Suggestion of added value by bevacizumab to chemotherapy in patients with unresectable or recurrent small bowel cancer

Takayoshi, Kotoe; Kusaba, Hitoshi; Uenomachi, Masato; Mitsudo, Kenji; Makiyama, Chinatsu; Makiyama, Akitaka; Uchino, Kenji; Shirakawa, Tsuyoshi; Shibata, Yoshihiro; Shinohara, Yoshikuni; Inadomi, Kyoko; Tsuchihashi, Kazufumi; Arita, Shuji; Ariyama, Hiroshi; Esaki, Taito; Akashi, Koichi; Baba, Eishi

doi:10.1007/s00280-017-3371-0

Cited by 24 publications

(30 citation statements)

References 37 publications

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“…Moreover, a retrospective study included 21 unresectable or recurrent duodenum cancer patients to explore the value of the combination of chemotherapy with bevacizumab. The median OS of patients who received a bevacizumab-chemotherapy combination therapy was 21.9 months 34 . The predictive role of LDH in primary duodenum adenocarcinoma patients receiving antiangiogenetic therapy needs to be further validated.…”

Section: Discussionmentioning

confidence: 99%

Elevated baseline serum lactate dehydrogenase indicates a poor prognosis in primary duodenum adenocarcinoma patients

Chen

Qiu

et al. 2018

J. Cancer

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Purpose: Tumour cells produce energy through glycolysis and lactate dehydrogenase (LDH) is a key part of glycolysis. Elevation of serum LDH may indicate poor prognosis in primary duodenum adenocarcinoma. We aim to explore the prognostic significance of LDH in this disease.Methods and materials: Two hundred forty-four patients diagnosed with primary duodenum adenocarcinoma who were treated at the Sun Yat-sen Cancer Center from February 1996 to January 2016 were retrospectively analysed. We collected routine clinical data, including baseline LDH. Patients were classified into a normal LDH group (≤ 245U/L) and higher LDH group (>245U/L). Correlations of the LDH level and other clinicopathological characteristics were explored using the Chi-square test. Prognostic factors for overall survival were identified using univariate and multivariate analyses.Results: Two hundred seven patients (84.9%) had normal LDH levels, while 37 patients (15.1%) had abnormally high LDH levels. Higher LDH levels were significantly associated with more distant metastasis, node metastasis, poor differentiation and TNM stage Ⅲ-Ⅳ (P<0.05). Consistently, patients with node metastasis, poor differentiation and TNM stageⅢ-Ⅳ had a significantly higher median LDH level (P<0.05). The median survival of patients in the higher LDH group was significantly shorter than that of the patients in the normal LDH group (16.3 m vs. 42.5 m, P=0.02). Using multivariate analysis, LDH, age and radical surgery were independent prognostic factors associated with overall survival(OS) (HR=1.571, P=0.036 for LDH; HR=1.514, P=0.013 for age; HR=0.248, P<0.0001 for radical surgery, respectively).Conclusions: For the first time, our research suggests that baseline serum LDH is an independent prognostic factor in primary duodenum adenocarcinoma patients and elevated baseline serum LDH indicates a poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Elevated baseline serum lactate dehydrogenase indicates a poor prognosis in primary duodenum adenocarcinoma patients

Chen

Qiu

et al. 2018

J. Cancer

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“…Indeed, the interpretation of data should consider the following remarks: small sample of patients included, heterogeneity of the study population (SBA with or without ampullary adenocarcinoma), nature of the study, different chemotherapy protocols (FOLFOX-FOLFIRI-CAPOX-SOX) used with bevacizumab and finally, variability of patients set. [ 7 – 9 ] Even a lower level of evidence supports the option of an anti-EGFR therapy. In fact, only few patients affected with SBA received cetuximab while none was treated with panitumumab until now.…”

Section: Discussionmentioning

confidence: 99%

Anti epidermal growth factor receptor therapy in small bowel adenocarcinoma

Falcone¹,

Roberto²,

Filetti³

et al. 2018

Medicine

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Rationale:Small bowel adenocarcinoma (SBA) is an uncommon gastrointestinal cancer, thus limited data about treatment for advanced disease are available. The lack of specific guidelines has justified the use of therapeutic protocols usually applied in advanced colorectal cancer. Few and preliminary data have suggested possible clinical benefit from the use of target therapy such as bevacizumab and cetuximab.Patient concerns:We present the case of a young woman who was admitted to the emergency department for acute abdominal pain, nausea, and vomiting related to a jejunal stenosis.Diagnoses:An enteroscopy with jejunal biopsy showed poorly differentiated cancerous cells suggestive for primary intestinal cancer. There were no signs of metastatic disease at radiological evaluation. A jejunal resection was subsequently carried out and the diagnosis of mucinous adenocarcinoma of the jejunum was confirmed.Interventions:The computed tomography scan performed 1 month after surgery showed metastatic disease. Therefore, the patient received combined protocols of chemotherapy and either bevacizumab or the anti-epidermal growth factor receptor (EGFR) panitumumab.Outcomes:A partial response (PR) was achieved with Folfox plus panitumumab and a maintenance therapy with panitumumab is being conducted with a mild toxicity and a progression free survival of 19 months since the beginning of panitumumab.Lessons:This is, to the best of our knowledge, the first report in the literature of a patient with SBA who has benefitted from panitumumab with an overall survival of 83 months.

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“…A 2017 retrospective analysis reported that the efficacy of cetuximab-containing chemotherapy for RAS wild-type SBA was inconclusive. 116 Subsequently, a phase II trial published in 2018 showed that panitumumab has no clinically meaningful activity in RAS wild-type SBA 117 ; therefore, cetuximab or panitumumab should not be used for treatment of SBA.…”

Section: Systemic Therapy For Metastatic Diseasementioning

confidence: 99%

“…125 Retrospective analyses have supported these results, reporting favorable outcomes in patients treated with bevacizumab-containing chemotherapy regimens without adding significant toxicity. 116,126 Based on these data, FOLFOX, CAPEOX, or FOLFOXIRI may be given with or without bevacizumab as first-line therapy for advanced SBA.…”

Section: Folfox Capeox or Folfoxiri Plus Bevacizumab As First-line mentioning

confidence: 99%

Small Bowel Adenocarcinoma, Version 1.2020, NCCN Clinical Practice Guidelines in Oncology

Benson

Venook

Al-Hawary

et al. 2019

Journal of the National Comprehensive Cancer Network

119

128

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Small bowel adenocarcinoma (SBA) is a rare malignancy of the gastrointestinal tract that has increased in incidence across recent years. Often diagnosed at an advanced stage, outcomes for SBA are worse on average than for other related malignancies, including colorectal cancer. Due to the rarity of this disease, few studies have been done to direct optimal treatment, although recent data have shown that SBA responds to treatment differently than colorectal cancer, necessitating a separate approach to treatment. The NCCN Guidelines for Small Bowel Adenocarcinoma were created to establish an evidence-based standard of care for patients with SBA. These guidelines provide recommendations on the workup of suspected SBA, primary treatment options, adjuvant treatment, surveillance, and systemic therapy for metastatic disease. Additionally, principles of imaging and endoscopy, pathologic review, surgery, radiation therapy, and survivorship are described.

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Suggestion of added value by bevacizumab to chemotherapy in patients with unresectable or recurrent small bowel cancer

Abstract: The analysis indicates that combination CT for advanced SBA is associated with modest efficacy and safety, and bevacizumab-containing CT may contribute to favorable outcome in these patients.

Cited by 24 publications

References 37 publications

Elevated baseline serum lactate dehydrogenase indicates a poor prognosis in primary duodenum adenocarcinoma patients

Elevated baseline serum lactate dehydrogenase indicates a poor prognosis in primary duodenum adenocarcinoma patients

Anti epidermal growth factor receptor therapy in small bowel adenocarcinoma

Small Bowel Adenocarcinoma, Version 1.2020, NCCN Clinical Practice Guidelines in Oncology

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