Prognostic Value of Circulating Tumor Markers in Patients with Pseudomyxoma Peritonei Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Baratti, Dario; Kusamura, Shigeki; Martinetti, Antonia; Seregni, Ettore; Laterza, Barbara; Oliva, Daniela G.; Deraco, Marcello

doi:10.1245/s10434-007-9393-9

Cited by 91 publications

(67 citation statements)

References 24 publications

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“…We rationalised the following: (i) serum CEA and CA19-9 levels are elevated in over 50% PMP patients at presentation and drop markedly following cytoreductive surgery and HIPEC (van Ruth et al, 2002); (ii) elevated CA 19-9 levels prior to cytoreductive surgery may be an independent predictor of worse progression-free survival (Baratti et al, 2007); and (iii) in a case study of a patient with DPAM treated with capecitabine, there was a decrease in CEA and CA19-9 levels (Levitz et al, 2004). Serum CA125 concentrations are commonly raised in patients with PMP, and at initial presentation, may mimic gynaecological malignancies (Pranesh et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

A phase II study evaluating the use of concurrent mitomycin C and capecitabine in patients with advanced unresectable pseudomyxoma peritonei

et al. 2008

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Pseudomyxoma peritonei (PMP) is a rare neoplastic process characterised by progressive intra-abdominal dissemination of mucinous tumour, and generally considered resistant to systemic chemotherapy. A phase II study in patients with advanced unresectable PMP was undertaken to evaluate the combination of systemic concurrent mitomycin C (7 mg m À2 i.v. on day 1) and capecitabine (1250 mg m À2 b.d. on days 1 -14) in a 3-weekly cycle (MCap). Response was determined by semiquantitative assessment of disease volume on serial computed tomographic (CT) scans and serum tumour marker (CEA, CA125, CA19-9) changes at 12 weeks. Between 2003 and 2006, 40 patients were recruited through a national centre for the treatment of peritoneal surface tumours. At baseline, 23 patients had progressive disease and 17 had stable disease. Of 39 assessable patients, 15 (38%, 95% confidence intervals (CIs): 25, 54%) benefited from chemotherapy in the form of either reductions in mucinous deposition or stabilisation of progressive pretreatment disease determined on CT scan. Notably, two patients, originally considered unresectable, following MCap and re-staging underwent potentially curative cytoreductive surgery. Grade 3/4 toxicity rates were low (6%, 95% CIs: 4, 9%). Twenty out of 29 assessed patients (69%, 95% CIs: 51, 83%) felt that their Global Health Status improved during chemotherapy. This is the first trial to demonstrate an apparent benefit of systemic chemotherapy in patients with advanced unresectable PMP.

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Section: Discussionmentioning

confidence: 99%

A phase II study evaluating the use of concurrent mitomycin C and capecitabine in patients with advanced unresectable pseudomyxoma peritonei

et al. 2008

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“…It has been clearly demonstrated that a combined approach of CRS and HIPEC is the standard treatment of patients with PPM because it is able to provide a survival advantage compared with historical controls. Treatment failure may be predicted by several prognostic factors, which were validated in large series [6,[16][17][18]. Several retrospective analyses documented that previous use of systemic chemotherapy was an independent poor prognostic factor for patients undergoing curative CRS and HIPEC for appendiceal neoplasms associated with PPM [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

FOLFOX-4 Chemotherapy for Patients With Unresectable or Relapsed Peritoneal Pseudomyxoma

et al. 2014

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Purpose. The standard treatment of peritoneal pseudomyxoma is based on cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The establishment of newer systemic treatments is an unmet clinical need for unresectable or relapsed peritoneal pseudomyxoma. The aim of our study was to assess the activity of chemotherapy with 5‐fluorouracil and oxaliplatin (FOLFOX‐4 regimen) in terms of response rate in this subset of patients. Materials and Methods. Patients were included in a single‐center, observational study and treated with FOLFOX‐4 administered every 2 weeks for up to 12 cycles or until progressive disease or unacceptable toxicity. Results. Twenty consecutive patients were reviewed from July 2011 to September 2013. Only partial responses were observed, with an objective response rate of 20%. Median progression‐free survival and overall survival were 8 months and 26 months, respectively. Two patients were able to undergo laparotomy with complete cytoreduction and HIPEC in one case. Safety data for FOLFOX‐4 were consistent with the literature. By means of a mutant enriched polymerase chain reaction, KRAS mutation was found in 16 of 19 cases (84%), and MGMT promoter methylation was found in 8 (42%, all KRAS mutant). Conclusion. FOLFOX‐4 chemotherapy is tolerable and active in patients with peritoneal pseudomyxoma when disease is deemed unresectable or relapsed after peritonectomy and HIPEC. The identification of predictive biomarkers, such as KRAS for resistance to anti‐epidermal growth factor receptor monoclonal antibodies and MGMT for response to temozolomide, is a priority for the development of evidence‐based treatment strategies for peritoneal pseudomyxoma.

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“…However, the role of serum tumour markers has been underlined. In patients with peritoneal mesothelioma, we reported a sensitivity rate of 100% (12/12) for CA125 in assessing disease progression after complete CRS and HIPEC [46] In patients with pseudomyxoma peritonei with positive baseline values, marker concentrations at progression were elevated in 24 of 29 (82.7%) patients for CEA, in 18 of 22 (81.8%) patients for CA19.9, in 12 of 19 (63.1%) patients for CA125, and in 4 of 6 (66.7%) patients for CA15.3 [47] . Van Ruth reported that CEA normalized in 73% patients and CA19.9 in 57% patients with preoperative increased levels, and that CA19.9 was positive in 14 of 14 cases of relapsing PMP with elevated preoperative levels [48] .…”

Section: Long Term Follow-upmentioning

confidence: 99%

Early and long-term postoperative management following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Baratti¹,

Kusamura²,

Laterza³

et al. 2010

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Peritoneal surface malignancies have been traditionally regarded as end-stage conditions amenable to merely palliative options. The combination of aggressive cytoreductive surgery (CRS), involving peritonectomy procedures and multivisceral resections, with intraoperative hyperthermic intra-peritoneal chemotherapy (HIPEC) and/or early postoperative intra-peritoneal chemotherapy (EPIC) to treat the microscopic residual tumor is a new concept. In recent years, promising results have been reported for peritoneal mesothelioma and carcinomatosis of gastrointestinal and gynaecologic origin treated by this combined protocol. However, CRS with HIPEC and/or EPIC is a complex procedure associated with high rates of potentially life-threatening complications. Furthermore, disease progression following comprehensive treatment is not uncommon and represents a relevant cause of treatment failure. The present paper reviews the available information on early postoperative management and long-term follow-up in patients treated with CRS and intraperitoneal chemotherapy. The peculiar clinical and biological alterations that can be expected during an uncomplicated postoperative course, as compared to standard digestive surgery, are discussed. Early recognition and appropriate management of the most common adverse events are addressed, in order to minimize the impact of treatment-related morbidity on survival and quality of life results. Since re-operative surgery with additional HIPEC, has proven to be useful in selected patients with recurrent disease, long-term surveillance aiming at early detection of postoperative disease progression has become a relevant issue. Current results on follow-up investigations are presented.

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Prognostic Value of Circulating Tumor Markers in Patients with Pseudomyxoma Peritonei Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Abstract: Normal CA125 correlated to the likelihood to achieve adequate CRS, which is a significant prognostic factor for PMP. Increased baseline CA19.9 was an independent predictor of worse PFS after CRS and HIPEC.

Cited by 91 publications

References 24 publications

A phase II study evaluating the use of concurrent mitomycin C and capecitabine in patients with advanced unresectable pseudomyxoma peritonei

A phase II study evaluating the use of concurrent mitomycin C and capecitabine in patients with advanced unresectable pseudomyxoma peritonei

FOLFOX-4 Chemotherapy for Patients With Unresectable or Relapsed Peritoneal Pseudomyxoma

Early and long-term postoperative management following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

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