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Bonilla CE, Montenegro P, O’Connor JM, Hernando-Requejo O, Aranda E, Pinto Llerena J, Llontop A, Gallardo Escobar J, Díaz Romero MDC, Bautista Hernández Y, Graña Suárez B, Batagelj EJ, Wali Mushtaq A, García-Foncillas J. Ibero-American Consensus Review and Incorporation of New Biomarkers for Clinical Practice in Colorectal Cancer. Cancers (Basel) 2023; 15:4373. [PMID: 37686649 PMCID: PMC10487247 DOI: 10.3390/cancers15174373] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Advances in genomic technologies have significantly improved the management of colorectal cancer (CRC). Several biomarkers have been identified in CRC that enable personalization in the use of biologic agents that have shown to enhance the clinical outcomes of patients. However, technologies used for their determination generate massive amounts of information that can be difficult for the clinician to interpret and use adequately. Through several discussion meetings, a group of oncology experts from Spain and several Latin American countries reviewed the latest literature to provide practical recommendations on the determination of biomarkers in CRC based on their clinical experience. The article also describes the importance of looking for additional prognostic biomarkers and the use of histopathology to establish an adequate molecular classification. Present and future of immunotherapy biomarkers in CRC patients are also discussed, together with several techniques for marker determination, including liquid biopsy, next-generation sequencing (NGS), polymerase chain reaction (PCR), and fecal immunohistochemical tests. Finally, the role of Molecular Tumor Boards in the diagnosis and treatment of CRC is described. All of this information will allow us to highlight the importance of biomarker determination in CRC.
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Affiliation(s)
- Carlos Eduardo Bonilla
- Fundación CTIC—Centro de Tratamiento e Investigación sobre Cáncer, Bogotá 1681442, Colombia
| | - Paola Montenegro
- Institución AUNA OncoSalud e Instituto Nacional de Enfermedades Neoplásicas, Lima 15023, Peru
| | | | | | - Enrique Aranda
- Departamento de Oncología Médica, Hospital Reina Sofía, IMIBIC, UCO, CIBERONC, 14004 Cordoba, Spain;
| | | | - Alejandra Llontop
- Instituto de Oncología Ángel H. Roffo, Ciudad Autónoma de Buenos Aires C1437FBG, Argentina
| | | | | | | | - Begoña Graña Suárez
- Servicio de Oncología Médica, Hospital Universitario de A Coruña, Servicio Galego de Saúde (SERGAS), 15006 A Coruña, Spain;
| | | | | | - Jesús García-Foncillas
- Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, 28040 Madrid, Spain
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2
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Cesca MG, Ruiz-Garcia E, Weschenfelder R, D’Agustini N, Iseas S, Luca R, O’Connor JM, D’Alpino R, Pereira AA, Mello CA, Aguiar S, e Silva VS, Riechelmann RP. Influence of proton pump inhibitors on the pathological response of rectal cancer: a multicentre study. Ecancermedicalscience 2023; 17:1586. [PMID: 37799958 PMCID: PMC10550299 DOI: 10.3332/ecancer.2023.1586] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Indexed: 10/07/2023] Open
Abstract
Background The standard neoadjuvant therapy for rectal cancer involves fluoropyrimidines and radiotherapy and, most recently, total neoadjuvant therapy (TNT). A drug-drug interaction between fluoropyrimidines and proton-pump inhibitors (PPI) was suggested, with a negative impact on oncological outcomes in breast, colon and gastric cancers. Little is known about such an effect on rectal tumours. We aimed to evaluate the impact of PPI utilisation on the pathological response after chemoradiation for rectal cancer. Materials and methods Retrospective multicentre study of rectal cancer patients treated with neoadjuvant chemoradiotherapy with capecitabine (cohort 1) or 5-fluororuracil (5-FU) (cohort 2); TNT with oxaliplatin-based regimens was allowed. The pathological response was considered a complete (ypCR) or complete + partial (ypCR + ypPR) according to American Joint Committee on Cancer. PPI use was considered at any time during the neoadjuvant period if concomitant to fluoropyrimidines. Results From January 2007 to November 2020, 251 patients received capecitabine and 196 5-FU. The rates of PPI use in cohorts 1 and 2 were 20.3% and 26.5%, respectively. TNT was offered to 18.3% in cohort 1. PPI use did not influence ypCR in cohort 1 (yes versus no: 29.4% versus 19.5%; p = 0.13) or 2 (yes versus no: 25.0% versus 26.4%; p = 1.0). Similar ypCR + ypPR were observed in both cohorts 1 (76.5% versus 72.0%; p = 0.60) and 2 (86.5% versus 76.4%; p = 0.16). PPI use was not associated with pathological response in multivariable analysis. PPI users experienced more grade 3 or higher diarrhoea and infections. Conclusion PPI concomitant to capecitabine/5-FU chemoradiation did not influence the pathological response in rectal cancer but was associated with more treatment-related adverse events.
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Affiliation(s)
- Marcelle G Cesca
- A.C. Camargo Cancer Center, Antonio Prudente Street, 211, São Paulo, SP 10509001, Brazil
| | - Erika Ruiz-Garcia
- Instituto Nacional de Cancerología, San Fernando Avenue, 22, Mexico City 14080, Mexico
| | - Rui Weschenfelder
- Hospital Moinhos de Vento, Ramiro Barcelos Street, 910, Porto Alegre, RS 90035-000, Brazil
| | - Nathalia D’Agustini
- Hospital Moinhos de Vento, Ramiro Barcelos Street, 910, Porto Alegre, RS 90035-000, Brazil
| | - Soledad Iseas
- Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Caseros Avenue, 2061, Buenos Aires C1264AAA CABA, Argentina
| | - Romina Luca
- Instituto Alexander Fleming, Crámer Street, 1180, Buenos Aires C1426ANZ, Argentina
| | - Juan Manuel O’Connor
- Instituto Alexander Fleming, Crámer Street, 1180, Buenos Aires C1426ANZ, Argentina
| | - Renata D’Alpino
- Hospital Alemão Oswaldo Cruz, Treze de Maio Street, 1815, São Paulo, SP 01323-020, Brazil
| | - Allan A Pereira
- Hospital Sírio Libanês Distrito Federal, SGAS 613 Street, Brasília 70200-730, Brazil
| | - Celso A Mello
- A.C. Camargo Cancer Center, Antonio Prudente Street, 211, São Paulo, SP 10509001, Brazil
| | - Samuel Aguiar
- A.C. Camargo Cancer Center, Antonio Prudente Street, 211, São Paulo, SP 10509001, Brazil
| | - Virgílio Souza e Silva
- A.C. Camargo Cancer Center, Antonio Prudente Street, 211, São Paulo, SP 10509001, Brazil
| | - Rachel P Riechelmann
- A.C. Camargo Cancer Center, Antonio Prudente Street, 211, São Paulo, SP 10509001, Brazil
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Tissera NS, Esteso F, Luca R, Enrico D, Waisberg F, Rodriguez A, Bruno L, Kucharczyk M, Amat M, García X, Pombo T, Salazar IP, Loria FS, Huertas E, Galli M, Chacón M, O’Connor JM. Atypical pattern of response in rectal cancer after neoadjuvant pembrolizumab treatment: a case report, literature review, and proposed management model. J Gastrointest Oncol 2023; 14:1635-1642. [PMID: 37435212 PMCID: PMC10331748 DOI: 10.21037/jgo-22-1140] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 05/17/2023] [Indexed: 07/13/2023] Open
Abstract
Background Immunotherapy is the first-line treatment in patients with advanced microsatellite instability-high (MSI-H) or deficient mismatch repair (dMMR) colorectal cancer (CRC). Although immune checkpoint inhibitors (ICIs) for locally advanced rectal cancer (LARC) are not yet a standard, the results are very encouraging and raise the question of whether patients with clinical complete response (cCR) could receive nonoperative management (NOM). However, different patterns of response have challenged management strategies. Case Description A 34-year-old woman diagnosed with dMMR LARC started treatment with capecitabine 2,000 mg/m2 on day 1 to 14 and oxaliplatin 130 mg/m2 on day 1 and every 21 days. Magnetic resonance imaging (MRI), performed three cycles later, showed local progression of the primary rectal lesion, which at that time had new peritoneal reflex involvement. A new hepatic lesion in segment V was observed. Due to disease progression, she was administered pembrolizumab 200 mg every 21 days. After three cycles, a discordant radiological response was observed on a new MRI scan that showed a complete response of the liver lesion and magnetic resonance tumor regression grade (mrTRG) 1 in the rectum. However, new involvement of the mesentery and enlargement of the regional lymph nodes (LNs) were also evident. A new colonoscopic biopsy was performed, showing no cancerous cells. She underwent surgery on the rectum and liver lesion. Pathology showed a complete response of the rectal wall and liver lesion, but 1 of 22 LNs was positive for adenocarcinoma (ypT0 N1 M0). The patient continued on pembrolizumab, and 14 months after surgery, she had not relapsed. Conclusions Neoadjuvant immunotherapy for rectal cancer requires new recommendations for the assessment of clinical response. Pseudoprogression should be ruled out as an atypical response before deciding on surgical treatment. We propose an algorithm to address pseudoprogression in this setting.
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Affiliation(s)
- Natalia S. Tissera
- Upper Gastrointestinal Cancer Translational Research Group, Vall’d Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Federico Esteso
- Department of Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Romina Luca
- Department of Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Diego Enrico
- Department of Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
- Research Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Federico Waisberg
- Department of Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
- Research Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Andrés Rodriguez
- Department of Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
- Research Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Luisina Bruno
- Department of Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Mariana Kucharczyk
- Department of Radiology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Mora Amat
- Department of Pathology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Ximena García
- Department of Pathology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Teresa Pombo
- Department of Pathology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | | | | | - Eduardo Huertas
- Department of Surgery, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Mariana Galli
- Department of Radiotherapy, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Matías Chacón
- Department of Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
- Research Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Juan Manuel O’Connor
- Department of Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
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Tissera NS, Freile B, Waisberg F, Esteso F, Galli M, Loria FS, Luca R, Pedraza II, Enrico DH, Chacón C, Huertas E, Chacón MR, O’Connor JM. Short-course radiotherapy for rectal cancer: real-world evidence in Argentina. Ecancermedicalscience 2023; 17:1555. [PMID: 37396101 PMCID: PMC10310334 DOI: 10.3332/ecancer.2023.1555] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Indexed: 07/04/2023] Open
Abstract
Background Short-course radiotherapy (SCRT) of 25 Gy in five daily fractions is a recommended strategy in the neoadjuvant setting for resectable locally advanced rectal cancer (LARC), as well as in cases of metastatic disease for local control. There is scarce information regarding the use of SCRT for patients who have received nonoperative management. Objectives To describe the characteristics of patients who received treatment with SCRT for LARC and metastatic rectal cancer, toxicity, and the approach after radiation treatment. Methods This is a retrospective analysis of all patients who underwent SCRT for rectal cancer at the Alexander Fleming Institute from March 2014 to June 2022. Results In total, 44 patients were treated with SCRT. The majority were male (29, 66%), with a median age of 59 years (interquartile range 46-73). Most patients had stage IV disease (26, 59.1%), followed by LARC (18, 40.9%). Most lesions were located in the middle rectum (30, 68%). The majority of LARC patients underwent SCRT followed by consolidation chemotherapy (ChT) (16/18, 89%), while most patients with metastatic disease underwent SCRT followed by consolidation ChT (14/26, 53.8%). A clinical complete response (cCR) was documented in 8/44, 18.2% of patients. Most patients with LARC and cCR were managed by a watch and wait approach (5/18, 27.7%). Local recurrence was observed in LARC cases (2/18, 11.1%). Patients who underwent SCRT following consolidation ChT were more likely to have adverse events (AEs) than those undergoing induction ChT following SCRT (11/30, 36.7% versus 3/12, 25%, p = 0.02). Conclusion In a subgroup of patients diagnosed with LARC and treated with SCRT followed by ChT, surgical treatment could be omitted after they achieved a cCR. Local recurrence was similar to that reported in a previous study. SCRT is a reasonable option for local disease control in stage IV disease, yielding low toxicity rates. Therefore, decisions must be made by a multidisciplinary team. Prospective studies are necessary to reach further conclusions.
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Affiliation(s)
- Natalia S Tissera
- Upper Gastrointestinal Cancer Translational Research Group, Vall´d Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- https://orcid.org/0000-0002-3396-6878
| | - Berenice Freile
- Department of Oncology, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0003-3192-126X
| | - Federico Waisberg
- Department of Oncology, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0003-4435-5068
| | - Federico Esteso
- Department of Oncology, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0003-1977-9846
| | - Mariana Galli
- Department of Radiotherapy, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0003-0147-2192
| | - Fernando Sanchez Loria
- Department of Surgery, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0001-9708-0649
| | - Romina Luca
- Department of Oncology, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0001-8564-905X
| | - Ivana Inés Pedraza
- Department of Surgery, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0001-9679-8368
| | - Diego Hernán Enrico
- Department of Oncology, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0003-4121-6855
| | - Carolina Chacón
- Department of Radiotherapy, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0009-0004-8556-6325
| | - Eduardo Huertas
- Department of Surgery, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0003-3473-0928
| | - Matías Rodrigo Chacón
- Department of Oncology, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0001-6872-4185
| | - Juan Manuel O’Connor
- Department of Oncology, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0002-6975-5466
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O’Connor JM, Esteso F, Chacón M. Official French SARS-CoV-2 guidelines for cancer patients, a triage solution with precision medicine. Colorectal Cancer 2020; 9:CRC21. [PMID: 33014141 PMCID: PMC7524005 DOI: 10.2217/crc-2020-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022]
Affiliation(s)
| | - Federico Esteso
- Instituto Alexander Fleming, 1180 Crámer St., Buenos Aires, Argentina
| | - Matías Chacón
- Instituto Alexander Fleming, 1180 Crámer St., Buenos Aires, Argentina
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