Triplet chemotherapy with or without bevacizumab as first line treatment for metastatic colorectal cancer: An AGEO multicenter real-world study

BACKGROUND

Prior trials validated triplet chemotherapy (Tri-CT) with bevacizumab as first line treatment for metastatic colorectal cancer (mCRC) but real-world data are scarce and practices remain heterogeneous.

AIMS

To evaluate Tri-CT +/- bevacizumab efficacy and safety, and to identify factors influencing treatment decisions.

METHODS

The COLOTRIP retrospective study enrolled mCRC patients treated from 2014 to 2019 in 14 French centers.

RESULTS

Of 299 patients (81% PS 0-1, 58% RAS-mutated and 19% BRAF-mutated), 51% received Tri-CT and 49% Tri-CT + bevacizumab. Metastatic disease was classified as resectable (6.5%), potentially resectable (40%), and unresectable (54%). Bevacizumab use was associated with primary tumor location, mutational status and number of metastases. Median overall survival was 33.5 months in the Tri-CT group and 23.9 months in the Tri-CT + bevacizumab group, with median progression-free survival being 14.5 and 11.4 months. After adjusting for initial characteristics, no difference in survival was noted. Around 30% of patients experienced grade ≥3 adverse events.

CONCLUSIONS

This study highlights several factors influencing Tri-CT use +/- bevacizumab decision and confirms the real-world good oncological outcomes and tolerability of these regimens in mCRC patients. Our results suggest that Tri-CT alone may by an appropriate option for specific subgroups of patients.

Physical Activity as the Best Supportive Care in Cancer: The Clinician's and the Researcher's Perspectives

Multidisciplinary supportive care, integrating the dimensions of exercise alongside oncological treatments, is now regarded as a new paradigm to improve patient survival and quality of life. Its impact is important on the factors that control tumor development, such as the immune system, inflammation, tissue perfusion, hypoxia, insulin resistance, metabolism, glucocorticoid levels, and cachexia. An increasing amount of research has been published in the last years on the effects of physical activity within the framework of oncology, marking the appearance of a new medical field, commonly known as "exercise oncology". This emerging research field is trying to determine the biological mechanisms by which, aerobic exercise affects the incidence of cancer, the progression and/or the appearance of metastases. We propose an overview of the current state of the art physical exercise interventions in the management of cancer patients, including a pragmatic perspective with tips for routine practice. We then develop the emerging mechanistic views about physical exercise and their potential clinical applications. Moving toward a more personalized, integrated, patient-centered, and multidisciplinary management, by trying to understand the different interactions between the cancer and the host, as well as the impact of the disease and the treatments on the different organs, this seems to be the most promising method to improve the care of cancer patients.

[From incidentaloma to secondary discovery]

The term incidentaloma, created in 1982, has spread throughout medical literature. However, there does not seem to be a precise definition to describe what an incidentaloma is. In the initial uses, the word incidentaloma systematically designated a mass that was detected during an imaging examination prescribed for diagnostic purposes unrelated to the reason for carrying out the examination. Naming this mass "incidentaloma" did not give any precision on its nature as it can be located in many anatomical zones, secreting or not, benign or malignant, etc. Today, the term "incidentaloma" carries a much broader dimension which seems to cover the notion of incidental discovery, whether radiological, biological or genetic. The evolution of the term "incidentaloma" demonstrates its heuristic nature. It is a sign of a change in modern medicine which hesitates between a patient clinic and a data clinic. Fortuitous discoveries are a phenomenon known and anticipated by radiologists. Thus, these discoveries are no longer fortuitous, or even unexpected, but secondary to the use of health technology.

[Fluoropyrimidines cardiac toxicity: 5-fluorouracil, capecitabine, compound S-1 and trifluridine/tipiracil]

The incidence of cardiac toxicity of 5-flurorouracil (5-FU) IV and capecitabine varies from 1.2 to 18%. The physiopathology of this toxicity is still under study, various hypotheses are mentioned. In the absence of identified prophylactic treatment, reintroduction of this cytotoxic is at risk. A discussion between oncologists and cardiologists is essential to estimate the balance between benefit and risk and the careful reintroduction of treatment. An alternative compound might be raltitrexed which is currently the treatment recommended in case of intolerance to fluoropyrimidines. The compound S-1 does not have any cardiac toxicity. Of a total of 2910 patients in phase II or III studies, no grade III or IV cardiovascular events were reported. However, the treatment is not reimbursed in France and therefore not available. The trifluridine/tipiracil, for which approval from French authorities was obtained in November 2016 for patients with metastatic colorectal cancer in progress despite standard treatment lines, does not appear to have cardiac toxicity according to studies published to date. The pivotal phase III study (RECOURSE), that led to this marketing authorization, was performed in 800 patients with metastatic colorectal cancer refractory and only one patient (less than 1% of patients) treated with trifluridine/tipiracil presented an episode of cardiac ischemia. Thus, trifluridine/tipiracil, which is well tolerated, could be an alternative to raltitrexed for patients with cardiovascular history contraindicating or discouraging the use of fluoropyrimidines.

Dietary oleoyl-estrone delays the growth rate of young rats

BACKGROUND

Oleoyl-estrone administration induces the rapid loss of fat preserving body protein.

AIM OF THE STUDY

We intended to check whether the fat-shedding effect of oleoyl-estrone arrests growth in young rats, limiting the buildup of protein and fat.

METHODS

Oleoyl-estrone diluted in a powdered hyperlipidic diet (33 mumol/kg) was given for 30 days to 30-day old Zucker lean (Fa/?) rats. Their body weight and food consumption were followed daily; on day 30 of treatment (60-day old rats), whole body composition (lipid, protein) was determined, and plasma energy parameters and leptin were measured.

RESULTS

Oleoyl-estrone-treated rats grew more slowly than controls fed the hyperlipidic diet alone, and on day 60 their lipid content was about half that of controls. Protein content per kg was identical in both groups, but treated rats tended to accumulate less nitrogen and energy because of their smaller size. No changes in plasma glucose, urea, triacylglycerols or total cholesterol were observed, but oleoyl-estrone-treated rats showed lower circulating leptin than controls.

CONCLUSION

Despite limiting the accumulation of lipids, oleoyl-estrone slowed, but did not arrest growth of young rats, nor elicit a loss of fat or protein.

Oral oleoyl-estrone induces the rapid loss of body fat in Zucker lean rats fed a hyperlipidic diet

OBJECTIVE

To test whether oleoyl-estrone affects body weight when given orally, which may help curtail the secondary growth-boosting effects of derived estrone.

DESIGN

The rats were fed for 15 days with a powdered hyperlipidic diet (16.97 MJ/kg metabolizable energy) in which 46.6% was lipid-derived and 16.1% protein-derived energy (HL group), containing 1.23+/-0.39micromol/kg of fatty-acyl esters of estrone. This diet was supplemented with additional oleoyl-estrone to produce diets with 2.5 micromol/kg (diet OE2.5), 4.4 micromol/kg (diet OE4.4), and 33.3 micromol/kg content in fatty-acyl estrone (diet OE33).

SUBJECTS

Twelve-week old female Zucker lean (Fa/?) rats initially weighing 200-235g.

MEASUREMENTS

Food intake and body weight changes; urine and droppings production and nitrogen content. Body composition (water, lipid, protein) and total energy. Energy and nitrogen balances. Plasma chemistry including free amino acids.

RESULTS

Oral administration of oleoyl-estrone in a hyperlipidic diet resulted in significant losses of fat, energy and, ultimately, weight, which were dependent on the dose of oleoyl-estrone ingested. Treatment induced the maintenance of energy expenditure combined with lower food intake, creating an energy gap that was filled with internal fat stores whilst preserving body protein. The decrease in food intake was not a consequence of food aversion but of diminished appetite. Energy expenditure was practically constant for all groups except for the OE33, which showed values about 25% lower than the controls. In most of the groups studied, there was a net protein deposition in spite of severe lipid and energy drainage. Amino acid levels agreed with this N-sparing shift. In spite of lowered energy intake, the N balance was positive or near zero in all groups, with a sizeable N-gap in controls and in lower-dose groups that disappeared in the OE33 group.

CONCLUSION

Treatment of rats with a hyperlipidic diet containing added oleoyl-estrone resulted in the dose-related loss of fat reserves with scant modification of other metabolic parameters and preservation of body protein. The results agree with the postulated role of oleoyl-estrone as a ponderostat signal and open the way for its development as anti-obesity drug.

Estrone in food: a factor influencing the development of obesity?

BACKGROUND

Estrone is a relatively abundant hormone widely distributed in tissues of animal and plant origin. It is a mild estrogen that induces increases in body weight in experimental animals. The relative abundance of estrone esters in animal tissues suggests that it may also be found in foods, from which it may alter the mechanisms of body weight control.

AIM OF THE STUDY

To measure the total estrone content in food and to determine whether this may affect body weight.

METHODS

In the first part of the study, a method was devised for the measurement of total estrone content in food. This was applied to the analysis of estrone content in a variety of food. Finally, hyperlipidic diets (18.6 MJ/kg) with a total estrone content 0.89 +/- 0.21 mumol/kg (control group) and 1.37 +/- 0.13 mumol/kg (laced with estrone fatty esters) were given to rats during 15 days, in order to determine the influence of dietary estrone on the body mass. Zucker lean (Fa/?) rats weighing initially 200-215 g were used. The total estrone (essentially as fatty esters) content of food was investigated by combining a dried methanol extraction with saponification and measurement of the free estrone evolved through radioimmunoassay.

RESULT

The content of estrone was zero in some vegetables, but significant in fruits, meats, and especially fats, both of plant and animal origin. The application of these analyses to a standard recommended diet for humans may result in intakes of more than 1 mumol of estrone per day, a figure comparable to the estrogen production by women. When rats were exposed to a raised estrone content in a fat-rich diet, they significantly increased their body weights, doubling their rate of growth (1.99 g/day) compared with controls (0.81 g/day), but maintaining their plasma composition and the proportions of lipid, water, and protein in their carcasses.

CONCLUSION

The widely distributed estrone esters in food and their relatively high concentrations may result in high free hormone intakes in humans. The continued and massive intake of estrone may enhance tissue deposition and lead to obesity.

[Tobacco addiction and current treatment methods]

Smoking currently is considered to be an addiction with severe medical and social effects. It has been implicated in some respiratory and extra-respiratory diseases. In spite of knowing its dangerous effects, many patients cannot stop smoking without outside help. This help usually is provided by health-care personnel. It is necessary to be familiar with disintoxication methods in order to be able to advise patients on the use of any one or a combination of them. The most efficient method is individual medical help. Nicotine substitutes have demonstrated their effectiveness. Other complementary methods are not considered effective unless combined.

[Tissue engineering of cartilagenous tissue. Vital cryopreservation]

The characteristics of in vitro synthesized cartilage tissue using tissue engineering techniques before and after cryopreservation are described. We determined cell survival, growth of extracellular matrix (collagen and proteoglycan) using a computer analysis system, and characterized the cell phenotype with a monoclonal antibody specific for collagen type II. Chondrocytes maintained a differentiated phenotype with collagen and proteoglycan synthesis before and after cryopreservation.

[Cellular viability of cryopreserved cartilage grafts]

Transplantation of preserved cartilage has an important role in reconstructive surgery. Opinions vary with regard to the performance of cryopreserved cartilage. We studied the functional state of chondrocytes after cryopreservation. Cellular survival was studied using the trypan blue dye exclusion test, a functional assay for cell adhesion, and transmission electron microscopy. Most chondrocytes were irreversibly damaged by cryopreservation and the cartilage could not originate new cartilage. Therefore, cryopreserved cartilage tends to generate fibrosis and resorption and is not practical for reconstructing skeletal parts exposed to mechanical stress.