Contribution of CXCR4 and SMAD4 in predicting disease progression pattern and benefit from adjuvant chemotherapy in resected pancreatic adenocarcinoma

BACKGROUND

Prognosis of patients with pancreatic adenocarcinoma is poor. Many prognostic biomarkers have been tested, but most studies included heterogeneous patients. We aimed to investigate the prognostic and/or predictive values of four relevant biomarkers in a multicentric cohort of patients.

PATIENTS AND METHODS

A total of 471 patients who had resected pancreatic adenocarcinoma were included. Using tissue microarray, we assessed the relationship of biomarker expressions with the overall survival: Smad4, type II TGF-β receptor, CXCR4, and LKB1.

RESULTS

High CXCR4 expression was found to be the only independent negative prognostic biomarker [hazard ratio (HR) = 1.74; P < 0.0001]. In addition, it was significantly associated with a distant relapse pattern (HR = 2.19; P < 0.0001) and was the strongest prognostic factor compared with clinicopathological factors. In patients who did not received adjuvant treatment, there was a trend toward decrease in the overall survival for negative Smad4 expression. Loss of Smad4 expression was not correlated with recurrence pattern but was shown to be predictive for adjuvant chemotherapy (CT) benefit (HR = 0.59; P = 0.002).

CONCLUSIONS

CXCR4 is a strong independent prognostic biomarker associated with distant metastatic recurrence and appears as an attractive target to be evaluated in pancreatic adenocarcinoma. Negative SMAD4 expression should be considered as a potential predictor of adjuvant CT benefit.

Oxaliplatin/Capecitabine combination (Xelox) with or without targeted therapies in advanced colorectal cancer (ACRC) and pharmacokinetic analysis

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From 04/2002 to 12/2004, and 03/2006 to 08/2008, two consecutive steps were conducted in ACRC patients with chemotherapy alone for the step 1 and with Cetuximab and Bevacizumab for the step 2. Treatment schedule: oxaliplatin (0) 130 mg/m2 D1 over 4 to 6 hours, capecitabine (X) 1000 mg/m2 bi daily D2 to 15, 1 week rest. Cetuximab D1 at cyle 1 and at D2 at cycle 2(400 mg/m2 loading dose, then 250 mg/m2 every week), bevacizumab 7.5 mg/Kg D2 at cycle 1 and at D1 for the cycle 2. At cycle 3 cetuximab and bevacizumab were given at D1. PK analysis were performed at cycles 1 and 2, days 1,2,15,22 and 23. In the step 1, 23 pts were included, M/F = 9/14, M. age 57, PS 0–1-2 = 14/6/3, 1st line /2/3 = 18/4/1. Eleven responses were obtained (4 CR and 7 PR) 2 pts were in CR after hepatectomy, ORR = 48 %( intent to treat). In the step 2, 18 pts were included, M/F = 11/7, M. age = 55, PS 0–1-2 = 8/7/3, 1st line/2 = 17/1.Status K-RAS mutated/wild = 2/13.Seven pts responded to therapy: 1 CR, 6 PR and 1MR for an ORR of 38 %(intent to treat) 3 pts were in CR after hepatectomy and 6 pts were in SD, tumor control in 16/18 pts=88 %.Toxicity was mild, only 1 pt had G3 diarrhoea, 1pt G3 acne, 1pt had G3 neurotoxicity with need oxaliplatin discontinuation after 14 cycles. One pt had fatal pulmonary embolism at first cycle. PK results in plasma ( 14 pts in step 1 and 12 pts in step 2):no statistical differences between X and its metabolites on D2 and 15. Urinary elimination is about 2 % of total dose administered over 4 hours for 5- FU and 8 to 22% for Fluoro β Alanine (FBAL). Plasma clearance of 1.73±1.22ml/h/m2 for 5FU, 53.76±25.36ml/h/m2 for FBAL. For O, residual level at D15 higher in erythrocytes than in plasma suggest an important irreversible binding with red cells without blood toxicity. Conclusions: Xelox with and without targeted therapies is an active and safe combination in ACRC. When O is administered over a long period of time and X is given at least 12 h later, neurotoxicity was mild and no hand-foot syndrome was observed. Important PK parameters variability mainly for 5FU and FBAL suggest posology adaptation on the basis of concentration ratio 5FU/FBAL in blood. No PK interaction between monoclonal antibodies and X or O were observed whatever the schedule of drug administration.

No significant financial relationships to disclose.