Irinotecan monotherapy was relatively safely performed as salvage-line treatment for AGC in Japanese clinical practice. Careful patient selection and intensive modification of the dose of irinotecan might possibly be associated with favorable survival.
Although the neutrophil to lymphocyte ratio (NLR) was reported to be a predictive biomarker for clinical outcomes in various types of cancer, including recurrent or metastatic head and neck cancer (R/M HNSCC) treated with nivolumab, the usefulness of the pretreatment C-reactive protein/albumin ratio (CAR) as a prognostic marker remains to be clarified. This study aimed to analyze the clinical usability of the CAR in comparison with that of the NLR. 46 R/M HNSCC patients treated with nivolumab were retrospectively analyzed. The optimal cutoff value for the CAR was calculated using receiver operating characteristic curve analysis. The optimal cutoff value for the CAR was set to 0.30. On multivariate analyses, a high CAR was significantly associated with poor overall survival (adjusted HR, 2.19; 95% CI, 1.42–3.47; p < 0.01) and progression-free survival (adjusted HR, 1.98; 95% CI, 1.38–2.80; p < 0.01). The overall response rate and disease control rate for the high CAR patients were lower than for the low CAR patients. The CAR had significantly higher area under the curve values than the NLR at 2 and 4 months. The pretreatment CAR might be an independent marker for prognosis and efficacy in R/M HNSCC patients treated with nivolumab.
Our findings do not support the survival benefit of SP over S-1 in elderly patients with AGC. We are now conducting a prospective comparative study to optimize treatment strategy and explore applicability of the geriatric assessment for these patients.
Abstract. Background: Significant efficacy of oxaliplatinbased chemotherapy has been demonstrated for advanced gastric cancer (AGC).Gastric cancer (GC) is the fourth most frequent malignant tumor and the second most common cause of tumor death in the world (1). Recurrent GC after curative resection and initially unresectable metastatic GC (advanced GC; AGC) are treated with systemic chemotherapy (CT), that can prolong survival and maintain quality of life. For the initial CT, combination consisting of fluorouracil or fluoropyrimidine and platinum has been demonstrated to be effective. The triplet regimen including fluoropyrimidine, platinum and epirubicin is often used in European countries (2). Effectiveness of a triplet of docetaxel, cisplatin and fluorouracil has been shown in the United States (3). The standard therapy for patients with AGC in Japan has been a combination of the oral fluoropyrimidine S-1 and cisplatin (SP) based on the results of the phase 3 SPIRITS study (4). Another fluoropyrimidine, capecitabine, has also been shown to be effective for AGC in combination with cisplatin (5).Oxaliplatin has also been employed for systemic CT for AGC in combination with fluorouracil or fluoropyrimidine 2663
Rationale:Regorafenib is effective for metastatic colorectal cancer but its toxicity such as hemorrhage should be considered. The safety of regorafenib for the patient with the liver disease is not known.Patient concerns:Seventy-one-year old man of colon cancer had myodesopsia and blood stool after 14 days from the initiation of regorafenib administration with 50% dose reduction due to liver dysfunction.Diagnoses:Fundus examination revealed hemorrhage of the retinal vein.Interventions:Regorafenib treatment was discontinued and observational therapy was pursued.Outcomes:Retinal and gastrointestinal hemorrhage resolved in 1 week.Lessons:Retinal hemorrhage should be considered as the differential diagnosis of myodesopsia in the patient treated by regorafenib. Safety and pharmacokinetic of continuous regorafenib administration for patients with liver dysfunction remains to be clarified.
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