnaire. DISCUSSION The already completed RAMIRIS phase II demonstrated feasibility and efficacy of FOLFIRI-Ram. Especially docetaxel-pretreated patients seemed to markedly benefit from FOLFIRI-Ram, with favorable response- and PFS rates and lower toxicity. This offers a rationale for the phase III trial. If the RAMIRIS III trial transfers and confirms the results, they will affect the current treatment guidelines, recommending the combination therapy of FOLFIRI-Ram for taxane-pretreated patients with advanced GEA. TRIAL REGISTRATION NCT03081143 Date of registration: 13.11.2015.
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Affiliation(s)
- Sylvie Lorenzen
- Klinikum rechts der Isar, Technische Universität München, III. Medizinische Klinik und Poliklinik, München, Germany.
| | - Alix Schwarz
- Klinikum rechts der Isar, Technische Universität München, III. Medizinische Klinik und Poliklinik, München, Germany
| | - Claudia Pauligk
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt/Main, Germany
| | - Eray Goekkurt
- Hämatologisch-Onkologische Praxis Eppendorf (HOPE), und Universitäres Cancer Center Hamburg (UCCH), Hamburg, Germany
| | - Gertraud Stocker
- Universitäres Krebszentrum Leipzig (UCCL), Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie - Bereich Onkologie Leipzig, Leipzig, Germany
| | - Jorge Riera Knorrenschild
- Universitätsklinikum Marburg, Klinik für Innere Medizin, Hämatologie, Onkologie und Immunologie, Marburg, Germany
| | - Gerald Illerhaus
- Klinikum Stuttgart, Klinik für Hämatologie, Onkologie und Palliativmedizin, Stuttgart, Germany
| | - Tobias Dechow
- Studienzentrum Onkologie Ravensburg, Ravensburg, Germany
| | - Markus Moehler
- I. Department of Internal Medicine, University Cancer Center Mainz, Mainz, Germany
| | - Jean-Charles Moulin
- Ortenau Klinikum Lahr, Medizinische Klinik, Sektion Hämatologie/Onkologie, Lahr, Germany
| | - Daniel Pink
- Klinik und Poliklinik für Innere Medizin C, Hämatologie und Onkologie, Transplantationszentrum, Palliativmedizin, Universität Greifswald, Greifswald, and Klinik für Hämatologie, Onkologie und Palliativmedizin, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Bad-Saarow, Bad Saarow, Germany
| | - Michael Stahl
- Evang. Kliniken Essen-Mitte, Klinik für Internistische Onkologie und Hämatologie, Essen, Germany
| | - Marina Schaaf
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt/Main, Germany
| | - Thorsten Oliver Goetze
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt/Main, Germany
- University Cancer Center Frankfurt, Krankenhaus Nordwest, Institut für Klinisch-Onkologische Forschung, Frankfurt/Main, Germany
| | - Salah-Eddin Al-Batran
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt/Main, Germany
- University Cancer Center Frankfurt, Krankenhaus Nordwest, Institut für Klinisch-Onkologische Forschung, Frankfurt/Main, Germany
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Zarenezhad E, Abdulabbas HT, Kareem AS, Kouhpayeh SA, Barbaresi S, Najafipour S, Mazarzaei A, Sotoudeh M, Ghasemian A. Protective role of flavonoids quercetin and silymarin in the viral-associated inflammatory bowel disease: an updated review. Arch Microbiol 2023; 205:252. [PMID: 37249707 DOI: 10.1007/s00203-023-03590-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic recurrent inflammation of the gastrointestinal tract (GIT). IBD patients are susceptible to various infections such as viral infections due to the long-term consumption of immunosuppressive drugs and biologics. The antiviral and IBD protective traits of flavonoids have not been entirely investigated. This study objective included an overview of the protective role of flavonoids quercetin and silymarin in viral-associated IBD. Several viral agents such as cytomegalovirus (CMV), Epstein-Barr virus (EBV), varicella zoster virus (VZV) and enteric viruses can be reactivated and thus develop or exacerbate the IBD conditions or eventually facilitate the disease remission. Flavonoids such as quercetin and silymarin are non-toxic and safe bioactive compounds with remarkable anti-oxidant, anti-inflammatory and anti-viral effects. Mechanisms of anti-inflammatory and antiviral effects of silymarin and quercetin mainly include immune modulation and inhibition of caspase enzymes, viral binding and replication, RNA synthesis, viral proteases and viral assembly. In the nutraceutical sector, natural flavonoids low bioavailability and solubility necessitate the application of delivery systems to enhance their efficacy. This review study provided an updated understanding of the protective role of quercetin and silymarin against viral-associated IBD.
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Affiliation(s)
- Elham Zarenezhad
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Hussein T Abdulabbas
- Department of Medical Microbiology, Medical College, Al Muthanna University, Al Muthanna, Iraq
| | - Ahmed Shayaa Kareem
- Department of Medical Laboratories Techniques, Imam Ja'afar Al-Sadiq University, Al-Muthanna, 66002, Iraq
| | - Seyed Amin Kouhpayeh
- Department of Pharmacology, Faculty of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Silvia Barbaresi
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Sohrab Najafipour
- Department of Microbiology, Faculty of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Abdulbaset Mazarzaei
- Department of Immunology, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Mitra Sotoudeh
- Department of Nutrition, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Abdolmajid Ghasemian
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
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Fuldeore R, Chaves LP, Feng Q, Rozario N, Nimke D, Braun S. Treatment patterns, healthcare resource utilization and costs of HER2-negative gastric/gastroesophageal junction cancer. Future Oncol 2023; 19:575-586. [PMID: 37082938 DOI: 10.2217/fon-2022-0977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Aim: To describe treatment patterns, healthcare resource utilization and costs in HER2-negative gastric/gastroesophageal (G/GEJ) cancer in the USA. Methods: Retrospective IQVIA Adjudicated Closed Claims database analysis; patients with HER2-negative G/GEJ cancer initiating systemic therapy between October 2016 and December 2019 were identified. Results: Among 1317 patients, platinum plus taxane regimens (54%) were common in neoadjuvant/adjuvant settings. Platinum-taxane (41%) and platinum-fluoropyrimidine (36%) regimens were common first-line therapies in the metastatic setting. Treatment regimens were heterogeneous in later lines. Hospitalization rates ranged from 39% (first-, second-line metastatic settings) to 61% (neoadjuvant/adjuvant setting). High healthcare resource utilization was driven by high outpatient costs. Mean per-patient per-month outpatient costs combining physician office and hospital visits ranged from US$10,944 to $12,582 (representing 52-70% of total costs). Conclusion: For G/GEJ cancer, systemic regimens varied across lines of therapy with variation increasing with subsequent therapy lines; high healthcare costs persist for systemic treatment, particularly outpatient services.
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Affiliation(s)
- Rupali Fuldeore
- Astellas Pharma Global Development, Inc., Northbrook, IL, 60062, USA
| | | | - Qi Feng
- Astellas Pharma Global Development, Inc., Northbrook, IL, 60062, USA
| | - Nigel Rozario
- Astellas Pharma Global Development, Inc., Northbrook, IL, 60062, USA
| | - David Nimke
- Astellas Pharma Global Development, Inc., Northbrook, IL, 60062, USA
| | - Stephanie Braun
- Astellas Pharma Global Development, Inc., Northbrook, IL, 60062, USA
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Alsina M, Arrazubi V, Diez M, Tabernero J. Current developments in gastric cancer: from molecular profiling to treatment strategy. Nat Rev Gastroenterol Hepatol 2023; 20:155-170. [PMID: 36344677 DOI: 10.1038/s41575-022-00703-w] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
Abstract
Gastric cancer and gastro-oesophageal junction cancer represent a global health-care challenge. Despite the efficacy of improved chemotherapy and surgical options, these patients still have a poor prognosis. In advanced disease, only trastuzumab and some immune checkpoint inhibitors, such as nivolumab and pembrolizumab in addition to chemotherapy, have demonstrated consistent and reliable efficacy in patients with HER2-positive and PDL1-positive tumours, respectively. In this Review, we discuss the intrinsic characteristics of gastric and gastro-oesophageal cancer from the molecular and clinical perspectives and provide a comprehensive review of previously reported and ongoing phase II and III clinical trials with targeted agents and immunotherapy in advanced and localized settings. Finally, we suggest alternative strategies to help overcome current challenges in precision medicine and to improve outcomes for these patients.
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Affiliation(s)
- Maria Alsina
- Gastrointestinal and Endocrinology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Medical Oncology Department, Hospital Universitario de Navarra (HUN), Pamplona, Spain.,Oncobiona Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Virginia Arrazubi
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Pamplona, Spain.,Oncobiona Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Marc Diez
- Gastrointestinal and Endocrinology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Medical Oncology Department, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - Josep Tabernero
- Gastrointestinal and Endocrinology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain. .,Medical Oncology Department, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain.
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Chang C, Pei Y, Xu J, Zhang W, Zhang J, Shi S. The full management from first-line to third-line treatments in patients with Her-2-negative advanced gastric cancer. Front Oncol 2022; 12:949941. [PMID: 36457494 PMCID: PMC9705955 DOI: 10.3389/fonc.2022.949941] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/17/2022] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The aim of this study was to retrospectively evaluate the efficacy of full management from first-line to third-line treatments in patients with human epidermal growth factor receptor 2 (Her-2)-negative advanced gastric cancer (GC). METHODS The efficacy and survival time of a total of 126 patients who received the first-line treatment with oxaliplatin plus fluoropyrimidine (S-1 or capecitabine or fluorouracil), the second-line treatment with nab-paclitaxel, and the third-line treatment of immune checkpoint inhibitors between September 2019 and December 2021 were analyzed. RESULTS A total of 42, 36, and 48 patients received CapeOX, FOLFOX, and SOX as a first-line treatment, respectively. All patients received nab-paclitaxel alone as a second-line treatment. In addition, 31, 56, and 39 patients received nivolumab, sintilimab, and tislelizumab as a third-line treatment, respectively. The median PFS1, median PFS2, and median PFS3 was 6.9 months [95% confidence interval (CI), 6.8-7.4], 5.5 months (95% CI, 5.3-5.7), and 3.5 months (95% CI, 3.4-3.7). The median PFS3 was 3.8 months (95% CI, 3.3-4.2) and 3.5 months (95% CI, 3.3-3.7) among the Epstein-Barr virus (EBV)-positive and EBV-negative, respectively (P = 0.09). In addition, the median PFS3 was 4.2 months (95% CI,3.6-4.7) and 3.5 months (95% CI, 3.3-3.6) in the patients with programmed death ligand 1 (PD-L1) combined positive score (CPS) ≥5 and CPS <5, respectively (P = 0.02). The median OS was 17.4 months (95% CI, 17.2-18.1). The multivariate analysis showed that the two parameters were associated with a significantly longer OS: number of metastatic sites <3 and PD-L1 CPS ≥5. CONCLUSION The patients who received three lines of treatment had a long survival time, and the efficacy of immunotherapy was not affected by the EBV subtypes in advanced GC. The toxicity was managed, and the concept of full management needs to be confirmed in the future.
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Affiliation(s)
- Chunxiao Chang
- Department of Gastrointestinal Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yanqing Pei
- Department of Infection Management, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jun Xu
- Department of Gastrointestinal Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Wenyu Zhang
- Department of Imaging, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jianbo Zhang
- Department of Pathology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Shengbin Shi
- Department of Gastrointestinal Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
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Lidocaine Suppresses Gastric Cancer Development Through Circ_ANO5/miR-21-5p/LIFR Axis. Dig Dis Sci 2022; 67:2244-2256. [PMID: 34050852 DOI: 10.1007/s10620-021-07055-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/11/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lidocaine has been manifested to exert anti-tumor role in gastric cancer (GC) progression. However, the action mechanism by which Lidocaine functions in GC has not been fully elucidated. AIM The study aimed to reveal the molecular mechanism of Lidocaine in GC progression. METHODS Cell clonogenicity and viability were assessed by colony formation and methyl thiazolyl tetrazolium assays, respectively. Transwell assay was employed to detect cell migration and invasion. Flow cytometry was implemented to monitor cell apoptosis. Relative expression of circular RNA ANO5 (circ_ANO5), microRNA (miR)-21-5p and Leukemia inhibitory factor receptor (LIFR) was examined by quantitative reverse transcription-polymerase chain reaction. Western blot assay was performed to analyze the levels of LIFR and cell metastasis-related proteins. The target relationship between miR-21-5p and circ_ANO5 or LIFR was confirmed by dual-luciferase reporter assay. In addition, xenograft model was established to explore the role of Lidocaine in vivo. RESULTS Lidocaine inhibited cell proliferation, migration and invasion, while promoted apoptosis of GC cells. Lidocaine upregulated circ_ANO5 and LIFR expression, but downregulated miR-21-5p expression in GC cells. Additionally, expression of circ_ANO5 and LIFR was decreased, while miR-21-5p expression was increased in GC cells. Circ_ANO5 depletion or miR-21-5p overexpression attenuated Lidocaine-induced anti-proliferative and anti-metastatic effects on GC cells. Circ_ANO5 could sponge miR-21-5p, and miR-21-5p targeted LIFR. Moreover, Lidocaine suppressed the tumor growth in vivo. CONCLUSION Lidocaine might GC cell malignancy by modulating circ_ANO5/miR-21-5p/LIFR axis, highlighting a novel insight for GC treatment.
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Davis JA, Cui ZL, Ghias M, Li X, Goodloe R, Wang C, Liepa AM, Hess LM. Treatment heterogeneity and overall survival in patients with advanced/metastatic gastric or gastroesophageal junction adenocarcinoma in the United States. J Gastrointest Oncol 2022; 13:949-957. [PMID: 35837150 PMCID: PMC9274038 DOI: 10.21037/jgo-21-890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/20/2022] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Gastric or gastroesophageal junction (GEJ) adenocarcinoma is the most common form of gastric cancer diagnosed in the United States (US) each year. Diagnosis typically is in later stages of disease when it has advanced. Patients have been treated with a variety of regimens. METHODS The goal of this retrospective study was to understand if treatment patterns were becoming more homogeneous or remaining heterogeneous using the Herfindahl-Hirschman index (HHI) and if treatments were becoming more concordant to treatment guidelines published by the National Comprehensive Cancer Network (NCCN). HHI scores were calculated for each site by 2-year increments. Trend analyses were conducted for HHI scores over time using a linear regression model. Concordance to Category 1 and any category NCCN guidelines was determined based on the date treatment was initiated with the version of the NCCN guidelines at that time. Time trend analyses were conducted using linear regression models. This study utilized data from the Flatiron Advanced Gastric/Esophageal cohort. This study also examined overall survival (OS) rates estimated by the Kaplan-Meier method by line of therapy. RESULTS There were no statistically significant differences in HHI scores in the first-line setting over time, suggesting heterogeneity has not improved. Concordance to NCCN treatment guidelines for any category significantly increased over time, however Category 1 regimen concordance remained low in the first-line setting. Concordance over time improved in second-line treatment. Median OS from the start of first-line therapy was 13.57 months. There was no relationship between OS time from initiation of first-line therapy and HHI score, concordance with NCCN guidelines, or concordance with NCCN Category 1 guidelines in the first-line setting. CONCLUSIONS Treatment heterogeneity persists in gastric cancer care, though there is a significant association between heterogeneity and concordance with both Category 1 and any category in the NCCN treatment guidelines, and that concordance has increased over time.
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Affiliation(s)
| | | | | | - Xiaohong Li
- Eli Lilly and Company, Indianapolis, IN, USA
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Shah S, Hubscher E, Pelletier C, Jacob R, Vinals L, Yadlapati R. Helicobacter pylori infection treatment in the United States: clinical consequences and costs of eradication treatment failure. Expert Rev Gastroenterol Hepatol 2022; 16:341-357. [PMID: 35315732 DOI: 10.1080/17474124.2022.2056015] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Helicobacter pylori (Hp) is causal in benign and malignant gastrointestinal diseases. Accordingly, current guidelines recommend Hp eradication in patients with active infection. Unfortunately, treatment failure is common, exposing patients to complications associated with persistent Hp infection and consequences of repeated treatment, including promotion of antibiotic resistance. In the United States (US), data regarding eradication rates with available therapies are limited. Moreover, the clinical and economic burden of eradication treatment failure have not been thoroughly described. AREAS COVERED We aimed to characterize Hp eradication rates and the clinical consequences and associated costs of persistent Hp infection among US adults. We conducted focused literature reviews using initial searches in Embase, MEDLINE, and Cochrane Database of Systematic Reviews via Ovid followed by manual searches to identify relevant publications. EXPERT OPINION Hp eradication rates were suboptimal, with most studies reporting rates ≤80% with clarithromycin-based triple therapy and bismuth quadruple therapy. There was direct evidence supporting numerous benefits of successful Hp eradication, including decreased risk of recurrent or complicated peptic disease and non-cardia gastric cancer. Cost benefits of eradication were related to mitigation of conditions associated with persistent Hp infection, (e.g. complicated peptic ulcer disease, and gastric cancer) which altogether exceed US$5.3 billion.
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Affiliation(s)
- Shailja Shah
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | | | - Corey Pelletier
- HEOR, Phathom Pharmaceuticals, Florham Park, New Jersey, USA
| | - Rinu Jacob
- Medical Affairs, Phathom Pharmaceuticals, Florham Park, New Jersey, USA
| | - Lydia Vinals
- Real-World Advanced Analytics, Cytel, Inc, Waltham, Massachusetts, USA
| | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
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Alsina M, Tabernero J, Diez M. Chemorefractory Gastric Cancer: The Evolving Terrain of Third-Line Therapy and Beyond. Cancers (Basel) 2022; 14:cancers14061408. [PMID: 35326560 PMCID: PMC8945913 DOI: 10.3390/cancers14061408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Gastric and gastro-oesophageal junction cancers (GC) are the fourth cause of cancer-related deaths, representing an international problem which needs a proper assessment. Beyond being an aggressive disease, which rapidly progress to different lines of treatment, patients suffering GC normally present a non-depreciable number of symptoms that make them especially fragile. In this context, sequential treatment lines with few toxic adverse events have been associated to an increased survival. A satisfactory GC therapy comprise at least three lines of treatment including chemotherapy and immunotherapy and/or targeted agents when indicated. Abstract Gastric and gastro-oesophageal junction cancer (GC) represent a global healthcare problem being the fifth most common tumour type and the fourth cause of cancer mortality. Extremely poor median survival of approximately 10 months is normally reported within advanced GC patients, mainly secondary to two factors, i.e., the fragility of these patients and the aggressiveness of this disease. In this context, the correct treatment of GC patients requires not only a multidisciplinary team with special attention to palliative and nutritional care but also a close follow-up with regular monitoring of disease symptoms and tumour evaluation. Sequential treatment lines with few toxic adverse events have emerged as the best therapeutic approach, and a third line of therapy could further improve survival and quality of life of GC patients. Chemotherapy, immunotherapy, and targeted agents -when indicated- constitute the treatment armamentarium of these patients. In this review, we discuss treatment options in the refractory setting as well as novel approaches to overcome the poor prognosis of GC.
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Affiliation(s)
- Maria Alsina
- Gastrointestinal & Endocrine Tumours Group, Vall d’Hebron Institute of Oncology (VHIO), C/ Natzaret 115-117, 08035 Barcelona, Spain; (M.A.); (M.D.)
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Irunlarrea 3, 31008 Pamplona, Spain
| | - Josep Tabernero
- Gastrointestinal & Endocrine Tumours Group, Vall d’Hebron Institute of Oncology (VHIO), C/ Natzaret 115-117, 08035 Barcelona, Spain; (M.A.); (M.D.)
- Medical Oncology Department, Hospital Universitari Vall d’Hebron (HUVH), Universitat Autònoma de Barcelona (UAB), Pg. Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Correspondence:
| | - Marc Diez
- Gastrointestinal & Endocrine Tumours Group, Vall d’Hebron Institute of Oncology (VHIO), C/ Natzaret 115-117, 08035 Barcelona, Spain; (M.A.); (M.D.)
- Medical Oncology Department, Hospital Universitari Vall d’Hebron (HUVH), Universitat Autònoma de Barcelona (UAB), Pg. Vall d’Hebron 119-129, 08035 Barcelona, Spain
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Shigemi D, Morishima T, Yamana H, Yasunaga H, Miyashiro I. Validity of initial cancer diagnoses in the Diagnosis Procedure Combination data in Japan. Cancer Epidemiol 2021; 74:102016. [PMID: 34450452 DOI: 10.1016/j.canep.2021.102016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND In Japan, the Diagnosis Procedure Combination (DPC) data have been used as a nationwide administrative hospital discharge database for clinical studies. However, few studies have evaluated the validity of recorded diagnoses of cancer in the database. METHODS We compared the DPC data with hospital-based cancer registries in Osaka Prefecture, Japan to assess the validity of the recorded cancer diagnoses in the DPC data. Fifteen types of cancer were included in the analysis. Cancer stage with tumor-node-metastasis (TNM) classification was assessed for eight cancer types with >400 patients. We evaluated concordance and positive predictive value of cancer diagnosis, and concordance of cancer stage between the DPC data and the hospital-based cancer registry. RESULTS In total, we identified 29,180 eligible patients. The five types of cancer with the highest number of patients were as follows: 6,765 (23.2 %) colorectal, 6,476 (22.2 %) stomach, 4,862 (16.7 %) breast, 4,445 (15.2 %) lung, and 2,257 (7.7 %) liver. Concordance of diagnosis ranged from 63.9 %-99.5 %, and twelve of the fifteen types of cancers had concordance of over 90 %. Positive predictive values of diagnosis ranged from 86.8 %-100 %. Regarding cancer stage, the overall degree of concordance was 67.2 % in all patients and the concordance was over 70 % in four types of cancers. CONCLUSIONS The DPC data had high validity of cancer diagnosis. However, the potential impact of the misclassifications and low concordance in cancer stage among specific type of cancers in the DPC data should be considered.
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Affiliation(s)
- Daisuke Shigemi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.
| | | | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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11
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Tabernero J, Shitara K, Zaanan A, Doi T, Lorenzen S, Van Cutsem E, Fornaro L, Catenacci DVT, Fougeray R, Moreno SR, Azcue P, Arkenau HT, Alsina M, Ilson DH. Trifluridine/tipiracil versus placebo for third or later lines of treatment in metastatic gastric cancer: an exploratory subgroup analysis from the TAGS study. ESMO Open 2021; 6:100200. [PMID: 34175675 PMCID: PMC8253956 DOI: 10.1016/j.esmoop.2021.100200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Metastatic gastric cancer and cancer of the esophagogastric junction (GC/EGJ) is an aggressive disease with poor prognosis. In the TAGS study, trifluridine/tipiracil (FTD/TPI) improved overall survival (OS) compared with placebo in heavily pre-treated patients. This unplanned, exploratory subgroup analysis of the TAGS study aimed to clarify outcomes when FTD/TPI was used as third-line (3L) treatment and fourth- or later-line (4L+) treatment. PATIENTS AND METHODS Patients were divided into a 3L group (126 and 64 in FTD/TPI and placebo arms, respectively) and 4L+ group (211 and 106 in FTD/TPI and placebo arms, respectively). Endpoints included OS, progression-free survival (PFS), time to Eastern Cooperative Oncology Group performance status (ECOG PS) deterioration to ≥2, and safety. RESULTS Baseline characteristics were generally well balanced between FTD/TPI and placebo for 3L and 4L+ treatment. Median OS (mOS) for FTD/TPI versus placebo was: 6.8 versus 3.2 months {hazard ratio (HR) [95% confidence interval (CI)] = 0.68 (0.47-0.97), P = 0.0318} in the 3L group; and 5.2 versus 3.7 months [0.73 (0.55-0.95), P = 0.0192] in the 4L+ group. Median PFS for FTD/TPI versus placebo was 3.1 versus 1.9 months [0.54 (0.38-0.77), P = 0.0004] in the 3L group; and 1.9 versus 1.8 months [0.57 (0.44-0.74), P < 0.0001] in the 4L+ group. Time to deterioration of ECOG PS to ≥2 for FTD/TPI versus placebo was 4.8 versus 2.0 months [HR (95% CI) = 0.60 (0.42-0.86), P = 0.0049] in the 3L group; and 4.0 versus 2.5 months [0.75 (0.57-0.98), P = 0.0329] in the 4L+ group. The safety of FTD/TPI was consistent in all subgroups. CONCLUSIONS This analysis confirms the efficacy and safety of FTD/TPI in patients with GC/EGJ in third and later lines with a survival benefit that seems slightly superior in 3L treatment. When FTD/TPI is taken in 3L as recommended in the international guidelines, physicians can expect to provide patients with an mOS of 6.8 months.
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Affiliation(s)
- J Tabernero
- Department of Medical Oncology, Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain.
| | - K Shitara
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - A Zaanan
- Department of Gastrointestinal Oncology, European Georges Pompidou Hospital, AP-HP Centre, University of Paris, Paris, France
| | - T Doi
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - S Lorenzen
- Third Department of Internal Medicine (Hematology/Medical Oncology), Klinikum Rechts der Isar, Technische Universitaet München, München, Germany
| | - E Van Cutsem
- Department of Gastroenterology and Digestive Oncology, University Hospital Gasthuisberg and University of Leuven, Leuven, Belgium
| | - L Fornaro
- Division of Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - D V T Catenacci
- Gastrointestinal Oncology Program, University of Chicago Medical Center, Chicago, USA
| | - R Fougeray
- Centre of EXcellence Methodology and Valorization of Data (CentEX MVD), Institut de Recherches Internationales Servier, Suresnes, France
| | - S R Moreno
- Global Medical and Patient Affairs, Les Laboratoires Servier SAS, Suresnes, France
| | - P Azcue
- Global Medical and Patient Affairs, Les Laboratoires Servier SAS, Suresnes, France
| | - H-T Arkenau
- Drug Development Unit, Sarah Cannon Research Institute UK Limited, London, UK
| | - M Alsina
- Department of Medical Oncology, Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), Barcelona, Spain
| | - D H Ilson
- Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, USA
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12
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Hess LM, Li X, Wu Y, Goodloe RJ, Cui ZL. Defining treatment regimens and lines of therapy using real-world data in oncology. Future Oncol 2021; 17:1865-1877. [DOI: 10.2217/fon-2020-1041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Retrospective observational research relies on databases that do not routinely record lines of therapy or reasons for treatment change. Standardized approaches to estimate lines of therapy were developed and evaluated in this study. A number of rules were developed, assumptions varied and macros developed to apply to large datasets. Results were investigated in an iterative process to refine line of therapy algorithms in three different cancers (lung, colorectal and gastric). Three primary factors were evaluated and included in the estimation of lines of therapy in oncology: defining a treatment regimen, addition/removal of drugs and gap periods. Algorithms and associated Statistical Analysis Software (SAS®) macros for line of therapy identification are provided to facilitate and standardize the use of real-world databases for oncology research.
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Affiliation(s)
- Lisa M Hess
- Eli Lilly & Company, Indianapolis, IN 46285, USA
| | - Xiaohong Li
- Eli Lilly & Company, Indianapolis, IN 46285, USA
| | - Yixun Wu
- Eli Lilly & Company, Indianapolis, IN 46285, USA
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13
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Smyth EC, Gambardella V, Cervantes A, Fleitas T. Checkpoint inhibitors for gastroesophageal cancers: dissecting heterogeneity to better understand their role in first-line and adjuvant therapy. Ann Oncol 2021; 32:590-599. [PMID: 33609722 DOI: 10.1016/j.annonc.2021.02.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
Gastroesophageal adenocarcinoma (GEA) and squamous esophageal cancer (ESCC) are responsible for >1 million deaths annually globally. Until now, patients with metastatic GEA and ESCC could anticipate survival of <1 year. Anti- programmed cell death protein 1 (anti-PD-1) monotherapy has demonstrated modest efficacy in previously treated GEA and ESCC. In 2020, four pivotal trials have established anti-PD-1 therapy as a new standard of care for selected GEA and ESCC patients as first-line advanced and adjuvant therapy. In this review, we discuss the recent results of the CheckMate 649, ATTRACTION-4, KEYNOTE-590 and CheckMate 577 trials. We consider these results in the context of current standards of care and historical trials of immune checkpoint blockade in GEA and ESCC. We explore biomarker selection for anti-PD-1 therapy and appraise the future of combination therapies. In CheckMate 649, treatment with oxaliplatin-fluoropyrimidine chemotherapy plus nivolumab in patients with combined positive score ≥5 GEA tumors provided a clinically meaningful and statistically significant improvement in overall survival. The ATTRACTION-4 trial did not see a similar overall survival benefit, despite a clear improvement in progression-free survival. We review potential explanations for this result. KEYNOTE-590 showed profoundly improved survival when pembrolizumab was added to cisplatin-fluoropyrimidine chemotherapy in ESCC patients with combined positive score ≥10 tumors; this benefit was less convincing in unselected ESCC. Finally, CheckMate 577 provides proof-of-concept for the improvement in disease-free survival with adjuvant nivolumab in high-risk resected GEA and ESCC following trimodality therapy. Immune checkpoint blockade has come of age in GEA and ESCC, and will now be integrated into first-line and earlier lines of therapy, providing benefit for a larger proportion of patients. Biomarker standardization will be critical to select the patients most likely to benefit from treatment. For patients with immune evasive tumors, novel combinations under development show promise; however, global trials are needed.
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Affiliation(s)
- E C Smyth
- Cambridge University Hospitals National Health Service Foundation Trust, Department of Oncology, Cambridge, UK
| | - V Gambardella
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - A Cervantes
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain.
| | - T Fleitas
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain.
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14
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Yan Y, Qian H, Cao Y, Zhu T. Nuclear factor-κB inhibitor Bay11-7082 inhibits gastric cancer cell proliferation by inhibiting Gli1 expression. Oncol Lett 2021; 21:301. [PMID: 33732377 PMCID: PMC7905653 DOI: 10.3892/ol.2021.12562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/28/2021] [Indexed: 02/07/2023] Open
Abstract
Dysregulated nuclear factor (NF)-κB signaling pathway is involved in gastric carcinogenesis. The present study aimed to investigate the antitumor effects of the NF-κB inhibitor, Bay11-7082, on gastric cancer (GC) and elucidate its underlying molecular mechanisms. The MTT assay was performed to assess the effects of Bay11-7082 on the proliferation of HGC27 and MKN45 gastric cancer cells. In addition, the Transwell and wound healing assays were performed to determine cell migration and invasion, respectively. Reverse transcription-quantitative PCR and western blot analyses were performed to detect the mRNA and protein expression levels of the target genes. The results demonstrated that the half-maximal inhibitory concentration (IC50) of Bay11-7082 in HGC27 cells was 24.88, 6.72 and 4.23 nM at 24, 48 and 72 h, respectively. Furthermore, the IC50 of Bay11-7082 in MKN45 cells was 29.11, 11.22 and 5.88 nM at 24, 48 and 72 h, respectively. Treatment with Bay11-7082 significantly suppressed the cell migratory and invasive abilities compared with the control group. Notably, Bay11-7082 suppressed GLI Family Zinc Finger 1 (Gli1) mRNA and protein expression levels. Taken together, the results of the present study demonstrated that Bay11-7082 inhibited GC cell proliferation, at least in part through inhibition of Gli1.
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Affiliation(s)
- Yan Yan
- Department of Pharmacology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Heya Qian
- Department of Oncology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Ying Cao
- Department of Pharmacology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Tao Zhu
- Department of Laboratory, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu 215600, P.R. China
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15
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Tsang ES, Lim HJ, Renouf DJ, Davies JM, Loree JM, Gill S. Real-world treatment attrition rates in advanced esophagogastric cancer. World J Gastroenterol 2020; 26:6027-6036. [PMID: 33132652 PMCID: PMC7584053 DOI: 10.3748/wjg.v26.i39.6027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/24/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Over the last decade, multiple agents have demonstrated efficacy for advanced esophagogastric cancer (EGC). Despite the availability of later lines of therapy, there remains limited real-world data about the treatment attrition rates between lines of therapy.
AIM To characterize the use and attrition rates between lines of therapy for patients with advanced EGC.
METHODS We identified patients who received at least one cycle of chemotherapy for advanced EGC between July 1, 2017 and July 31, 2018 across six regional centers in British Columbia (BC), Canada. Clinicopathologic, treatment, and outcomes data were extracted.
RESULTS Of 245 patients who received at least one line of therapy, median age was 66 years (IQR 58.2-72.3) and 186 (76%) were male, Eastern Cooperative Oncology Group (ECOG) performance status 0/1 (80%), gastric vs GEJ (36% vs 64%). Histologies included adenocarcinoma (78%), squamous cell carcinoma (8%), and signet ring (14%), with 31% HER2 positive. 72% presented with de novo disease, and 25% had received previous chemoradiation. There was a high level of treatment attrition, with patients receiving only one line of therapy n = 122, 50%), two lines n = 83, 34%), three lines n = 34, 14%), and four lines n = 6, 2%). Kaplan-Meier analysis demonstrated improved survival with increasing lines of therapy (median overall survival 7.7 vs 16.6 vs 22.8 vs 40.4 mo, P < 0.05). On multivariable Cox regression, improved survival was associated with better baseline ECOG and increased lines of therapy (P < 0.05).
CONCLUSION The steep attrition rates between therapies highlight the unmet need for more efficacious early-line treatment options for patients with advanced EGC.
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Affiliation(s)
- Erica S Tsang
- Department of Medicine, BC Cancer, Vancouver V5Z 4E6, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver V5Z 4E6, Canada
| | - Howard J Lim
- Department of Medicine, BC Cancer, Vancouver V5Z 4E6, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver V5Z 4E6, Canada
| | - Daniel J Renouf
- Department of Medicine, BC Cancer, Vancouver V5Z 4E6, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver V5Z 4E6, Canada
| | - Janine M Davies
- Department of Medicine, BC Cancer, Vancouver V5Z 4E6, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver V5Z 4E6, Canada
| | - Jonathan M Loree
- Department of Medicine, BC Cancer, Vancouver V5Z 4E6, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver V5Z 4E6, Canada
| | - Sharlene Gill
- Department of Medicine, BC Cancer, Vancouver V5Z 4E6, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver V5Z 4E6, Canada
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16
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Abraham P, Wang L, Jiang Z, Gricar J, Tan H, Kelly RJ. Healthcare utilization and total costs of care among patients with advanced metastatic gastric and esophageal cancer. Future Oncol 2020; 17:291-299. [PMID: 32996811 DOI: 10.2217/fon-2020-0516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Aim: Study first-line (1L) treatment patterns and economic outcomes among patients with advanced metastatic gastric cancer (GC) and esophageal cancer (EC). Materials & methods: Newly diagnosed patients with systemic GC and EC treatments were identified between 1 January 2011 and 31 July 2017; costs were presented as per patient per month (PPPM) basis. Results: Study included 392 GC and 436 EC patients. Most frequently used 1L regimens were: 5-fluorouracil (5-FU) + oxaliplatin (22.5%) and epirubicin + cisplatin + 5-FU (ECF)/ECF modifications (21.9%) in patients with GC; and carboplatin + paclitaxel (29.6%) and 5-FU + oxaliplatin (11.5%) in EC patients. Mean all-cause costs were US$16,242 PPPM for GC, and $18,384 PPPM for EC during 1L treatment. Conclusion: GC and EC were resource intensive and costly. High costs and short treatment durations underscored a gap in care in 1L treatment.
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Affiliation(s)
| | - Liya Wang
- HealthCore, Inc., Wilmington, DE 19801, USA
| | | | | | | | - Ronan J Kelly
- Charles A. Sammons Cancer Center at Baylor University Medical Center, Dallas, TX 75246, USA
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17
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Chen X, Wang X, Yi L, Song Y. The KN Motif and Ankyrin Repeat Domains 1/CXXC Finger Protein 5 Axis Regulates Epithelial-Mesenchymal Transformation, Metastasis and Apoptosis of Gastric Cancer via Wnt Signaling. Onco Targets Ther 2020; 13:7343-7352. [PMID: 32801759 PMCID: PMC7395690 DOI: 10.2147/ott.s240991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/12/2020] [Indexed: 12/26/2022] Open
Abstract
Background Emerging research indicates that CXXC finger protein 5 (CXXC5) is involved in the development of various cancers. Besides, KN motif and ankyrin repeat domains 1 (KANK1) was proved as a tumor suppressor in multiple cancers. Our study aimed to illustrate the functional role and mechanism of CXXC5 and KANK1 in gastric cancer (GC) pathogenesis. Methods The tissues of 55 GC patients and six GC cell lines were used to investigate CXXC5 and KANK1 expression using RT-qPCR. Western blot assay was conducted to measure the protein levels of CXXC5, KANK1, epithelial-mesenchymal transformation (EMT) proteins (Vimentin, E-cadherin) and Wnt signaling proteins (β-catenin, Axin2). The correlation between KANK1 and CXXC5 was estimated by Pearson’s correlation analysis. The results of Transwell assays showed the migration and invasion abilities of GC cells, while the apoptosis rate was detected by flow cytometry. Results The expressions of CXXC5 and KANK1 were both decreased in GC tissues and cells, compared with the normal ones (P < 0.01). Overexpressing CXXC5 significantly induced apoptosis (P < 0.05) and inhibited EMT, migration (P < 0.05) and invasion (P < 0.01) in GC cells. Wnt/β-catenin/Axin2 signaling was suppressed by CXXC5 overexpression, and activating Wnt/β-catenin/Axin2 signaling reversed the effects of CXXC5. The expression of KANK1 was found to be positively correlated with CXXC5 (r2 = 0.4024). KANK1 presented similar effects with CXXC5 on GC cells; however, silencing CXXC5 or activating Wnt/β-catenin/Axin2 signaling antagonized the effects of KANK1 overexpression on EMT and apoptosis in GC (P < 0.05). Conclusion Our study suggested that CXXC5 was downregulated in GC and participated in EMT and apoptosis regulations via the Wnt/β-catenin/Axin2 pathway. Besides, the decreased expression of CXXC5 in GC was caused by KANK1 dysregulation.
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Affiliation(s)
- Xin Chen
- Gastroenteric Medicine and Digestive Endoscopy Center, The Second Hospital of Jilin University, Changchun, Jilin 13000, People's Republic of China
| | - Xiaodong Wang
- Gastroenteric Medicine and Digestive Endoscopy Center, The Second Hospital of Jilin University, Changchun, Jilin 13000, People's Republic of China
| | - Lanjuan Yi
- Department of Gastroenterology, Yantaishan Hospital of Yantai City, Yantai, Shandong 264000, People's Republic of China
| | - Ying Song
- Gastroenteric Medicine and Digestive Endoscopy Center, The Second Hospital of Jilin University, Changchun, Jilin 13000, People's Republic of China
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18
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Hess LM, Grabner M, Wang L, Liepa AM, Li XI, Cui ZL, Bowman L, Schelman WR. Reliability of Conclusions from Early Analyses of Real-World Data for Newly Approved Drugs in Advanced Gastric Cancer in the United States. Pragmat Obs Res 2020; 11:27-43. [PMID: 32431558 PMCID: PMC7205419 DOI: 10.2147/por.s241427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background As real-world data resources expand and improve, there will increasingly be opportunities to study the effectiveness of interventions. There is a need to ensure that study designs explore potential sources of bias and either acknowledge or mitigate them, in order to improve the accuracy of findings. The objective of this study was to understand newly approved drug utilization patterns in real-world clinical settings over time. Methods This retrospective study included three sources of real-world data (claims, electronic health records, and recoded data from a quality care program) collected from patients diagnosed with gastric cancer who initiated therapy with either trastuzumab or ramucirumab. Linear regression was used to investigate trends in the use of these drugs for the care of patients with gastric cancer over time from Food and Drug Administration (FDA) approval. Results Eligible patients (n=1700) had consistent demographic and clinical characteristics over time. After regulatory approval, trastuzumab was used in later lines of therapy and then shifted to earlier lines (p=0.002), while ramucirumab utilization remained consistent over time after FDA approval (p=0.49). Ramucirumab augmentation, defined as the addition of the drug after initiation of a line of therapy, decreased over time (p=0.03), and trastuzumab augmentation remained consistent over time (p=0.58). Conclusion Since treatment effectiveness may change across lines of treatment, bias may arise if there are changes in the use of the drug (such as line migration) during the time period of analysis using real-world data.
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Affiliation(s)
- Lisa M Hess
- Global Patient Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
| | - Michael Grabner
- Life Sciences Research, HealthCore Inc., Wilmington, DE, USA
| | - Liya Wang
- Life Sciences Research, HealthCore Inc., Wilmington, DE, USA
| | - Astra M Liepa
- Global Patient Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
| | - Xiaohong Ivy Li
- Global Statistics, Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Lee Bowman
- Global Patient Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
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19
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Hallet J, Look Hong NJ, Zuk V, Davis LE, Gupta V, Earle CC, Mittmann N, Coburn NG. Economic impacts of care by high-volume providers for non-curative esophagogastric cancer: a population-based analysis. Gastric Cancer 2020; 23:373-381. [PMID: 31834527 DOI: 10.1007/s10120-019-01031-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/06/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Esophagogastric cancer (EGC) is one of the deadliest and costliest malignancies to treat. Care by high-volume providers can provide better outcomes for patients with EGC. Cost implications of volume-based cancer care are unclear. We examined the cost-effectiveness of care by high-volume medical oncology providers for non-curative management of EGC. METHODS We conducted a population-based cohort study of non-curative EGC over 2005-2017 by linking administrative datasets. High-volume was defined as ≥ 11 patients/provider/year. Healthcare costs ($USD/patient/month-survived) were computed from diagnosis to death or end of follow-up from the perspective of the healthcare system. Multivariable quantile regression examined the association between care by high-volume providers and costs. Sensitivity analyses were conducted by varying costing horizons and high-volume definitions. RESULTS Among 7011 non-curative EGC patients, median overall survival was superior with care by high-volume providers with 7.0 (IQR 3.3-13.3) compared to 5.9 (IQR 2.6-12.1) months (p < 0.001) for low-volume providers. Median costs/patient/month-lived were lower for high-volume providers ($5518 vs. $5911; p < 0.001), owing to lower inpatient acute care costs, despite higher medication-associated and radiotherapy costs. Care by high-volume providers was independently associated with a reduction of $599 per patient/month-lived (95% confidence interval - 966 to - 331) compared to low-volume providers. The incremental cost-effectiveness ratio was - 393. Care by high-volume providers remained the dominant strategy when varying the costing horizon and the high-volume definition. CONCLUSION Care by high-volume providers for non-curative EGC is associated with superior survival and lower healthcare costs, indicating a dominant strategy that may provide an opportunity to improve cost-effectiveness of care delivery.
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Affiliation(s)
- Julie Hallet
- Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075, Bayview Avenue, T2-063, Toronto, ON, M4N 3M5, Canada. .,Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Sunnybrook Research Institute, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada.
| | - Nicole J Look Hong
- Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075, Bayview Avenue, T2-063, Toronto, ON, M4N 3M5, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Victoria Zuk
- Sunnybrook Research Institute, Toronto, ON, Canada
| | | | - Vaibhav Gupta
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Craig C Earle
- Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Natalie G Coburn
- Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075, Bayview Avenue, T2-063, Toronto, ON, M4N 3M5, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
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20
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Catenacci DVT, Rasco D, Lee J, Rha SY, Lee KW, Bang YJ, Bendell J, Enzinger P, Marina N, Xiang H, Deng W, Powers J, Wainberg ZA. Phase I Escalation and Expansion Study of Bemarituzumab (FPA144) in Patients With Advanced Solid Tumors and FGFR2b-Selected Gastroesophageal Adenocarcinoma. J Clin Oncol 2020; 38:2418-2426. [PMID: 32167861 PMCID: PMC7367551 DOI: 10.1200/jco.19.01834] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate the safety, pharmacokinetics, and preliminary activity of bemarituzumab in patients with FGFR2b-overexpressing gastric and gastroesophageal junction adenocarcinoma (GEA). PATIENTS AND METHODS FPA144-001 was a phase I, open-label, multicenter trial consisting of the following 3 parts: part 1a involved dose escalation in patients with recurrent solid tumors at doses ranging from 0.3 to 15 mg/kg; part 1b involved dose escalation in patients with advanced-stage GEA; and part 2 involved dose expansion in patients with advanced-stage GEA that overexpressed FGFR2b at various levels (4 cohorts; high, medium, low, and no FGFR2b overexpression) and 1 cohort of patients with FGFR2b-overexpressing advanced-stage bladder cancer. RESULTS Seventy-nine patients were enrolled; 19 were enrolled in part 1a, 8 in part 1b, and 52 in part 2. No dose-limiting toxicities were reported, and the recommended dose was identified as 15 mg/kg every 2 weeks based on safety, tolerability, pharmacokinetic parameters, and clinical activity. The most frequent treatment-related adverse events (TRAEs) were fatigue (17.7%), nausea (11.4%), and dry eye (10.1%). Grade 3 TRAEs included nausea (2 patients) and anemia, neutropenia, increased AST, increased alkaline phosphatase, vomiting, and an infusion reaction (1 patient each). Three (10.7%) of 28 patients assigned to a cohort receiving a dose of ≥ 10 mg/kg every 2 weeks for ≥ 70 days reported reversible grade 2 corneal TRAEs. No TRAEs of grade ≥ 4 were reported. Five (17.9%; 95% CI, 6.1% to 36.9%) of 28 patients with high FGFR2b-overexpressing GEA had a confirmed partial response. CONCLUSION Overall, bemarituzumab seems to be well tolerated and demonstrated single-agent activity as late-line therapy in patients with advanced-stage GEA. Bemarituzumab is currently being evaluated in combination with chemotherapy in a phase III trial as front-line therapy for patients with high FGFR2b-overexpressing advanced-stage GEA.
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Affiliation(s)
| | - Drew Rasco
- The START Center for Cancer Care, San Antonio, TX
| | - Jeeyun Lee
- Samsung Medical Center, Seoul, South Korea
| | - Sun Young Rha
- Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Keun-Wook Lee
- Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Yung Jue Bang
- Seoul National University College of Medicine, Seoul, South Korea
| | - Johanna Bendell
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | | | | | - Hong Xiang
- Five Prime Therapeutics, South San Francisco, CA
| | - Wei Deng
- Five Prime Therapeutics, South San Francisco, CA
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21
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Lauren B, Ostvar S, Silver E, Ingram M, Oh A, Kumble L, Laszkowska M, Chu JN, Hershman DL, Manji G, Neugut AI, Hur C. Cost-Effectiveness Analysis of Biomarker-Guided Treatment for Metastatic Gastric Cancer in the Second-Line Setting. JOURNAL OF ONCOLOGY 2020; 2020:2198960. [PMID: 32148492 PMCID: PMC7048937 DOI: 10.1155/2020/2198960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/26/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The 5-year survival rate of patients with metastatic gastric cancer (GC) is only 5%. However, trials have demonstrated promising antitumor activity for targeted therapies/immunotherapies among chemorefractory metastatic GC patients. Pembrolizumab has shown particular efficacy among patients with programmed death ligand-1 (PD-L1) expression and high microsatellite instability (MSI-H). The aim of this study was to assess the effectiveness and cost-effectiveness of biomarker-guided second-line GC treatment. METHODS We constructed a Markov decision-analytic model using clinical trial data. Our model compared pembrolizumab monotherapy and ramucirumab/paclitaxel combination therapy for all patients and pembrolizumab for patients based on MSI status or PD-L1 expression. Paclitaxel monotherapy and best supportive care for all patients were additional comparators. Costs of drugs, treatment administration, follow-up, and management of adverse events were estimated from a US payer perspective. The primary outcomes were quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100,000/QALY over 60 months. Secondary outcomes were unadjusted life years (survival) and costs. Deterministic and probabilistic sensitivity analyses were performed to evaluate model uncertainty. RESULTS The most effective strategy was pembrolizumab for MSI-H patients and ramucirumab/paclitaxel for all other patients, adding 3.8 months or 2.0 quality-adjusted months compared to paclitaxel. However, this strategy resulted in a prohibitively high ICER of $1,074,620/QALY. The only cost-effective strategy was paclitaxel monotherapy for all patients, with an ICER of $53,705/QALY. CONCLUSION Biomarker-based treatments with targeted therapies/immunotherapies for second-line metastatic GC patients substantially improve unadjusted and quality-adjusted survival but are not cost-effective at current drug prices.
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Affiliation(s)
| | - Sassan Ostvar
- Columbia University Medical Center, New York, NY, USA
| | | | - Myles Ingram
- Columbia University Medical Center, New York, NY, USA
| | - Aaron Oh
- Columbia University Medical Center, New York, NY, USA
| | | | | | | | - Dawn L. Hershman
- Columbia University Medical Center, New York, NY, USA
- Columbia University Irving Cancer Research Center, New York, NY, USA
| | - Gulam Manji
- Columbia University Medical Center, New York, NY, USA
- Columbia University Irving Cancer Research Center, New York, NY, USA
| | - Alfred I. Neugut
- Columbia University Irving Cancer Research Center, New York, NY, USA
| | - Chin Hur
- Columbia University Medical Center, New York, NY, USA
- Columbia University Irving Cancer Research Center, New York, NY, USA
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22
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Puhr HC, Preusser M, Prager G, Ilhan-Mutlu A. New Treatment Options for Advanced Gastroesophageal Tumours: Mature for the Current Practice? Cancers (Basel) 2020; 12:E301. [PMID: 32012895 PMCID: PMC7072704 DOI: 10.3390/cancers12020301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 12/26/2022] Open
Abstract
Several clinical trials attempted to identify novel treatment options for advanced gastroesophageal tumours in first, second and further lines. Although results of targeted therapy regimens were mainly disappointing, novel immunotherapy agents showed promising activity, which led to their approval in second and third lines in many countries. This review focuses on the results of recent clinical trials investigating novel agents including targeted therapies, immunotherapy components and chemotherapies and discuss their current impact as well as current approval status on the treatment armamentarium of advanced gastroesophageal tumours.
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Affiliation(s)
- Hannah Christina Puhr
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; (H.C.P.); (M.P.); (G.P.)
- Comprehensive Cancer Center Vienna—Gastroesophageal Tumors Unit, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; (H.C.P.); (M.P.); (G.P.)
- Comprehensive Cancer Center Vienna—Gastroesophageal Tumors Unit, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Gerald Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; (H.C.P.); (M.P.); (G.P.)
- Comprehensive Cancer Center Vienna—Gastroesophageal Tumors Unit, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Aysegül Ilhan-Mutlu
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; (H.C.P.); (M.P.); (G.P.)
- Comprehensive Cancer Center Vienna—Gastroesophageal Tumors Unit, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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23
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Chau I, Le DT, Ott PA, Korytowsky B, Le H, Le TK, Zhang Y, Sanchez T, Maglinte GA, Laurie M, Abraham P, Patel D, Shangguan T. Developing real-world comparators for clinical trials in chemotherapy-refractory patients with gastric cancer or gastroesophageal junction cancer. Gastric Cancer 2020; 23:133-141. [PMID: 31549264 PMCID: PMC6942583 DOI: 10.1007/s10120-019-01008-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are few third-line or later (3L+) treatment options for advanced/metastatic (adv/met) gastric cancer/gastroesophageal junction cancers (GC/GEJC). 3L+ Nivolumab demonstrated encouraging results in Asian patients in the ATTRACTION-2 study compared with placebo (12-month survival, 26% vs 11%), and in Western patients in the single-arm CheckMate 032 study (12-month survival, 44%). This analysis aimed to establish comparator cohorts of US patients receiving routine care in real-world (RW) clinical practice. METHODS A 2-step matching process generated RW cohorts from Flatiron Health's oncology database (January 1, 2011-April 30, 2017), for comparison with each trial: (1) clinical trial eligibility criteria were applied; (2) patients were frequency-matched with trial arms for baseline variables significantly associated with survival. Median overall survival (OS) was calculated by Kaplan-Meier analysis from last treatment until death. RESULTS Of 742 adv/met GC/GEJC patients with at least 2 prior lines of therapy, matching generated 90 US RW ATTRACTION-2-matched patients (median OS: 3.5 months) versus 163 ATTRACTION-2 placebo patients (median OS: 4.1 months), and 100 US RW CheckMate 032-matched patients (median OS: 2.9 months) versus 42 CheckMate 032 nivolumab-treated patients (median OS: 8.5 months). Baseline characteristics were generally similar between clinical trial arms and RW-matched cohorts. CONCLUSIONS We successfully developed RW cohorts for comparison with data from clinical trials, with comparable baseline characteristics. Survival in US patients receiving RW care was similar to that seen in Asian patients receiving placebo in ATTRACTION-2; survival with nivolumab in CheckMate 032 appeared favorable compared with US RW clinical practice.
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Affiliation(s)
- Ian Chau
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital, Surrey, SM2 5PT UK
| | - Dung T. Le
- Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins, Baltimore, MD USA
| | | | | | - Hannah Le
- Bristol-Myers Squibb Company, Lawrenceville, NJ USA
| | - T. Kim Le
- Bristol-Myers Squibb Company, Lawrenceville, NJ USA
| | - Ying Zhang
- Bristol-Myers Squibb Company, Lawrenceville, NJ USA
| | | | | | | | | | - Dhiren Patel
- Bristol-Myers Squibb Company, Lawrenceville, NJ USA
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24
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Brown J, Liepa AM, Bapat B, Madhwani S, Lorenzen S, García-Foncillas J, Candrilli SD, Kaye JA. Clinical management patterns of advanced and metastatic gastro-oesophageal carcinoma after fluoropyrimidine/platinum treatment in France, Germany, Spain and the United Kingdom. Eur J Cancer Care (Engl) 2019; 29:e13213. [PMID: 31883156 DOI: 10.1111/ecc.13213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/15/2019] [Accepted: 12/02/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe treatment patterns and resource utilisation in France, Germany, Spain and the United Kingdom (UK) in patients with unresectable locally advanced and/or metastatic gastro-oesophageal adenocarcinoma (GEA), who failed first-line fluoropyrimidine/platinum treatment. METHODS Treating physicians completed a web-based chart review (2013-2015). Eligible patients were ≥ 18 years old; had unresectable locally advanced and/or metastatic gastric adenocarcinoma including the gastro-oesophageal junction; received first-line fluoropyrimidine/platinum-based therapy; and had ≥ 3 months of follow-up after first-line discontinuation. Data were summarised descriptively for each country. RESULTS There were n = 201 patients in France, n = 202 in Germany, n = 208 in Spain and n = 200 in the UK whose charts were reviewed. Percentages of patients receiving second-line therapy were 55% (France), 48% (Germany), 54% (Spain) and 29% (UK). At the start of second-line therapy, most patients had an ECOG performance status of 1 (range 0-3). Second-line therapy was primarily monotherapy, but agents used varied within and across countries. Supportive care use and resource utilisation were frequent whether receiving additional therapy or not; >60% patients had clinic visits unrelated to chemotherapy administration, and > 30% has ≥ 1 hospital admission. CONCLUSIONS For the time of study, established GEA treatment guidelines were generally followed. However, therapies varied widely in the second-line setting.
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Affiliation(s)
| | | | - Bela Bapat
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | - Sylvie Lorenzen
- Department of hematology and oncology, Klinikum rechts der Isar der TU München, München, Germany
| | - Jesús García-Foncillas
- Cancer Institute, University Hospital Fundacion Jimenez Diaz, Autonomous University, Madrid, Spain
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25
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Barzi A, Hess LM, Zhu YE, Liepa AM, Sugihara T, Beyrer J, Chao J. Real-World Outcomes and Factors Associated With the Second-Line Treatment of Patients With Gastric, Gastroesophageal Junction, or Esophageal Adenocarcinoma. Cancer Control 2019; 26:1073274819847642. [PMID: 31056940 PMCID: PMC6503607 DOI: 10.1177/1073274819847642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This retrospective observational study was designed to evaluate overall survival
in a real-world patient population and to identify predictive factors associated
with receipt of second-line therapy. A retrospective analysis of electronic
medical records (Flatiron Health, New York) was conducted among patients
initiating first-line therapy from January 1, 2013, through April 30, 2018.
Eligible patients were diagnosed with advanced gastric, gastroesophageal
junction, or esophageal adenocarcinoma and ≥18 years of age at the time of
treatment initiation. Patients alive 45 days after discontinuation of first-line
therapy were considered potentially eligible for continued therapy and were
categorized into those who received and those who did not receive second-line
therapy. Survival analyses were conducted using Kaplan-Meier method and log-rank
test without adjusting for any baseline covariates. Factors associated with
further treatment were evaluated using logistic regression. A total of 3850
patients met eligibility criteria. Among the 2516 patients available to receive
second-line therapy, 1515 (60.2%) received second-line therapy and 1001 (39.8%)
did not receive further therapy. Among those potentially eligible to receive
second-line therapy, median survival was 15.4 months (95% confidence interval
[CI]: 14.6-16.0) from initiation of first-line therapy for those who received
second-line therapy and 10.0 months (95% CI: 9.3-10.7) for those who did not.
Longer duration of first-line therapy (≥169 vs ≤84 days), HER2-positive tumors,
initially diagnosed with stage IV disease, less weight loss during first-line
therapy, and younger age were associated with receipt of second-line therapy
(all P < .001). Longer survival was associated with multiple
lines of therapy; however, these results should be interpreted with caution, and
no causal relationship can be inferred.
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Affiliation(s)
- Afsaneh Barzi
- 1 Norris Comprehensive Cancer Center, University of Southern California, Los Angles, CA, USA
| | - Lisa M Hess
- 2 Global Patient Outcomes and Real-World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
| | - Yajun E Zhu
- 2 Global Patient Outcomes and Real-World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
| | - Astra M Liepa
- 2 Global Patient Outcomes and Real-World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Julie Beyrer
- 2 Global Patient Outcomes and Real-World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
| | - Joseph Chao
- 4 City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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26
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Le DT, Ott PA, Korytowsky B, Le H, Le TK, Zhang Y, Maglinte GA, Abraham P, Patel D, Shangguan T, Chau I. Real-world Treatment Patterns and Clinical Outcomes Across Lines of Therapy in Patients With Advanced/Metastatic Gastric or Gastroesophageal Junction Cancer. Clin Colorectal Cancer 2019; 19:32-38.e3. [PMID: 31813769 DOI: 10.1016/j.clcc.2019.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/06/2019] [Accepted: 09/17/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND First-line (1L) and second-line (2L) therapies for advanced/metastatic gastric cancer (GC) and gastroesophageal junction cancer (GEJC) have modest efficacy, and therapeutic options in subsequent lines are limited as disease progresses. We assessed real-world treatment patterns and outcomes for advanced/metastatic GC/GEJC. PATIENTS AND METHODS Adult patients diagnosed with advanced/metastatic GC/GEJC between January 1, 2011 and April 30, 2018 were identified using the Flatiron Health database. Median overall survival (OS) from start of each line of therapy until death was estimated by the Kaplan-Meier method. Duration of therapy (DoT) was time from start date until end date of each line. RESULTS We identified 3291 patients with advanced/metastatic GC/GEJC adenocarcinoma. At diagnosis, the median age was 68 years, 60% were white, 53% had initial stage IV disease, and 57% had GC. Of these 3291 patients, most (75%) received at least 1 therapy; 32% received 2L, 14% received third-line (3L) therapy, and 6% received at least 4 lines of therapy (4L+). The median OS from start of 1L was 10.7 months (2L, 7.6 months; 3L, 6.1 months; 4L+, 2.8 months). The median DoT in 1L was 2.2 months (2L, 2.1 months; 3L, 1.7 months; 4L+, 3.0 months). Use of targeted and immunotherapies generally increased progressively with each subsequent line of therapy. CONCLUSION One-quarter of patients with advanced/metastatic GC/GEJC remained untreated, and only approximately one-half of patients receiving 1L therapy received subsequent treatment. In all lines of therapy, OS was generally poor and DoT was short. More effective treatment options are needed across all lines of therapy for this highly burdensome disease.
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Affiliation(s)
- Dung T Le
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD.
| | | | | | - Hannah Le
- Bristol-Myers Squibb Company, Lawrenceville, NJ
| | - T Kim Le
- Bristol-Myers Squibb Company, Lawrenceville, NJ
| | - Ying Zhang
- Bristol-Myers Squibb Company, Lawrenceville, NJ
| | | | | | | | | | - Ian Chau
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital, Surrey, United Kingdom
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Smyth EC, Moehler M. Late-line treatment in metastatic gastric cancer: today and tomorrow. Ther Adv Med Oncol 2019; 11:1758835919867522. [PMID: 31489035 PMCID: PMC6713955 DOI: 10.1177/1758835919867522] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/30/2019] [Indexed: 12/14/2022] Open
Abstract
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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Affiliation(s)
- Elizabeth C Smyth
- Department of Oncology, Cambridge University Hospital, Cambridge, Cambridgeshire CB2 QQ0, UK
| | - Markus Moehler
- Department of Internal Medicine, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
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28
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Efficacy and Safety of Xiao Ai Ping Injection Combined with Chemotherapy in Advanced Gastric Cancer: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:3821053. [PMID: 31236124 PMCID: PMC6545757 DOI: 10.1155/2019/3821053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 04/16/2019] [Indexed: 12/24/2022]
Abstract
Xiao Ai Ping injection (XAPI), extracted from the Chinese herbal medicine Marsdenia tenacissima, is widely used in the adjuvant treatment of tumors in China. The present study aimed to evaluate the efficacy and safety of XAPI combined with chemotherapy for treating patients with advanced gastric cancer. Seven databases were searched for relevant studies published up to October 1, 2018, and Review Manager 5.3 software and Stata 12.0 software were used for meta-analysis. Fourteen studies, representing 1097 enrolled patients, were included in our analysis. Compared with chemotherapy alone, combination treatment with XAPI and the XELOX regimen (capecitabine plus oxaliplatin) was found to improve the objective response rate (ORR) [RR=1.36; 95%CI (1.10, 1.70); P=0.006], disease control rate (DCR) [RR=1.15; 95% CI (1.04, 1.28); P=0.010], and Karnofsky Performance Status (KPS) improvement rate [RR=1.51; 95%CI (1.14, 2.00); P=0.004] and to reduce the incidence of leukopenia [RR=0.68; 95%CI (0.55,0.84); P=0.0005], liver damage [RR=0.59; 95% CI (0.37, 0.92); P=0.02], renal impairment [RR=0.39; 95% CI (0.18, 0.85); P=0.02], and hand-foot syndrome [RR=0.56; 95%CI (0.35,0.90); P=0.02]. However, median progression-free survival (PFS), 1-year survival rate, and median overall survival (OS) were not extended by XAPI plus XELOX. Combination treatment with XAPI and the SOX regimen (tegafur plus oxaliplatin) did not improve ORR or DCR, but it did enhance the KPS improvement rate [RR=1.73; 95%CI (1.23,2.43); P=0.002] and reduce the incidence of nausea and vomiting [RR=0.66; 95% CI (0.50, 0.88); P=0.004]. XAPI in combination with the FOLFOX regimen (fluorouracil/calcium folinate/oxaliplatin) enhanced only the KPS improvement rate [RR=1.68; 95%CI (1.18,2.39); P=0.004] and had no significant effect on ORR or DCR or the incidence of adverse events. A single study reported that XAPI combined with the CPT-11 regimen (irinotecan) was superior to chemotherapy alone with respect to DCR and also reduced the incidence of leukopenia, liver damage, and hand-foot syndrome during chemotherapy, while prolonging PFS. Finally, one study reported that XAPI combined with the TP regimen (palitaxel plus cisplatin) improved ORR and KPS improvement rate to a greater extent than TP alone. Although the present review has some limitations, the findings suggest that XAPI combined with chemotherapy may represent a beneficial treatment strategy, particularly the combination of XAPI and XELOX.
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Klempner SJ, Maron SB, Chase L, Lomnicki S, Wainberg ZA, Catenacci DVT. Initial Report of Second-Line FOLFIRI in Combination with Ramucirumab in Advanced Gastroesophageal Adenocarcinomas: A Multi-Institutional Retrospective Analysis. Oncologist 2019; 24:475-482. [PMID: 30470690 PMCID: PMC6459251 DOI: 10.1634/theoncologist.2018-0602] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 10/16/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The randomized phase III RAINBOW trial established paclitaxel (pac) plus ramucirumab (ram) as a global standard for second-line (2L) therapy in advanced gastric and gastroesophageal junction adenocarcinoma, together gastroesophageal adenocarcinoma (GEA). Patients (pts) receiving first-line (1L) FOLFOX often develop neuropathy that renders continued neurotoxic agents in the 2L setting unappealing and other regimens more desirable. As such, FOLFIRI-ram has become an option for patients with 2L GEA. FOLFIRI-ramucirumab (ram) has demonstrated safety and activity in 2L colorectal cancer, but efficacy/safety data in GEA are lacking. SUBJECTS, MATERIALS, AND METHODS Patients with GEA treated with 2L FOLFIRI-ram between August 2014 and April 2018 were identified. Clinicopathologic data including oxaliplatin neurotoxicity rates/grades (G), 2L treatment response, progression-free survival (PFS), overall survival (OS), safety, and molecular features were abstracted from three U.S. academic institutions. Kaplan-Meier survival analysis was used to generate PFS/OS; the likelihood ratio test was used to determine statistical significance. RESULTS We identified 29 pts who received 2L FOLFIRI-ram. All pts received 1L platinum + fluoropyrimidine, and 23 of 29 (79%) had post-1L neuropathy; 12 (41%) had G1, and 11 (38%) had G2. Patients were evenly split between esophagus/gastroesophageal junction (12; 41%) and gastric cancer (17; 59%). Among evaluable pts (26/29), the overall response rate was 23% (all partial response) with a disease control rate of 79%. Median PFS was 6.0 months and median OS was 13.4 months among all evaluable pts. Six- and 12-month OS were 90% (n = 18/20) and 41% (n = 7/17). There were no new safety signals. CONCLUSION We provide the first data suggesting FOLFIRI-ram is a safe, non-neurotoxic regimen comparing favorably with the combination of pac + ram used in the seminal RAINBOW trial. IMPLICATIONS FOR PRACTICE Results of this study provide initial support for the safety and efficacy of second-line (2L) FOLFIRI-ramucirumab (ram) after progression on first-line platinum/fluoropyrimidine in patients with gastroesophageal adenocarcinoma (GEA). The overall response, progression-free survival, overall survival, and toxicity profile compare favorably with paclitaxel (pac) + ram and highlight the importance of the ongoing phase II RAMIRIS trial examining FOLFIRI-ram versus pac + ram in 2L GEA (NCT03081143). FOLFIRI-ram may warrant consideration for inclusion as an alternate regimen in consensus guidelines for GEA.
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Affiliation(s)
- Samuel J Klempner
- The Angeles Clinic and Research Institute, Los Angeles, California, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Steven B Maron
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois, USA
| | - Leah Chase
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois, USA
| | - Samantha Lomnicki
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois, USA
| | - Zev A Wainberg
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Daniel V T Catenacci
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois, USA
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30
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Hospital Utilization in Patients With Gastric Cancer and Factors Affecting In-Hospital Mortality, Length of Stay, and Costs. J Clin Gastroenterol 2019. [PMID: 29517707 DOI: 10.1097/mcg.0000000000001016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Although gastric cancer (GC) rates have been declining in the United States, it continues to be a major cause of morbidity. This study examined trends in hospital admissions, in-hospital mortality, length of stay (LOS), and inpatient costs related to GC. In addition, various factors associated with in-hospital mortality, LOS, and inpatient costs were examined. METHODS National inpatient sample-the largest publicly available all-payer inpatient care database-was interrogated to obtain information about various demographic and hospital-related factors (including those mentioned above) in patients who were primarily admitted for GC between the years 1998 to 2013. These trends were analyzed. Multivariate analysis was also performed to identify risk factors associated with LOS, costs, and mortality. RESULTS A total of 679,330 hospital discharges with the principal diagnosis of GC were obtained. Hospital stays increased by approximately 340 stays per year (±110; P=0.00079). However, inpatient mortality rate and LOS declined by 0.36% per year (±0.024%; P<0.0001), and 0.11 days per year (±0.01; P<0.0001), respectively. The inpatient charges have increased at the rate of $3241 per year (±133.3; P<0.0001). Differences in mortality rate, LOS, and inpatient costs were affected by multiple factors. CONCLUSIONS Despite the overall decline in GC incidence, the incidence of hospitalizations per 100,000 US population related to GC did not change significantly. Although LOS and mortality declined, inpatient charges increased over the study period.
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31
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Zhang H, Jiang H, Zhang H, Liu J, Hu X, Chen L. Ribophorin II potentiates P-glycoprotein- and ABCG2-mediated multidrug resistance via activating ERK pathway in gastric cancer. Int J Biol Macromol 2019; 128:574-582. [PMID: 30710584 DOI: 10.1016/j.ijbiomac.2019.01.195] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/15/2019] [Accepted: 01/29/2019] [Indexed: 12/12/2022]
Abstract
Multidrug resistance (MDR) is a critical reason of cancer chemotherapy failure. Ribophorin II (RPN2) has emerged as a vital regulator of MDR in multiple cancers including gastric cancer (GC). However, the roles and molecular mechanisms of RPN2 in MDR have not been well featured till now. The present study aimed to explore the roles and molecular mechanisms of RPN2 in MDR of drug-resistant GC cells. Results showed that the expressions of RPN2, multidrug resistance 1 (MDR1), and ATP binding cassette subfamily G member 2 (ABCG2) were upregulated in SGC7901/DDP and SGC7901/VCR cells. Knockdown of RPN2 alleviated MDR through downregulating MDR1 and ABCG2 expressions in SGC7901/DDP and SGC7901/VCR cells. RPN2 depletion inhibited the activation of MEK/ERK pathway. RPN2 overexpression enhanced MDR by upregulating P-glycoprotein (P-gp) and ABCG2 protein expressions in SGC7901/DDP or SGC7901/VCR cells, while this effect of RPN2 was abrogated by ERK knockdown or treatment with ERK inhibitor PD98059. Our findings suggested that RPN2 potentiated P-gp- and ABCG2-mediated MDR via activating MEK/ERK pathway in GC, hinting the critical values of RPN2 in ameliorating MDR and providing a promising target for GC therapy.
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Affiliation(s)
- Hongzhi Zhang
- Department of Radiotherapy, Huaihe Hospital of Henan University, Kaifeng 475000, PR China.
| | - Huijuan Jiang
- Department of Radiotherapy, Huaihe Hospital of Henan University, Kaifeng 475000, PR China
| | - Huixiang Zhang
- Department of Radiotherapy, Huaihe Hospital of Henan University, Kaifeng 475000, PR China
| | - Juncai Liu
- Department of Radiotherapy, Huaihe Hospital of Henan University, Kaifeng 475000, PR China
| | - Xigang Hu
- Department of Radiotherapy, Huaihe Hospital of Henan University, Kaifeng 475000, PR China
| | - Lei Chen
- Department of Radiotherapy, Huaihe Hospital of Henan University, Kaifeng 475000, PR China
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Yang L, Wang X, Wang B, Chao P, Li D, Chai C. The clinical outcomes of S-1 plus cisplatin for patients with advanced gastric cancer: A meta-analysis and systematic review. Medicine (Baltimore) 2018; 97:e12789. [PMID: 30544367 PMCID: PMC6310499 DOI: 10.1097/md.0000000000012789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/12/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To evaluate the clinical outcomes of S-1 plus cisplatin (SC) for the treatment of patients with advanced gastric cancer (AGC). METHODS A systematic literature search was conducted by searching PubMed, the Cochrane Library, Embase, China Biology Medicine disc (CBMdisc), China National Knowledge Infrastructure (CNKI), and WanFang Database, for all year up to January 2017. Pooled analyses of overall survival (OS), progress-free survival rates, and adverse events were performed. RESULTS A total of 8 random controlled trails (RCTs) consisting of 2699 patients with AGC were selected and included in this meta-analysis. The results of our meta-analysis showed that AGC patients who treated with SC regimen receive a similar OS (HR = 1.01, 95%CI: 0.86-1.18, P = .928), PFS (HR = 0.89, 95%CI: 0.72-1.09, P = .263), and overall response rate (HR = 0.88, 95%CI: 0.70-1.11, P = .283). However, SC regimen may increase the risk of 1 to 2 grade (OR = 1.128, 95%CI: 1.075-1.184, P = .000) and 3 to 4 grade (OR = 1.24, 95%CI: 1.01-1.52, P = .039) adverse events. CONCLUSION SC chemotherapy showed no difference in survival compared with 5-FU- and S-1-based other therapy, but has a higher rate of adverse events compared with other chemotherapy regimens.
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Affiliation(s)
- Lei Yang
- Department of General Surgery, First Hospital of Lanzhou University
| | - Xingcheng Wang
- Department of General Surgery, First Hospital of Lanzhou University
- The First Clinical College of Lanzhou University, Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Binsheng Wang
- Department of General Surgery, First Hospital of Lanzhou University
| | - Peng Chao
- Department of General Surgery, First Hospital of Lanzhou University
| | - Debang Li
- Department of General Surgery, First Hospital of Lanzhou University
| | - Chen Chai
- Department of General Surgery, First Hospital of Lanzhou University
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Casamayor M, Morlock R, Maeda H, Ajani J. Targeted literature review of the global burden of gastric cancer. Ecancermedicalscience 2018; 12:883. [PMID: 30679950 PMCID: PMC6345079 DOI: 10.3332/ecancer.2018.883] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Indexed: 12/12/2022] Open
Abstract
Gastric cancer (GC) and gastroesophageal junction cancers (GEJCs) are the third leading cause of cancer-related death worldwide. Although several studies have evaluated the epidemiology and management of GC and GEJC, to our knowledge, no global estimates of the economic burden of GC and GEJC have yet been reported. This targeted literature review was conducted to summarise the epidemiology and management of GC and GEJC and to estimate its global economic and humanistic burden. The incidence of GC and GEJC is highest in Eastern Asia, several South and Central American countries and Central and Eastern Europe and lowest in North America and Africa. Prognosis is generally poor; the global 5-year survival rate is 5%-10% in advanced stages. Patients with GC and GEJC have more severe symptoms compared with patients with other cancers, and health-related quality of life (HRQoL) worsens as the disease progresses. Given the rapid progression of GC and GEJC at advanced stages, chemotherapy, despite its toxicity, improves HRQoL compared with best supportive care. The costs of GC/GEJC are generally higher than for other cancers; in the US, the average annual cost per patient between 1998 and 2003 was 46,501 USD, compared with 29,609 USD and 35,672 USD for colorectal and lung cancer, respectively. Based on the 2012 incidence data and average costs per patient, estimates of the annual financial burden of GC and GEJC revealed great regional differences. Japan and Iran had the highest (8,492 million USD) and lowest (27 million USD) costs for 2017, respectively, while the estimate for the US was 3,171 million USD. The overall annual cost of GC and GEJC estimated for 2017 in a geographic area including Europe (France, Germany, Italy, Spain and the UK), Asia (Iran, Japan and China), North America (Canada and the US) and Australia was 20.6 billion USD.
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Affiliation(s)
| | - Robert Morlock
- Astellas Pharma Global Development, Inc., 1 Astellas Way, Northbrook, IL 60062 USA
| | - Hiroshi Maeda
- Astellas Pharma Global Development, Inc., 1 Astellas Way, Northbrook, IL 60062 USA
| | - Jaffer Ajani
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
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Zhong S, Wang J, Hou J, Zhang Q, Xu H, Hu J, Zhao J, Feng J. Circular RNA hsa_circ_0000993 inhibits metastasis of gastric cancer cells. Epigenomics 2018; 10:1301-1313. [PMID: 30215537 DOI: 10.2217/epi-2017-0173] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Shanliang Zhong
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, PR China
| | - Jinyan Wang
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, PR China
| | - Junchen Hou
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, PR China
| | - Qian Zhang
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, PR China
| | - Hanzi Xu
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210009, PR China
| | - Jiahua Hu
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, PR China
| | - Jianhua Zhao
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, PR China
| | - Jifeng Feng
- Department of Medical Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, PR China
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Abrams T, Hess LM, Zhu YE, Schelman W, Liepa AM, Fuchs C. Predictors of heterogeneity in the first-line treatment of patients with advanced/metastatic gastric cancer in the U.S. Gastric Cancer 2018; 21:738-744. [PMID: 29392573 DOI: 10.1007/s10120-018-0802-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/24/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with metastatic gastric cancer have a poor prognosis (5-year survival of less than 10%). This study was designed to describe the treatment patterns of patients with gastric cancer and to understand the factors associated with treatment choices to inform evidence-based care. METHODS A retrospective observational study was conducted using two real-world databases to describe treatment trends and to quantify variability in treatment patterns of patients diagnosed with advanced/metastatic gastric cancer between 1/1/2007 and 9/30/2014 in the U.S. Heterogeneity was measured by the Herfindahl-Hirschman Index (HHI). Predictors (baseline clinical, treatment, and demographic variables) of treatment regimen choice were evaluated using logistic regression. RESULTS A total of 5772 patients with advanced/metastatic gastric cancer were included in this study [5044 from claims data and 728 from electronic medical records (EMR)]. Of the 5044 from claims data, 2457 had evidence of metastatic disease at diagnosis. Only the fluorouracil + oxaliplatin regimen exceeded 10% utilization in the first-line setting [claims metastatic (12.1%), claims advanced (8.2%), and EMR metastatic (16.6%) cohorts]. The HHI demonstrated extreme heterogeneity (0.14 for first-line therapy and 0.13 for second-line therapy). Patient age and geographic region of residence were significantly associated with treatment choice across all three cohorts in the first-line setting (p < 0.05). CONCLUSION Treatment of patients with gastric cancer was highly variable. Despite the availability of treatment guidelines, there is a lack of consistent treatment patterns. There is a need to improve evidence-based care for patients with gastric cancer.
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Affiliation(s)
- Thomas Abrams
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Lisa M Hess
- Eli Lilly and Company, Global Patient Outcomes and Real World Evidence, Corporate Center, DC 5220, Indianapolis, IN, 46254, USA.
| | - Yajun Emily Zhu
- Eli Lilly and Company, Global Patient Outcomes and Real World Evidence, Corporate Center, DC 5220, Indianapolis, IN, 46254, USA
| | - William Schelman
- Eli Lilly and Company, US Medical Affairs, Indianapolis, IN, USA
| | - Astra M Liepa
- Eli Lilly and Company, Global Patient Outcomes and Real World Evidence, Corporate Center, DC 5220, Indianapolis, IN, 46254, USA
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Patient Experience After Receiving a Diagnosis of Gastric Cancer in the USA. J Gastrointest Cancer 2018; 49:25-34. [PMID: 27975181 DOI: 10.1007/s12029-016-9904-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE This study investigated the patient perspective during cancer treatment and throughout the survivorship period and to understand how the patient experience may be related to choices for the treatment of gastric cancer. METHODS Eligible patients in the Vector Oncology electronic medical records database were ≥18 years of age, diagnosed with gastric cancer, and received active treatment. Quality of life (QOL) was collected using the Patient Care Monitor (PCM). Time to deterioration in QOL and overall survival were measured, adjusting for demographic and baseline clinical characteristics. Logistic regression model and classification and regression trees (CART) were used to identify factors associated with treatment choice. RESULTS There were 776 patients in this study, of whom 301 (38.8%) reported QOL data. Most patients reported problems on all PCM subscales; problems were more common during the treatment period. Median time to deterioration of PCM subscales ranged from 42 days for treatment side effects to 331 days for impaired performance. Median survival was low: 6.9 and 5.5 months from the start of first- and second-line therapy, respectively. The choices made between therapeutic options were primarily associated with the site at which the oncologist practiced. CONCLUSIONS Patients with gastric cancer report a considerable number of concerns on all subscales of the PCM, particularly during active treatment periods. The treatment heterogeneity and relative lack of clinical and symptom- or QOL-related factors associated with treatment choice suggest a gap in evidence that must be filled.
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Treatment Patterns Among Patients with Metastatic and/or Unresectable Gastric Cancer in Brazil. J Gastrointest Cancer 2018; 50:780-793. [PMID: 30078125 DOI: 10.1007/s12029-018-0145-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE In Brazil, patients with gastric cancer have not been systematically followed-up and evaluated, thus data regarding patterns of care and outcomes are scarce or missing. The objective of this study was to evaluate patterns of care of advanced gastric cancer in standard practice in Brazil. METHODS This was an observational, multicenter, retrospective study, which included patients with metastatic and/or unresectable gastric cancer (MGC) who underwent at least one line of treatment. RESULTS We analyzed data on 155 patients diagnosed with MGC, most are men (57.4%), with mean age of 61.9 years at diagnosis, with 99 (63.9%) from the public healthcare system and 56 (36.1%) from the private setting. Platinum- and/or fluoropyrimidine-containing regimens prevailed as first-line therapy, while irinotecan was the most used regimen in the second and in the third lines. More than 40% of patients underwent only one line of systemic therapy, of which around 40% either died during the treatment or went on to best supportive care (BSC) only. The remaining patients received further treatment lines. A fifth of the patients in the study died within two months after discontinuation of the first-line treatment. Adverse events, use of concomitant medications, support procedures, outpatient visits, and hospitalizations were reported for most patients, especially in the first and second lines of treatment and during exclusive BSC. CONCLUSIONS Survival during or after the first-line chemotherapy remains poor among patients with MGC. Adverse events and health resource use were common in the first and second lines of treatment and in exclusive BSC. These results suggest that there is space for improvement in the treatment of MGC in Brazil.
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Cui ZL, Hess LM, Goodloe R, Faries D. Application and comparison of generalized propensity score matching versus pairwise propensity score matching. J Comp Eff Res 2018; 7:923-934. [PMID: 29925271 DOI: 10.2217/cer-2018-0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM A comparison of conventional pairwise propensity score matching (PSM) and generalized PSM method was applied to the comparative effectiveness of multiple treatment options for lung cancer. MATERIALS & METHODS Deidentified data were analyzed. Covariate balances between compared treatments were assessed before and after PSM. Cox proportional hazards regression compared overall survival after PSM. RESULTS & CONCLUSION The generalized PSM analyses were able to retain 61.2% of patients, while the conventional PSM analyses were able to match from 24.1 to 77.1% of patients from each treatment comparison. The generalized PSM achieved statistical significance (p < 0.05) in 8/10 comparisons, whereas conventional pairwise PSM achieved 1/10. The noted differences arose from different matched patient samples and the size of the samples.
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Affiliation(s)
- Zhanglin L Cui
- Global Patient Outcomes & Real World Evidence, Eli Lilly & Company, Indianapolis, IN 46285, USA
| | - Lisa M Hess
- Global Patient Outcomes & Real World Evidence, Eli Lilly & Company, Indianapolis, IN 46285, USA
| | - Robert Goodloe
- Global Patient Outcomes & Real World Evidence, Eli Lilly & Company, Indianapolis, IN 46285, USA
| | - Doug Faries
- Global Patient Outcomes & Real World Evidence, Eli Lilly & Company, Indianapolis, IN 46285, USA
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Erdem GU, Bozkaya Y, Ozdemir NY, Demirci NS, Yazici O, Zengin N. 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI) as a third-line chemotherapy treatment in metastatic gastric cancer, after failure of fluoropyrimidine, platinum, anthracycline, and taxane. Bosn J Basic Med Sci 2018; 18:170-177. [PMID: 28941466 DOI: 10.17305/bjbms.2017.2258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 02/01/2023] Open
Abstract
Studies on the effects of third-line chemotherapy (CT) in advanced gastric cancer (GC) patients are still scarce. The aim of this study was to evaluate the efficacy and safety of the modified 5-fluorouracil, leucovorin, and irinotecan (mFOLFIRI) regimen as a third-line CT in metastatic GC patients, after failure of fluoropyrimidine, platinum, anthracycline, and taxane. After failure of first- and second-line therapies, 42 patients received third-line FOLFIRI (180 mg/m² irinotecan and 400 mg/m² leucovorin administered concomitantly as a 90-minute intravenous (IV) infusion on day 1, followed by a 400 mg/m² 5-fluorouracil IV bolus then 2600 mg/m² continuous infusion over 46 hours), between January 2009 and December 2015. FOLFIRI was administered for a median of 6 cycles (range 4-12 cycles). Eight patients achieved partial response, while 13 patients showed stable disease, resulting in the overall response rate (ORR) of 19% and disease control rate (DCR) of 50%. The most frequent grade 3-4 hematological and non-hematological toxicities were neutropenia (14.2%) and diarrhea (7.1%). The median progression-free survival (PFS) and overall survival (OS) from the start of third-line CT were 3.8 months (95% confidence interval [CI], 3.0-4.5) and 6.8 months (95% CI, 5.6-7.9), respectively. According to the multivariate analysis, two factors were independently predictive of the poor OS: >2 regions of metastasis (relative risk [RR], 2.6; 95% CI, 1.3-5.4) and a high level of carcinoembryonic antigen [CEA] (RR, 3.4; 95% CI, 1.6-7.4). In conclusion, FOLFIRI was well tolerated as third-line CT and showed promising PFS and OS in advanced GC patients, after failure of fluoropyrimidine, platinum, anthracycline, and taxane.
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Affiliation(s)
- Gokmen Umut Erdem
- Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
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Szabo SM, Hirji I, Johnston KM, Juarez-Garcia A, Connors JM. Treatment patterns and costs of care for patients with relapsed and refractory Hodgkin lymphoma treated with brentuximab vedotin in the United States: A retrospective cohort study. PLoS One 2017; 12:e0180261. [PMID: 28991893 PMCID: PMC5633181 DOI: 10.1371/journal.pone.0180261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Although brentuximab vedotin (BV) has changed the management of patients with relapsed or refractory Hodgkin lymphoma (RRHL), little information is available on routine clinical practice. We identified treatment patterns and costs of care among RRHL patients in the United States (US) treated with BV. METHODS A retrospective observational study of adults initiating BV for RRHL from 2011-2015, with ≥6 months of data prior to and following BV initiation, was conducted. Treatments were classified based on dispensations and chemotherapy administration. Median total and monthly costs were estimated based on all-cause healthcare resource use in 2015 US dollars (USD). RESULTS The cohort comprised 289 patients (59% male; mean age at diagnosis, 42 years) with a mean follow-up of 250 weeks. Eleven percent had BV salvage therapy prior to ASCT, and 32% had BV for a relapse post-ASCT. 43% received treatment post-BV, most commonly allogeneic stem cell transplant (SCT) and bendamustine (both 10.2%). Median (IQR) total costs from BV initiation to censoring were 294,790 (142,110-483,360) USD; and were highest among those treated with BV prior to ASCT (up to 421,900 [300,940-778,970] USD). Median monthly costs were almost 20,000 USD per month, and up to 25,000 USD per month among those with BV and ASCT. Medications were the greatest driver of median monthly costs. CONCLUSIONS Median total all-cause costs were almost 300,000 USD, and median monthly costs approximately 20,000 USD, per patient treated. Patients requiring treatment following BV continue to incur high costs, highlighting the economic burden associated with managing patients in the RRHL setting.
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Affiliation(s)
| | - Ishan Hirji
- Bristol-Myers Squibb, Princeton, New Jersey, United States of America
| | | | | | - Joseph M. Connors
- BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
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Abstract
BACKGOUND Little information regarding to the survival advantage of third-line chemotherapy in advanced gastric cancer patients is available. The current study is designed to systematically review and perform meta-analysis on the effect of third-line chemotherapy on progressive or recurrent gastric cancer treatment. METHODS After thorough searching of online databases, total 20 articles were included into qualitative systematic review and 6 of them were used to conduct qualitative meta-analysis. RESULTS It was found that the third-line chemotherapy was superior to placebo or best supportive care in terms of prolonging median oval survival (OS) length and progress free survival (PFS) length (Hedges's g for OS = -0.315 ± 0.077, P < .001; and for PFS = -0.382 ± 0.098, P < .001). In addition, the third-line chemotherapy was favored (Hedges's g = 0.848, P < .001) in terms of overall survival rate (Hazard ratio = 0.679, 95% confidence interval: 0.565-0.816, P < .001) or tumor free survival rate (Hazard ratio = 0.561, 95% confidence interval: 0.444-0.709, P < .001). CONCLUSION The third-line chemotherapy is superior to the best supportive care in advanced gastric cancer patients who had been pretreated with first-line and second-line chemotherapy.
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Affiliation(s)
- Yu Zheng
- Department of Medical Oncology, Sir Run Run Shao Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xu-Qing Zhu
- Department of Gastroenterology, Taizhou Municipal Hospital, Taizhou
| | - Xiao-Gang Ren
- Department of Urinary Surgery, Zhejiang Provincial Hospital of TCM, Hangzhou, China
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Xu GY, Tang XJ. Troxerutin (TXN) potentiated 5-Fluorouracil (5-Fu) treatment of human gastric cancer through suppressing STAT3/NF-κB and Bcl-2 signaling pathways. Biomed Pharmacother 2017; 92:95-107. [PMID: 28531805 DOI: 10.1016/j.biopha.2017.04.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/05/2017] [Accepted: 04/13/2017] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer still presents a significant problem for public health worldwide. Troxerutin (TXN), a flavonoid present in tea, coffee, cereal grains, and a variety of fruits and vegetables, exhibits various pharmacological and biological activities in vitro and in vivo. We investigated the ability of TXN to reverse the in vitro and in vivo drug resistance of human gastric cancer cells, which were resistant to treatment of 5-Fluorouracil (5-FU). 5-Fu is a pyrimidine analog, which is widely used in the treatment of cancers. Here, we found the growth inhibitory effects of TXN on human gastric cancer cell, resistant to 5-FU. TXN and 5-FU co-treatment resulted in a dose-dependent suppression of the cell proliferation. Decreasing of phosphorylated signal transducers and activation of transcription 3 (STAT3) was included in suppression of p65 by TXN with 5-FU in combination. Additionally, the presence of TXN sensitized gastric cancer cells resistant to 5-FU to 5-FU-induced apoptosis by suppressing Bcl-2. The pro-apoptotic proteins of Bax and Bid were up-regulated, accompanied with Caspase cleavage, leading to apoptosis. Moreover, in mice xenograft models, the combined therapy inhibited tumor growth compared to the TXN or 5-FU treatment alone. Our data indicated a novel therapeutic strategy to potentiate 5-FU-induced anti-tumor effect in gastric cancer cells with resistance to 5-FU by TXN through suppression of p-STAT3/NF-κB (p65 and p50) and Bcl-2.
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Affiliation(s)
- Gui-Yun Xu
- Department of General Surgery, The Second People's Hospital of Huai'an, The Huai'an Hospital Affiliated with Xuzhou Medical College, Huai'an 223002, China; Department of General Surgery, Huai'an First People's Hospital, Nanjing Medical University, Huai'an 223002, China
| | - Xiao-Jun Tang
- Department of General Surgery, The Second People's Hospital of Huai'an, The Huai'an Hospital Affiliated with Xuzhou Medical College, Huai'an 223002, China; Department of General Surgery, Huai'an First People's Hospital, Nanjing Medical University, Huai'an 223002, China.
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Pasquini G, Vasile E, Caparello C, Vivaldi C, Musettini G, Lencioni M, Petrini I, Fornaro L, Falcone A. Third-Line Chemotherapy with Irinotecan plus 5-Fluorouracil in Caucasian Metastatic Gastric Cancer Patients. Oncology 2016; 91:311-316. [PMID: 27705972 DOI: 10.1159/000443962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/15/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate the activity of the combination of 5-fluorouracil/folinic acid and irinotecan (FOLFIRI) as third-line chemotherapy (CT) in metastatic gastric cancer (mGC) patients pretreated with platinum derivatives, fluoropyrimidines, and taxanes. METHODS We prospectively collected data of mGC patients treated with third-line FOLFIRI at our institution from 2009 to 2014. Eligible patients should be treated with a fluoropyrimidine-platinum first-line CT and a subsequent taxane-based second-line CT. FOLFIRI consisted of irinotecan 180 mg/m2 and leucovorin 200 mg/m2, followed by 5-fluorouracil 2,800 mg/m2 (administered as 48-hour i.v. continuous infusion from day 1 to 3), with cycles repeated every 2 weeks. Response rate (RR) was evaluated according to RECIST version 1.0, while progression-free (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS A total of 33 patients were included. The majority (97%) had good performance status (0-1 according to ECOG), while median PFS after first-line and second-line CT was 5.2 and 4.4 months, respectively. Two patients experienced an objective response (RR: 6%), while 14 patients achieved disease stabilization (disease control rate: 42%). Median PFS and OS from the start of third-line CT were 3.3 and 7.5 months, respectively. Hematological and nonhematological grade 3-4 toxicities were uncommon and included neutropenia (6.1%), diarrhea (9.1%), vomiting (3%), and asthenia (3%). Febrile neutropenia was not reported. CONCLUSIONS Third-line CT with FOLFIRI may be an option in heavily pretreated mGC patients with preserved performance status and organ function. This regimen has a favorable safety profile, and signs of activity have been observed after standard first- and second-line CT.
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Affiliation(s)
- Giulia Pasquini
- Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Russell MC. Comparison of neoadjuvant versus a surgery first approach for gastric and esophagogastric cancer. J Surg Oncol 2016; 114:296-303. [PMID: 27511285 DOI: 10.1002/jso.24293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/11/2016] [Indexed: 01/24/2023]
Abstract
Gastric cancer remains a significant worldwide health concern. While surgery is required for cure, all but the earliest of cancers will require multimodality therapy. Chemotherapy and chemoradiation in the neoadjuvant and adjuvant settings have shown to improve overall survival, but the sequencing of treatment is controversial. As healthcare expenses surge, it is increasingly important to impart value to these treatments. This review will look at the intersection of effective treatment and costs for gastric cancer. J. Surg. Oncol. 2016;114:296-303. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Maria C Russell
- Department of Surgery, Emory University Hospital, Atlanta, Georgia
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Cuyun Carter G, Kaltenboeck A, Ivanova J, Liepa AM, San Roman A, Koh M, Rajan N, Cheng R, Birnbaum H, Chen JS. Treatment patterns in patients with advanced gastric cancer in Taiwan. Asia Pac J Clin Oncol 2016; 13:185-194. [DOI: 10.1111/ajco.12497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/09/2016] [Accepted: 03/13/2016] [Indexed: 02/02/2023]
Affiliation(s)
| | | | | | | | | | - Maria Koh
- Analysis Group; New York New York USA
| | | | | | | | - Jen-Shi Chen
- Division of Hematology/Oncology; Linkou Chang Gung Memorial Hospital and Chang Gung University; Tao-Yuan Taiwan
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Zhong J, Zhao W, Ma W, Ren F, Qi S, Zheng J, Wang X, Lv T, Su Z, Yin H, Ren J, Huan Y. DWI as a Quantitative Biomarker in Predicting Chemotherapeutic Efficacy at Multitime Points on Gastric Cancer Lymph Nodes Metastases. Medicine (Baltimore) 2016; 95:e3236. [PMID: 27043694 PMCID: PMC4998555 DOI: 10.1097/md.0000000000003236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The purpose of the hypothesis testing is to determine that apparent diffusion coefficient (ADC) as an early biomarker can predict the metastatic lymph nodes' (LNs) response to neoadjuvant chemotherapy in advanced gastric cancer (GC) in early stage. From March 2011 to June 2015, 106 patients with advanced GC were enrolled in the study. Patients underwent conventional magnetic resonance imaging and functional diffusion weighted imaging before and 3 days, 7 days, 30 days, and 60 days following the standard chemotherapy. After surgery, among 3034 detected LNs, the positive group was divided into complete response (CR) group, partial response (PR) group, and stable disease (SD) group in accordance to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Mean ADCs, short/long diameters of LNs before chemotherapy between the whole positive and the negative LNs were compared by t test. Changes of mean ADCs in 3 groups were analyzed by 1-way ANOVA. The mean ADC of the whole positive LNs was (1.145 ± 0.014) × 10⁻³ mm²/s, which was significantly lower than that of the whole negative LNs ([1.491 ± 0.010] × 10⁻³ mm²/s; P < 0.05). The means of both short/long diameters in the whole positive LNs were significantly longer than those in the whole negative LNs (P < 0.05). In CR, PR, and SD groups, the mean ADC of metastatic LNs on the 3rd day, 7th day, 13th day, and 16th day following the chemotherapy were all higher than that of LNs before chemotherapy, respectively (all P < 0.05). In addition, significant difference was found between mean ADCs in any 2 time points (all P < 0.05), except between mean ADCs in the 3rd day and in the 7th day of the chemotherapy. In conclusion, ADC can be used as an early biomarker to predict the metastatic LNs' response to neoadjuvant chemotherapy in advanced GC in early stage.
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Affiliation(s)
- Jinman Zhong
- From the Department of Radiology (JZ, WZ, WM, FR, SQ, JZ, HY, JR, YH), Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China; and Department of Radiology (XW, TL, ZS, JR), Feinberg School of Medicine, Northwestern University, Chicago, IL
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