bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of previous adjuvant oxaliplatin combination therapy on survival in elderly colorectal cancer patients with recurrence.
Authors: Nagata Yusuke , Amano Katsushi , Mikuni Hayato , Kano Tomohiro , Ishikawa Masashi , Ishimoto Utako , Nishimura Takashi , Noguchi Masaaki , Sawada Ryoichi , Imakita Tomonori , Ohkuma Masahisa , Aoki Hiroaki , Nagasaki Eijiro , Kosuge Makoto , Hokari Atsushi , Ogawa Masaichi , Eto Ken , Saruta Masayuki 
Published: January 2022

48 Background: The benefit of adjuvant chemotherapy with oxaliplatin for elderly patients with colorectal cancer (CRC) remains controversial. Our study could not demonstrate the benefit of adding oxaliplatin for elderly CRC patients aged over 70 years as with the previous clinical trials. Here, we evaluated the prognosis after recurrence in the elderly patients who received adjuvant chemotherapy. Methods: This retrospective study included patients aged over 70 years who were diagnosed with high-risk stage II and stage III CRC and received adjuvant chemotherapy in our two hospitals (The Jikei University Hospital and Katsushika Medical Center) between January 2010 and December 2019. The patients were divided into two groups; patients who received fluoropyrimidine monotherapy were included in Fp group and those who received fluoropyrimidine plus oxaliplatin were included in Fp+OX group. Moreover, we evaluated patient characteristics, treatment, and survival in the patients with recurrence and compared them between two groups. Results: A total of 127 patients received adjuvant chemotherapy; 75 patients in Fp group and 52 patients in Fp+OX group. With a median follow-up time of 64.5 months, the 5-years disease-free survival and 5-years overall survival in Fp group/Fp+OX group were 70.6/67.1% (hazard ratio [HR] 1.10, 95% confidence interval [CI] 0.61–1.98) and 89.0/71.8% (HR 1.48, 95% CI 0.76–2.88), respectively. The benefit of adding oxaliplatin was not observed. Among them, 15 patients in Fp group and 14 patients in Fp+OX group were relapsed; median age was 78 (range: 72-83) and 78 (range: 72-86) years, male was 67% and 64%, PS of 0/1 was 67/33% and 86/14%, primary tumor site of right/left was 47/53% and 57/43%, and RAS mutation was 20% and 29%, respectively. Median relapse-free survival was 17.7 and 14.3 months (p = 0.453). There were no significant differences in treatment after recurrence; aggressive treatment (surgery/chemotherapy) was 73% (33/40%) and 86% (21/65%), best supportive care was 7% each, and unknown was 20% and 7%, respectively. However, the median overall survival from the date of relapse was significantly worse in Fp+OX group than Fp group (45.0 and 14.4 months, p = 0.011). Conclusions: Recurrence after receiving adjuvant oxaliplatin combination therapy was considered as one of the poor prognostic factors. It might attenuate the benefit of adding oxaliplatin in adjuvant setting in elderly patients.
An open-label, multicenter, randomized controlled study of mXELIRI versus FOLFIRI in combination with bevacizumab as the first-line treatment in metastatic colorectal cancer: A single-center report.
Authors: SUN Yongkun , Zhang Wen , Jiang Zhichao , Wang Wei , Qu Wang , Zhou Ai-Ping 
Published: January 2022

52 Background: The first-line treatments in metastatic colorectal cancer were FOLFOX, CAPOX, FOLFIRI and even FOLFOXIRI as basic chemotherapy regimen combined with targeted therapy. XELIRI regimen was not recommended because of the concerns about the toxicity, efficacy and controversy in optimal dosage. An increasing number of studies indicated promising efficacy with manageable safety profile of dosage and administration-adjusted XELIRI regimen. Therefore, the present study investigated the efficacy, safety and appropriate dosage of mXELIRI regimen in the first-line treatment of advanced colorectal cancer. Methods: The EXIST study was a multicenter, randomized controlled, non-inferiority study and we performed stratification based on the tumor location (left or right side). In the mXELIRI+Bev group, patients received intravenous infusion of irinotecan (a reduced dosage,150mg/m2) with bevacizumab (5mg/kg) on day 1 and oral administration of capecitabine (2000mg/m2/day) tablet on day 1-10/Q14 days. Patients in FOLFIRI+Bev group received intravenous infusion of irinotecan (180mg/m2), calcium folinate (400mg/m2) and 5-Fu (400mg/m2) bolus with bevacizumab (5mg/kg) on day 1 followed by a 46-hour continuous infusion of 5-Fu (2400mg/m2)/Q14 days. The primary endpoint was progression-free survival rate at 12 month(PFSR12m) and the secondary endpoints included ORR,OS and safety. Results: 142 patients were enrolled and randomly assigned to receive mXELIRI+Bev (n=76) or FOLIRI+Bev (n=66) in our center between May 2018 and April 2021. Baseline characteristics were well balanced between two groups. In the mXELIRI+Bev group, 70 patients were evaluable with an ORR of 60.0% (1 complete response, CR; 41 partial response, PR; 24 stable disease, SD; 4 progression disease PD). While 57 patients were evaluable in the FOLFIRI+Bev group, with an ORR of 63.2% (36 PR; 15 SD; 6 PD). The PFSR12m for two groups were 32.3% and 21.3%, the median PFS were 9.72 months and 8.77 months, respectively. For safety profiles, no statistical differences were observed in adverse events, such as nausea, vomiting, diarrhea, bone marrow suppression and abnormal liver function. While 10 serious adverse events were recorded in the mXELIRI+Bev group, including intestinal obstruction occurred in 8 patients, intestinal perforation occurred in 1 patients and venous thrombosis occurred in 1 patient. In the FOLIRI+Bev group, intestinal obstruction, venous thrombosis and pulmonary thrombosis was reported in one patient respectively. Conclusions: The modified biweekly XELIRI plus bevacizumab regimen demonstrated promising effect and could be well tolerated based on the data from a single center. Clinical trial information: NCT04247984.
Treatment patterns and outcomes of patients with metastatic colorectal cancer in third-line and beyond systemic therapy: Real-world data from a setting with limited resources.
Authors: Jácome Alexandre A. , Gil Roberto Almeida , Moraes Eduardo Dias de , Peixoto Renata D'Alpino , Canedo Jorge Alexandre , Passarini Thais , Gil Mariana , Pereira Sabrina , Amorim Larissa , Prolla Gabriel , Freitas Laura , Coelho Fernanda , Paiva Isabela , Paes Rafael , Cruz Heloisa , Costa e Silva Matheus , Ferreira Carlos Gil , Ferrari Bruno Lemos , Garicochea Bernardo , Dienstmann Rodrigo 
Published: January 2022

58 Background: Regorafenib and trifluridine/tipiracil (TAS-102) are the only therapeutic options for patients with chemorefractory metastatic colorectal cancer (mCRC) with demonstrated benefit in overall survival (OS). However, they are not accessible worldwide. In Brazil, they have been recently approved, but they have not yet been provided by public health system or private health insurances. We aimed to describe the treatment patterns and clinical outcomes of that population in a setting with limited access to those drugs. Methods: Retrospective study evaluating 510 patients with mCRC who were treated at five Oncoclinicas centers in Brazil from January 2011 to December 2019. Demographic and clinical data were retrieved from electronic medical records. The median OS was calculated by Kaplan-Meier method and prognostic factors were evaluated via multivariable Cox Regression, calculating the Hazard Ratio (HR) and the confidence interval (CI95%). Results: A total of 163 patients (33% of the overall population) received third-line and 73 (15%) fourth-line systemic therapy. Median age was 62 years, 59% were male. Tumors were right-sided in 19%, RAS mutated 44%, BRAF mutated 3%, and high-frequency microsatellite instability 3%. Metastasectomy prior to third-line was performed in 62% of the patients. From the start of third-line therapy, median follow-up was 9.0 months, with 67% of deaths, and median OS was 13.7 months (CI95% 11.8m–20.0m). Most adopted regimens in third-and fourth-line were (1) rechallenge with oxaliplatin-based therapy (39% and 26%, respectively); (2) rechallenge with irinotecan-based therapy (32% and 34%); (3) rechallenge with anti-EGFR monoclonal antibodies (20% and 29%); (4) regorafenib (13% and 25%); and (5) TAS-102 (2% and 4%). In multivariable model including clinical and molecular variables, prior metastasectomy was the only significant prognostic factor for OS (HR 0.51, CI95% 0.31–0.83, p=0.007). Conclusions: In real-world, a meaningful proportion of patients with mCRC are eligible for third and later lines of therapy. Rechallenge with chemotherapy and anti-EGFR agents is overused in a setting of limited access to therapies with demonstrated OS benefit, such as regorafenib and TAS-102. Barriers to drug access impair the adoption of the best evidence-based continuum of care and strategies to overcome them are urgently needed. Refractory patients in later lines of therapy derive survival benefit from prior metastasectomy.
Preferences for colorectal cancer screening of physicians and individuals at average risk in the United States: A discrete choice experiment.
Authors: Heidenreich Sebastian , Finney Rutten Lila J , Miller-Wilson Lesley-Ann , Moreno-Jimenez Cecilia , Chua Gin Nie , Fisher Deborah 
Published: January 2022

60 Background: Several colorectal cancer (CRC) screening options are considered in guidelines for individuals at average-risk (IAR). These options differ in aspects such as invasiveness, recommended frequency, and precision that need to be compared and weighed. This study elicited and compared the relative importance that physicians and IAR place on these screening aspects. Methods: Primary care physicians [PCPs] and gastroenterologists [GIs] who recommended/performed ≥1 screening one month prior to study and adult IAR completed a discrete choice experiment (DCE). Participants repeatedly chose between screening tests described by type of test, frequency, true-positive (TP), true-negative (TN), and adenoma TP (physicians only). The instrument was tested in qualitative (physicians: n=6; IAR: n=6) and quantitative pilots (physicians: n=100; IAR: n=202). A mixed logit model was used to estimate relative attribute importance (RAI) and predicted choice probabilities for colonoscopy, multi-target stool DNA (mt-sDNA), fecal immunochemical test (FIT), and methylated septin 9 (mSEPT9) blood test. Generalizability to the population was confirmed. Results: 1,249 IAR and 400 physicians participated. IAR were 46% male and the mean age was 58.9. Physicians were 79% male and their mean age was 53.4. Preferences were most affected by TP rates (IAR RAI=58%; physicians RAI=42%). Physicians also placed high importance (RAI=41%) on adenoma TP rates. TN rates (IAR RAI=33%; physician RAI=9%), frequency (IAR RAI=6%; physician RAI=2%) and type (IAR RAI=4%; physician RAI=6%) were less important. Despite both IAR and physicians placing most importance on precision, preferences for screening modalities differed. On average, physicians preferred colonoscopy, while IAR preferred mt-sDNA over colonoscopy (p<0.001). Both preferred mt-sDNA and colonoscopy over FIT (p<0.001), with a mSEPT9 blood test being least preferred (p<0.001). Preferences of IAR were heterogeneous with individuals who underwent colonoscopy or sigmoidoscopy screening preferring colonoscopy and the rest preferring mt-sDNA (p<0.001). Conclusions: While both GI and PCPs overwhelmingly preferred colonoscopy, preferences of IAR were heterogenous, with mt-sDNA being preferred on average other modalities. Offering choices in addition to colonoscopy could improve screening uptake. [Table: see text]
Adherence with the multitarget stool DNA test for colorectal cancer screening in rural southeastern Kentucky.
Authors: Smith Forrest , Elsoueidi Joseph , Wisnieski Lauren , Kolagatla Sandhya , Moka Nagabhishek 
Published: January 2022

64 Background: Colorectal cancer (CRC) screening has shown to improve early detection and reduce mortality. Despite, the availability of multiple screening tests for CRC, the current screening rates remains below the national goal. The multi-target stool (MTS) DNA test (commercially known as Cologuard) has contributed to an increase in population adherence to CRC screening and is currently recommended by multiple guidelines. Southeastern Kentucky (SE KY) has a high incidence of colorectal cancer and a low rate of CRC screening. The aim of this study is to assess the adherence to the MTSDNA test in rural SE KY. Methods: A retrospective review of all patients 45 and older with a MTSDNA test ordered between August 2020 and February 2021 at a large primary care group in SE KY. All patients had Tests ordered and kits delivered. Cross-sectional adherence was defined as completion and return of the kit within 180 days from test order and was assessed as overall adherence and by patient characteristics including age, sex and healthcare coverage. Results: 450 tests were ordered. 160 (35%) were male and 290 (65%) females. Mean age was 62 with age range (46-87). 207 tests were returned with a cross-sectional adherence of 46%. Adherence was significantly lower for age 45 - 55 at 35.2% (26.2-45.2) compared to age 55 - 65 at 48.9% (40.9-56.3), 65 and older at 50.0% (42.3-57.7) (P = 0.04). Highest adherence with Medicaid coverage 65.4% [44.3-82.8] and lowest in Managed Care Organization (MCO) coverage 34.0% [4.7-44.2] (P < 0.01). Gender was not associated with adherence (P = 0.75). Conclusions: This retrospective study showed that only 46% of patients were adherent to the MTS DNA test for colorectal screening which is significantly lower than previously reported in larger studies and further studies are needed to identify the barriers to non-adherence to this test, especially in the younger population with alarming increase in incidence of CRC. There is impending need to implement different strategies to improve screening adherence.
Biomarker testing in patients (pts) with metastatic colorectal cancer (mCRC): Perspectives from U.S. oncologists (ONC) in rural areas and urban clusters.
Authors: Lewis Mark Andrew , Stansfield Lindsay , Kelton John M. , Edwards Michelle L. , Lieu Christopher Hanyoung 
Published: January 2022

70 Background: In the US, pts living in rural areas have higher CRC mortality rates than urban areas. Clinical guidelines recommend testing for BRAF and RAS mutations and deficient mismatch repair/microsatellite instability in pts with mCRC. However, data on biomarker testing rates in rural communities compared with urban areas are limited. We surveyed ONC in the US who practice in rural areas or urban clusters to identify biomarker testing patterns and barriers (data previously reported) and conducted interviews with a select group of respondents to further understand key differences that may contribute to substandard biomarker testing rates in rural areas. Methods: A 2-part (quantitative and qualitative) survey was conducted with ONC who spend > 40% of their time providing direct care to pts in rural areas or urban clusters and who had treated ≥2 pts with stage IV mCRC in the month prior to the survey. After screening, a subset of those who completed the quantitative survey participated in the qualitative survey (a 30-minute, web-assisted, telephone interview). The interview questions targeted 6 areas: clinical practice description, biomarker and genomic testing patterns, pathology and molecular tumor board, tumor tissue journey, electronic health records, and training/educational opportunities. Results: Of the 99 ONC who responded to the quantitative survey, 17 were interviewed for the qualitative survey from June 16–29, 2021. A key finding of the quantitative survey was that although ONC reported being familiar with biomarkers relevant to mCRC, the reported rate of biomarker testing was suboptimal. The interviews probed reasons why testing does not align with current guidelines and found that challenges exist throughout the tumor tissue journey including insufficient tumor tissue available for testing (especially in the relapsed/refractory setting); lack of or limited protocols, clinical decision support systems, reflexive testing, and molecular tumor boards; lengthy and difficult-to-navigate next-generation sequencing reports; and financial toxicity surrounding biomarker tests (especially for underinsured pts), among other barriers. Despite these challenges, ONC reported easy access to third-party reference labs and electronic references, such as NCCN and UpToDate. Although telehealth visits have nearly quadrupled during the COVID pandemic, access to telehealth may be limited for pts living in rural areas or urban clusters. Conclusions: The ONC surveyed reported that practicing in rural/urban clusters poses unique challenges related to tissue acquisition, practice resources, pts’ ability to pay, and clinical knowledge gaps that may affect biomarker testing rates in pts with mCRC. Addressing these gaps is warranted if optimal utilization of precision medicine tools is to be realized.
Prevalence of information needs among emerging and young adult colorectal cancer survivors.
Authors: Yi Serena , Rodriguez Karli , Stal Julia , Cohen-Cutler Sally , Gallagher Phuong , Barzi Afsaneh , Freyer David R. , Milam Joel , Lenz Heinz-Josef , Miller Kimberly Ann 
Published: January 2022

71 Background: The information needs of young adult (YA) cancer survivors have been described, however, the specific needs of YA colorectal cancer (CRC) survivors are not well-documented. Characterizing the distinct unmet needs of YA CRC survivors is important given their unique cancer experience which may include an ostomy, chronic bowel symptoms, and functional deficits. The purpose of this study was to examine CRC survivors’ unmet needs across general, clinical, and psychosocial domains. Methods: An online, cross-sectional survey was administered via Facebook in collaboration with a national YA CRC patient advocacy organization. Respondents (diagnosed 18-39) endorsed areas in which they required more information on aspects of their lives that may have been affected by their cancer experience. Needs were stratified by life stage (emerging [18-29 years] and young [30-39] adulthood). Results: Respondents (n=189) were colon (40.2%) and rectal (59.8%) cancer survivors with a mean current age of 32.2 years (SD=4.6) and a mean age of 30.2 years (SD=4.3) at diagnosis. Most endorsed items per domain included: nutrition and diet (52.1%), complementary and alternative treatments (45.4%), and talking about your cancer experience with family, friends, and co-workers (36.1%). Survivors in emerging adulthood (n=80), compared with those in young adulthood (n=109), endorsed notably greater needs in: staying physically fit (57.5% versus 38.5%), complementary and alternative treatments (57.5% versus 36.7%), and advice/help about dating and intimate relationships (18.8% versus 6.4%). Conclusions: Overall, half of respondents endorsed a desire for information on nutrition and diet, staying physically fit, and complementary and alternative treatments. Differing endorsement rates by age group indicate the importance of tailored approaches. Optimal counseling, resources, and referrals specific to life stage can mitigate the unmet needs of YA CRC survivors to improve health outcomes and quality of life.[Table: see text]
Preventives for oxaliplatin-induced peripheral neuropathy in colorectal cancer patients.
Authors: Hines Robert Brooks , Schoborg Christopher , Zhu Xiang , Elgin Elizabeth , Zhang Shunpu 
Published: January 2022

83 Background: For colorectal cancer patients treated with the chemotherapy drug oxaliplatin, oxaliplatin-induced peripheral neuropathy (OIPN) is a serious side effect. We conducted an observational comparative effectiveness study to evaluate whether several potential preventives reduced the rate of OIPN diagnosis in the two years following chemotherapy initiation. Methods: This was a retrospective cohort study that utilized the Surveillance, Epidemiology, and End Results database combined with Medicare claims (SEER-Medicare). Eligible patients were diagnosed with colorectal cancer between 2007-2015, 66 years of age or older, and received at least two cycles of oxaliplatin. We used two definitions to denote diagnosis of OIPN: OIPN 1 (diagnosis codes specific to CIPN) and OIPN 2 (additional codes for peripheral neuropathy). Multinomial propensity score weighting was used to balance potential confounders. The Fine-Gray subdistribution hazards model was used to perform a competing risk, time to event analysis for diagnosis of OIPN. Results: There were 4,482 subjects analyzed for the outcome of OIPN 1 (n = 477, 10.1%), and 4,561 for OIPN 2 (n = 1,191, 26.1%). Duloxetine, venlafaxine (marginally significant for OIPN 1), opioids, and minocycline were associated with a decreased rate of OIPN according to both definitions. In addition, memantine and neuromuscular therapy were associated with a decreased rate of OIPN 1 but not OIPN 2. Gabapentin and pregabalin exposure was associated with an increased rate of OIPN diagnosis according to both definitions. Mixed results were obtained for nortriptyline and cannabinoids. Conclusions: This study revealed several potentially effective preventive options for OIPN in colorectal cancer patients receiving oxaliplatin. A limitation of this study is the observational design which cannot directly inform treatment guidelines. However, evidence from this study may serve as preliminary data to support a future randomized clinical trial.[Table: see text]