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Le Corre D, Ghazi A, Balogoun R, Pilati C, Aparicio T, Martin-Lannerée S, Marisa L, Djouadi F, Poindessous V, Crozet C, Emile JF, Mulot C, Le Malicot K, Boige V, Blons H, de Reynies A, Taieb J, Ghiringhelli F, Bennouna J, Launay JM, Laurent-Puig P, Mouillet-Richard S. The cellular prion protein controls the mesenchymal-like molecular subtype and predicts disease outcome in colorectal cancer. EBioMedicine 2019; 46:94-104. [PMID: 31377347 PMCID: PMC6710984 DOI: 10.1016/j.ebiom.2019.07.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 02/08/2023] Open
Abstract
Background Comprehensive transcriptomic analyses have shown that colorectal cancer (CRC) is heterogeneous and have led to the definition of molecular subtypes among which the stem-cell, mesenchymal-like group is associated with poor prognosis. The molecular pathways orchestrating the emergence of this subtype are incompletely understood. In line with the contribution of the cellular prion protein PrPC to stemness, we hypothesize that deregulation of this protein could lead to a stem-cell, mesenchymal-like phenotype in CRC. Methods We assessed the distribution of the PrPC-encoding PRNP mRNA in two large CRC cohorts according to molecular classification and its association with patient survival. We developed cell-based assays to explore the impact of gain and loss of PrPC function on markers of the mesenchymal subtype and to delineate the signalling pathways recruited by PrPC. We measured soluble PrPC in the plasmas of 325 patients with metastatic CRC and probed associations with disease outcome. Findings We found that PRNP gene expression is enriched in tumours of the mesenchymal subtype and is associated with poor survival. Our in vitro analyses revealed that PrPC controls the expression of genes that specify the mesenchymal subtype through the recruitment of the Hippo pathway effectors YAP and TAZ and the TGFß pathway. We showed that plasma levels of PrPC are elevated in metastatic CRC and are associated with poor disease control. Interpretation Our findings define PrPC as a candidate driver of the poor-prognosis mesenchymal subtype of CRC. They suggest that PrPC may serve as a potential biomarker for patient stratification in CRC. Funding Grant support was provided by the following: Cancéropôle Ile de France (grant number 2016-1-EMERG-36-UP 5-1), Association pour la Recherche sur le Cancer (grant number PJA 20171206220), SATT Ile de France Innov (grant number 415) as well as INSERM.
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Affiliation(s)
- Delphine Le Corre
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Alexandre Ghazi
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Ralyath Balogoun
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Camilla Pilati
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, AP-HP, Hôpital Saint-Louis, Université Paris Diderot, F-75010 Paris, France
| | - Séverine Martin-Lannerée
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Laetitia Marisa
- Programme "Cartes d'Identité des Tumeurs", Ligue Nationale Contre le Cancer, F-75013 Paris, France
| | - Fatima Djouadi
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Virginie Poindessous
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Carole Crozet
- Institut de Médecine Régénératrice et de Biothérapie (I.M.R.B.), Université de Montpellier UMR-1183, Centre Hospitalo-Universitaire de Montpellier, F-34000 Montpellier, France
| | - Jean-François Emile
- Department of Pathology, AP-HP, Hôpital Ambroise Paré, F-92100 Boulogne-Billancourt, France
| | - Claire Mulot
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Université de Bourgogne et and Franche Comté, F-21000 Dijon, France
| | - Valérie Boige
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France; Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, F-94800 Villejuif, France
| | - Hélène Blons
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France; Department of Biology, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Aurélien de Reynies
- Programme "Cartes d'Identité des Tumeurs", Ligue Nationale Contre le Cancer, F-75013 Paris, France
| | - Julien Taieb
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France; Department of Gastroenterology and GI Oncology, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - François Ghiringhelli
- Department of Medical Oncology, Centre Georges-François Leclerc, F-21000 Dijon, France
| | - Jaafar Bennouna
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, F-44800 Saint-Herblain, France
| | - Jean-Marie Launay
- Department of Biochemistry and Molecular Biology, INSERM U942, AP-HP, Hôpital Lariboisière, Université Paris Descartes, F-75010 Paris, France; Pharma Research Department, F. Hoffmann-La-Roche Ltd., CH-4070 Basel, Switzerland
| | - Pierre Laurent-Puig
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France; Department of Biology, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Sophie Mouillet-Richard
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France.
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Marschner N, Frank M, Vach W, Ladda E, Karcher A, Winter S, Jänicke M, Trarbach T. Development and validation of a novel prognostic score to predict survival in patients with metastatic colorectal cancer: the metastatic colorectal cancer score (mCCS). Colorectal Dis 2019; 21:816-826. [PMID: 30834622 PMCID: PMC6850201 DOI: 10.1111/codi.14600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/02/2019] [Indexed: 12/20/2022]
Abstract
AIM Published prognostic scores for metastatic colorectal cancer (mCRC) are based on data from highly selected patient subgroups with specified first-line treatments and may not be applicable to routine practice. We have therefore developed and validated the metastatic colorectal cancer score (mCCS) to predict overall survival (OS) for patients with mCRC. METHOD A total of 1704 patients from the prospective, multicentre cohort study Tumour Registry Colorectal Cancer were separated into learning (n = 796) and validation (n = 908) samples. Using a multivariate Cox regression model, the six-factor mCCS was established. RESULTS The six independent prognostic factors for survival are as follows: two or more metastatic sites at the start of first-line treatment, tumour grading ≥ G3 at primary diagnosis, residual tumour classification ≥ R1/unknown, lymph node ratio (of primary tumour) ≥ 0.4, tumour stage ≥ III/unknown at primary diagnosis and KRAS status mutated/unknown. The mCCS clearly separated the learning sample into three risk groups: zero to two factors (low risk), three factors (intermediate risk) and four to six factors (high risk). The prognostic performance of the mCCS was confirmed in the validation sample and additionally stratified a large sample of patients with known (K)RAS mutation status. CONCLUSION The novel prognostic score, mCCS, clearly defines three prognostic groups for OS at start of first-line therapy. For oncologists, the mCCS represents a simple and easy-to-apply tool for routine clinical use, as it is based on objective tumour characteristics and can assist with treatment decision-making and communication of the prognosis to patients.
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Affiliation(s)
- N Marschner
- Praxis für interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany
| | - M Frank
- Biostatistics, iOMEDICO, Freiburg, Germany
| | - W Vach
- Department of Orthopaedics and Traumatology, Universitätsspital Basel, Basel, Switzerland
| | - E Ladda
- Onkologische Schwerpunktpraxis Neumarkt, Neumarkt in der Oberpfalz, Germany
| | - A Karcher
- Onkologische Schwerpunktpraxis, Heidelberg, Germany
| | - S Winter
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - M Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - T Trarbach
- MVZ des Klinikums Wilhelmshaven, Wilhelmshaven, Germany
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3
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Gouverneur A, Coutureau J, Jové J, Rouyer M, Grelaud A, Duc S, Gérard S, Smith D, Ravaud A, Droz C, Bernard MA, Lassalle R, Forrier-Réglat A, Noize P. Patterns of Use, Safety, and Effectiveness of Targeted Therapies in First-Line Treatment of Metastatic Colorectal Cancer According to Age: The STROMBOLI Cohort Study. Clin Colorectal Cancer 2019; 18:e150-e162. [PMID: 30630730 DOI: 10.1016/j.clcc.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Metastatic colorectal cancer (mCRC) is increasingly treated using targeted therapies. Their real-life evaluation is insufficient, especially in elderly and frail patients. The aim was to describe use, safety, and effectiveness of targeted therapies in first-line mCRC treatment according to age. PATIENTS AND METHODS Two field cohorts of patients initiating bevacizumab or cetuximab for first-line mCRC were pooled. Patients characteristics, use, and safety were compared between younger and elderly patients (<75 vs. ≥75 years). Two-year overall survival (OS) and progression-free survival (PFS) were estimated in both age groups using the Kaplan-Meier method adjusted on factors associated with death or progression identified with Cox multivariate modeling. RESULTS Eight hundred patients (n = 411, 51.4% bevacizumab) were included: 498 (62.3%) male, median age 64 years, 118 (14.8%) Eastern Cooperative Oncology Group performance status (ECOG-PS) ≥2. Elderly patients (n = 126, 15.8%) were more often treated with 5-fluorouracil alone than younger. Severe adverse events were equivalent across age groups. ECOG-PS ≥1, abnormal hemoglobin, and abnormal alkaline phosphatases were associated with a higher risk of death; OS adjusted on these factors was similar between elderly and younger patients. ECOG-PS ≥1, lung metastases, abnormal hemoglobin, and abnormal creatinine clearance were associated with a higher risk of progression or death; PFS adjusted on these factors was similar across groups. CONCLUSION Despite treatment adaptations, elderly patients could benefit from targeted therapies as younger without safety warning.
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Affiliation(s)
- Amandine Gouverneur
- Univ Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France; Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; CHU de Bordeaux, Pôle de Sante publique, Service de Pharmacologie médicale, Bordeaux, France.
| | - Juliette Coutureau
- Univ Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France; CHU de Bordeaux, Pôle de Sante publique, Service de Pharmacologie médicale, Bordeaux, France
| | - Jérémy Jové
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Magali Rouyer
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Angela Grelaud
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Sophie Duc
- Service de Gériatrie, CHU Bordeaux, Bordeaux, France
| | | | - Denis Smith
- Service d'Oncologie médicale, CHU Bordeaux, Bordeaux, France
| | - Alain Ravaud
- Service d'Oncologie médicale, CHU Bordeaux, Bordeaux, France
| | - Cécile Droz
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Marie-Agnès Bernard
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Annie Forrier-Réglat
- Univ Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France; Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; CHU de Bordeaux, Pôle de Sante publique, Service de Pharmacologie médicale, Bordeaux, France
| | - Pernelle Noize
- Univ Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France; Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; CHU de Bordeaux, Pôle de Sante publique, Service de Pharmacologie médicale, Bordeaux, France
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4
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Hegewisch-Becker S, Nöpel-Dünnebacke S, Hinke A, Graeven U, Reinacher-Schick A, Hertel J, Lerchenmüller CA, Killing B, Depenbusch R, Al-Batran SE, Lange T, Dietrich G, Tannapfel A, Arnold D. Impact of primary tumour location and RAS/BRAF mutational status in metastatic colorectal cancer treated with first-line regimens containing oxaliplatin and bevacizumab: Prognostic factors from the AIO KRK0207 first-line and maintenance therapy trial. Eur J Cancer 2018; 101:105-13. [PMID: 30036739 DOI: 10.1016/j.ejca.2018.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND The major prognostic relevance of primary tumour location (LPT) in advanced colorectal cancer was shown in large retrospective studies, but quantitative estimates are highly heterogeneous, and there is still limited information about its impact within the framework of biomarker-guided treatment strategies. Therefore, we analysed LPT in relation to other clinical and molecular parameters, based on mature survival data from the recent randomised AIO KRK0207 trial. METHODS Patients uniformly received first-line induction treatment with a combination of bevacizumab, oxaliplatin and fluoropyrimidine. LPT was retrospectively determined using surgical reports, pathology reports and endoscopy reports. The prognostic analyses were performed using Kaplan-Meier estimations and log-rank tests, while hazard ratios (HRs) and multivariable results were derived from Cox models. RESULTS Among 754 patients with unequivocal information on LPT, patients with left-sided tumours showed a median overall survival of 24.8 months compared with the right-sided cohort with 18.4 months (HR: 1.54, 95% confidence interval: 1.30-1.81, P < 0.0001). In a multivariable model, LPT proved to be the strongest prognosticator (HR 1.60), with performance status, number of metastatic sites, baseline carcinoembryonic antigen (CEA) and platelets independently retaining prognostic significance. In the subgroup of patients with known RAS/BRAF status (n = 567, 75%), a BRAF mutation showed the greatest unfavourable impact (HR 3.16). Although BRAF is strongly correlated to LPT, the latter remained a significant prognosticator in the BRAF wild-type subgroup. In contrast, no major impact of LPT was seen on tumours carrying RAS mutations. CONCLUSIONS Within the framework of a uniform treatment strategy according to the current standards, LPT proved to have an important, although not solely dominating, relevance for survival prognosis. Its impact seems to be low in tumours with a RAS mutation. REGISTRATION ClinicalTrials.govNCT00973609.
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Aparicio T, Bouché O, Francois E, Retornaz F, Barbier E, Taieb J, Kirscher S, Etienne PL, Faroux R, Khemissa Akouz F, El Hajbi F, Locher C, Rinaldi Y, Lecomte T, Lavau-Denes S, Baconnier M, Oden-Gangloff A, Genet D, Bedenne L, Paillaud E, Zawadi MA, Volet J, Cavaglione G, Lepere C, Rougier P, Zaanan A, Besson D, Fawzi KS, Adenis A, Gatineau-Sailliant G, Brezault C, Coriat R, Tougeron D, Hautefeuille V, Chone L, Molin Y, Seitz JF, Le Tallec VJ, Ben Abdelghani M, Villing AL, Aouakli A, Sebbagh V, Bedjaoui A, Mitry E, Carola E, Boulat O, Queuniet AM, Capitain O, Jouve JL, Baumgaertner I, Almaric F, Bonnetain F, Subtil F. Geriatric analysis from PRODIGE 20 randomized phase II trial evaluating bevacizumab + chemotherapy versus chemotherapy alone in older patients with untreated metastatic colorectal cancer. Eur J Cancer 2018; 97:16-24. [DOI: 10.1016/j.ejca.2018.03.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 12/27/2022]
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Mahar AL, Compton C, Halabi S, Hess KR, Weiser MR, Groome PA. Personalizing prognosis in colorectal cancer: A systematic review of the quality and nature of clinical prognostic tools for survival outcomes. J Surg Oncol 2017; 116:969-982. [PMID: 28767139 DOI: 10.1002/jso.24774] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/16/2017] [Indexed: 12/13/2022]
Abstract
Integrating diverse types of prognostic information into accurate, individualized estimates of outcome in colorectal cancer is challenging. Significant heterogeneity in colorectal cancer prognostication tool quality exists. Methodology is incompletely or inadequately reported. Evaluations of the internal or external validity of the prognostic model are rarely performed. Prognostication tools are important devices for patient management, but tool reliability is compromised by poor quality. Guidance for future development of prognostication tools in colorectal cancer is needed.
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Affiliation(s)
- Alyson L Mahar
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Ontario, Canada
| | - Carolyn Compton
- Professor Life Sciences, Arizona State University and Professor of Laboratory Medicine and Pathology, Mayo Clinic School of Medicine, Rochester, Minnesota.,Chair, Precision Medicine Core, American Joint Committee on Cancer 8th Edition Editorial Board, Rochester, Minnesota
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University and Alliance Statistics and Data Center, Durham, North Carolina
| | - Kenneth R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Chair, Evidence-Based Medicine and Statistics Core, AJCC 8th Edition Editorial Board, Rochester, Minnesota
| | | | - Patti A Groome
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Ontario, Canada
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Jary M, Lecomte T, Bouché O, Kim S, Dobi E, Queiroz L, Ghiringhelli F, Etienne H, Léger J, Godet Y, Balland J, Lakkis Z, Adotevi O, Bonnetain F, Borg C, Vernerey D. Prognostic value of baseline seric Syndecan-1 in initially unresectable metastatic colorectal cancer patients: a simple biological score. Int J Cancer 2016; 139:2325-35. [PMID: 27472156 DOI: 10.1002/ijc.30367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 06/24/2016] [Accepted: 07/01/2016] [Indexed: 01/17/2023]
Abstract
In first-line metastatic colorectal cancer (mCRC), baseline prognostic factors allowing death risk and treatment strategy stratification are lacking. Syndecan-1 (CD138) soluble form was never described as a prognostic biomarker in mCRC. We investigated its additional prognostic value for overall survival (OS). mCRC patients with unresectable disease at diagnosis were treated with bevacizumab-based chemotherapy in two independent prospective clinical trials (development set: n = 126, validation set: n = 51, study NCT00489697 and study NCT00544011, respectively). Serums were collected at baseline for CD138 measurement. OS determinants were assessed and, based on the final multivariate model, a prognostic score was proposed. Two independent OS prognostic factors were identified: Lactate Dehydrogenase (LDH) high level (p = 0.0066) and log-CD138 high level (p = 0.0190). The determination of CD138 binary information (cutoff: 75 ng/mL) allowed the assessment of a biological prognostic score with CD138 and LDH values, identifying three risk groups for death (median OS= 38.9, 30.1 and 19.8 months for the low, intermediate and high risk groups, respectively; p < 0.0001). This score had a good discrimination ability (C-index = 0.63). These results were externally confirmed in the validation set. Our study provides robust evidence in favor of the additional baseline soluble CD138 prognostic value for OS, in mCRC patients. A simple biological scoring system is proposed including LDH and CD138 binary status values.
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Affiliation(s)
- Marine Jary
- Department of Medical Oncology, University Hospital, Besançon, France. .,INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France. .,Clinical Investigation Center 1431, EFS Bourgogne-Franche Comté, Besançon, France.
| | - Thierry Lecomte
- CNRS, Unit 7292, University François-Rabelais, Tours, France.,Department of HepatoGastroenterology and Digestive Oncology, University Hospital, Tours, France
| | - Olivier Bouché
- Department of HepatoGastroenterology and Digestive Oncology, University Hospital Robert Debré, Reims, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital, Besançon, France.,Clinical Investigation Center 1431, EFS Bourgogne-Franche Comté, Besançon, France
| | - Erion Dobi
- Department of Medical Oncology, University Hospital, Besançon, France
| | - Lise Queiroz
- INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France
| | | | - Hélène Etienne
- Department of Medical Oncology, University Hospital, Besançon, France.,Department of Gastroenterology, University Hospital, Besançon, France
| | - Julie Léger
- INSERM, Clinical Investigational Center CIC 1415, Tours, France
| | - Yann Godet
- INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France
| | - Jérémy Balland
- INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France
| | - Zaher Lakkis
- Department of Digestive Surgery and Liver Transplantation, University Hospital, Besançon, France
| | - Olivier Adotevi
- Department of Medical Oncology, University Hospital, Besançon, France.,INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France
| | - Franck Bonnetain
- INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France.,Clinical Investigation Center 1431, EFS Bourgogne-Franche Comté, Besançon, France.,Methodological and Quality of Life in Oncology Unit, EA 3181, University Hospital, Besançon, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital, Besançon, France.,INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France.,Clinical Investigation Center 1431, EFS Bourgogne-Franche Comté, Besançon, France
| | - Dewi Vernerey
- INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France.,Clinical Investigation Center 1431, EFS Bourgogne-Franche Comté, Besançon, France.,Methodological and Quality of Life in Oncology Unit, EA 3181, University Hospital, Besançon, France
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8
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Lee SY, Oh SC. Advances of Targeted Therapy in Treatment of Unresectable Metastatic Colorectal Cancer. Biomed Res Int. 2016;2016:7590245. [PMID: 27127793 PMCID: PMC4835624 DOI: 10.1155/2016/7590245] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/07/2016] [Accepted: 03/14/2016] [Indexed: 12/13/2022]
Abstract
Despite being one of the most frequently diagnosed cancers worldwide, prognosis of metastatic colorectal cancer (CRC) was poor. Development and introduction of biologic agents in treatment of patients with metastatic CRC have brought improved outcomes. Monoclonal antibodies directing epidermal growth factor receptors and vascular endothelial growth factor are main biologic agents currently used in treatment of metastatic CRC. Encouraged by results from many clinical trials demonstrating efficacy of those monoclonal antibodies, the combination therapy with those targeted agents and conventional chemotherapeutic agents has been established as the standard therapy for patients with metastatic CRC. However, emergency of resistance to those target agents has limited the efficacy of treatment, and strategies to overcome the resistance are now being investigated by newly developed biological techniques clarifying how to acquire resistance. Here, we introduce mechanisms of action of the biologic agents currently used for treatment of metastatic CRC and several landmark historical clinical studies which have changed the main stream of treatment. The mechanism of resistance to those agents, one of serious problems in treatment metastatic CRC, and ongoing clinical trials to overcome the limitations and improve treatment outcomes will also be presented in this review.
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Dréanic J, Dhooge M, Barret M, Brezault C, Mir O, Chaussade S, Coriat R. Anti-epidermal or anti-vascular endothelial growth factor as first-line metastatic colorectal cancer in modified Glasgow prognostic score 2' patients. J Cachexia Sarcopenia Muscle 2015; 6:231-6. [PMID: 26401469 PMCID: PMC4575554 DOI: 10.1002/jcsm.12022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 11/23/2014] [Accepted: 02/12/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In metastatic colorectal cancer, the modified Glasgow prognostic score (mGPS) has been approved as an independent prognostic indicator of survival. No data existed on poor prognosis patients treated with molecular-targeted agents. METHODS From January 2007 to February 2012, patients with metastatic colorectal cancer and poor predictive survival score (mGPS = 2), treated with 5-fluorouracil-based chemotherapy in addition to an anti-epidermal growth factor receptor (EGFR) or anti-vascular epidermal growth factor (VEGF) therapy, were included to assess the interest of targeted therapy within mGPS = 2' patients. RESULTS A total of 27 mGPS = 2' patients were included and received a 5-fluorouracil-based systemic chemotherapy in addition to an anti-EGFR treatment (cetuximab; n = 18) or an anti-VEGF treatment (bevacizumab; n = 9). Median follow-up was 12.1 months (interquartile range 4.9-22). Patients were Eastern Cooperative Oncology Group (ECOG) Performance Status 1, 2, and 3 in 66% (n = 18), 26% (n = 7), and 8% (n = 2), respectively. Comparing anti-EGFR and anti-VEGF groups, median progression-free survival was 3.9 and 15.4 months, respectively, and was significantly different (P = 0.046). Conversely, the median overall survival was not significantly different between the two groups (P = 0.15). CONCLUSION Our study confirmed the poor survival of patients with mGPS = 2 despite the use of targeted therapy and identified the superiority of an anti-VEGF treatment in progression-free survival, without a significant benefit in the overall survival compared with the anti-EGFR therapy. Our results deserved confirmation by a prospective clinical trial.
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Affiliation(s)
- Johann Dréanic
- Gastroenterology and Endoscopy Unit, Hôpital Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, AP-HP Paris, France
| | - Marion Dhooge
- Gastroenterology and Endoscopy Unit, Hôpital Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, AP-HP Paris, France
| | - Maximilien Barret
- Gastroenterology and Endoscopy Unit, Hôpital Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, AP-HP Paris, France
| | - Catherine Brezault
- Gastroenterology and Endoscopy Unit, Hôpital Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, AP-HP Paris, France
| | - Olivier Mir
- Medical Oncology, Department of Cancer Medicine, Gustave Roussy, Cancer Campus Grand Paris Villejuif, France
| | - Stanislas Chaussade
- Gastroenterology and Endoscopy Unit, Hôpital Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, AP-HP Paris, France
| | - Romain Coriat
- Gastroenterology and Endoscopy Unit, Hôpital Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, AP-HP Paris, France
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Gillams A, Goldberg N, Ahmed M, Bale R, Breen D, Callstrom M, Chen MH, Choi BI, de Baere T, Dupuy D. Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, The Interventional Oncology Sans Frontières meeting 2013. Eur Radiol. 2015;25:3438-3454. [PMID: 25994193 PMCID: PMC4636513 DOI: 10.1007/s00330-015-3779-z] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 02/02/2015] [Accepted: 04/07/2015] [Indexed: 12/16/2022]
Abstract
Objectives Previous attempts at meta-analysis and systematic review have not provided clear recommendations for the clinical application of thermal ablation in metastatic colorectal cancer. Many authors believe that the probability of gathering randomised controlled trial (RCT) data is low. Our aim is to provide a consensus document making recommendations on the appropriate application of thermal ablation in patients with colorectal liver metastases. Methods This consensus paper was discussed by an expert panel at The Interventional Oncology Sans Frontières 2013. A literature review was presented. Tumour characteristics, ablation technique and different clinical applications were considered and the level of consensus was documented. Results Specific recommendations are made with regard to metastasis size, number, and location and ablation technique. Mean 31 % 5-year survival post-ablation in selected patients has resulted in acceptance of this therapy for those with technically inoperable but limited liver disease and those with limited liver reserve or co-morbidities that render them inoperable. Conclusions In the absence of RCT data, it is our aim that this consensus document will facilitate judicious selection of the patients most likely to benefit from thermal ablation and provide a unified interventional oncological perspective for the use of this technology. Key Points • Best results require due consideration of tumour size, number, volume and location. • Ablation technology, imaging guidance and intra-procedural imaging assessment must be optimised. • Accepted applications include inoperable disease due to tumour distribution or inadequate liver reserve. • Other current indications include concurrent co-morbidity, patient choice and the test-of-time approach. • Future applications may include resectable disease, e.g. for small solitary tumours.
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Giessen C, Fischer von Weikersthal L, Laubender RP, Stintzing S, Modest DP, Schalhorn A, Schulz C, Heinemann V. Evaluation of prognostic factors in liver-limited metastatic colorectal cancer: a preplanned analysis of the FIRE-1 trial. Br J Cancer 2013; 109:1428-36. [PMID: 23963138 PMCID: PMC3776986 DOI: 10.1038/bjc.2013.475] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/24/2013] [Accepted: 07/23/2013] [Indexed: 02/07/2023] Open
Abstract
Background: Liver-limited disease (LLD) denotes a specific subgroup of metastatic colorectal cancer (mCRC) patients. Patients and Methods: A total of 479 patients with unresectable mCRC from an irinotecan-based randomised phase III trial were evaluated. Patients with LLD and non-LLD and hepatic resection were differentiated. Based on baseline patient characteristic, prognostic factors for hepatic resection were evaluated. Furthermore, prognostic factors for median overall survival (OS) were estimated via Cox regression in LLD patients. Results: Secondary liver resection was performed in 38 out of 479 patients (resection rate: 7.9%). Prognostic factors for hepatic resection were LLD, lactate dehydrogenase (LDH), node-negative primary, alkaline phosphatase (AP) and Karnofsky performance status (PS). Median OS was significantly increased after hepatic resection (48 months), whereas OS in LLD (17 months) and non-LLD (19 months) was comparable in non-resected patients. With the inapplicability of Koehne's risk classification in LLD patients, a new score based on only the independent prognostic factors LDH and white blood cell (WBC) provided markedly improved information on the outcome. Conclusion: Patients undergoing hepatic resection showed favourable long-term survival, whereas non-resected LLD patients and non-LLD patients did not differ with regard to progression-free survival and OS. The LDH levels and WBC count were confirmed as prognostic factors and provide a useful and simple score for OS-related risk stratification also in LLD.
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Affiliation(s)
- C Giessen
- Department of Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
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