Systemic therapy for appendiceal cancer
Wim P. Ceelen, Edward A. Levine in Intraperitoneal Cancer Therapy, 2015
One hundred and nine patients were identified as high-grade appendiceal MCP, 70 (64%) of which received perioperative chemotherapy and 39 (36%) did not receive any systemic chemotherapy [5]. Thirty-seven (34%) received preoperative systemic treatment, 22 patients (20%) received postoperative systemic treatment, and 11 patients (10%) received both pre- and postoperative systemic treatments. The pattern of chemotherapy utilized in the high-grade appendiceal MCP patients was similar to that of the low-grade appendiceal MCP patients mentioned previously—regimens consisting of a 5-fluorouracil backbone. The most common systemic chemotherapy regimen was FOLFOX, followed by 5-fluorouracil monotherapy, and FOLFIRI. The median duration of treatment was 4 months (range 1.5–16 months) in those who received preoperative systemic treatment versus a median of 6 months (range 1.5–17 months) duration for those who received postoperative systemic treatment [5].
Hepatic Directed Therapy
Jim Cassidy, Patrick Johnston, Eric Van Cutsem in Colorectal Cancer, 2006
The current vogue for the optimal utilization of systemic therapy is the sequential use of modern chemotherapy agents. The median survival of patients correlates with the percentage of patients who receive all three effective chemotherapies for colorectal cancer (5-FU, CPT-11, oxaliplatin) at some point in their course (135). However, the choice of second-line therapy was not an important parameter in outcome. The best example of a study analyzing the sequential use of chemotherapy was performed by Tournigand et al. (3) and has resulted in the longest median survival seen in published trials to date. Patients were randomized to FOLFOX-6 followed by folinic acid, fluorouracil, and irinotecan (FOLFIRI) or the same drugs but in the opposite order. The second-line response rate for FOLFIRI was 4% and for FOLFOX-6 15%. Similarly, Rothenberg et al. (113) demonstrated response rates of 9.9%, 1.3%, and 0% for FOLFOX-4, oxaliplatin, and 5-FU, respectively, in patients who had previously progressed on CPT-11/5-FU/LV. A recent trial reported a second-line response rate of 15% for oxaliplatin/5-FU also in patients who had progressed on CPT-11-based chemotherapy (136). However, despite the low second-line response rates, the sequential use of all active agents has increased the median survival of patients from 12 to 14 months for trials performed at the beginning of the decade to 17 to 20 months for trials reported this year (3,4,137,138).
Effects of treatment on the abdomen and pelvis
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
Chemotherapy effects on the bowel mainly occur early following treatment (Table 39.3). Benign non-specific small bowel thickening is seen with many agents manifested by smooth thickening of the valvulae conniventes without evidence of any free fluid, obstruction, or inflammatory changes (Figure 39.11a). Enteritis may be diffuse or limited to the terminal ileum. Chemotherapeutic regimens like FOLFIRI, i.e. folinic acid (leucovorin) with fluorouracil (5-FU) and irinotecan, increase the risk. This is seen as hyperaemia with submucosal oedema producing a ‘target sign’ on CT (36) (Figure 39.11b). Neutropenic enterocolitis results from chemotherapy-induced mucosal injury and secondary superinfection, most commonly associated with treatment of acute leukaemia. Typhlitis is the localized form limited to the caecum (Figure 39.12).
Telmisartan Influences the Antiproliferative Activity of Linoleic Acid in Human Colon Cancer Cells
Published in Nutrition and Cancer, 2020
Magdalena Mielczarek-Puta, Dagmara Otto-Ślusarczyk, Alicja Chrzanowska, Agnieszka Filipek, Wojciech Graboń
Colorectal cancer (CRC) is the third most common malignancy and the fourth lethal disease worldwide. In recent decades, the incidence and mortality rates of CRC in Eastern Europe, Latin America, and Asia significant increased. Moreover, the risk of developing CRC depends on age (1). The most common treatment for CRC is chemo- and radiotherapy often given after tumor resection. FOLFIRI and FOLFOX regimens commonly used in colon cancer chemotherapy prolong the survival period over 20 months. However, 40% of patients with disease progression after a first line of treatment cannot undergo long-term therapy because of deterioration of their performance condition or liver function (2). Therefore, it seems important to find other agents that can be administrated every day and selectively affect cancer cells through time- and cell-specific effect. Literature data have been reported that polyunsaturated fatty acids (PUFAs) possess selectively tumoricidal action (3–5). Numerous epidemiological and animal experimental studies have shown that PUFAs have growth-inhibitory and pro-apoptotic effects on colon cancer cells such as HT-29, HCT116, SW480, SW620, and Caco-2 (6–10). One of the important PUFAs commonly present in diet is linoleic acid ((LA), n-6, 18:2) (11). In vivo and in vitro studies suggested that LA induced apoptosis in cancer cells by free radical generation and mitochondrial dysfunction as well as by PPARgamma activation (12,13).
KRAS codon 12 and 13 mutations may guide the selection of irinotecan or oxaliplatin in first-line treatment of metastatic colorectal cancer
Published in Expert Review of Molecular Diagnostics, 2019
Yakup Ergun, Yusuf Acikgoz, Oznur Bal, Gokhan Ucar, Merve Dirikoc, Eda Caliskan Yildirim, Nadiye Akdeniz, Dogan Uncu
The first-line treatment of patients was one of the following regimens, FUFA, modified FOLFOX6 or FOLFIRI. The FUFA regimen comprised folinic acid 400 mg/m2/day administered as a 2-h infusion, followed by a 10-min bolus 5-FU 400 mg/m2, and a 46-h continuous infusion of 5-FU, 2400 mg/m2. The FOLFOX combination included oxaliplatin 85 mg/m2 in 250 mL of dextrose 5%, concurrent with FA 400 mg/m2/day administered as a 2-h intravenous infusion, followed by a 10-min bolus 5-FU 400 mg/m2, and a 46-h continuous infusion of 5-FU 2400 mg/m2. The FOLFIRI combination regimen comprised irinotecan 180 mg/m2, followed by FA 400 mg/m2 in a 2-h infusion, and then by a 10-min bolus 5-FU 400 mg/m2, and a 46-h continuous infusion of 5-FU 2400 mg/m2. For patients receiving anti-VEGF treatment, bevacizumab was administrated either with FOLFOX or FOLFIRI regimens at a dose of 5 mg/kg. For patients receiving anti-EGFR, cetuximab (500 mg/m2) or panitumumab (6 mg/kg) was administrated with either FOLFOX or FOLFIRI regimens. The cycles were repeated every 2 weeks.
Cost-minimization analysis of biweekly dosing of cetuximab and FOLFIRI compared with panitumumab and FOLFOX for first-line treatment of patients with KRAS wild-type metastatic colorectal cancer in the United States
Published in Journal of Medical Economics, 2021
Wambui Grace Gathirua-Mwangi, Harsheen Sethi, Manuel Geroy Afable, Devarshi Bhattacharyya, Taha Khan
This CMA evaluated the economic outcome of first-line treatment with cetuximab-FOLFIRI versus panitumumab-FOLFOX among patients with KRAS WT mCRC from a U.S. payer’s perspective over a 43-week time horizon. Overall, the results demonstrated that cetuximab-FOLFIRI administered biweekly may provide cost savings compared with biweekly panitumumab-FOLFOX. For the base case analysis based on overall population estimates (mean BSA/body weight 1.92 m2/82.04 kg), a cost reduction of $400 per patient was observed with cetuximab-FOLFIRI compared with panitumumab-FOLFOX. Cost savings for cetuximab-FOLFIRI resulted from lower drug cost of combination chemotherapy (FOLFIRI versus FOLFOX) and cost of administration. Cetuximab-FOLFIRI showed cost savings compared with panitumumab-FOLFOX in all scenarios. A cost saving of >$15,000 per patient was observed with cetuximab-FOLFIRI for mean, median, and upper limits of BSA and weight inputs for both men and women.
Related Knowledge Centers
- Adjuvant Therapy
- Bevacizumab
- Colorectal Cancer
- Fluorouracil
- Pyrimidine Analogue
- Stomach Cancer
- Topoisomerase
- Chemotherapy Regimen
- Folinic Acid
- Irinotecan