No abstract

Although the long-term safety of BTS should be determined in a future clinical trial, mechanical compression by SEMS may suppress cancer cell proliferation and this result could provide some insights into the issue.

Background/Aim: TAS-102 is recommended as salvage-line therapy for metastatic colorectal cancer (mCRC), but practical predictors for its efficacy are lacking. Patients and Methods: In a single-institutional retrospective study of 33 patients treated with TAS-102, we investigated the predictive value of the pretreatment neutrophil-tolymphocyte (NLR), platelet-to-lymphocyte (PLR), and lymphocyte-monocyte (LMR) ratios for progression-free (PFS) and overall (OS) survival. Predictive ability using cutoffs of the median value (3.14) and 5 for NLR were compared. Results: In univariate analysis, Eastern Cooperative Oncology Group performance score, NLR, and PLR were negatively significantly associated with PFS and OS. The number of treatment lines was negatively associated with PFS. The NLR cut-off of 5 was superior to the median value. Multivariate analyses showed a significant prognostic impact for NLR at cut-off 5 (hazard ratio(HR)=6.26, p=0.02 for PFS; HR=6.97, p=0.07 for OS). Conclusion: The pretreatment NLR is a prognostic biomarker for patients with mCRC who receive TAS-102 treatment.

Tension-free hernia repair with a mesh plug causes relatively low postoperative pain and allows an earlier return to work, as well as a low recurrence rate. Occasionally, however, hernioplasty can result in complications including mesh migration and invasion of intra-abdominal organs. This report describes the case of a 57-year-old man who had undergone a right inguinal hernioplasty 13 years previously. Recovery was uneventful until he experienced inflammation of the groin, and required open drainage three times for a refractory abscess in his right groin. Additional colonoscopy and x-ray examinations with contrast medium clearly demonstrated a mesh plug that had migrated and penetrated the cecum, forming a colocutaneous fistula. The mesh was successfully removed under general anesthesia, and the inflammation in the groin resolved. (J Nippon Med Sch 2015; 82: 246 249)

Approximately 10% of patients with colorectal cancer (CRC) develop malignant large bowel obstruction (MLBO) at diagnosis. Furthermore, for 35% of patients with MLBO, curative primary tumor resection is unfeasible because of locally advanced disease and comorbidities. The practice of placing a self-expandable metallic stent (SEMS) has dramatically increased as an effective palliative treatment. Recent advances in systemic chemotherapy for metastatic CRC have significantly contributed to prolonging patients' prognosis and expanding the indications. However, the safety and efficacy of systemic chemotherapy in patients with SEMS have not been established. This review outlines the current status of this relatively new therapeutic strategy and future perspectives. Some reports on this topic have demonstrated that 1) systemic chemotherapy and the addition of molecular targeted agents contribute to prolonged survival in patients with SEMS; 2) delayed SEMS-related complications are a major concern, and this requires strict patient monitoring; however, primary tumor control by chemotherapy might result in decreased complications, especially regarding re-obstruction; and 3) using bevacizumab could be a risk factor for SEMS-related perforation, which may be lethal. Although this relatively new approach for unresectable stage IV obstructive CRC requires a well-planned clinical trial, this therapy could be promising for patients who are unideal candidates for emergency surgery and require immediate systemic chemotherapy.

For surgeons with sufficient knowledge of the anatomy and expertise in reducing the strangulated organ, TAPP for strangulated inguinal hernia is at least comparable to open hernioplasty via the anterior approach in short-term outcomes.

Background/Aim: Although weekly administration of cetuximab is the standard regimen in patients with metastatic colorectal cancer (mCRC), the efficacy and safety of a biweekly regimen is a pending issue. We conducted this meta-analysis to compare the efficacy and safety of a biweekly vs. a weekly regimen of cetuximab in the treatment of mCRC. Patients and Methods: We conducted a comprehensive electronic literature search up to January 2020 to identify studies directly comparing the efficacy and safety of biweekly cetuximab administration and conventional weekly administration in patients with mCRC. We then performed a meta-analysis using random-effects models to calculate risk ratios and mean differences with 95% confidence intervals. Results: Four studies with a total of 381 patients were included in this meta-analysis. The meta-analysis showed that biweekly administration conferred equivalent efficacy, including objective response rate, disease-control rate, progression-free survival, and overall survival, as well as safety, including skin toxicity, gastrointestinal toxicity, and hematologic toxicity, compared with weekly administration in patients with mCRC. Conclusion: Results from this meta-analysis support the administration of biweekly instead of weekly cetuximab, which is beneficial for both patients and health resources.Cetuximab, an IgG1 human/mouse chimera-type monoclonal antibody, binds to the extracellular domain of the epidermal growth factor receptor (EGFR), inhibiting ligand binding and downstream signaling (1). In preclinical models, cetuximab was found to promote apoptosis, angiogenesis, and metastasis, and inhibit tumor cell proliferation (2, 3). Furthermore, antitumor antibody-dependent cell-mediated cytotoxicity is also known to play a role in the mode of action of cetuximab (4).The clinical efficacy of weekly cetuximab in patients with metastatic colorectal cancer (mCRC) has been demonstrated in randomized phase II and III clinical trials, either as monotherapy, or in combination with oxaliplatin-and irinotecan-based chemotherapy regimens in first-and subsequent-line treatment (5-10). Cetuximab is approved in several countries for clinical use in patients with mCRC. National Comprehensive Cancer Network (NCCN) Guidelines ® version 2.2020 suggest that both weekly and biweekly (every 2 weeks) cetuximab are indicated in combination with oxaliplatin-and irinotecan-based therapy or monotherapy in KRAS/NRAS/BRAF wild-type patients. In contrast, only conventional weekly cetuximab has been approved in Japan for initial IV infusion of 400 mg/m 2 on day 1 infused over 120 min followed by weekly doses of 250 mg/m 2 infused over 60 min.A pharmacokinetic study by Tabernero et al. (11) demonstrated no significant differences between weekly cetuximab of 250 mg/m 2 (following an initial dose of 400 mg/m 2 ) and biweekly cetuximab of 500 mg/m 2 in combination with irinotecan. Considering that many commonly used chemotherapy agents for mCRC are administrated on a biweekly basis, the synchronization of the a...

Background/Aim: The efficacy of aflibercept plus 5fluorouracil, leucovorin and irinotecan (FOLFIRI) therapy has been demonstrated in patients with metastatic colorectal cancer (mCRC) in global and Japanese clinical trials. However, a practical biomarker to predict its efficacy is lacking. Patients and Methods: This was a single-institution retrospective study of 21 patients with mCRC consecutively treated with aflibercept plus FOLFIRI from March 2018 to July 2019. We investigated the association and predictive value of pretreatment blood inflammation and immune-based scores, including the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio, using their median values as cutoffs , in regard to disease control (DC), progression-free (PFS), and overall (OS) survival. Results: The number of patients in each treatment line of aflibercept was as follows: Second, 14 (66.7%); third, four (19.0%); fourth, two (9.5%); eighth, one (4.8%). The median number of aflibercept treatment courses was seven (range=2-17). The median followup time was 391 days. In univariate analysis, patients with DC had a significantly lower PLR than those without DC. Only the PLR was significantly negatively associated with PFS, but not with OS. Multivariate analysis showed a significantly poor prognostic impact of a high PLR on PFS (hazard ratio=10.28; p=0.003). Conclusion: A low pretreatment PLR might be a predictor of aflibercept efficacy in patients with mCRC and may be clinically useful for selecting patient responders.