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Tangella AV. The Evolving Role of Intra-arterial Chemotherapy in Adult and Pediatric Cancers: A Comprehensive Review. Cureus 2023; 15:e46631. [PMID: 37808598 PMCID: PMC10559942 DOI: 10.7759/cureus.46631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 10/10/2023] Open
Abstract
The development of intra-arterial chemotherapy (IAC) was driven by an ambition to mitigate systemic side effects, enhance the bioavailability of drugs, and optimize the efficacy of chemotherapeutic agents. While the initial research on IAC primarily examined its effectiveness in treating various liver malignancies, the application of this treatment has undergone significant advancements since its introduction. The primary objective of this article is to examine the current range of utilization of IAC, both with and without radiotherapy, while also evaluating the results of relevant clinical trials. Furthermore, this article explores potential future advancements and opportunities in this field. From the scoping review of available articles, it can be concluded that IAC is an effective treatment alternative and, sometimes, a better first-line option, but there is a need for more evidence to make IAC a regular treatment option available for patients.
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Affiliation(s)
- Adarsh Vardhan Tangella
- Internal Medicine, Andhra Medical College, Visakhapatnam, IND
- Internal Medicine, King George Hospital, Visakhapatnam, IND
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Guo F, Xiang X, Huang Y, Chen A, Ma L, Zhu X, Abdulla Z, Jiang W, Li J, Li G. Long-term survival outcome of locally advanced gastric cancer patients who achieved a pathological complete response to neoadjuvant chemotherapy. Int J Clin Oncol 2023; 28:1158-1165. [PMID: 37318644 DOI: 10.1007/s10147-023-02369-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Long-term outcome of patients with locally advanced gastric cancer (LAGC) who achieved a pathological complete response (pCR) was scarcely discussed, and never had the factors affecting the prognosis of pCR patients been investigated. METHODS We retrospectively reviewed all patients who achieved a pCR to neoadjuvant chemotherapy (NAC) in Jinling Hospital. The 3- and 5-year overall survival (OS) and progression-free survival (PFS) were calculated with the Kaplan-Meier method. Meanwhile, univariate and multivariate COX regression analysis was applied to identify prognostic factors affecting patients' survival. RESULTS A total of 37 consecutive LAGC patients with pCR were included. The 3- and 5-year OS rates were 88.8% and 78.6%, and the 3- and 5-year PFS rates were 86.5% and 75.8%. In the multivariate COX model, NAC duration of more than 3 cycles (HR 0.11 [0.02-0.62], P = 0.013) and poorly differentiated tumor at diagnosis (HR 0.17 [0.03-0.95], P = 0.043) were detected as protective factors for patients OS. Whereas for PFS, NAC duration (HR 0.12 [0.02-0.67], P = 0.015) was the only protective factor confirmed, with tumor differentiation at diagnosis exhibiting marginal significance (HR 0.21 [0.04-1.09], P = 0.063). CONCLUSIONS Patients with LAGC who achieved a pCR displayed favorable long-term survival outcome, especially those with adequate cycles (≥ 3) of NAC. Besides, poor differentiation at diagnosis might also predict the better OS when pCR achieved.
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Affiliation(s)
- Feilong Guo
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Xiaosong Xiang
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Yuhua Huang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Aoxue Chen
- Department of Neurology, Huashan Hospital, Fudan University, No. 12 Urumchi Middle Road, Shanghai, 200040, China
| | - Long Ma
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Xi Zhu
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Zulpikar Abdulla
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Wendi Jiang
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Jiafei Li
- Department of Biostatistics, Columbia University, New York, NY, 10032, USA
| | - Guoli Li
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China.
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Xiang X, Guo F, Li G, Ma L, Zhu X, Abdulla Z, Li J, Zhang J, Huang M. Efficacy of intra-arterial chemotherapy with sequential anti-PD-1 antibody in unresectable gastric cancer: A retrospective real-world study. Front Oncol 2023; 12:1015962. [PMID: 36686751 PMCID: PMC9849699 DOI: 10.3389/fonc.2022.1015962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023] Open
Abstract
Background The prognosis of unresectable gastric cancer is poor, while the efficacy of anti-PD antibodies has not been evaluated. Methods Patients with unresectable gastric cancer who received intra-arterial chemotherapy (IAC) with sequential anti-PD-1 antibody as induction therapy in Jinling Hospital were retrospectively analyzed. The primary outcome is R0 resection rate. The secondary outcomes include safety, conversion surgery rate, overall survival (OS) and progression free survival (PFS) after postoperative IAC and anti-PD-1 treatments. Meanwhile, Tumor immunity in the microenvironment (TIME) before and after IAC was comprehensively dissected with multiplex immunofluorescence in order to detect possible mechanisms favoring anti-PD-1 treatment response. Results Between May 2019 and October 2020, 36 patients received at least one cycle of IAC with sequential anti-PD-1 antibody in our institution. The objective response was achieved in 28 patients (77.8%). Thirty patients (83.3%) successfully underwent conversion surgery, among which R0 resection was managed in 25/30 patients, and 23.3% (7/30) was assessed as pathological complete remission. During the median follow-up period of 19.7 months, patients who underwent R0 resection displayed superior OS (HR 0.14 [95% CI 0.04-0.50], P < 0.0001) and PFS (HR 0.11 [0.03-0.44], P < 0.0001) than those who did not. Grade 3 adverse events (AEs) were only encountered in 19.4% patients, no grade 4 AEs observed. In TIME analysis, the number of tertiary lymphoid structures (TLSs) (P = 0.004) were greatly induced by IAC, as well as CD8+ T cells (P = 0.011) and PD-1+ cells (P = 0.025). Meanwhile, Tumor associated macrophages shifted towards anti-tumor M1-like subtypes, with CD68+CD163+ M2-like subpopulation significantly decreased (P = 0.04). Conclusion Preoperative IAC with sequential anti-PD-1 antibody exhibited promising clinical benefit for unresectable gastric cancer with remarkable conversion rate and R0 resection rate, and also prolonged survival as postoperative regimen. TIME transformation induced by ICA might mediate the additive effect with the immune checkpoint inhibitor.
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Affiliation(s)
- Xiaosong Xiang
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Feilong Guo
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Guoli Li
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China,*Correspondence: Guoli Li,
| | - Long Ma
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Xi Zhu
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Zulpikar Abdulla
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jiafei Li
- Department of Biostatistics, Columbia University, New York, NY, United States
| | - Junling Zhang
- The Medical Department, 3D Medicines Inc., Shanghai, China
| | - Mengli Huang
- The Medical Department, 3D Medicines Inc., Shanghai, China
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Li B, Tang R, Zhang G, Cheng J, Chao M, Ding K. The efficacy and safety of continuous intra-arterial infusion neoadjuvant chemotherapy with surgery for locally advanced gastric cancer: a preliminary pilot study. J Gastrointest Oncol 2022; 13:968-976. [PMID: 35837182 DOI: 10.21037/jgo-22-304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/27/2022] [Indexed: 02/03/2023] Open
Abstract
Background Neoadjuvant chemotherapy (NAC) followed by R0 resection is regarded as a standard treatment strategy for locally advanced gastric cancer (GC); however, the response to systemic chemotherapy remains unsatisfactory. Continuous intra-arterial infusion chemotherapy (CAIC) is a new method, compared with systematic chemotherapy, it can deliver chemotherapy drugs more accurately, so as to achieve higher surgical conversion rate. This study aimed to explore the efficacy and safety of CAIC in locally advanced GC patients. Methods In this retrospective pilot study, four patients with histologically confirmed locally advanced GC were identified from a tertiary hospital between May 2018 and December 2018. Clinic stage was belonged to T4N1-3M0 in all cases with potential probability for surgery. All cases received three cycles of NAC by CAIC with oxaliplatin (100 mg on day 1) plus oral S-1 (80 mg/m2/day twice daily for 14 days) (SOX). Contrast-enhanced computed tomography (CT) scans and pathological examinations were performed to evaluate chemotherapeutic response based on the tumor regression grade (TRG) and post-neoadjuvant pathological Tumor Node Metastasis (ypTNM) staging. All cases were regularly followed up with face-to-face interviews at outpatient, abdominal enhanced CT scan and serum tumor markers were be requested at 3-month intervals for up to 1 year postoperatively. Results The obstruction was significantly alleviated after three cycles of CAIC. Contrast-enhanced CT scans showed decreased tumor volume to some extent, along with lymph node shrinkage after treatment. Radical (R0) resection was achieved in all cases. Histopathological analysis showed tumor downstaging in three cases and upstaging in one case. The tumor response to treatment demonstrated TRG1a in one case, TRG1b in one case, and TRG2 in two cases, with an overall tumor regression rate of 100%. No obvious adverse events or perioperative complications were observed during or following treatment. All cases were alive without tumor recurrence or progression after the 1-year postoperative follow-up. Conclusions Our study may shed light on super-selective CAIC as an effective method for improving the NAC response in locally advanced GC. Future studies with a larger sample sizes and long-term outcomes are required for a final conclusion.
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Affiliation(s)
- Bin Li
- Department of Interventional Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Rui Tang
- Department of Interventional Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Guangqiang Zhang
- Department of Interventional Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jingkai Cheng
- Department of Interventional Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ming Chao
- Department of Interventional Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Kefeng Ding
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Xiang XS, Su Y, Li GL, Ma L, Zhou CS, Ma RF. Phase II Study of Preoperative Intra-Arterial Epirubicin, Etoposide, and Oxaliplatin Combined with Oral S-1 Chemotherapy for the Treatment of Borrmann Type 4 Gastric Cancer. J Gastric Cancer 2020; 20:395-407. [PMID: 33425441 PMCID: PMC7781743 DOI: 10.5230/jgc.2020.20.e40] [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: 07/28/2020] [Revised: 11/01/2020] [Accepted: 11/14/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose A phase II study was conducted to evaluate the safety and efficacy of preoperative, intra-arterial perfusion of epirubicin, etoposide, and oxaliplatin combined with oral chemotherapy S-1 (SEEOX) for the treatment of type 4 gastric cancer. Materials and Methods A single-center, single-arm phase II trial was conducted on 36 patients with histologically proven type 4 gastric cancer without distant peritoneal or organ metastasis. Patients received 3, 21-day courses of SEEOX preoperative chemotherapy. The primary endpoint was overall survival (OS) and the secondary outcomes assessed were chemotherapeutic response, radical resection rate, pathological regression, toxicities, postoperative morbidity, and mortality. Results All patients were at an advanced stage of cancer (stage III or IV) and completed the entire course of treatment. Based on changes in tumor volume and peritoneal metastasis, the objective response rate was 55.6% (20/36; 95% confidence interval [CI], 38.5%–72.6%) and the disease control rate was 69.4% (25/36; 95% CI, 53.6%–85.3%). The radical resection rate was 75% (27/36; 95% CI, 60.1%–89.9%) and the proportion of R0 resections was 66.7% (21/36; 95% CI, 50.5%–82.8%). The pathological response rate was 33.3%, of which 13.9% showed complete pathological regression. The median survival was 27.1 months (95% CI, 22.24–31.97 months), and the 2-year OS was 48.5% (95% CI, 30.86%–66.1%). Conclusions Preoperative SEEOX is a safe and effective treatment for type 4 gastric cancer. Based on these preliminary data, a phase III study will be conducted to confirm the superiority of this regimen over standard treatment. Trial Registration ClinicalTrials.gov Identifier: NCT02949258
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Affiliation(s)
- Xiao-Song Xiang
- Jinling Hospital Research Institute of General Surgery, School of Medicine, Nanjing University, Nanjing, China
| | - Yu Su
- Department of General Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Guo-Li Li
- Jinling Hospital Research Institute of General Surgery, School of Medicine, Nanjing University, Nanjing, China
| | - Long Ma
- Jinling Hospital Research Institute of General Surgery, School of Medicine, Nanjing University, Nanjing, China
| | - Chang-Sheng Zhou
- Jinling Hospital Medical Imaging Center, School of Medicine, Nanjing University, Nanjing, China
| | - Ru-Feng Ma
- Jinling Hospital Research Institute of General Surgery, School of Medicine, Nanjing University, Nanjing, China
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Ji X, Yang Q, Qin H, Zhou J, Liu W. Tumor blood supply may predict neoadjuvant chemotherapy response and survival in patients with gastric cancer. J Int Med Res 2019; 47:2524-2532. [PMID: 31039658 PMCID: PMC6567713 DOI: 10.1177/0300060519845491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objectives We investigated the prognostic value of tumor blood supply in patients with
advanced gastric cancer (GC) receiving neoadjuvant chemotherapy. Methods We retrospectively reviewed 53 patients with advanced GC treated with FLEEOX
chemotherapy. The tumor computed tomography (CT) enhancement value was
measured before chemotherapy (CT1; arterial phase CT–plain phase CT). The
liver parenchyma CT enhancement value (CT2) was also measured using the same
method, to eliminate individual differences. Tumor blood supply was defined
as good or poor based on the median CT1/CT2 values. We evaluated the
relationships between tumor blood supply and response to chemotherapy,
clinicopathologic characteristics, and overall survival (OS). Results A good blood supply (GBS) was associated with significantly better clinical
and pathological responses to chemotherapy than a poor blood supply (PBS).
The 3-year OS was 65.8% for the entire cohort. Patients with a GBS had a
significantly higher OS (78.57%) than those with a PBS (54.44%).
Additionally, patients with Bormann type III GC had a better blood supply
than those with type II GC. Conclusion Patients with advanced GC and a GBS are more likely to benefit from
neoadjuvant chemotherapy than those with a PBS. Blood supply may thus be a
predictor for chemotherapy response.
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Affiliation(s)
- Xiang Ji
- Changzhou No. 2 People's Hospital, Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Qiaoyun Yang
- Changzhou No. 2 People's Hospital, Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Hui Qin
- Changzhou No. 2 People's Hospital, Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Jie Zhou
- Changzhou No. 2 People's Hospital, Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Wenming Liu
- Changzhou No. 2 People's Hospital, Affiliated Hospital of Nanjing Medical University, Changzhou, China
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He Q, Li G, Ji X, Ma L, Wang X, Li Y, Fan C. Impact of the immune cell population in peripheral blood on response and survival in patients receiving neoadjuvant chemotherapy for advanced gastric cancer. Tumour Biol 2017; 39:1010428317697571. [PMID: 28475005 DOI: 10.1177/1010428317697571] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We aimed to investigate the prognostic value of the immune cells population in peripheral blood from patients with advanced gastric cancer treated with neoadjuvant chemotherapy. A total of 105 patients with advanced gastric cancer were evaluated in this study. Blood samples were collected before and 1 week after the last dose of chemotherapy. The percentage of CD3+, CD3+CD4+, CD3+CD8+, and CD4+CD25+Foxp3+ T cells was assessed using flow cytometry analysis. The relationship between T cell subsets and clinical outcome was evaluated. The percentage of CD3+CD8+ lymphocytes was significantly increased after chemotherapy and CD4+CD25+Foxp3+ regulatory T cells (Tregs) decreased ( p = 0.003 and p < 0.001, respectively). The percentage of CD3+CD8+ lymphocytes and Tregs was strongly associated with response to chemotherapy ( p = 0.017 and p < 0.030, respectively). Patients with high CD3+CD8+ T cells and low CD4+CD25+Foxp3+ Tregs had significantly increased overall survival ( p = 0.012 and p = 0.048, respectively). Neither CD3+ nor CD3+CD4+ T cells showed significant changes after chemotherapy or correlations with the clinical outcome. The positive correlation between a high CD3+CD8+ T cells or low CD4+CD25+Foxp3+ Tregs and clinical outcome indicates its key role in the prognosis of gastric cancer patients and may serve as a biomarker to identify patients likely to benefit from neoadjuvant chemotherapy.
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Affiliation(s)
- Qi He
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Guoli Li
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Xiang Ji
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Long Ma
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Xulin Wang
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Yang Li
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Chaogang Fan
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
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