Autologous natural killer cells as a promising immunotherapy for locally advanced colon adenocarcinoma: Three years follow-up of resectable case

BACKGROUND

Over the last decade, a new modality of immunotherapy has been announced, with the expectation of better long-term clinical outcomes and disease-free survival after the definitive surgical treatment of colon cancer. Natural killer (NK) cells as part of cellular therapy in immunotherapy have the potential effect as an adjuvant therapy for locally advanced and metastasized colorectal adenocarcinoma. We would evaluate the clinical outcome of autologous NK cell therapy for resectable colon cancer.

CASE

A 64-year-old woman presented with a transverse colon tumor-related partial intestinal obstruction and a history of bloody diarrhea. A transverse colectomy has been done, and the pathology report reported adenocarcinoma of the transverse colon and positive lymph node involvement (TNM stage III). The patient had R0 resection status. A PET scan was done 6 months later, with positive lymph node glucose uptake at mesocolic. NK cell therapy was administered for 2 cycles with a 3-month interval, and PET scan follow-up was done 3 years after resection; no more glucose uptake was found, and the patients tolerated the therapy well with no immune-related adverse effects reported.

CONCLUSION

As a new modality in immunotherapy strategies for locally advanced colon adenocarcinoma, particularly in cases unsuitable for standard chemotherapeutic treatment, autologous NK cells have a promising effect and are feasible and well tolerated in our clinical practice.

Resectable Gastric Adenocarcinoma Cancer and the Role of Early Feeding on Clinical Outcome

Background: Gastric adenocarsinoma is one of the most common gastrointestinal tract cancer, it could be found either in elderly or young patients.  Surgical resection is still the main therapeutic option  and  the gold standard for the resectable cases.  Enhanced recovery protocols has been announced  to improved the clinical outcome in of gastrointestinal cancer surgery. Especially in upper GI cancer, which still challenging in starting the oral feeding after surgical resection. We will reported the clincal outcome of early feeding on resectable gastric adenocarsinoma patients.   Methods: This was a retrospective study, taken from January 2018 - December 2020.  All resectable gastric adenocarsinoma  patients were included.  Tumor locations, type of resection and reconstruction were evaluated.  All patients had early oral feeding from the first post operative day, continued with liquid and semi solid food.  The short term outcome were recorded including the anastomose leakage and surgical site infection.     Results: We reported eight gastric cancer patients during this study, 1 patient was young gastric cancer patiens and the rest were > 50 years old patients.  Gastric anthrum was the most common tumor site with partial gatrectomy and Billroth II  have been done.  3 patients were corpus site and 1 case of fundus cancer,  total gastrectomy and roux en y esófago-jejunostomy reconstruction was done.  We found   no anastomosis leakage.  No SSI and no readmission associated with post operative morbidity.    Conclusion:  Early feeding on resectable gastric adenocarsinoma patients was feasibel, has good clinical outcomes and could tolerated well, no matter what type of gastric resection we did.      

Gastrointestinal Cancer and Vaccination Safety during COVID-19 Pandemic

BACKGROUND: During our past 18 months, we must be faced with the current COVID-19 pandemic era with much uncertainty in the continuation of multimodality treatment of the gastrointestinal cancer patients. Especially in this immunocompromised group with the history of previous chemotherapy treatment, these patients have an increased risk of COVID-19 transmission. Many studies have been reported about the current recommendation for gastrointestinal cancer patients during this pandemic, but there might be a lack of evidence about the safety of vaccination for the gastrointestinal cancer patients. AIM: Since the vaccination has been approved by our government medical support, we would evaluate the safety of the COVID-19 vaccination program in gastrointestinal cancer patients. METHODS: All gastrointestinal cancer patients who have been already diagnosed with cancer will be included in this study. The vaccine-related sign symptoms will be recorded and evaluated. The chemotherapy schedule was not been interrupted following the vaccination. The patient who refused to receive the second vaccination dose will be excluded from this study. RESULTS: Thirty-two patients were included in this study (our past 6-month evaluation from February till August 2021), colorectal adenocarcinoma was the most common gastrointestinal cancer according to organ-specific (25 patients), the others were gastric adenocarcinoma, pancreatic adenocarcinoma, and small bowel gastrointestinal stromal tumor. Both of them already received two doses of COVID-19 vaccine during this period, we reported there was no side effect related to these and the chemotherapy cycle has not been interrupted during vaccination. All of the patients could be tolerated it well and did not refuse to continue the treatment. CONCLUSION: There were no significant signs and symptoms of vaccine-related side effects on gastrointestinal cancer patients. COVID-19 vaccination during this pandemic and following the chemotherapy schedule on any kind of gastrointestinal cancer patients was safe and could be suggested as a routine protocol.

Relationship between 25(OH)D and Colorectal Cancer Prevalence at Dr. Moewardi Hospital Surakarta-Indonesia: A Cross-Sectional Study

Background: Colorectal cancer is a malignancy of the colon and / or rectum. Vitamin D has a role as an inhibitor of tumor progression, namely through the process of influencing cellular differentiation and proliferation. (VDR) Vitamin D Receptor affects cell differentiation by upregulating brush boundary enzymes and improving morphological microvilli. This study seeks to determine the relationship between 25(OH)D levels and colorectal cancer in dr. Moewardi Hospital, Surakarta, Indonesia. Methods: A cross-sectional design study with quantitative-analytical observation was conducted. All patients had symptoms of colorectal cancer, either undiagnosed or previously diagnosed. 25(OH)D samples were taken from a total of 50 patients at dr. Moewardi Surakarta and subsequent diagnostic measures from the results of histopathology were assessed. The parameters assessed were 25(OH)D level and a diagnosis of colorectal malignancy. Statistical analysis of 25(OH)D levels and colorectal diagnosis using the Chi Square test. Results: The prevalence of colorectal cancer is higher in respondents with 25(OH)D deficiency and insufficiency compared to respondents with normal 25(OH)D concentrations who tend to have non-colorectal cancer. Based on the Chi-Square test result, the significance value was 0.004, marking a statistically significant association. Conclusion: This study shows a significant relationship between deficiency and insufficiency of 25(OH)D concentrations with the occurrence of colorectal malignancy

Moist Exposed Burn Ointment Effectiveness for Capecitabine Associated Grade II and III Hand Foot Syndrome on Stage III Colonic

Background:Hand-foot syndrome (HFS), also known as palmoplantar erythrodysesthesia, is a common adverse effect of the fluoropyrimidine chemotherapy agent capecitabine. Hand-foot syndrome of any grade is reported to affect 43% to 71% of patients treated with single-agent capecitabine chemotherapy. Although not life-threatening, it can have adverse effects on the quality of life (QoL) and daily living activities of a patient.  Sometimes the dose interruptions and reductions required after observation of HFS can also impact on dose intensity and treatment outcomes.  As an option for the treatment of this case, we would reported our preliminary study of the effectiveness of moist exposed burn ointment (MEBO) for stage II and III HFS.   Methods:  We will evaluate the clinical sign and symptoms of hand foot syndrome grade II and III associated with capecitabine as adjuvant chemotherapy agent on advanced stage colorectal cancer.  All patients with HFS will treated with topical MEBO twice daily, the clinical improvement of the symptoms will be recorded.   Results: We reported 8 cases of grade II and III hand foot syndrome, 2 patients were grade III HFS and the others were grade II.  These symptoms occurred after 2 until 3 months after capecitabine administration for locally advanced (stage III) colonic adenocarsinoma.  Topical MEBO were used twice a day for 3 months, pain reduction was achieved with no capicetabine dose interruption and reduction during chemotherapy period.  Allergic reaction was not found during and after MEBO application in this case.   Conclusion:Moist exposed burn ointment was an effective treatment option in managing hand foot syndrome, better option in reducing the pain without interrupting the capecitabine doses.

A rare clinical presentation of third part duodenal perforation due to post-endoscopic retrograde cholangiopancreatography stent migration on advanced stage peri-ampullary tumor

As a diagnostic and therapeutic treatment role on malignant biliary obstruction, endoscopic retrograde cholangiopancreatography (ERCP) has already been used as a routine procedure, especially for palliative treatment on advanced stage peri‐ampullary tumor. This minimal invasive procedure has many early or late complications such as bleeding, post‐ERCP pancreatitis, perforation, cholangitis, and the rare duodenal perforation from the stent migration. The current review reported the incidence of stent erosion associated with duodenal perforation was only 1% for this palliative procedure. We report a 75 years old male patient with diffuse abdominal tenderness 7 days after palliative ERCP stent placement for malignant biliary obstruction, metal stent could not be placed, and plastic stent placement had been done. There was no post‐ERCP pancreatitis found during the first 24 h. The patient came to the emergency with clinical sign and symptoms of diffuse peritonitis; abdominal X‐ray found no free intraperitoneal air. Exploratory laparotomy was performed, and we found bile leak from the third part of perforated duodenal with 5 mm in diameter, plastic stent exposed from the perforation site, and no active bleeding. We performed primary suture of the duodenum, cholecysto‐enteric bypass, pyloric exclusion, gastro‐jejunostomy bypass, and braun anastomosis. Jejunostomy feeding has been placed. There were no postoperative cardiopulmonary complication, and the patient could tolerate well for oral intake and discharged from hospital at 10th postoperative day (POD). This rare duodenal perforation complication could happen even in plastic stent placement during the ERCP procedure, and early management was needed to gain the favorable outcome.

Bismuth Classification of Bile Duct Injury and Its Association with Increasing 30 Days Mortality after Revision Surgery

Background: The incidence rate of bile duct injury has not been changed for many years for both open or laparoscopic technique.  Open cholecystectomy has risen from 0.5% to 1.4% when gallbladder removal is performed laparoscopically.  Injuries of the bile duct system after laparoscopic cholecystectomy are more complex than that after an open approach, causing significant morbidity and even death.  From initial classification published by Bismuth, there have been many classifications of common bile duct injury.  We would reported the 30 days mortality rate following reconstruction after bile duct injury according to type of Bismuth classification. Case Report: 7 cases of common bile duct injury were reported from 2016 until 2018 following cholecystectomy (both open and laparoscopic), all cases were diagnosed as early complication and without intra operative cholangiography performed.  The most common bile duct injury was Bismuth type II and IV (2 patients in each type).  Reconstruction has been done by hepatico jejunostomy for type III and IV.  Choledoco Duodenostomy bypass was done for type I and II.  2 patients with bismuth type IV have long standing cholangitis and cannot survive during 30 days of follow up.  4 others patients could survive with no intra abdominal complication nor other morbidity. Conclusion:  Bismuth  classification was the simpliest type to described the bile duct injury, Bismuth type IV was associated with the high risk of 30 days mortality rate.   Keywords: bismuth classification, bile duct injury, cholecystectomy, mortality

Abstract PO-080: Increasing of emergency presentation on colorectal cancer patients during COVID-19 pandemic: A retrospective study on single-center academic hospital

Background: Colorectal cancer was the most common cancer found in the GI tract; the two most common clinical emergency presentations were intestinal obstruction and perforation on the tumor site or proximally to the distal tumor. During the COVID-19 pandemic, we must face the new condition; we should modify the clinical outpatients’ schedule, which could address the other problem, that colorectal cancer patients refuse to continue treatment planning and that elective and well-prepared operations will be decreased.

Methods: We will report the clinical presentation of our colorectal cancer patients during the last 2 months from March until May 2020. All patients with emergency presentation of colorectal cancer will be included; any comorbidities will be recorded on this study. Patients with emergency colorectal cancer who could not fit for emergency operation will be excluded. Inpatient mortality and postoperative complications will be evaluated.

Results: During the 2-month period, we evaluated 26 cases of emergency colorectal cancer patients. Most of the patients came with total intestinal obstruction on the emergency presentation (22 cases); the others (4 cases) came with diffuse peritonitis due to colonic perforation. All patients were reported negative for COVID-19 on rapid test. Exploratory laparotomy was done in this emergency setting; 10 patients had sigmoid colon cancer, 15 patients had rectal cancer, and 6 patients had right colonic cancer. Intestinal perforation was found on rectal cancer patients. Tumor resection and primary anastomosis were done on 18 patients, and the others had stoma diversion. Inpatient mortality reported on 4 patients of perforation cases and had cardiopulmonary complication postoperatively.

Conclusion: During the COVID-19 pandemic, emergency presentation of colorectal patients increased, and intestinal perforation was the risk factor of inpatient mortality.

Citation Format: Budhi Ida Bagus, Metria Ida Bagus, Setyawati Ida Ayu, Mastini Ida Ayu Kade. Increasing of emergency presentation on colorectal cancer patients during COVID-19 pandemic: A retrospective study on single-center academic hospital [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-080.