Stereotactic body radiation therapy for liver metastasis from colorectal cancer: size matters

PURPOSE

We analysed our initial experience with SBRT in liver metastasis from colorectal cancer at our institution.

MATERIALS AND METHODS

Between January/2014 and December/2017, 22 patients with 31 LMCCR were treated. Local control (LC) was assessed using the Kaplan-Meier and log-rank tests. We analysed potential prognostic factors for LC: sex, PTV size, number of LM and the radiation scheme.

RESULTS

Median age: 69 years. Prior chemotherapy or local liver treatments: 81.8% and 63.6% of patients, respectively. SBRT consisted of 3 × 20 Gy (42.9%) and 3 × 15 Gy (31.4%). There were 88.5% responses (57.1% CR and 31.4% PR). Median follow-up was 30 months. LC per lesion at 12 and 24 months was 85.3% and 61.8%, respectively. Tumour volumes > 30 cc correlated with worsened 2-year-control rates (90% vs 34.5%) (p = 0.005). There was only a patient with CTC-grade 3 toxicity.

CONCLUSIONS

Liver SBRT is a safe and effective treatment that achieves high local control rates. We found a significant correlation between larger LMCRC and worse local control.

Optimal duration of first-line chemotherapy for advanced gastric cancer: data from the AGAMENON registry

BACKGROUND

The optimal duration of first-line chemotherapy for patients with advanced gastric cancer is unknown. Diverse clinical trials have proposed different strategies including limited treatment, maintenance of some drugs, or treatment until progression.

METHOD

The sample comprises patients from the AGAMENON multicenter registry without progression after second evaluation of response. The objective was to explore the optimal duration of first-line chemotherapy. A frailty multi-state model was conducted.

RESULTS

415 patients were divided into three strata: discontinuation of platinum and maintenance with fluoropyrimidine until progression (30%, n = 123), complete treatment withdrawal prior to progression (52%, n = 216), and full treatment until progression (18%, n = 76). The hazard of tumor progression decreased by 19% per month with the full treatment regimen. However, we found no evidence that fluoropyrimidine maintenance (hazard ratio [HR] 1.07, confidence interval [CI] 95%, 0.69-1.65) worsened progression-free survival (PFS) with respect to treatment until progression. Predictive factors for PFS were ECOG performance status, ≥ 3 metastatic sites, prior tumor response, and bone metastases. Toxicity grade 3/4 was more common in those who continued the full treatment until progression vs fluoropyrimidine maintenance (16% vs 6%).

CONCLUSION

The longer duration of the full initial regimen exerted a protective effect on the patients of this registry. Platinum discontinuation followed by fluoropyrimidine maintenance yields comparable efficacy to treatment up to PD, with a lower rate of serious adverse events.

SEOM clinical guidelines for the diagnosis and treatment of gastroenteropancreatic and bronchial neuroendocrine neoplasms (NENs) (2018)

NENs are a heterogeneous family of tumors of challenging diagnosis and clinical management. Their incidence and prevalence continue to rise across all sites, stages and grades. Although improved diagnostic techniques have led to earlier detection and stage migration, the improved prognosis documented over time for advanced gastrointestinal and pancreatic neuroendocrine tumors also reflect improvements in therapy. The aim of this guideline is to update practical recommendations for the diagnosis and treatment of gastroenteropancreatic and lung NENs. Diagnostic procedures, histological classification and therapeutic options are briefly discussed, including surgery, liver-directed therapy, peptide receptor radionuclide therapy, and systemic hormonal, cytotoxic or targeted therapy, and treatment algorithms are provided.

Prognostic significance of thymidylate synthase polymorphisms in rectal cancer patients treated with neoadjuvant chemoradiotherapy

AIM

There is a lack of prognostic factors of preoperative chemoradiation for locally advanced rectal cancer. Thymidylate synthase (TS) is the most important target of 5-fluorouracil; three main genetic polymorphisms of TS have been described. We analysed the prognostic value of these in patients with locally advanced rectal cancer treated with fluoropyrimidine-based chemoradiation.

METHOD

Ninety-nine patients treated between November 2001 and March 2009 were included. All were treated by radiotherapy (5040 cGy) and concomitant fluoropyrimidine-based chemotherapy. Three polymorphisms were analysed: (i) a double (2R) or triple (3R) repeat of a 28 base pair (bp) tandem sequence upstream of the ATG codon initiation site in the 5'-terminal regulatory region, (ii) a functional G > C single nucleotide polymorphism present in the second repeat of the 3R alleles and (iii) a 6 bp deletion at nucleotide 1494 in the 3'-untranslated region. DNA was extracted from paraffin-embedded core biopsies taken from the tumour and the genotype was analysed using polymerase chain reaction restriction fragment length polymorphism.

RESULTS

The 6 bp polymorphism was significantly associated with disease-free survival (+ 6 bp/+ 6 bp vs-6 bp/-6 bp, P = 0.032 logistic regression). No differences were found in disease-free survival according to the other polymorphisms studied. No relationship was observed between the different TS genotypes and pathological regression.

CONCLUSION

The study suggests that the TS 6 bp polymorphism may be a predictor of disease-free survival in patients with locally advanced rectal cancer treated with fluoropyrimidine-based chemoradiation.

Escalating doses of hepatic arterial oxaliplatin in combination with docetaxel and capecitabine in patients with liver metastases from non-colorectal gastrointestinal malignancies

14110

Background: Docetaxel (T), oxaliplatin (O) and capecitabine (C) are active agents in gastrointestinal (g.i.) tumors. Synergism has been reported in several preclinical studies. The purpose of this study was to assess the maximum tolerated dose of hepatic arterial oxaliplatin in combination with docetaxel and capecitabine in patients (pts) with hepatic metastases from non-colorectal g.i. tumors. Preliminary evidence of activity was also evaluated. Methods: Patients with liver metastases from gastric (n=3), pancreas (n=6), esophageal (n=2) and cholangiocarcinoma (n=1) were treated with fixed doses of docetaxel (60 mg/m2), capecitabine (650 mg/m2 bid on days 1–14) and escalating doses of hepatic intraarterial oxaliplatin. Oxaliplatin dose was escalated according to the following schedule: level 1, 100 mg/m2; level 2, 110 mg/m2; level 3, 120 mg/m2. The cycle was repeated every 3 weeks. A CT scan or MRI was performed to evaluate response. Liver function tests were performed the day after and before the hepatic arterial infusion. Results: The median number of cycles was 5. At first dose level, 1 pt showed grade 3 mucositis and capecitabine intolerance that required treatment discontinuation. Three pts were later included in the same level with no further toxicity. At dose level 3, grade 3 vomiting was recorded in 1 pt and subsequently this level is now being expanded. Liver function tests on day 2 were elevated over baseline in 10 pts (83%). Seven pts (58%) required morphine due to pain associated with intraarterial infusion. Among 11 evaluable pts, 10 (83%) PRs have been confirmed. Conclusions: Accrual is ongoing at dose level 3. Preliminary data on efficacy seems promising.

No significant financial relationships to disclose.

Dose-finding study of fixed dose rate (FDR) infusion of gemcitabine in combination with bevacizumab and escalating doses of irinotecan in patients with advanced gastrointestinal (GI) tumors

13068

Background: Gemcitabine (GMB), Bevacizumab and Irinotecan (CPT-11) are active agents in GI tumors with preclinical evidence of synergism. The purpose of this study was to assess the maximum tolerated dose (MTD) of FDR GMB, Bevacizumab and CPT-11 in patients (pts) with advanced GI malignancies. Preliminary evidence of antitumor activity was also evaluated. Methods: A biweekly schedule of FDR GMB at a dose of 1000 mg/m2, Bevacizumab 5 mg/kg and CPT-11 (100–160 mg/m2 with a 10 mg/m2 increase in each cohort level) was analysed. The dose of CPT-11 was escalated in cohorts of three pts until the MTD was defined. Results: Thirty eligible pts with GI tumors were included (oesophagus: 2; gastroesophagic junction: 1; gastric: 2; pancreas: 2; colon: 17; rectum: 6) The median age was 60 years. ECOG status was 0–1 in 70% of pts. Male/female ratio was 21/9. Twenty-nine pts had received prior chemotherapy. The median number of cycles administered was six. Two of three pts at a CPT-11 dose of 160mg/m2 had grade 3 asthenia that required hospitalization. Recommended dose was thus established at CPT-11 dose of 150 mg/m2. Nine additional pts were included in this cohort and no further toxicity was observed. Antitumor activity was seen in 13 pts, with 3 complete responses and 10 partial responses. Conclusions: The recommended dose for phase II studies is CPT-11 150 mg/m2, GMB 1000 mg/m2 in FDR infusion and Bevacizumab 5 mg/kg on a biweekly schedule. Overall, this is a feasible regimen with a promising activity.

No significant financial relationships to disclose.