No abstract available.
Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Camptothecin/*analogs & derivatives/therapeutic use ; Female ; Fluorouracil/therapeutic use ; Humans ; Leucovorin/therapeutic use ; Male ; Organoplatinum Compounds/therapeutic use ; Stomach Neoplasms/*drug therapy

Pancreatic cancer is a very lethal cancer. It is the 5th most common cause for cancer related mortality in Korea. Most of patients have unresectable pancreatic cancer, and systemic chemotherapy remains the only treatment option for them. Gemcitabine has been adopted as the standard first-line agent for advanced pancreatic cancer, but the progression free survival with gemcitabine is short. Many of patients need further treatment. We reviewed the clinical trials of second line chemotherapy for gemcitabine refractory pancreatic cancer and tried to show currently available treatment options.
Antibodies, Monoclonal/therapeutic use ; Antineoplastic Agents/therapeutic use ; Camptothecin/therapeutic use ; Deoxycytidine/analogs & derivatives/therapeutic use ; Drug Therapy, Combination ; Fluorouracil/therapeutic use ; Humans ; Organoplatinum Compounds/therapeutic use ; Pancreatic Neoplasms/*drug therapy ; Taxoids/therapeutic use

Colorectal cancer is the second most common malignant tumor in China. The FOLFOXIRI regimen, which combines 5-fluorouracil/leucovorin, oxaliplatin, and irinotecan, is a high-intensity and highly effective chemotherapy regimen. However, the original regimen is poorly tolerated in Chinese patients. In order to promote the standardized and rational application of FOLFOXIRI regimen by clinicians in China, "
Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Camptothecin/therapeutic use* ; China ; Colorectal Neoplasms/drug therapy* ; Consensus ; Fluorouracil/therapeutic use* ; Humans ; Irinotecan/therapeutic use* ; Leucovorin/therapeutic use* ; Organoplatinum Compounds/therapeutic use* ; Oxaliplatin ; Treatment Outcome

OBJECTIVETo investigate the association of CD133 expression in rectal cancer tissues with neoadjuvant chemoradiotherapy (nCRT) and tumor regression grading (TRG) after nCRT.

METHODSRadical resected rectal cancer specimens and clinicopathological data of 105 patients, including 60 men and 45 women with median age of 59 years, diagnosed as locally advanced rectal cancer in Peking Union Medical College Hospital from January 2008 to December 2014 were collected retrospectively. Thirty-nine and 66 cases were histologically classified as good-moderate and poor differentiation respectively. Sixty-eight and 37 cases were clinically graded as stage I(-II( and III(-IIII( in preoperative assessment respectively. NCRT was administered in 61 cases before surgery (nCRT group). The nCRT consisted of preoperative pelvic radiotherapy using 50 Gy (2 Gy once, for 25 sessions) with FOLFOX regimen (5-fluorouracil plus oxaliplatin) for 2-3 cycles or XELOX regimen (capecitabine plus oxaliplatin) for 2 cycles. Patients underwent surgery after 6 courses of nCRT, and then received the same previous chemotherapy regimen. In nCRT group, biopsy specimens before nCRT were obtained in 45 cases. Forty-four cases received surgery alone without nCRT (surgery alone group). CD133 expression was tested by immunohistochemical Envision two-step methods. The histological TRG evaluation was performed in the nCRT group. TRG score 0-2 was defined as insensitivity to nCRT, whereas TRG score 3-4 was defined as sensitivity. CD133 expression in rectal cancer samples before and after nCRT was compared. Association of CD133 expression with TRG after nCRT was examined.

RESULTSNo significant differences of baseline parameters were found between nCRT group and surgery alone group (all P>0.05). The positive rate of CD133 in nCRT group was 70.4%(43/61,) which was significantly higher than that in surgery alone group (47.7%, 21/44)(χ(2)=5.566, P=0.018) and that in biopsy samples before nCRT group (44.4%, 20/45)(χ(2)=7.287, P=0.007). Twenty-two cases (36.1%, 22/61) in nCRT group had TRG score of 3-4 . Among these 22 cases, 11 cases were negative CD133, and constituted 61.1% (11/18) of all CD133-low expression cases in nCRT group, whereas the other 11 cases were positive CD133, and constituted 25.6%(11/43) of all CD133-high expression cases in nCRT group (χ(2)=6.974, P=0.008).

CONCLUSIONThe CD133 expression up-regulates markedly in rectal cancer after nCRT and nCRT may have potential positive modulation on CD133 expression. CD133-positive cancer reveals lower response to nCRT, suggesting CD133 may be a potential target for improving efficacy of nCRT in rectal cancer.

AC133 Antigen ; metabolism ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Chemoradiotherapy ; Deoxycytidine ; analogs & derivatives ; therapeutic use ; Female ; Fluorouracil ; analogs & derivatives ; therapeutic use ; Humans ; Leucovorin ; therapeutic use ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Organoplatinum Compounds ; therapeutic use ; Rectal Neoplasms ; metabolism ; therapy

OBJECTIVETo compare the therapeutic effect and toxicity of chemotherapy, used alone or in combined with Shenqi Fuzheng Injection (SFI), for the treatment of advanced colorectal carcinoma (ACRC).

METHODSOne hundred and fifty-two patients with ACRC were equally randomized by digital table, to the treated group, treated by chemotherapy of FOLFOX regimen combined with SFI, and the control group treated by FOLFOX regimen alone. The therapeutic effect and adverse reaction of the treatment in patients were assessed.

RESULTSThe effective rate (CR +PR) was 63.2% (48/76) in the treated group and 46.1% (35/76) in the control group, showing significant difference between the two groups (P < 0.05). The median survival time in the two groups was 31 weeks and 28 weeks respectively. CD4/CD8 ratio was significantly increased in the treated group (1.56 +/- 0.21, 1.64 +/- 0.28, P < 0.05), but significantly decreased in the control group (1.58 +/- 0.22, 1.46 +/- 0.33, P < 0.01). Quality of life in the former group was higher than that in the latter group (P < 0.05). Times/case of nausea, vomiting, leukopenia occurring in the control group was more than those in the treated group A (P < 0.05).

CONCLUSIONBy combining with SFI, some adverse reactions of chemotherapy (such as nausea, vomiting, leukopenia) and its influence on patients' immunity could be alleviated in treating ACRC, which might enhance the efficacy of chemotherapy, and improve the quality of life and prolong the median survival time in patients.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Colorectal Neoplasms ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Fluorouracil ; therapeutic use ; Humans ; Leucovorin ; therapeutic use ; Organoplatinum Compounds ; therapeutic use ; Quality of Life ; Survival Rate

Preoperative concurrent chemoradiotherapy based on 5-fluorouracil (5-FU) is an standard treatment mode for patients with locally advanced rectal cancer (LARC). Currently, more and more interests has now focused on new chemotherapeutic drugs, such as capecitabine, oxaliplatin, irinotecan, bevacizumab, and cetuximab in this treatment mode. Many prospective phase I-III clinical trials have been developed to explore these new drugs efficacy in the neoadjuvant chemoradiation (nCRT) for patients with LARC. Some results are very encouraging, yet others are undesirable. Capecitabine has been widely recognized in the nCRT for patients with LARC, and has the tendency to replace 5-FU. However, there are some controversies for oxaliplatin, irinotecan, and biologically targeted drugs in the nCRT mode because of their limited clinical benefits. It is potentially the development direction to study the mutual interaction mechanism among concurrent drugs or radiation and biologically targeted drugs, find new predicatively responsive targets, and screen the appropriate patient in the treatment of neoCRT for patients with LARC in the future.
Antineoplastic Agents ; therapeutic use ; Camptothecin ; analogs & derivatives ; therapeutic use ; Capecitabine ; Chemotherapy, Adjuvant ; Deoxycytidine ; analogs & derivatives ; therapeutic use ; Fluorouracil ; analogs & derivatives ; therapeutic use ; Humans ; Organoplatinum Compounds ; therapeutic use ; Rectal Neoplasms ; drug therapy ; surgery

BACKGROUNDTo compare clinical efficacy and toxicity of irinotecan combined with 5-fluorouracil and leucovorin with those of oxaliplatin combined with 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer.

METHODSLiterature search was performed by keywords "irinotecan", "oxaliplatin" and "colorectal cancer" on all randomized controlled trails reported on irinotecan versus oxaliplatin combined with 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer in MEDLINE, OVID, Springer, Cochrane Controlled Trials Register (CCTR) and CBMdisc (Chinese Biology and Medicine disc) before January 2010. Two authors drew the details of trial design, characteristics of patients, outcomes, and toxicity from the studies included. Data analysis was performed by RevMan 4.2.

RESULTSAccording to the screening criteria, 7 clinical studies with 2095 participants of advanced colorectal cancer were included in this meta analysis. The baseline characteristics of irinotecan group were similar to those of oxaliplatin group. The response rate of oxaliplatin group was higher than that of irinotecan group (relative risk (RR) = 0.82, 95% confidence interval (95%CI) (0.70, 0.96), P = 0.01), and the median overall survival of oxaliplatin group was longer by 2.04 months than that of irinotecan group (95%CI (-3.54, -0.54), P = 0.008). In the comparison of grade 3 - 4 toxicity between the two groups, the incidences of nausea, emesis, diarrhoea and alopecia in irinotecan group were higher than those in oxaliplatin group (RR = 1.94, 95%CI (1.22, 3.09), P = 0.005; 1.71, 95%CI (1.34, 2.18), P < 0.001; 14.56, 95%CI (4.11, 51.66), P < 0.0001), respectively. However, the incidence of neurotoxicity, neutropenia and thrombocytopenia in irinotecan group were lower than those in oxaliplatin group (RR = 0.06, 95%CI (0.03, 0.14), P < 0.00001; 0.70, 95%CI (0.55, 0.91), P = 0.006; 0.18, 95%CI (0.05, 0.61), P = 0.006), respectively.

CONCLUSIONSBoth irinotecan and oxaliplatin combined with 5-fluorouracil and leucovorin were effective in the first-line therapy of advanced colorectal cancer. However, the combined regimen of oxaliplatin plus 5-fluorouracil and leucovorin is more excellent. Irinotecan tended to result in more gastrointestinal tract reactions than oxaliplatin did, but the myelosuppression and neurotoxicity were more frequent in oxaliplatin regimen than irinotecan regimen.

Antineoplastic Agents ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; Camptothecin ; analogs & derivatives ; therapeutic use ; Colorectal Neoplasms ; drug therapy ; Fluorouracil ; therapeutic use ; Humans ; Leucovorin ; therapeutic use ; Organoplatinum Compounds ; therapeutic use ; Treatment Outcome

OBJECTIVETo observe the effect of modified Sijunzi Decoction (SJZD) on immune function in patients with colorectal cancer undergoing chemotherapy (CM) with FOLFOX4 protocol (oxaliplatin + calcium folinate + 5-fluorouracil).

METHODSForty-five patients with colorectal cancer were randomly assigned to two groups, the 22 in the control group treated with CM alone and the 23 in the treated group treated with CM plus SJZD. The therapeutic course for both groups was 2 chemotherapy cycles. Immunologic indices, including T-lymphocyte subgroup and NK cell proportion were detected before and after treatment using immunofluorescence stain and flow cytometry. Meantime, patients' quality of life (QOL) was scaled by KPS scoring, body mass was weighed, side and toxic effects of chemotherapy were recorded.

RESULTSCompared with pre-treatment, CD4 and CD4/CD8 significantly decreased after treatment in the control group (P < 0.05), while in the treated group, CD3, CD4 and CD4/CD8 increased significantly (P < 0.05). In addition, CD4 and CD4/CD8 were much higher in the treated group than in the control group (P < 0.05). Compared with the control group, the treated group had stabilized KPS score and body weight, and reduced chemotherapeutic toxicity shown as higher level of leucocyte amount, less symptoms of nausea and vomiting (P < 0.05).

CONCLUSIONSJZD could improve the immune function and QOL of colorectal cancer patients undergoing FOLFOX4, and reduce the side effects of CM.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Colorectal Neoplasms ; drug therapy ; immunology ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Female ; Fluorouracil ; therapeutic use ; Humans ; Leucovorin ; therapeutic use ; Male ; Middle Aged ; Organoplatinum Compounds ; therapeutic use ; Phytotherapy ; Quality of Life

PURPOSE: The purpose of this study is to provide a comprehensive overview of the various measures available for assessment of oxaliplatin-induced peripheral neuropathy (OXLIPN) and to evaluate the measurement properties of each assessment tool. METHODS: A systematic review was conducted to identify existing measures for OXLIPN found in the databases of PubMed, Cochrane Library, Embase, RISS and KoreaMed. The quality of the 24 identified tools was evaluated based on their properties of measurement including content validity, internal consistency, criterion validity, construct validity, reproducibility, responsiveness, floor-ceiling effects and interpretability. RESULTS: Ten (41.7%) of the 24 tools were identified as specific measures for assessing OXLIPN and the most popular type of measures were clinical grading systems by clinicians (58.3%) and only 29.2% of measures were identified as patient reported outcomes. The most frequently used tool was National Cancer Institute-Common Toxicity Criteria (NCI-CTC), but the validity of NCI-CTC has not been reported appropriately. Overall, the Neuropathic Pain Symptom Inventory (NPSI) received the best psychometric scores, and the Chemotherapy-induced Peripheral Neuropathy Assessment Tool (CIPNAT) and Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group-neurotoxicity-12 (FACT/GOG-Ntx-12) followed NPSI. CONCLUSION: To select appropriate measure, evidences should be accumulated through the clinical use of tools. Therefore, practitioner and researchers are urged to report relevant statistics required for the validation of the currently used measures for assessment of OXLIPN.
Activities of Daily Living ; Antineoplastic Agents/*adverse effects/therapeutic use ; Databases, Factual ; Humans ; Neoplasms/drug therapy ; Organoplatinum Compounds/*adverse effects/therapeutic use ; Peripheral Nervous System Diseases/*etiology ; Psychometrics

OBJECTIVETo evaluate the efficacy and toxicity of concurrent chemoradiotherapy for patients with locally advanced unresectable extrahepatic cholangiocarcinoma.

METHODSThirty-eight patients with locally advanced unresectable extrahepatic cholangiocarcinoma admitted in Shaoxing People's Hospital from February 2007 to February 2012 were enrolled in the study. They were randomized into sequential chemoradiotherapy (n=19) or concurrent chemoradiotherapy group (n=19). All patients were treated with intensity modulated radiation therapy (IMRT). Patients in concurrent chemoradiotherapy group received the regimen of gemcitabine plus oxaliplatin. Tumor response and adverse effects were observed periodically. The primary end points were disease progression-free survival (PFS) and overall survival (OS).

RESULTSThe response rates of sequential chemoradiotherapy and concurrent chemoradiotherapy groups were 42.1% (8/19) and 63.2% (12/19). The disease control rates of them were 78.9% (15/19) and 84.2% (16/19))， respectively. The median PFS of sequential chemoradiotherapy group and concurrent chemoradiotherapy group was 8.3 (95%CI: 7.6-9.0) and 10.4 months (95%CI: 9.4-11.4, P=0.037), and the median OS in two groups were 14.2 (95%CI: 12.6-15.8) and 15.6 months (95%CI: 14.2-17.0, P=0.095), respectively. The major adverse reactions were controllable hematology toxicity and gastrointestinal reaction. There was no significant difference in incidence of adverse reactions between two groups (P>0.05).

CONCLUSIONSequential chemoradiotherapy and concurrent chemoradiotherapy may improve PFS and OS in patients with locally advanced unresectable extrahepatic cholangiocarcinoma, and both are well-tolerated. In addition, concurrent chemoradiotherapy might provide additional PFS benefit and would be preferable.

Bile Duct Neoplasms ; therapy ; Bile Ducts, Intrahepatic ; pathology ; Chemoradiotherapy ; Cholangiocarcinoma ; therapy ; Deoxycytidine ; analogs & derivatives ; therapeutic use ; Disease-Free Survival ; Humans ; Organoplatinum Compounds ; therapeutic use ; Survival Rate