Multidisciplinary case teams: an approach to the future management of advanced colorectal cancer

Minsky, Bruce D.

doi:10.1038/bjc.1998.418

Cited by 15 publications

(7 citation statements)

References 23 publications

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“…There is an increasing appreciation of the importance of the palliative effects of treatment in patients with advanced cancer; Redmond (1998) and Minsky (1998) have shown how the overall effectiveness of treatment can be enhanced by using therapies that combine increased well-being for patients with clinical efficacy in terms of objective response and survival. In the present phase III clinical trials, clinically significant palliative benefits were obtained to a similar extent with raltitrexed and 5-FU + LV in terms of weight gain, improvements in performance status and reductions in disease symptoms (e.g.…”

Section: Objective Response Ratesmentioning

confidence: 99%

Mature results from three large controlled studies with raltitrexed ('Tomudex')

Cunningham

1998

Br J Cancer

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Summary Since the publication of the results of phase I dose-finding studies, an extensive phase 11 and III clinical study programme has been undertaken to study the clinical efficacy and tolerability of the quinazoline folate analogue raltitrexed ('Tomudex'), a novel direct and specific inhibitor of thymidylate synthase. Two international phase III trials, studies 3 and 12, have compared raltitrexed 3 mg m-2 with 5-fluorouracil (5-FU) plus low-dose leucovorin (LV) (Mayo regimen) or high-dose LV (Machover regimen) respectively. A North American study (study 10) was originally set up to compare two raltitrexed dosage arms (3.0 and 4.0 mg m-2) with 5-FU and low-dose LV, but the 4.0 mg m-2 arm was discontinued prematurely because of excessive toxicity. Minimum follow-up times for studies 3, 10 and 12 were 15.5, 12 and 9 months, respectively (for data other than survival), with corresponding survival follow-up times of 26, 12 and 17 months. Objective response rates were similar for raltitrexed and 5-FU + LV, and palliative improvements were seen to a similar extent with both treatments in all phase III studies. Survival was statistically similar for raltitrexed and 5-FU + LV in both studies 3 and 12. Raltitrexed was, however, associated with inferior survival to 5-FU + low-dose LV in study 10, but there appears to be evidence that this was linked to an unconscious effect on investigator behaviour of early toxicity problems in this trial, in that patients appeared to be withdrawn from raltitrexed treatment without progression or protocolled toxicity. Moreover, it appeared that 5-FU + LV patients were continued on treatment after disease progression.5-FU-based therapy was associated with a higher incidence of mucositis than raltitrexed in all studies, with the attainment of statistical significance in studies 3 and 12. Elevations in hepatic transaminase levels were seen with raltitrexed, but these are thought to be of no clinical significance. Overall, much greater levels of toxicity were seen with 5-FU + LV than with raltitrexed in early treatment cycles. In addition, retrospective UK audit data have shown the monthly cost of raltitrexed therapy to be similar to that of Mayo and continuous infusion 5-FU regimens, and appreciably lower than that of the de Gramont regimen of 5-FU (bolus + 22-h infusion) + high-dose LV. Thus, raltitrexed is an effective alternative to 5-FU-based therapy in patients with advanced colorectal cancer, with an acceptable and, unlike 5-FU, predictable toxicity profile. In particular, patients receiving raltitrexed may benefit from the minimization or avoidance of mucositis, and both patients and healthcare providers may find the convenient administration schedule of the drug advantageous.

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Section: Objective Response Ratesmentioning

confidence: 99%

Mature results from three large controlled studies with raltitrexed ('Tomudex')

Cunningham

1998

Br J Cancer

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“…Usually, the multidisciplinary team (MDT) of colorectal cancer consists of several departments; imaging and pathology make the diagnosis while colorectal surgery, oncology, radiotherapy and palliative care provide the therapy 9, 10. The MDT mode can improve the survival of rectal cancer, and is recommended by many guidelines 11-13. However, there is few researches report the importance of MDT in the assessment of MRI and the influence of MDT for accurate staging and therapy strategy selecting.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Magnetic Resonance Imaging in Staging Rectal Cancer with Multidisciplinary Team: A Single-Center Experience

Yu¹,

Wang²,

Tan³

et al. 2019

J. Cancer

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Purpose: To investigate the accuracy of magnetic resonance imaging (MRI) in preoperative staging diagnosis for rectal cancer with multidisciplinary team (MDT) discussion.Methods: The retrospective study included 377 patients of rectal cancer with preoperative MRI staging from February 2015 to April 2018, in which 137 patients (36 received MDT discussion) received neoadjuvant therapy, 240 did not (97 received MDT discussion) and direct surgery was given. With postoperative pathological stage as the standard, the accuracy of MRI in preoperative staging for rectal cancer with MDT discussion was compared with non-MDT.Results: For direct surgery group, 21 out 97 (21.6%) patients changed their therapy strategy due to the change of the stage assessment after MDT. The accuracy of MRI for the diagnosis of preoperative N stage with MDT was significantly higher than those without MDT (56.2% vs. 42.1%, P=0.021). And for those without lymph node metastasis, the accuracy of MRI was higher after MDT (61.2% vs. 37.8%, P=0.009). For neoadjuvant therapy group, 7 out of 36 (19.4%) patients altered their therapy after MDT because of the changed stage. MDT improved the accuracy of restaging N stage with MRI (70.0% vs. 33.3%, P=0.003). The accuracy of MRI in staging T stage seemed not improved after MDT in both groups.Conclusions: In conclusion, MDT discussion increased the accuracy of MRI in preoperative staging diagnosis for rectal cancer. This mode could give a more accurate clinical stage of patients, which was in favor of choosing a preferable therapy strategy.

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“…After examining the probability and frequency of emergency care utilization presented by other variables, we found that the deterioration of health conditions, such as advanced cancer staging and increase in outpatient visits and inpatient visits, increases the probability and frequency of emergency care utilization and there were significant differences among groups, which is consistent with the results of many studies on survival of patients with colorectal cancer. [ 11 , 32 , 33 ] Some studies suggested that patients with advanced colorectal cancer received the best quality of overall treatment with MDT, [ 34 , 35 ] which means that with the advance of colorectal cancer, the challenges to diagnosis, treatment and care would be greater. We hope to see more investigators dedicate their research in this area in the future.…”

Section: Discussionmentioning

confidence: 99%

Effects of multidisciplinary team on emergency care for colorectal cancer patients

et al. 2017

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The literature describing the effectiveness of multidisciplinary team (MDT) for the care of colorectal cancer remains unclear. We investigated the effects of MDT care on the quality of colorectal cancer treatment, and the emergency department visit number was used as an indicator. In total, 45,418 patients newly diagnosed with colorectal cancer from the Taiwan National Health Insurance Research Database (2005–2009) were included. Propensity score matching with a ratio of 1:3 was adopted to reduce differences in characteristics between MDT care participants and non-MDT care participants. After matching, 3039 participation MDT care groups and 9117 nonparticipation groups were included and analyzed with χ2 and t tests, determine the distribution was similar. Without the control of variables, the percentage difference between participation and nonparticipation MDT care groups in utilization of emergency care was 0.03% (P > .05). The logistic regression model involving controlled variables demonstrated that odds ratio (OR) by probability of emergency care used for participation MDT care groups within a year of cancer diagnosis was less than that for nonparticipation (OR = 0.87, 95% confidence interval: 0.78–0.96). Large amount data were used and confirmed significant benefits of MDT in colorectal cancer care.

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Multidisciplinary case teams: an approach to the future management of advanced colorectal cancer

Cited by 15 publications

References 23 publications

Mature results from three large controlled studies with raltitrexed ('Tomudex')

Mature results from three large controlled studies with raltitrexed ('Tomudex')

Accuracy of Magnetic Resonance Imaging in Staging Rectal Cancer with Multidisciplinary Team: A Single-Center Experience

Effects of multidisciplinary team on emergency care for colorectal cancer patients

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