Differentiating between benign and malignant biliary stenosis (BS) is challenging, where tissue diagnosis plays a crucial role. Endoscopic retrograde cholangiopancreatography (ERCP)-based tissue sampling and endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) or biopsy (FNB) are used to obtain tissue specimens from BS. The aim of this retrospective study was to evaluate the diagnostic yield of EUS-FNA/B plus ERCP with brushing or forceps biopsy in BS. All endoscopic procedures performed in patients with BS at our gastroenterology unit were reviewed. The gold standard for diagnosis was histopathology of surgical specimens or the progression of the malignancy at radiological or clinical follow-up. A total of 70 endoscopic procedures were performed in 51 patients with BS. Final endoscopic diagnosis was reached in 96% of the patients and was malignant in 61.7% and benign in 38.3% of cases. Sensitivity, specificity, and diagnostic accuracy were 73.9%, 100%, and 80%, respectively, for EUS-FNA/B; 66.7%, 100%, and 82.5% for ERCP; and 83.3%, 100%, and 87.5% for both procedures carried out in the same session. The combination of EUS and ERCP tissue sampling seems to increase diagnostic accuracy in defining the etiology of BS. Performing both procedures in a single session reduces the time required for diagnostic work-up and optimizes resources.
45 Background: Regorafenib (R) and Trifluridine/tipiracil (T) have been shown to prolong survival for patients (pts) with refractory metastatic colorectal cancer (mCRC) but it's to date unclear which agent should be administered first. Our analysis aimed to compare the efficacy and safety profiles of these drugs sequentially administered in daily clinical practice. Methods: Clinical data of pts diagnosed with mCRC who received R and/or T between July 2012 and March 2022, were retrospectively collected from 12 institutes in Lazio Region. Overall survival (OS), progression-free survival (PFS), overall response rate (ORR), disease control rate (DCR), and adverse events (AEs) were compared between the two groups. Results: 781 pts were included. Of these, 270 (34.5%) received T alone, 278 (35.5%) R alone, 124 (15.8%) T followed by R, and 109 (13.9%) the reverse sequence. M/F = 452/329; median age was 68 (42-86); median duration of follow-up was 24.7 months (mos) (95%CI = 19.7-81.1). The prevalent ECOG PS was 1 (54%). We focused our attention on 233 pts who received R/T (N = 110, 14%) or T/R sequence (N = 123, 15.7%). ≥2 metastatic sites prevailed in both groups (83% T/R, 88% R/T; p = 0.45). Drug dose reductions due to grade 3/4 AEs were carried out in 81.8% of the R/T-treated pts (the R dose reduction to 120 mg and the T dose reduction to 30 mg/m2 were both the most prevalent in 28.8% of the cases) vs. 77.2% of the reverse sequence (R dose reduction to 120 mg was the most prevalent in 34.7% of the events) (p = 0.42). 143 pts (61.3%) experienced grade 3-4 toxicities (50.3% in R/T vs. 49.6% in T/R). The most common grade 3/4 AEs related to the R/T group were non-haematologic like hand-foot syndrome (21.6%) and fatigue (15.4%); on the other hand, these were haematologic: neutropenia (36.4%) and anemia (13%) (p = 0.28). Only 1 pt discontinued T in the T/R group. No therapy-related death was reported. The median PFS and OS of R/T were longer than the T/R sequence: 11 vs. 8,5 mos (HR = 0,62; 95%CI = 0,46-0,83; p = 0.0014) and 14,9 vs. 13 mos (HR = 0,70; 95%CI = 0,51-0,96; p = 0.0296), respectively. The ORR did not differ significantly showing slightly higher in the T/R sequence (4.8% vs. 2.2%; p = 0.45). The DCR was in favor of the R/T group (44.4% vs. 33.9%; p = 0.14). Conclusions: In our real-world context, PFS and OS were significantly longer in the R/T group. R and T used sequentially could extend survival and stabilize cancer growth without acting on tumor shrinkage. Safety profiles are in line with published data. Dose reductions were more frequent in the R/T group. We suggest that prospective clinical trials directly comparing R and T are needed.
In response to the recently published article by Sharma et al, this letter to the editor presents data about the concordance of blood and normal tissue-based evaluation of DPYD genotyping that suggests that pharmacogenetic screening could be contextual to tumor molecular profiling.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.