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Published in Valerio Voliani, Nanomaterials and Neoplasms, 2021
Joseph M. Caster, Artish N. Patel, Tian Zhang, Andrew Wang
Irinotecan is a topoisomerase 1 inhibitor which is indicated in the treatment of several malignancies including colorectal and pancreatic cancer. There are no currently approved nanoformulations available, but two pegylated liposomal formulations of irinotecan are in clinical development. IHL-305 (Yakult Honsha, Co.) has undergone phase I studies and appears to be well tolerated [11]. The second formulation, MM-398/PEP02 (Merrimack Pharmaceuticals) has been more thoroughly studied and generated promising results in the setting of metastatic pancreatic cancer. A randomized Phase II study of 5-fluorouracil (5-FU) and MM-398 versus FOLFIRI in metastatic pancreatic cancer showed comparable response rates (14.3% versus 11.1%) with decreased rates of neutropenia (10.7% vs. 29.6%) and diarrhea (21.4% vs. 33.3%). A subsequent phase III study randomized patients with metastatic pancreatic cancer to MM-398 alone, 5-FU/leucovorin, or MM-398 and 5-FU/leucovorin. The study showed an improved median OS of 1.9 months (6.1 months for MM-398 and 5-FU/leucovorin vs. 4.2 months for 5-FU/leucovorin) [12]. MM-398 has been granted fast-track status by the FDA, and further phase III studies are ongoing.
Gastrointestinal cancers
Published in Ruijiang Li, Lei Xing, Sandy Napel, Daniel L. Rubin, Radiomics and Radiogenomics, 2019
Colorectal liver metastasis: Simpson et al. (2017) evaluated whether pre-operative CT texture analysis could predict OS and DFS in 198 patients who underwent colorectal metastasis (CRLM) resection. It turned out that the tumor signal (a predictor integrated by two texture features extracted from the tumor, namely, correlation and contrast) and the future liver remnant (FLR) signal (a predictor integrated by two texture features extracted from the FLR, namely, energy and entropy) were independent predictors of OS (hazard ratio 2.35 and 2.15, p = 0.013 and 0.029, respectively), while the FLR signal was an independent predictor of DFS (hazard ratio 2.21, p = 0.01). In three other studies (Ahn et al. 2016, Lubner et al. 2015, Rao et al. 2016), the capability of texture features in the prediction of clinical outcomes or treatment responses of chemotherapy in patients with CRLM was assessed. In Lubner et al. (2015) study, entropy at coarse filtration levels could negatively predict the OS of CRLM (hazard ratio for death 0.65, p = 0.03). Ahn et al. (2016) analyzed the histogram features, volumetric features, and morphologic features in 235 patients with CRLM who received 5-fluorouracil and leucovorin and oxaliplatin (FOLFOX) and 5-fluorouracil/levofolinate/irinotecan (FOLFIRI) chemotherapy and found that skewness extracted in 2D analysis and standard deviation in 3D were independent predictors of therapeutic response (odds ratios 6.739 and 3.163, p = 0.025 and 0.002, respectively). Similarly, Rao et al. (2016) collected 21 patients with CRLMs and extracted the mean intensity, entropy, and uniformity under different filters in an attempt to determine the best predictors of chemotherapy response. In their study, the relative changes in entropy and uniformity without filtration between pre- and post-treatment turned out to be the significant predictors (odds ratios 1.34 and 0.95, respectively, p values not provided). In the study of Beckers et al. (2017), 165 patients with colorectal cancer were retrospectively collected, and whole-liver CT texture analysis determined that uniformity with a filter of σ = 0.5 as a significant predictor of early liver metastasis, but no predictors of intermediate/late metastases were found.
An update on locoregional percutaneous treatment technologies in colorectal cancer liver metastatic disease
Published in Expert Review of Medical Devices, 2023
Stavros Spiliopoulos, Ornella Moschovaki-Zeiger, Akshay Sethi, George Festas, Lazaros Reppas, Dimitris Filippiadis, Nikolaos Kelekis
A limitation of this RCT was the lack of bevacizumab, oxaliplatin, cetuximab, or panitumumab in the study as this was not part of standard care at the time; however, studies have shown better overall survival when used along with FOLFIRI [23].