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Rais G, Boutaagount F, Mokfi R, Maskrout M, Bennour S, Senoussi C, Rais F, Lahlou L. The Safety and Effectiveness of Bevacizumab in Metastatic Colorectal Cancer With Unresectable Metastases: A Real-Life Study From the South of Morocco. Cureus 2024; 16:e56733. [PMID: 38646225 PMCID: PMC11033042 DOI: 10.7759/cureus.56733] [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] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Background Colorectal cancer constitutes a significant public health challenge, despite remarkable strides made in the last two decades, particularly in the medical management of metastatic stages. Notable progress has been achieved through targeted therapies such as anti-epidermal growth factor receptors or anti-angiogenic antibodies, as well as advancements in surgical approaches for hepatic metastases. This study seeks to assess the efficacy and safety of bevacizumab plus chemotherapy in individuals with metastatic colorectal cancer. Methodology This is an observational, cross-sectional, retrospective study of all patients who were followed up for metastatic colorectal cancer with unresectable metastases and were treated with bevacizumab in combination with standard chemotherapy from January 2010 until December 2019 in the medical oncology department of the Centre Hospitalier Universitaire (CHU) Souss-Massa of Agadir. Results Of the total 162 cases, 117 (72%) had metastatic disease, and 45 (28%) progressed to metastatic disease after initial treatment. The median age of the patients was 55 years (range = 23-79 years) with a sex ratio of 1.1 (M/F). The tumor was located in the left colon in 135 (83.3%) patients. The results represented adenocarcinoma in 137 (84.6) cases and mucinous subtype in 23 (14.19) cases. The three most common sites of metastasis were the liver (99, 61.1), peritoneum (67, 41.3), and lung (33, 20.3). In the first line, all patients received bi-chemotherapy plus bevacizumab, i.e., fluorouracil, oxaliplatin, and leucovorin in 34 (20.9%) patients; capecitabine plus oxaliplatin in 88 (54.3%) patients; leucovorin, fluorouracil, and irinotecan in 17 (10.4%) patients; and capecitabine plus irinotecan in 23 (14.1%) patients. Response after first-line treatment was progression in 74 (45.7) cases, stability in 42 (25.9) cases, partial response in 35 (21.6) cases, and complete response in 11 (6.8) cases. Nine (6%) patients were able to benefit from surgical resection of metastatic lesions. Overall, 77 (47%) patients received second-line chemotherapy, i.e., 5-FU with irinotecan in 40 (51.8%) cases or with oxaliplatin in 30 (38.8%) cases. Two patients developed undesirable side effects under bevacizumab (hypertension). The median progression-free survival and median overall survival of the study cohort were 9 months and 14 months, respectively. Nevertheless, patients who underwent primary tumor resection (p = 0.048), those with right‑sided tumors (p = 0.022), those who received a higher number of treatment cycles (p = 0.020), and those who received maintenance treatment (p = 0.001) had a longer median overall survival. Conclusions Chemotherapy combination with bevacizumab is considered as the cornerstone of metastatic colorectal cancer treatment in our region. With the new healthcare and social security systems, easier access to expensive treatments and molecular pathology tests is currently available. It is important to highlight that real-world data can offer valuable insights into the daily clinical practice of medical oncology.
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Affiliation(s)
- Ghizlane Rais
- Medical Oncology, Centre Hospitalier Universitaire (CHU) Souss Massa, Agadir, MAR
- Medical Oncology, Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Agadir, MAR
| | - Farah Boutaagount
- Medical Oncology, Faculty of Medicine and Pharmacy of Agadir, University Ibn Zohr, Centre Hospitalier Universitaire (CHU) Souss Massa, Agadir, MAR
| | - Rania Mokfi
- Medical Oncology, Faculty of Medicine and Pharmacy of Agadir, University Ibn Zohr, Centre Hospitalier Universitaire (CHU) Souss Massa, Agadir, MAR
| | - Meryem Maskrout
- Medical Oncology, Faculty of Medicine and Pharmacy of Agadir, University Ibn Zohr, CHU Souss MassaCentre Hospitalier Universitaire (CHU) Souss Massa, Agadir, MAR
| | - Soundous Bennour
- Medical Oncology, Faculty of Medicine and Pharmacy of Agadir, University Ibn Zohr, Centre Hospitalier Universitaire (CHU) Souss Massa, Agadir, MAR
| | - Chaymae Senoussi
- Medical Oncology, Faculty of Medicine and Pharmacy of Agadir, University Ibn Zohr, Centre Hospitalier Universitaire (CHU) Souss Massa, Agadir, MAR
| | - Fadoua Rais
- Radiation Therapy, University Hospital Center of Montreal, Montreal, CAN
| | - Laila Lahlou
- Epidemiology and Clinical Research Laboratory, Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Agadir, MAR
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Huang L, Wei G, Chen N, Liu J, Wang Z, Yu Y, Qiu M. Impact of Upfront Chemotherapy on the Effect of Primary Tumour Resection for Asymptomatic Synchronous Colorectal Cancer With Unresectable Metastases: A Propensity-Score-Matched Cohort Analysis. Clin Med Insights Oncol 2022; 16:11795549221085054. [PMID: 35355515 PMCID: PMC8958687 DOI: 10.1177/11795549221085054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 10/15/2021] [Accepted: 02/05/2022] [Indexed: 02/05/2023] Open
Abstract
Background: It is controversial whether primary tumour resection (PTR) and the sequencing of chemotherapy and PTR are associated with the survival of patients with incurable stage IV colorectal cancer. This study aimed to explore the effects of PTR and the sequencing of chemotherapy and PTR on asymptomatic colorectal cancer with synchronous unresectable metastases (asmCRC). Patients and Methods: Patients with asmCRC were retrospectively identified from a single centre and categorised into 3 groups: PTR followed by chemotherapy (POC), upfront chemotherapy followed by PTR (UFC), and palliative chemotherapy (PC). The primary end points included median overall survival (OS) and progression-free survival (PFS). Clinical features were analysed using χ2 test, while survival curves were generated using the Kaplan-Meier test. Propensity-score matching (PSM) was performed when comparing survival between POC and UFC groups. Results: From 2008 to 2014, 255 patients were identified and included into the POC (n = 101), UFC (n = 40), and PC (n = 114) groups. The UFC and POC groups had significantly better median OS compared with the PC group (40.7 vs 16.3 months, P < .0001; 39.7 vs 16.3 months, P < .0001). Before PSM, the UFC group had better median PFS than the POC and PC groups (18.5 vs 9.7 months, P = .038; 18.5 vs 6.1 months, P < .0001). After PSM, UFC has better PFS than POC (P = .038). And the UFC group did not have higher postoperative or preoperative morbidity compared with the POC group (P = .235). Conclusions: Primary tumour resection could improve the survival of patients with asmCRC. Compared with POC or PC, UFC was associated with a better median PFS without significantly increasing preoperative or postoperative morbidity.
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Affiliation(s)
- Lin Huang
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Guixia Wei
- Department of Abdominal Cancer, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jiewei Liu
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yongyang Yu
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Meng Qiu
- Department of Abdominal Cancer, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Namikawa T, Marui A, Yokota K, Fujieda Y, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Successful Conversion Surgery for Advanced Gastric Cancer With Multiple Liver Metastases Following Ramucirumab Plus Paclitaxel Combination Treatment. In Vivo 2021; 35:2929-2935. [PMID: 34410989 PMCID: PMC8408704 DOI: 10.21873/invivo.12584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023]
Abstract
AIM To present the case of a patient with unresectable gastric cancer showing a remarkable effect by second-line drug treatment with ramucirumab plus paclitaxel and conversion surgery. CASE REPORT A 68-year-old woman who was diagnosed with gastric cancer was referred to us. Esophagogastroduodenoscopy showed an ulcerated lesion with an irregular nodulated border in the lower third of the stomach, and histology of biopsied specimens indicated a poorly differentiated adenocarcinoma. Enhanced computed tomography revealed extensive invasion of the liver, and the patients was treated using S-1 plus oxaliplatin as first-line chemotherapy. Because she developed liver metastases, the treatment regimen was changed to ramucirumab plus paclitaxel as the second-line treatment. After four cycles of weekly paclitaxel with ramucirumab treatment, the liver metastases had completely disappeared. Because no other metastatic lesions in other organs were detected, we performed total gastrectomy with D2 lymphadenectomy. The macroscopic findings of the surgically resected specimen revealed an ulcerated lesion with an irregularly modulated lesion measuring 9.5×4.5 cm. Pathological analysis demonstrated a poorly differentiated adenocarcinoma in the stomach, with invasion to the liver through the serosal layer, and seven lymph node metastases. The postoperative course was unremarkable, and she received ramucirumab in combination with paclitaxel treatment. However, liver metastasis appeared at 4 months after the operation, for which she was treated with irinotecan. Although the patient continued to receive irinotecan chemotherapy for 10 months, her general condition gradually deteriorated, and she was started on best supportive care 13 months after conversion surgery. CONCLUSION Conversion surgery may prolong survival not only through first-line but also second-line treatments in selected patients with unresectable advanced gastric cancer; however, assessments of additional cases and further studies are required to establish this treatment strategy.
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Affiliation(s)
| | - Akira Marui
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | - Yuki Fujieda
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
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Karanicolas PJ, Metrakos P, Chan K, Asmis T, Chen E, Kingham TP, Kemeny N, Porter G, Fields RC, Pingpank J, Dixon E, Wei A, Cleary S, Zogopoulos G, Dey C, D'Angelica M, Fong Y, Dowden S, Ko YJ. Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement. ACTA ACUST UNITED AC 2014; 21:e129-36. [PMID: 24523610 DOI: 10.3747/co.21.1577] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite significant improvements in systemic therapy for patients with colorectal liver metastases (crlms), response rates in the first-line setting are not optimal, and response rates in the second-line setting remain disappointing. Hepatic arterial infusion pump (haip) chemotherapy has been extensively studied in patients with crlms, but it remains infrequently used. We convened an expert panel to discuss the role of haip in the contemporary management of patients with crlm. Using a consensus process, we developed these statements: haip chemotherapy should be given in combination with systemic chemotherapy.haip chemotherapy should be offered in the context of a multidisciplinary program that includes expertise in hepatobiliary surgery, medical oncology, interventional radiology, nursing, and nuclear medicine.haip chemotherapy in combination with systemic therapy should be considered in patients with unresectable crlms who have progressed on first-line systemic treatment. In addition, haip chemotherapy is acceptable as first-line treatment in patients with unresectable colorectal liver metastases.haip chemotherapy is not recommended in the setting of extrahepatic disease outside the context of a clinical trial.haip chemotherapy in combination with systemic therapy is an option for select patients with resected colorectal liver metastases. These consensus statements provide a framework that clinicians who treat patients with crlm can use when considering treatment with haip.
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Affiliation(s)
- P J Karanicolas
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - P Metrakos
- Quebec: Department of Surgery (Metrakos, Zogopoulos), McGill University, Montreal
| | - K Chan
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - T Asmis
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - E Chen
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - T P Kingham
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - N Kemeny
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - G Porter
- Nova Scotia: Department of Surgery (Porter), Dalhousie University, Halifax
| | - R C Fields
- Missouri: Department of Surgery (Fields), Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis
| | - J Pingpank
- Pennsylvania: Department of Surgery (Pingpank), University of Pittsburgh, Pittsburgh
| | - E Dixon
- Alberta: Departments of Surgery (Dixon) and Medicine (Dowden), University of Calgary, Calgary
| | - A Wei
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - S Cleary
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - G Zogopoulos
- Quebec: Department of Surgery (Metrakos, Zogopoulos), McGill University, Montreal
| | - C Dey
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - M D'Angelica
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - Y Fong
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - S Dowden
- Alberta: Departments of Surgery (Dixon) and Medicine (Dowden), University of Calgary, Calgary
| | - Y J Ko
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
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