bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tolerability and toxicity profile of chemotherapy with oxaliplatin in combination with infusional fluorouracil (FOLFOX) and capecitabine (XELOX) in a community oncology setting.
Authors: Galiauskas Raimundas , Hassett Edel , Murphy Kate , Spillane Donna , Ahmed Gul , Bird Brian Richard , Murphy Conleth G. 
Published: March 2020

e14111 Background: Chemotherapy regimens combining oxaliplatin with infusional fluorouracil (folfox) and capecitabine (xelox) have been found to be superior to fluoropyrimidine chemotherapy alone in colon cancer and are also useful in other gastrointestinal tumor types, including gastro-oesophageal cancers. We retrospectively assessed the tolerability and deliverability of the folfox and xelox regimens in a community oncology setting. Methods: Patients (pts) receiving folfox or xelox chemotherapy for gastrointestinal malignancies over a five year period from 2006 to 2011 were identified through a pharmacy database. Patient and tumour characteristics were recorded. For each regimen, delays in planned chemotherapy administration (>3 days) as well as dose reductions were recorded. Reasons for dose modification and/or treatment discontinuation were recorded. Regimens were compared for these outcomes using Fisher's exact test for categorical variables and unpaired t-test for continuous variables. Results: Of 138 pts with adequate information for assessment, 94 received folfox and 44 received xelox. Pts who received folfox were more likely to experience dose delays (64% vs. 36%, 2-sided p=0.003). The mean dose delays during folfox and xelox were not significantly different (12.2 vs. 10.8 days, t-test p=0.657). Pts who received folfox were less likely to require any dose reductions during therapy (31% vs. 50%, 2-sided P=0.038). Similar numbers of pts receiving folfox and xelox required dose reductions of oxaliplatin (27% vs. 32%, 2-sided p=0.548), while fewer pts receiving folfox required dose reductions of the fluoropyrimidine component (14% vs. 39%, 2-sided p=0.002). Conclusions: We found that more pts required dose delays during treatment with infusional fluorouracil-based versus capecitabine-based oxaliplatin regimens. However, the infusional regimen was associated with considerably less dose reductions, largely related to the fluoropyrimidine component. We favour infusional fluoropyrimidine-based chemotherapy unless other factors (e.g., distance to the oncology unit) support oral fluoropyrimidine use.
Predictors of complications after cytoreductive surgery associated with HIPEC in the treatment of peritoneal carcinomatosis.
Authors: Ferreira Fabio Oliveira , Aguiar Samuel , Lima Alessandro , Santos Erika Maria Monteiro , Nakagawa Wilson Toshihiko , Bressan Alexsander Kurowa , Mello Celso Lopes , Lopes Ademar 
Published: March 2020

e14119 Background: A select group of patients with peritoneal carcinomatosis (PC) has been treated with curative intent by cytoreductive surgery (CCS) associated with intraperitoneal hyperthermic chemotherapy (HIPEC). The objective of this study is to identify predictors of postoperative complications in patients undergoing CCS + HIPEC. Methods: We analyzed data from 136 procedures of CCS + HIPEC in 128 patients with PC, from March 2001 to December 2010. Variables clinical, surgical, and the scores obtained by rating scales of risk (ASA, POSSUM and ACE-27), were correlated with scores obtained by rating scales of morbidity and postoperative results (Bennett-Guerrero, NCI and McPeek). Carcinomatosis was caused by tumors of the appendix in 54 cases (39.7%), ovary in 43 (31.6%), colorectal in 22 (16.2%), peritoneal mesothelioma in 14 (10.3%) and others in three (2.2%). All patients were classified as ECOG 0 and 1 and had KPS> 80%. Complete cytoreduction (CC0) was performed in 93 (68.4%), CC1 30 (22.1%) and CC2 or CC3 in 13 (9.5%). Results: The rates of OS and the median follow-up were respectively 79.6% and 102 months for patients with CP of origin in tumors of the appendix, 78.6% and 74.8 months for source of peritoneal mesotheliomas, 73,9% and 55.9 months for ovarian origin and 36.4% and 31.1 months for colorectal origin. The morbidity (serious complications NCI - grade 3, 4, and 5) and postoperative mortality (30 days) were respectively 16.9% and 2.9%. The duration of surgery (> 9 hours) and ASA classification Scale (ASA class III) were the main predictors of postoperative complications in multivariate analysis. Age was a predictor of cardiovascular complications and one of the variables responsible for longer ICU stay. The number of anastomoses performed per procedure (2 or 3) was associated with the occurrence of infectious complications systemic and wound. Conclusions: The duration of surgery, ASA classification in scale, age and number of anastomoses were the factors most often related to the occurrence of severe postoperative complications after cytoreductive surgery associated with intraperitoneal hyperthermic chemotherapy.
Sex as a predictive factor in metastatic colorectal cancer treated with bevacizumab containing chemotherapy.
Authors: Jeong Jae-Heon , Baek Sun Kyung , Chae Jung Min , Lee Gil Yeon , Park Sun Jin , Kim Si-Young , Yoon Hwi Joong , Cho Kyung Sam 
Published: March 2020

e14128 Background: Recently, bevacizuamb induced hypertension was suggested as being a predictive factor for bevacizumab in metastatic colorectal cancer (mCRC) patients. However, there wasn’t any useful pretreatment predictive factor for bevacizumab in our clinic. So, in this study, we investigated the predictive factors for bevacizumab in mCRC. Methods: From 2002 to 2011, thirty mCRC patients received bevacizumab containing chemotherapy in Kyung HeeUniversity Hospital, Seoul. Among them, 27 patients had a measurable disease which adequate for response evaluation using Response Evaluation Criteria for Solid Tumors. We analyzed predictive factors for bevacizumabin these 27 patients using chi-squaretest and binary logistic regression analysis. Results: Median age was 57.0. Thirteen patients (48.1%) were male. ECOG performance status was 0,1,2 (29.6%/59.3%/11.1%). Eight patients had right side tumor and nineteen patients had left sided tumor. Fifteen patients had two metastatic sites. Sixteen patients received bevacizumab containing chemotherapy as first or second line treatment. Fourteen patients received oxaliplatin based chemotherapy with bevacizumab. We analyzed predictive factors for bevacizumab containing chemotherapy. In the univariate analysis, response rate was higher (53.8% vs 14.3%) in male patients (p= 0.092, Fisher’s exact test). In the multivariate analysis (binary logistic regression analysis), gender was a significant predictive factor (p=0.046). Progression-free survival was 6.3 months (CI95%:2.14 – 10.46 months) and 5.2 months (CI95%: 3.92 –6.49 months) in male and female patients, respectively (log-rank, p=0.503). Overall survival was 9.4 months (CI95%:7.2 – 11.63 months) and 11.7 months (CI95%:10.3 – 13.08 months) in male and female patients, respectively (log-rank, p=0.773). Conclusions: Although sex is not a modifiable predictive factor, it appears that sex is an important predictive factor in metastatic colorectal cancer patients treated with bevacizumab containing chemotherapy.
Review of the current status of KRAS mutation testing in France in 2011: The Flash-KRAS study.
Authors: Artru Pascal , Ducreux Michel , Lièvre Astrid , Guiu Michel , Merlin Jean-Louis , Sabourin Jean-Christophe , Viguier Jérôme , Bastie Anne , Seronde Audrey , Laurent-Puig Pierre 
Published: March 2020

e14129 Background: KRAS testing is required before treatment initiation of cetuximab in the management of metastatic colorectal cancer (mCRC). The objective of the study was to examine the current situation in 2011 regarding KRAS testing in the initial management of mCRC. Methods: This observational, retrospective, national study was carried out between March 28th and April 8th 2011. During this period 538 patients with mCRC were included across 160 french hospitals. The main objective was to assess the rate of KRAS testing in patients who had started first line (L1) treatment for mCRC. The secondary objectives were to describe the time taken and techniques used for KRAS testing, the possible reasons this test was not requested, to describe and analyse the clinical characteristics of the patients and the planned L1 treatments and those finally received. Results: KRAS testing was carried out for 433 patients (81.1%) and not carried out for 101 patients (18.9%). The main reasons for not requesting the KRAS status were (several answers possible): anti-EGFR not prescribed (n=58), candidate for surgery (n=8), samples not useable (n=5), age of the patient (n=3), other (n=24), data missing (n=13). The genotyping results were available after a mean delay of 23.6 ± 28.2 days. The KRAS testing was requested by an oncologist (45.5%), a gastroenterologist (31%), a surgeon (11.2%), a pathologist (7.2%) or a multidisciplinary group (5.1%) approximately 15 days (-66.5;33.6) median (min ; max) after the diagnosis of metastases, and 15 days (-66.9;3.7) median (min ; max) before the start of L1 treatment. Result of KRAS status had not been received before the L1 treatment was chosen in 56.6% of the patients. For patients with wild-type KRAS status whose therapeutic management was modified after the result of KRAS testing (n=108), this change was a prescription of an anti-EGFR in 77.8% of the cases. Conclusions: The Flash-KRAS study is the first one to assess the current modalities of KRAS genotyping in France. It shows that in 2011 the KRAS test is an integral part of the management of patients with mCRC. Nonetheless, it shows disparities between regions in terms of time to obtain results, which need to be improved to be compatible with the therapeutic management.
MR-guided laser-induced thermotherapy (LITT) in liver metastases of colorectal cancer: Long-term survival data.
Authors: Vogl Thomas J. , Dommermuth Alena , Eichler Katrin , Zangos Stephan 
Published: March 2020

e14131 Background: To evaluate retrospectively long-term survival of 594 patients with colorectal liver metastases treated with MR-guided laser-induced thermotherapy (LITT) depending on different factors. Methods: 594 patients with liver metastases from colorectal carcinoma treated with MR-guided LITT between 01/99 and 12/10 were included. For survival analysis tumor localization, TNM classification, number of metastases, diameter and volume of metastases and necrosis, lobular spread, number of treatment sessions, performance of adjuvant chemotherapy and transarterial chemoembolisation were considered. The Kaplan-Meier method was used to conduct this survival analysis. Results: Log-rank test showed statistically significant differences between survival curves, multivariate Cox-regression-analysis (p<0.05) showed prognostic factors regarding overall survival like number of metastases pre intervention, adjuvant chemotherapy, diameter of metastases, ratio of volumes of necrosis and metastases, and affected lymph nodes. Median overall survival rate at the time of first LITT was 25 months, 1-year survival: 78%, 2-year survival: 50.1%, 3-year survival: 28%; 4-year survival: 16.4%; 5-year survival: 7.8%. Numbers of metastases pre intervention: 1-2 metastases with a median survival rate of 60 months; 3-4 metastases: 45 months; ≥5 metastases: 42 months. Median survival rate for metastases <20mm in diameter 36 months; 20-30mm 27 months, 30-40mm 24 months and >40mm 21 months. Affected lymph nodes: median survival rate for patients with N0-classification 30 months, N1-classification 24 months; N2/N3/N4-classification 22 months. Conclusions: Multivariate Cox regression model provided the minimal number of significant variables with the maximal prognostic value concerning overall survival for MR-guided LITT, i.e., diameter and number of metastases and primary classification of lymph nodes.
Perineal morbidity and functional results of pseudocontinent perineal colostomy for low rectal cancer surgery: Retrospective study of 149 cases.
Authors: Souadka Amine , Souadka Abdelilah 
Published: March 2020

e14133 Background: This retrospective study was designed to evaluate morbidity and functional results of pseudocontinent perineal colostomy (PCPC) using Schmidt’s technique in North African patients undergoing APR for managing low rectal adenocarcinoma. Methods: During 15 years, 380 Abdominoperineal resections for low rectal cancer were performed. One hundred forty nine cases among them had PCPC. There were 76 women, with an average age of 47 years old. All patients received néoadjuvante radiotherapy with or without chemotherapy. Functional results were evaluated prospectively at regular intervals. Results: There was no postoperative mortality. Operative Morbidity rate was only 18.3%, essentially dominated by perineal suppuration (40%). According to Kirwan score on a Functional level, 95 patients had gaz incontinence and 46 patients an occasional minimal soiling. At one year surveillance, the graft was clinically well detected in 72% of cases and anorectal manometric study on 15 cases showed a hypotonic pseudosphincter. Colic irrigation rhythm was, in 74% of cases, every 24 to 48h, and 15% of patients didn’t need irrigations any more 6 months after surgery. Except for major postoperative complications, no other conversion from perineal colostomy to an iliac colostomy was performed for dissatisfactory functional results since 77% of the patients were satisfied and 23% half-way satisfied of this technique. Conclusions: Pseudocontinent perineal colostomy is a simple, safe and reliable technique that represents an interesting alternative to permanent iliac colostomy after APR for low rectal adenocarcinoma. It improves perineal healing and provides good functional results and high degree of patient satisfaction in addition to body image preservation. it is well adapted to north-african cultural economical and religious coditions.
The prognostic value of an early response in chemoradiation of locally advanced rectal cancer.
Authors: Ploeen John , Lindebjerg Jan , Joergensen Jens Christian Riis , Jakobsen Anders Kristian Moeller 
Published: March 2020

e14134 Background: Preoperative chemoradiation is standard treatment of locally advanced rectal cancer, and there is an obvious need for new methods of assessing the effect. Evaluation by clinical examination with endoscopy is controversial. In most papers the assessment of effect has been performed after the end of treatment. The aim of the present study was to investigate the clinical value of an examination during chemoradiation. Methods: The study included 128 patients with histopathologically verified rectal cancer. Further inclusion criteria were a T3 tumor with a circumferential margin ≤ 5 mm by MRI or a T4 tumor, a distance of < 10 cm from the anal verge and localized diseased only by abdominal and chest CT scan. The treatment was 50.4 Gy/28 fractions or the same treatment with the addition of endorectal brachytherapy 10 Gy/2 fractions in a randomized trial. The concomitant chemotherapy was UFT 300 mg/m2 and L-leucovorin 22.5 mg daily. Both drugs were given five days a week. Clinical examination with endoscopy was performed week 4 during treatment. The clinical effect was classified into complete response (CR) or not complete response with clinical residual tumor (NCR). The patients were operated eight weeks after end of treatment and the pathological tumor response was classified according to Mandard (TRG). Results: CR was found in 14% of the patients. Comparison with TRG showed that 82% with CR had TRG1 as compared to the NCR group where only 9% had TRG1 (p<10-4). The risk of lymph node metastasis was also different with 94% pN0 in the group with CR compared to 57% in the NCR group (p=0.02). The rate of CR translated to a major difference in the risk of recurrence (local and distant). No patients with CR experienced recurrence as compared to 19% in the NCR group (p<0.05). The CR also correlated with cancer specific survival. None of the patients with CR died from rectal cancer with a median observation time of 36 months compared to 30% in the NCR group. Conclusions: CR is a major prognostic parameter in locally advanced rectal cancer treated with chemoradiation. Early CR should be considered in the selection of patients for Watchful Waiting.
Survival patterns by line of treatment of stage IV colorectal (CRC) patients from local U.S. oncology practice.
Authors: Kreilick Charles , Foltz Boklage Susan H , Sullivan Sean D , Ramsey Scott David , Haislip Sally , Gilmore James W. , Szabo Stephen , Sarma Syam , Asche Carl V , Valluri Satish , Seal Brian S. 
Published: March 2020

e14141 Background: Stage IV CRC patients have varying survival results from multiple lines of treatment. The objective of this study was to evaluate in a real world context, the impact of adding a third line of chemotherapy to a stage IV CRC population. Methods: The Georgia Cancer Specialist database (2005-2011) was used. Patients with stage IV colon or rectal cancer and treated with chemotherapy were followed from initial CRC diagnosis until death, study end or lost to follow-up. Patients were stratified into lines and type of protocol for treatments. Kaplan-Meier curves were used to compare the overall survival results between lines of therapy. Results: There were 335 patients with confirmed stage IV CRC of which 35% received one protocol, 27% two protocols, and 38% received three or more protocols. The most common first line agents consisted of FOLFOX with or without bevacizumab or FOLFIRI with or without bevacizumab. Some single agent 5FU or 5FU with bevacizumab was observed in first line. The most common second agents were the FOLFOX or FOLFIRI not given in first line. However single agent capecitabine, cetuximab and bevacizumab were observed. In third line similar single agents but more panitumumab and capecitabine combinations were observed. Of those treated with second line (45) and three or more lines (75). The median survival was no different between the patients that received second line and those that went on to a third line (Log-Rank p=0.1249). Conclusions: The addition of adding a third line to a stage IV population that already received a second line failed show an association to increase survival. The benefit of adding a third line may benefit some patients and the particular combination of therapy needs to be explored in future studies.
Clinical and biologic factors associated with time to progression in patients treated by first-line palliative FOLFOX chemotherapy in metastatic colorectal cancer.
Authors: Bal Wieslaw , Jarzab Michal , Stobiecka Ewa , Zebracka Jadwiga , Mianowska Marta , Oczko-Wojciechowska Malgorzata , Rusinek Dagmara , Tyszkiewicz Tomasz , Nowara Elzbieta , Jarzab Barbara , Tarnawski Rafal 
Published: March 2020

e14159 Background: Chemotherapy is the mainstay of treatment patients with metastatic colorectal cancer. The choice of first-line treatment is difficult, especially when cost-effectiveness is the primary constraint. Thus, the optimal use of the clinical and biological factors influencing prognosis would be beneficial. The aim of our study was to identify factors affecting the time to progression (TTP) after first-line FOLFOX chemotherapy in palliative setting. Methods: The study is a retrospective analysis of the series of consecutive patients from large cancer center in south of Poland. The analysis was carried out in the group of 180 patients (37.2% of women), treated between 2007-2010 by FOLFOX-4 regimen and followed-up with the median time of observation 16.3 month. Patients received chemotherapy with median time of 5.0 months, median 10 cycles. Progression was defined as PD by RECIST criteria, death due to disease or sympomatic deterioration. 94 paraffin blocks were available for KRAS testing and gene expression analysis by real-time PCR. Results: The median TTP (counted from beginning of chemotherapy) was 8.6 month, the median TTP from the end of treatment was 3.4 month. We tested the wide range of clinical variables associated with both disease and and patient status by multivariate Cox regression analysis. Two most potent independent negative predictors were identified: the presence of massive lymph node involvement as assessed in CT scan before palliative treatment (>10 nodes enlarged) – hazard ratio 2.82, p<0.001; and tumor grade in histopathological assessment (grade 3 vs. grade 1-2) – hazard ratio 2.76, p=0.003. KRAS status was not prognostic for the TTP; Ki67 gene expression measurement by quantitative RT-PCR did not predict better that the routine assessment of grade. Patients with either grade 3 or lymph node involvement showed significantly shorter TTP (median 5.7 months vs 9.7 months in patients with none of these factors). Conclusions: High tumor grade and the massive involvement of lymph nodes worsen prognosis and shorten time to progression in patients treated with first line palliative FOLFOX chemotherapy.
Use of cetuximab (CTX) in first-line therapy of metastatic colorectal cancer (mCRC): Patient characteristics, safety, and effectiveness in the EREBUS cohort.
Authors: Smith Denis , Rouyer Magali , Mitry Emmanuel , François Eric , Monnereau Alain , Sa Cunha Antonio , Bignon Emmanuelle , Le Monies Alise , Jove Jeremy , Noize Pernelle , Moore Nicholas , Fourrier-Réglat Annie 
Published: March 2020

e14168 Background: CTX has demonstrated improved survival outcomes in mCRC but information in real-life is sparse. Methods: EREBUS is a French multicentre (n=92) cohort. Patients (pts) initiating CTX 1st-line therapy for unresectable mCRC in 2009 and 2010 were identified from dispensation registries and followed 12 months. Presented here is preliminary data for those included in 2009. Results: A total of 205 pts were included, all had wild-type (wt) KRAS gene. Median age: 64 yrs, 67.3% male, 65.8% ECOG=0-1, 61% cardiovascular history, 78.5% colon primary site, 55.6% primary tumor resection, 73.7% synchronous metastasis, single metastatic site: 52.7% (39% exclusively liver). A multidisciplinary team considered 1st-line as palliative for 61.5% of pts, and 37.1% as potentially resectable. CTX was combined with oxaliplatin-based regimens: 37.6%, irinotecan-based regimens: 55.6%, and other regimens: 6.8%. For those receiving CTX+oxaliplatin (n=77): median duration of CTX use was 3.6 months and 63.6% were treated every 2 weeks. For those receiving CTX+irinotecan (n=114): it was 4.7 months and 81.6% treated every 2 weeks. Response rate (CR+PR) according to physician evaluation was 48.6% for CTX+oxaliplatin and 46.8% for CTX+irinotecan. 1-yr OS was 59.9% (95%CI 47.6-70.2) and median PFS was 8.6 months (6.3-10.5) for CTX+oxaliplatin. 1-yr OS was 69.1% (59.6-76.7) and median PFS was 9.3 months (7.4-10.5) for CTX+irinotecan. Incidence of any grade 3/4 event was 58% for CTX+oxaliplatin and 57% for CTX+irinotecan: neutropenia (18.2% and 19.3%, respectively), skin reaction (11.7% and 14%), asthenia (11.7% and 14.9%), hypokalaemia (13% and 4.4%), diarrhoea (6.5% and 10.5%) and infusion-related reactions (1.3% and 0.9%). Surgical evaluation was performed in 27.8%: 31.2% CTX+oxaliplatin and 24.6% CTX+irinotecan Conclusions: In France, CTX was frequently combined with irinotecan-based regimens in 1st-line wt KRAS mCRC. These results indicate a high proportion of exclusive liver metastases, and a high proportion of patients undergoing surgery. Effectiveness and safety profile of CTX in real life were in line with pivotal trials