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Mullin G, Sternschuss M, Landman Y, Sulkes A, Brenner B. Mitomycin C and capecitabine: An additional option as an advanced line therapy in patients with metastatic colorectal cancer. World J Gastrointest Oncol 2023; 15:1913-1924. [DOI: 10.4251/wjgo.v15.i11.1913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/31/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND In recent years survival of patients with metastatic colorectal cancer (mCRC), though still limited, has improved significantly; clearly, when the disease becomes refractory to standard regimens, additional treatment options are needed. Studies have shown that mitomycin C (MMC), an antitumor antibiotic, and capecitabine, a precursor of 5-fluorouracil, may act synergistically in combination. The efficacy of MMC/capecitabine has been demonstrated in the first-line setting, but only a few small studies have tested it in the advanced-line setting, with contradictory results.
AIM To summarize our experience using MMC/capecitabine as an advanced line treatment for mCRC.
METHODS A retrospective study was conducted at a tertiary medical center including all patients with histologically proven mCRC who were treated with MMC/capecitabine after at least two previous lines of standard chemotherapy in 2006-2020. Data on patient demographics and past medical history, laboratory, pathological, and radiological factors, and treatment and survival were collected from the files. Survival analyses were performed using the Kaplan-Meier method. The association of patient and tumor characteristics with treatment effectiveness and toxicity was evaluated with univariate and multivariate proportional hazard Cox regression analyses. P ≤ 0.05 was considered statistically significant.
RESULTS The cohort consisted of 119 patients of median age 64 years (range 37-85). Patients received a median of 2 MMC/capecitabine cycles (range 0.5-9.0). Thirty-four patients (28.6%) experienced grade ≥ 3 toxicity, including 2 (1.7%) with grade 4; there was no drug-related mortality. The objective response rate was 0.8%, and the disease control rate, 24.4%. Median progression-free survival (PFS) was 2.1 mo (range 0.2-20.3), and median overall survival, 4.8 mo (range 0.2-27.5). The 6-month overall survival rate was 44%; 8.7% of patients remained progression-free. Factors associated with longer PFS were lower gamma-glutamyl transferase level (P = 0.030) and primary tumor location in the left colon (P = 0.017). Factors associated with longer overall survival were lower gamma-glutamyl transferase level (P = 0.022), left-colon tumor location (P = 0.044), low-to-moderate histological grade (P = 0.012), Eastern Cooperative Oncology Group performance status 0-1 (P = 0.036), and normal bilirubin level (P = 0.047).
CONCLUSION MMC/capecitabine is an active, available, and relatively safe regimen for use beyond standard lines of therapy in mCRC. Several clinical and laboratory parameters can identify patients more likely to benefit.
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Affiliation(s)
- Gil Mullin
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- Institute of Oncology, Davidoff Cancer Center, Beilinson Campus, Petah-Tikva 4941492, Israel
| | - Michal Sternschuss
- Institute of Oncology, Davidoff Cancer Center, Beilinson Campus, Petah-Tikva 4941492, Israel
| | - Yosef Landman
- Institute of Oncology, Davidoff Cancer Center, Beilinson Campus, Petah-Tikva 4941492, Israel
| | - Aaron Sulkes
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- Institute of Oncology, Davidoff Cancer Center, Beilinson Campus, Petah-Tikva 4941492, Israel
| | - Baruch Brenner
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- Institute of Oncology, Davidoff Cancer Center, Beilinson Campus, Petah-Tikva 4941492, Israel
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He X, Lan H, Jin K, Liu F. Can immunotherapy reinforce chemotherapy efficacy? a new perspective on colorectal cancer treatment. Front Immunol 2023; 14:1237764. [PMID: 37790928 PMCID: PMC10543914 DOI: 10.3389/fimmu.2023.1237764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
As one of the main threats to human life (the fourth most dangerous and prevalent cancer), colorectal cancer affects many people yearly, decreases patients' quality of life, and causes irreparable financial and social damages. In addition, this type of cancer can metastasize and involve the liver in advanced stages. However, current treatments can't completely eradicate this disease. Chemotherapy and subsequent surgery can be mentioned among the current main treatments for this disease. Chemotherapy has many side effects, and regarding the treatment of this type of tumor, chemotherapy can lead to liver damage, such as steatohepatitis, steatosis, and sinus damage. These damages can eventually lead to liver failure and loss of its functions. Therefore, it seems that other treatments can be used in addition to chemotherapy to increase its efficiency and reduce its side effects. Biological therapies and immunotherapy are one of the leading suggestions for combined treatment. Antibodies (immune checkpoint blockers) and cell therapy (DC and CAR-T cells) are among the immune system-based treatments used to treat tumors. Immunotherapy targets various aspects of the tumor that may lead to 1) the recruitment of immune cells, 2) increasing the immunogenicity of tumor cells, and 3) leading to the elimination of inhibitory mechanisms established by the tumor. Therefore, immunotherapy can be used as a complementary treatment along with chemotherapy. This review will discuss different chemotherapy and immunotherapy methods for colorectal cancer. Then we will talk about the studies that have dealt with combined treatment.
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Affiliation(s)
- Xing He
- Department of Gastroenterology, Jinhua Wenrong Hospital, Jinhua, Zhejiang, China
| | - Huanrong Lan
- Department of Surgical Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, China
| | - Ketao Jin
- Department of Colorectal Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Fanlong Liu
- Department of Colorectal Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Gabizon AA, Tahover E, Golan T, Geva R, Perets R, Amitay Y, Shmeeda H, Ohana P. Pharmacokinetics of mitomycin-c lipidic prodrug entrapped in liposomes and clinical correlations in metastatic colorectal cancer patients. Invest New Drugs 2020; 38:1411-20. [DOI: 10.1007/s10637-020-00897-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/10/2020] [Indexed: 11/25/2022]
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Scartozzi M, Falcone A, Pucci F, Braconi C, Pierantoni C, Cavanna L, Franciosi V, Berardi R, Beretta G, Masi G, Allegrini G, Zaniboni A, Labianca R, Cascinu S. Capecitabine and Mitomycin c May be an Effective Treatment Option for Third-line Chemotherapy in Advanced Colorectal Cancer. Tumori 2018; 92:384-8. [PMID: 17168429 DOI: 10.1177/030089160609200503] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aims and Background We evaluated the activity in terms of time to progression (TTP) of mitomycin C and capecitabine in patients with advanced colorectal cancer who progressed after 2 lines of chemotherapy. Methods Patients with advanced colorectal cancer undergoing third-line chemotherapy after failure of 5-FU with CPT-11 or oxaliplatin-based chemotherapy regimens were treated with capecitabine and mitomycin C. Results Sixty-one patients were enrolled in this study. The median age was 55 years (range, 26-78 years) and the male:female ratio 21: 40. We observed partial remissions in 5 patients (8%), stable disease in 25 patients (40%) and progression of disease in 31 patients (52%). Median TTP was 3 months and median survival was 6 months. Global toxicity was mild and entirely acceptable. Grade 3-4 hematological toxicity occurred in 12 patients and grade 3-4 nonhematological toxicity in 5 patients. Conclusions The combination of capecitabine and mitomycin C could represent an effective and manageable treatment option for colorectal cancer patients failing previous chemotherapy regimens.
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Affiliation(s)
- Mario Scartozzi
- Clinica di Oncologia Medica, Azienda Ospedaliera Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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Rimassa L, Gullo G, Carnaghi C, Abbadessa G, Zuradelli M, Tronconi MC, Pressiani T, Santoro A. Chemotherapy with Mitomycin C and Capecitabine in Patients with Advanced Colorectal Cancer Pretreated with Irinotecan and Oxaliplatin. Tumori 2018; 92:285-9. [PMID: 17036517 DOI: 10.1177/030089160609200404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aims and background To assess the activity and tolerability of the combination of mitomycin C and capecitabine in patients with metastatic colorectal cancer after failure of irinotecan- and oxaliplatin-containing regimens. Methods We retrospectively reviewed 28 patients with pretreated advanced colorectal cancer who had been treated with mitomycin C, 6 mg/m2 on day 1, and capecitabine, 1,900 mg/m2 on days 1–14, every 3 weeks. Tumor assessment was performed every 3 cycles, toxicity assessed at each cycle. Results Main patient characteristics were median age, 61 years (range, 35–73); male/female ratio, 16/12; single metastatic site involvement, 5/28 (18%); ≥3 metastatic sites, 10/28 (36%). Ninety-six courses of therapy were given (median number, 3; range, 1–9). Twenty-six patients were assessable for response, and all were assessable for toxicity. There was 1 partial response (4%) and 12 had stable disease (43%). Median time to progression was 2 months (range, 1–9) and median overall survival was 6 months (range, 1–29+), with a 1-year overall survival rate of 25%. The regimen was very well tolerated without significant hematological toxicity. Conclusions Our results are disappointing. Despite the good safety profile, they do not support further investigation or the routine use of this regimen in this setting.
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Affiliation(s)
- Lorenza Rimassa
- Medical Oncology and Haematology Department, Istituto Clinico Humanitas, Rozzano, MI, Italy.
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Park YS, Ji J, Zalcberg JR, El-Serafi M, Buzaid A, Ghosn M. Oxaliplatin/5-fluorouracil-based adjuvant chemotherapy as a standard of care for colon cancer in clinical practice: Outcomes of the ACCElox registry. Asia Pac J Clin Oncol 2015; 11:334-342. [DOI: 10.1111/ajco.12409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Young Suk Park
- Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Jiafu Ji
- Beijing Cancer Hospital; Beijing China
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Ferrarotto R, Machado K, Mak MP, Shah N, Takahashi TK, Costa FP, Overman MJ, Kopetz S, Hoff PM. A multicenter, multinational analysis of mitomycin C in refractory metastatic colorectal cancer. Eur J Cancer 2012; 48:820-6. [DOI: 10.1016/j.ejca.2012.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 11/04/2011] [Accepted: 01/07/2012] [Indexed: 11/16/2022]
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Affiliation(s)
- Anastasios Dimou
- Yale School of Medicine, Division of Medical Oncology, 333 Cedar Street, FMP 116, New Haven, CT 06520, USA ;
| | - Kostas N Syrigos
- Yale School of Medicine, Division of Medical Oncology, 333 Cedar Street, FMP 116, New Haven, CT 06520, USA ;
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Lièvre A, Samalin E, Mitry E, Assenat E, Boyer-Gestin C, Lepère C, Bachet JB, Portales F, Vaillant JN, Ychou M, Rougier P. Bevacizumab plus FOLFIRI or FOLFOX in chemotherapy-refractory patients with metastatic colorectal cancer: a retrospective study. BMC Cancer 2009; 9:347. [PMID: 19785749 PMCID: PMC2761407 DOI: 10.1186/1471-2407-9-347] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 09/28/2009] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The anti-VEGF antibody bevacizumab associated with an irinotecan or oxaliplatin-based chemotherapy was proved to be superior to the chemotherapy alone in first or second line treatment of metastatic colorectal cancer (mCRC). However, it was reported to have no efficacy in 3rd or later-line, alone or with 5FU. The aim of this study was to evaluate the activity of bevacizumab combined with FOLFIRI or FOLFOX in mCRC who have failed prior chemotherapy with fluoropyrimidine plus irinotecan and/or oxaliplatin. METHODS Thirty one consecutive patients treated between May 2005 and October 2006 were included in this retrospective study. All of them have progressed under a chemotherapy with fluoropyrimidine plus irinotecan and/or oxaliplatin and received bevacizumab (5 mg/kg) in combination with FOLFIRI or simplified FOLFOX4 every 14 days. RESULTS Ten patients (32.2%) had an objective response (1 CR, 9 PR) and 12 (38.8%) were stabilized. The response and disease control rates were 45.4% and 100% when bevacizumab was administered in 2nd or 3rd line and 25% and 55% in 4th or later line respectively (p = 0.024 and p = 0.008). Among the patients who had previously received the same chemotherapy than that associated with bevacizumab (n = 28) the overall response rate was 35.7% and 39.3% were stabilized. Median progression free survival (PFS) and overall survival (OS) were of 9.7 and 18.4 months respectively. Except a patient who presented a hypertension associated reversible posterior leukoencephalopathy syndrome, tolerance of bevacizumab was acceptable. A rectal bleeding occurred in one patient, an epistaxis in five. Grade 1/2 hypertension occurred in five patients. CONCLUSION This study suggests that bevacizumab combined with FOLFOX or FOLFIRI may have the possibility to be active in chemorefractory and selected mCRC patients who did not receive it previously.
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Affiliation(s)
- Astrid Lièvre
- Gastroenterology and Digestive Oncology Unit, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France.
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Bekaii-Saab T, Hill M, Campbell A, Kosuri K, Thomas J, Villalona-Calero M. A phase I dose escalation study of a pharmacobiologically based scheduling of capecitabine and mitomycin C in patients with gastrointestinal malignancies. Cancer Chemother Pharmacol 2009; 65:863-9. [PMID: 19657639 DOI: 10.1007/s00280-009-1091-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Accepted: 07/20/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mitomycin C (MMC) produces significant upregulation of thymidine phosphorylase, a principal determinant of the therapeutic index of capecitabine-based treatment, starting 4-6 days after treatment. On the basis of the time-dependency of this upregulation, we performed a phase I dose escalation study of capecitabine and MMC in patients with gastrointestinal malignancies. METHODS A total of 29 patients with advanced gastrointestinal malignancies received MMC at 6 mg/m2 on day 1 and capecitabine escalated in four successive patient cohorts of doses 500-1,000 mg/m2/day twice daily on days 8-21, every 28 days. MMC was capped at 36 mg/m2. RESULTS A total of 29 patients were enrolled and 90% had at least one prior treatment in the metastatic setting. There was one DLT, grade 3 hand and foot syndrome, at dose level four. The most common toxicity was fatigue (61%). No patients experienced grade 4 toxicities. Nine patients experienced prolonged stability of disease. CONCLUSION Capecitabine in combination with MMC in the proposed schedule is well-tolerated with evidence of preliminary activity. The recommended dose for phase II studies are MMC at 6 mg/m2 on day 1 of a 28-day cycle with the dose capped at 36 mg/m2, in combination with capecitabine at 1,000 mg/m2 twice daily on days 8-21.
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Affiliation(s)
- Tanios Bekaii-Saab
- The Ohio State University Comprehensive Cancer Center, B407 Starling Loving Hall, 320 West 10th Avenue, Columbus, OH 43210, USA.
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Ntukidem N, Arce-Lara C, Otterson GA, Kraut E, Cataland S, Bekaii-Saab T. Capped-dose mitomycin C: a pooled safety analysis from three prospective clinical trials. Cancer Chemother Pharmacol 2009; 65:319-24. [DOI: 10.1007/s00280-009-1036-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Accepted: 05/10/2009] [Indexed: 10/20/2022]
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CHUA W, BEALE P, LEUNG M, CLARKE S. Retrospective review of mitomycin C use as third-line chemotherapy in metastatic colorectal cancer. Asia Pac J Clin Oncol 2008. [DOI: 10.1111/j.1743-7563.2008.00178.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Farquharson AL, Pranesh N, Witham G, Swindell R, Taylor MB, Renehan AG, Rout S, Wilson MS, O'Dwyer ST, Saunders MP. A phase II study evaluating the use of concurrent mitomycin C and capecitabine in patients with advanced unresectable pseudomyxoma peritonei. Br J Cancer 2008; 99:591-6. [PMID: 18682713 PMCID: PMC2527821 DOI: 10.1038/sj.bjc.6604522] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 06/23/2008] [Accepted: 06/30/2008] [Indexed: 11/12/2022] Open
Abstract
Pseudomyxoma peritonei (PMP) is a rare neoplastic process characterised by progressive intra-abdominal dissemination of mucinous tumour, and generally considered resistant to systemic chemotherapy. A phase II study in patients with advanced unresectable PMP was undertaken to evaluate the combination of systemic concurrent mitomycin C (7 mg m(-2) i.v. on day 1) and capecitabine (1250 mg m(-2) b.d. on days 1-14) in a 3-weekly cycle (MCap). Response was determined by semiquantitative assessment of disease volume on serial computed tomographic (CT) scans and serum tumour marker (CEA, CA125, CA19-9) changes at 12 weeks. Between 2003 and 2006, 40 patients were recruited through a national centre for the treatment of peritoneal surface tumours. At baseline, 23 patients had progressive disease and 17 had stable disease. Of 39 assessable patients, 15 (38%, 95% confidence intervals (CIs): 25, 54%) benefited from chemotherapy in the form of either reductions in mucinous deposition or stabilisation of progressive pretreatment disease determined on CT scan. Notably, two patients, originally considered unresectable, following MCap and re-staging underwent potentially curative cytoreductive surgery. Grade 3/4 toxicity rates were low (6%, 95% CIs: 4, 9%). Twenty out of 29 assessed patients (69%, 95% CIs: 51, 83%) felt that their Global Health Status improved during chemotherapy. This is the first trial to demonstrate an apparent benefit of systemic chemotherapy in patients with advanced unresectable PMP.
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Affiliation(s)
- A L Farquharson
- Peritoneal Tumour Service, Department of Surgery, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - N Pranesh
- Peritoneal Tumour Service, Department of Surgery, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - G Witham
- Peritoneal Tumour Service, Department of Surgery, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - R Swindell
- Department of Medical Statistics, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - M B Taylor
- Department of Radiology, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - A G Renehan
- Peritoneal Tumour Service, Department of Surgery, Christie Hospital NHS Foundation Trust, Manchester, UK
- School of Cancer and Imaging Sciences, University of Manchester, Manchester, UK
| | - S Rout
- Peritoneal Tumour Service, Department of Surgery, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - M S Wilson
- Peritoneal Tumour Service, Department of Surgery, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - S T O'Dwyer
- Peritoneal Tumour Service, Department of Surgery, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - M P Saunders
- School of Cancer and Imaging Sciences, University of Manchester, Manchester, UK
- Department of Clinical Oncology, Christie Hospital NHS Foundation Trust, Manchester, UK
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Hofheinz RD, Beyer U, Al-Batran SE, Hartmann JT. Mitomycin C in the treatment of gastrointestinal tumours: recent data and perspectives. ACTA ACUST UNITED AC 2008; 31:271-81. [PMID: 18497518 DOI: 10.1159/000122590] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Mitomycin C (MMC) is among the most effective anticancer drugs used for the treatment of a broad variety of tumours. This review summarises results of MMC-based chemotherapy in gastrointestinal tumours with special focus on current treatment options in gastric, pancreatic, biliary tract, colorectal, and anal cancer. In addition, these new developments are critically discussed with special attention to their potential clinical relevance.
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Affiliation(s)
- Ralf-Dieter Hofheinz
- Onkologisches Zentrum, III. Medizinische Klinik, Medizinische Fakultat Mannheim, Universitat Heidelberg, Germany.
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O’Neill B, Brown G, Wotherspoon A, Burton S, Norman A, Tait D. Successful downstaging of high rectal and recto-sigmoid cancer by neo-adjuvant chemo-radiotherapy. Clin Med Oncol 2008; 2:135-44. [PMID: 21892276 PMCID: PMC3161699 DOI: 10.4137/cmo.s348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The benefit of neoadjuvant therapy for tumours above the peritoneal reflection is not clear. The purpose of this study is to demonstrate the feasibility and downstaging of treating locally advanced tumours from high rectum to distal sigmoid with preoperative chemoradiotherapy (CRT). METHODS AND MATERIALS Seventeen patients with high rectal, rectosigmoid or distal sigmoid tumours above the peritoneal reflection received neoadjuvant CRT, selected on MRI findings indicating T4 disease or threatened circumferential resection margin. All patients were administered neoadjuvant chemotherapy, with Oxaliplatin or Mitomycin C and a Fluoropyrimidine. The pelvis received long-course CT-planned conformal RT, 45 Gy in 25 fractions, with a boost of 5.4-9 Gy in 3-5 fractions. Thirteen patients were treated with concomitant oral or intravenous Fluoropyrimidine chemotherapy. RESULTS Median follow-up was 37 months. Overall survival was 82.35% (95% Confidence Interval (CI) 54.7-93.9) and disease free survival 81.25% (95% CI 52.5-93.5). Only 1 patient suffered loco-regional relapse. Chemotherapy regimens were well tolerated, though some patients required dose reductions. Nine patients (52.9%) lowered pathologic disease AJCC stage, i.e. 'downstaged'. Six patients (35.3%) achieved complete pathological response. Clear margins were attained in all but 1 patient. Three patients were converted from cT4 to ypT3. No patient required a gap during CRT. One patient suffered a grade III acute toxicity, but no grade IV (RTOG). There were 3 grade III and 3 grade IV late toxicities (LENT-SOMA). CONCLUSIONS Locally advanced high rectal and recto-sigmoid tumours may be treated with pre-operative CRT with acceptable toxicity, impressive down-staging, and clear surgical margins.
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Affiliation(s)
- Brian O’Neill
- Department of Clinical Oncology, Mayday University Hospital, Croydon, U.K
| | - Gina Brown
- Department of Radiology, Mayday University Hospital, Croydon, U.K
| | | | - Sarah Burton
- Division of Colorectal Surgery, Mayday University Hospital, Croydon, U.K
| | - Andy Norman
- Medical Statistics, Royal Marsden Hospital, Sutton, Surrey, U.K
| | - Diana Tait
- Department of Clinical Oncology, Mayday University Hospital, Croydon, U.K
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Ernst T, Merx K, Gnad-Vogt U, Lukan N, Kripp M, Schultheis B, Hochhaus A, Hofheinz RD. Capecitabine in combination with docetaxel and mitomycin C in patients with pre-treated tumours: results of an extended phase-I trial. Br J Cancer 2007; 97:1475-9. [PMID: 18000507 PMCID: PMC2360249 DOI: 10.1038/sj.bjc.6604067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Preclinical data suggest that the anti-tumour activity of capecitabine is enhanced by taxanes and mitomycin C through up-regulation of thymidine phosphorylase (TP). Here, we studied safety and efficacy of the combination of capecitabine with docetaxel and mitomycin C. Two dose levels (DL) were investigated: capecitabine 1000 mg m(-2) b.i.d. on days 1-14, docetaxel 40 mg m(-2) i.v. day 1, mitomycin C 4 or 6 mg m(-2) i.v. day 1 (DL I or II). Cycles were repeated every 3 weeks. The primary aim was to determine the dose-limiting toxicities (DLT) during the first two treatment cycles and the maximum tolerated dose (MTD). A total of 46 patients (pts) refractory to standard therapies were enrolled, of whom the majority had gastrointestinal tumours (n=40). 14 pts had received >/=3 lines of prior chemotherapy. At DL I, one out of six pts experienced DLT. At DL II, two out of six pts had DLT (mucositis grade 3). Thus, DL I was determined as MTD. Among a total of 37 pts treated on DL I the following toxicities were observed during cycles 1 and 2 (number of patients with grade 1/2/3/4 toxicity; NCI-CTC v. 3.0): anaemia 10/8/3/0, leucocytopenia 4/11/1/2, thrombocytopenia 0/1/2/0, diarrhoea 8/1/2/0, stomatitis/mucositis 3/3/1/0, nausea/vomiting 10/2/0/0, and hand-foot skin reaction 5/1/1/0. Of 30 pts who received at least two treatment cycles nine achieved complete or partial remissions, six pts achieved minor remissions, and seven pts had stable disease (tumour control rate 73%). Of note, four out of 10 patients with pancreatic cancer had partial remissions. In conclusion, capecitabine can safely be combined with docetaxel (40 mg m(-2)) and mitomycin C (4 mg m(-2)). The established regimen was well tolerated and the preliminary efficacy data in this heavily pre-treated patients population appears to be promising.
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Affiliation(s)
- T Ernst
- Onkologisches Zentrum, III. Medizinische Klinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
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Abstract
Metastatic colorectal cancer remains a public-health issue on a global scale. With development of a new generation of cytotoxic agents, survival has improved for patients with metastatic disease. How to maximize the benefit of chemotherapy with acceptable toxicity remains incompletely answered. Hepatic resection can provide a significant hope for long term survival, and a subset of patients might benefit from perioperative approaches. More recently, specific molecular processes have been targeted for therapeutic interventions, and encouraging results have been achieved using inhibitors of the Epidermal Growth Factor Receptor and the Vascular Endothelial Growth Factor.
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Affiliation(s)
- Piercarlo Saletti
- Oncology Institute of Southern Switzerland, Ospedale S Giovanni, 6500 Bellinzona-CH, Switzerland.
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Abstract
Worldwide, colorectal cancer is a common cancer and a major cause of morbidity and mortality. Patients frequently present with, or later develop, metastatic disease. Median survival with supportive care alone is approximately 6 - 8 months. However, a number of recent developments have greatly increased the range of therapeutic options, improving median survival to > 20 months. Cytotoxic agents such as capecitabine, irinotecan and oxaliplatin are now established treatment strategies. In parallel, an improved understanding of tumour biology has led to the development of non-cytotoxic targeted therapies. Examples include bevacizumab (targeting tumour angiogenesis) and cetuximab (targeting the epidermal growth factor receptor). These agents have recently been incorporated into standard management. This paper reviews these and other advances in the care of patients with advanced colorectal cancer and discusses a number of agents that are currently under development.
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Affiliation(s)
- Kenneth Khamly
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Victoria 8006, Australia.
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Chong G, on behalf of the authors, Cunningham D. Reply: Capecitabine and mitomycin C in patients with metastatic colorectal cancer resistant to fluorouracil and irinotecan. Br J Cancer 2006; 94:937-937. [DOI: 10.1038/sj.bjc.6603022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Chong G, Dickson JLB, Cunningham D, Norman AR, Rao S, Hill ME, Price TJ, Oates J, Tebbutt N. Capecitabine and mitomycin C as third-line therapy for patients with metastatic colorectal cancer resistant to fluorouracil and irinotecan. Br J Cancer 2005; 93:510-4. [PMID: 16091760 PMCID: PMC2361607 DOI: 10.1038/sj.bjc.6602733] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Protracted venous infusion 5-fluorouracil (5FU) combined with mitomycin C (MMC) has demonstrated significant activity against metastatic colorectal cancer. Owing to potential synergy based upon upregulation of thymidine phosphorylase by MMC, the combination of capecitabine and MMC may improve outcomes in irinotecan-refractory disease. Eligible patients with progressive disease during or within 6 months of second-line chemotherapy were treated with capecitabine (1250 mg m−2 twice daily) days 1–14 every 3 weeks and MMC (7 mg m−2 IV bolus) once every 6 weeks. A total of 36 patients were recruited, with a median age of 64 years (range 40–77), and 23 patients (78%) were performance status 0–1. The objective response rate was 15.2%. In all, 48.5% of patients had stable disease. Median failure-free survival was 5.4 months (95% CI 4.6–6.2). Median overall survival was 9.3 months (95% CI: 6.9–11.7). Grade 3 toxicities were palmar-plantar erythema 16.7%, vomiting 8.3%, diarrhoea 2.8%, anaemia 8.3%, and neutropenia 2.8%. No patients developed haemolytic uraemic syndrome. Symptomatic improvement occurred for pain, bowel symptoms, and dyspnoea. Capecitabine in combination with MMC is an effective regimen for metastatic colorectal cancer resistant to 5FU and irinotecan with an acceptable toxicity profile and a convenient administration schedule.
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Affiliation(s)
- G Chong
- Department of Medicine, Royal Marsden Hospital, London and Surrey SM2 5PT, UK
| | - J L B Dickson
- Department of Medicine, Royal Marsden Hospital, London and Surrey SM2 5PT, UK
| | - D Cunningham
- Department of Medicine, Royal Marsden Hospital, London and Surrey SM2 5PT, UK
- Department of Medicine, The Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK. E-mail:
| | - A R Norman
- Department of Medicine, Royal Marsden Hospital, London and Surrey SM2 5PT, UK
| | - S Rao
- Department of Medicine, Royal Marsden Hospital, London and Surrey SM2 5PT, UK
| | - M E Hill
- Department of Medicine, Royal Marsden Hospital, London and Surrey SM2 5PT, UK
| | - T J Price
- Department of Medical Oncology, The Queen Elizabeth and Lyell McEwin Hospitals, Woodville, Australia
| | - J Oates
- Department of Medicine, Royal Marsden Hospital, London and Surrey SM2 5PT, UK
| | - N Tebbutt
- Department of Medicine, Royal Marsden Hospital, London and Surrey SM2 5PT, UK
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Toi M, Atiqur Rahman M, Bando H, Chow LW. Thymidine phosphorylase (platelet-derived endothelial-cell growth factor) in cancer biology and treatment. Lancet Oncol. 2005;6:158-166. [PMID: 15737832 DOI: 10.1016/S1470-2045(05)01766-3] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Thymidine phosphorylase (TP) is often induced in the tumour microenvironment by physiological and chemical stress. Its induction protects cells from apoptosis and helps cell survival by stimulating nucleoside metabolism and angiogenesis. Chemotherapy often upregulates TP, which acts in cell rescue; this result indicates that TP is a crucial therapeutic target. Clinical trials for metastatic diseases have shown that TP-targeting chemotherapy with fluorouracil derivatives greatly improves the effectiveness of conventional chemotherapy for not only response but also prognosis. This new idea, the improvement of TP-inducible therapy with TP-targeting therapy, should be further investigated for early disease states, and inhibitors of TP warrant extensive investigation.
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Ogata Y, Matono K, Sasatomi T, Ishibashi N, Torigoe S, Fukumitsu T, Mizobe T, Yamashita N, Yanagawa T, Shirouzu K. Upregulation of thymidine phosphorylase in rectal cancer tissues by mitomycin C. J Surg Oncol 2005; 93:47-55. [PMID: 16353181 DOI: 10.1002/jso.20390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES We have investigated the regulation by mitomycin C (MMC) of thymidine phosphorylase (dThdPase) and dihydropyrimidine dehydrogenase (DPD), which enhances or reduces the efficacy of capecitabine and its metabolite 5'-deoxy-5-fluorouridine (5'-DFUR), in rectal cancer tissues. MATERIALS AND METHODS In 31 patients with a rectal cancer, tumor biopsies were performed before and after pre-operative venous administration of 4 mg/m2, 6 mg/m2, or 10 mg/m2 of MMC. The dThdPase and DPD levels in the biopsy and surgical specimens were measured using ELISA, and immunostaining for dThdPase was performed. RESULTS The fitting multiple linear regression models indicated that the dThdPase levels increased after MMC administration, in particular in the patients with a pre-treatment dThdPase level less than 56.2 U/mg protein (median value). The time course analysis indicated that the increase in the dThdPase level by 4 mg/m2 of MMC administration continued for 3 weeks. The dThdPase/DPD ratio was increased after MMC administration in patients with a pre-treatment dThdPase/DPD ratio less than 1.79 (median value). MMC enhanced the expression of dThdPase protein both in the tumor cells and in the stromal cells. The disease free-survival rate in the Dukes B or C patients with a high dThdPase/DPD ratio in surgical specimen who received 5'-DFUR based adjuvant chemotherapy tended to be higher than that in those with a low dThdPase/DPD ratio. CONCLUSION MMC may upregulate the dThdPase level and the dThdPase/DPD ratio in rectal cancer tissues. Combined use of MMC with capecitabine or 5'-DFUR may offer a more effective colorectal cancer therapy.
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Affiliation(s)
- Yutaka Ogata
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
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