Effect Of Palliative Chemotherapy Research Articles

Effects of Palliative Chemotherapy in Unresectable or Metastatic Colorectal Cancer Patients With Poor Performance Status

IntroductionColorectal cancer is the second most common cancer in both genders and often presents as a metastatic, unresectable, or recurrent disease in early follow-up. It is uncertain the benefit of oxaliplatin-based palliative chemotherapy (CT) in the first line of treatment in patients with compromised performance status (PS), Eastern Cooperative Oncology Group (ECOG) 3 and 4. These patients are systematically excluded from clinical trials but may be treated in clinical practice. MethodsWe conducted a prospective observational cohort whose primary outcome was improving at least 2 points in the worst symptom in the Edmonton Symptom Assessment System Scale (ESAS-r), without grade 3 to 4 toxicity, comparing baseline and fourth week of treatment. Secondary endpoints included quality of life using the European Quality of Life-5 dimensions questionnaire, toxicity, response rate, clinical improvement of ECOG PS, and overall survival (OS). ResultsWe included 28 patients, and 12 (42.8%) achieved the primary endpoint. Median overall survival was 86 days, 46% of patients did not respond to the fourth-week reevaluation due to clinical deterioration, and 17.8% presented toxicity grade ≥3, with 5 patients dying from toxicity. In addition, ECOG PS 4 or cholestasis had poorer overall survival. Finally, 25% and 53.6% of patients received these treatments in the last 14 and 30 days of life, respectively. ConclusionIn the present study, palliative multiagent chemotherapy in poor performance status patients with non-molecularly selected colorectal cancer tended to impact tumor symptoms control; however, there is no benefit in OS and a considerable risk of toxicity and treatment-related death.

HPB P67 Patterns of recurrence after pancreatoduodenectomy for pancreatic cancer and the effect of palliative chemotherapy on survival

Abstract Background Pancreatoduodenectomy (PD) is recommended in fit patients with suspected early pancreatic ductal adenocarcinoma (PDAC) affecting the pancreatic head. Unfortunately, recurrence rates are high and only a minority achieve long-term survival. This study aimed to study the patterns of recurrence in patients who undergo PD for PDAC and investigate the impact of palliative chemotherapy on survival. Methods Data was extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective cohort study of outcomes following PD performed for pancreatic head malignancy (29 centres in 8 countries, n=1,484). Patients with PDAC who developed recurrence within five years of their operation were identified. The site of recurrence and details of palliative chemotherapy (if any) was recorded for each patient. Overall survival (OS) and time from recurrence to time of death was compared between those that received palliative chemotherapy and those that did not using the Mann-Whitney U test. Results In total, 885 patients (59.4%) had PDAC. Excluding the 37 patients who died within 90-days, 583 (68.8%) developed recurrent disease within five years (on imaging). The median number of months from time of surgery to time of recurrence was ten months (range: 0–58). Of those with recurrence, 30.4% had local recurrence only, 28.4% had local and distal recurrence, and 41.7% had distant recurrence only. The most common sites of recurrence were the liver (40.7%), the superior mesenteric artery area (33.3%), locoregional lymph nodes (20.2%), the omentum/peritoneum (14.9%), the pancreatic anastomosis site (11.8%), the superior mesenteric vein/portal vein area (10.8%), and the coeliac trunk area (9.4%). Among those with recurrence, 46.1% received palliative chemotherapy. The median number of cycles was four (range: 1–12). Just 41.2% of patients completed their planned course; 28.0% stopped their treatment due to disease progression and 17.4% stopped their treatment due to toxicity. Patients who received palliative chemotherapy had similar median OS to those who did not (both 18 months, p=0.6), however, time from recurrence to time of death was significantly longer in the former (9 vs 3 months, p<0.0001). Conclusions In our multicentre study, over two thirds of PD patients with PDAC developed disease recurrence within five-years of their operation. Just under half of these received palliative chemotherapy. Time from recurrence to time of death was significantly longer in those who did receive palliative chemotherapy.

A novel CD74-ROS1 gene fusion in a patient with inflammatory breast cancer: a case report

BackgroundCD74-ROS1 fusion genes have been detected in non-small cell lung carcinomas (NSCLC), but not in inflammatory breast cancer.Case presentationHerein, we report a CD74-ROS1 fusion gene identified in a 64-year-old Chinese woman with inflammatory breast cancer (IBC). The patient initially presented with a rapidly growing mass in the left breast with diffuse erythema developing over a period of 2 months. Diagnosis of invasive breast carcinoma was made by core needle biopsy. Positron emission tomography-computed tomography (PET/CT) demonstrated multiple organ metastases. Genomic DNA was extracted from tumor tissue and analyzed using next-generation sequencing (NGS). The CD74-ROS1 fusion gene was detected in the genomic DNA. The patient refused crizotinib treatment, and could not tolerate the side effects of palliative chemotherapy. Unfortunately, the patient died 4 months after diagnosis.ConclusionWe report the case of a CD74-ROS1 fusion gene in a patient with IBC. This may reveal, for the first time, a possible association between CD74-ROS1 gene fusion and rapid progression of inflammatory breast cancer. Multigene panel testing can be performed when rapidly progressive breast cancer occurs and could reveal potential therapeutic strategies.

The Role and Clinical Effectiveness of Multiline Chemotherapy in Advanced Desmoplastic Small Round Cell Tumor.

Background:A multimodal approach is the standard treatment for desmoplastic small round cell tumor (DSRCT); however, many patients are diagnosed with inoperable disease, which leaves chemotherapy as the only treatment option. There are limited data on the effectiveness of palliative chemotherapy, especially when used after first-line treatment. Here, we evaluated the clinical outcomes of patients with DSRCT treated with multiple lines of chemotherapy.Methods:We reviewed medical records of 14 patients with pathologically confirmed DSRCT at Asan Medical Center between 2004 and 2018.Results:The median age at diagnosis was 25, with males comprising 92.9% of patients. All patients had inoperable disease at presentation and received chemotherapy as the initial treatment. Four patients (28.6%) were treated with surgery, and complete resection was achieved in 1 patient. Median overall survival (OS) was 23.9 months, and 1-, 2-, and 3-year survival rates were 92.9%, 48.6%, and 19.5%, respectively. In patients receiving first- (N = 14), second- (N = 10), and third-line (N = 8) chemotherapy, median time-to-progression was 9.9, 3.5, and 2.5 months, respectively, and the disease control rates were 100%, 88.9%, and 75.0%, respectively. Factors associated with longer OS in the univariable analysis were ⩽2 metastatic sites at presentation (27.0 vs 14.7 months; P = .024) and surgery with intended complete resection (43.5 vs 20.1 months; P = .027).Conclusions:Although advanced DSRCT may initially respond to chemotherapy after first-line treatment, the response becomes less durable as the disease progresses. Individualized treatment decisions focused on palliation should be made.

1849P Safety and effectiveness of palliative chemotherapy (CTX) for patients (pts) with malignant bowel obstruction (MBO)

MBO is associated with a high disease burden and a dismal prognosis in cancer pts. Although CTX is frequently administered to pts with MBO, its benefit remains unknown. The present study assessed the outcomes of pts who received CTX as part of MBO treatment. For this retrospective cohort study, data was extracted from electronical records of pts hospitalized due to MBO at a tertiary cancer center from 2009 to 2019. Eligible pts were not candidates to surgery and received CTX for the malignancy causing MBO, as well as supportive measures to manage MBO according to local guidelines. Primary objective was to assess pts outcomes after CTX; secondary objectives were pts outcomes after MBO diagnosis, rates of intestinal function recovery and re-obstruction, and rates of grade ≥3 toxicities after CTX. The primary endpoint was overall survival (OS). Survival was estimated by Kaplan–Meier method, and comparisons performed with log-rank test. A total of 167 pts were included: median age was 55 years (18−81), 55.7% were females, 91% had an ECOG-PS ≥2, 75.4% had gastrointestinal primary tumors, and 70.1% had no previous systemic treatment. Median time from cancer diagnosis to MBO was 16 weeks (0-972.4), and median length of hospitalization after CTX was 2 weeks (0.1-13.6). Overall, a total of 159 deaths were observed, with a median OS of 4.4 weeks (95% confidence interval [CI], 3.4-5.5) after CXT administration, and 5.6 weeks (95% CI, 4.6-6.5) after MBO diagnosis. Treatment line, ECOG-PS and primary tumor did not impact OS. Intestinal function recovery was observed in 86 pts (51.5%) after CTX, out of whom 22 (25.5%) had a re-obstruction. Pts who recovered intestinal function had a longer OS when compared to those who did not (10 weeks vs. 2.1 weeks; p<0.001). Hospital discharge was possible in 51.5% of the pts, and it was significantly correlated with intestinal function recovery (p<0.001). Grade ≥3 toxicities occurred in 26.9% of the pts after CTX. MBO was associated with a poor prognosis in this mostly treatment naive population. The administration of CTX yielded a significant risk of toxicities, whereas it may provide a modest benefit of questionable clinical relevance in this scenario.

Palliative chemotherapy for patients with synchronous metastases of small-bowel adenocarcinoma: A reflection of daily practice.

As small-bowel adenocarcinoma (SBA) is scarce, no standard systemic regimen in metastatic disease has been defined. To obtain insights into the use and effects of palliative chemotherapy in patients with metastatic SBA in a population-based setting. Data from the Netherlands Cancer Registry of patients with metastatic SBA between 2007 and 2016 were used (n = 522). For patients treated with palliative chemotherapy, differences in treatment regimens and survival were evaluated. Palliative chemotherapy was received by 38% of patients (n = 199). First-line combination chemotherapy was administered to 80% of patients, mainly CAPOX/FOLFOX. Single-agent chemotherapy mostly consisted of capecitabine. Second-line treatment, mostly irinotecan-based (58%), was prescribed to 27% of patients. Age 70 years or older was an adverse predictive factor for receiving first-line combination chemotherapy (odds ratio (OR) 0.2, 95% confidence interval (CI) 0.08-0.62) and second-line therapy (OR 0.3, 95% CI 0.10-0.72). Median overall survival with palliative chemotherapy was 9.3 months, compared with 3.0 months without. In subanalyses, patients who received only first-line treatment had a median overall survival of 5.6 and 7.0 months after single-agent and combination chemotherapy, respectively. A minority of patients were treated with palliative chemotherapy. First-line treatment consisted predominantly of oxaliplatin-based combination chemotherapy, whereas second-line treatment was mainly irinotecan-based. Population-based median overall survival for selected patients treated with chemotherapy amounted to nine months.

What are the effects of palliative chemotherapy and targeted therapies for adults with esophageal or gastroesophageal junction cancer?

What are the effects of palliative chemotherapy and targeted therapies for adults with esophageal or gastroesophageal junction cancer?

Second-line therapy to improve overall survival in primary refractory non small-cell lung cancer (NSCLC) patients.

e21069Background: The effect of palliative chemotherapy (chemo) for non-small cell lung cancer (NSCLC) is well established. Recently, immune checkpoint inhibitors have shown promising efficacy in N...

The Effects of Palliative Chemotherapy in Metastatic Colorectal Cancer Patients With an ECOG Performance Status of 3 and 4

BackgroundAlthough chemotherapy is standard for patients with mCRC and ECOG PS of 0/1, the real benefit for patients with ECOG PS > 2 remains uncertain, because they are generally excluded from clinical trials. Our objectives were to compare the survival and safety of ECOG PS 3/4 patients who were administered chemotherapy with those who received BSC only. Patients and MethodsWe retrospectively analyzed all consecutive mCRC patients who started first-line chemotherapy at our institution in a 4-year period. A multivariable Cox regression model was used to adjust for prognostic factors and logistic regression, to identify predictive factors of Grade 3/4 toxicity. ResultsFrom June 2008 to June 2012, 240 consecutive patients were included: 100 (41.7%) had an ECOG PS of 0/1, 75 (31.3%) ECOG PS of 2, and 65 (27%) ECOG PS of 3/4. Median survival for patients treated with chemotherapy was 18.4 months for patients with ECOG PS of 0/1, 10.8 months for those with ECOG PS of 2, and 6.8 months for patients with ECOG PS of 3/4. Among those with ECOG PS of 3/4, chemotherapy use led to a nonsignificant survival gain (median, 6.8 vs. 2.3 months for BSC; P = .13). Factors significantly associated with worse survival in an adjusted analysis were right-sided tumors (hazard ratio [HR], 2.97; P = .005) and ECOG PS status (ECOG PS 2 vs. 0/1; HR, 1.67; P = .025, and ECOG PS 3/4 vs. 0/1; HR, 2.67; P < .0001). The rate of Grade ≥ 3 toxicities during the first cycle did not differ significantly across ECOG groups; likely because 40% of ECOG PS 3/4 patients received upfront dose-reduced therapy. The rates of treatment-related hospitalization were similar across all ECOG groups. All deaths were disease-associated. ConclusionOur retrospective study suggests that chemotherapy might benefit selected mCRC patients with poor PS. With up-front dose reduction and close monitoring for toxicity, the risk of serious adverse events is minimized.

S-1 and the treatment of gastric cancer with peritoneal dissemination

Peritoneal dissemination is the most common metastatic pattern of gastric cancer. We frequently face the necessity for gastrectomy in the event of gastric stenosis or gastric bleeding. However, the indication for palliative gastrectomy and the effectiveness of palliative chemotherapy are not clear. We retrospectively evaluated the prognostic factors after palliative gastrectomy in 121 gastric cancer patients with peritoneal dissemination. The expression of orotate phosphoribosyl transferase (OPRT) was examined immunohistochemically. The median survival time of all patients after palliative gastrectomy was 8.8 months. In the multivariate analyses, we adjusted the data of 82 patients without liver metastases for the background of 5-fluouracil (5-FU)-based chemotherapy regimen. The analysis revealed that the degree of peritoneal dissemination (multiple vs. a few metastases or cytology-positive; P= 0.01) and chemotherapy (S-1 vs. other 5-FU; P=0.01) were independent predictors of survival. Particularly, S-1 treatment was associated with a more favorable prognosis of the patients with high levels of OPRT expression compared to that of the patients with low expression. Patients with peritoneal dissemination are considered as terminal and inoperable. However, S-1 treatment may improve the survival after palliative gastrectomy in patients selected according to the degree of peritoneal dissemination and high OPRT expression.

7187 Clinical effectiveness of palliative chemotherapy for advanced bladder cancer

7187 Clinical effectiveness of palliative chemotherapy for advanced bladder cancer

Survival impact of primary tumor resection in metastatic small intestine adenocarcinoma (SIA): Retrospective analysis of 44 cases treated with palliative chemotherapy

15588 Background: SIA is a rare disease (0.5/100.000/y). Limited data is available concerning the effect of palliative chemotherapy (pCT) in this disease. Resection of the primary tumour (PT) is not routinely performed if distant metastases (DM) are present. Methods: We evaluated the files of all pts with SIA who received at least one cycle of pCT. Pts were classified to have the initial PT or local recurrence (LR) surgically completely removed or not and whether they were offered a 2nd-line pCT in case of failure of 1st-line or not. Results: 44 pts, age 32–72, median (M) 60 were identified. The PT was: duodenum 24, jejunum 14, ileum 6. 21 pts were initially resected in curative intent and suffered a distant and/or local relapse after 1 - 104 months (mo), M 11 mo. When pCT was started for DM in 25 pts no local tumor was present whereas the remaining had PT/LR without DM (3) or both (16). Pts received a broad variety of fluoropyrimidine- based regimens in 1 to 4 lines (mainly colorectal-like protocols). Long lasting complete or partial remissions (12 - 136+ mo) in 1st- but also 2nd-line were observed in pts without PT/LR whereas the outcome was poor in general when local tumor was present. Survival was significantly longer in pts without PT/LR (M 40 mo) as compared to those with local tumor present (M 8 mo, p = 0.003 logrank). No obvious difference was observed whether the PT was resected in curative intent and DM occurred later or if palliative but complete resection of PT or LR was performed with DM present. 6 pts are still in remission. 18/38 pts with progressive disease on/after 1st-line received 2nd-line pCT (colorectal like regimens). If 2nd-line was offered survival was significant longer (M 26 mo vs 8 mo). Conclusions: In our series outcome of pts with metastatic SIA who have PT in situ and treated with pCT is comparable to that of other metastasized upper GI-malignancies. Our retrospective study supports the hypothesis that pCT in pt with metastatic SIA but no LT might be very effective. This means that even in palliative intent surgical local tumor control appears to be essential for a favourable outcome and should be considered. This is different to the situation in colorectal cancer. A prospective study of the issue is warranted. No significant financial relationships to disclose.

Chemotherapy of Soft Tissue Sarcoma

The aim of the study was to evaluate the effect of palliative chemotherapy on soft tissue sarcomas given outside controlled trials. Therapy and response rates of 77 patients with non-resectable sarcoma treated with different regimens between 1991 and 2000 were reviewed. Thirty-six patients were treated with first-line chemotherapy comprising cyclophosphamide+vincristine+doxorubicin+dacarbazine (CYVADIC), with a response rate of 28% (median response duration 5.5 months). Etoposide and ifosfamide (IVP, or VIG, which also includes granulocyte colony-stimulating factor (G-CSF)) were used in the treatment of 18 patients. The response rate was 22% (median response duration 4.5 months); Nineteen patients were treated with doxorubicin+ifosfamide and one patient responded. Four patients received other first-line treatments. Thirty-eight patients were given second-line chemotherapy and 4 (10%) patients responded. Thirteen patients were given third-line treatment and 5 patients received fourth-line treatment, but without any response. Disease progression was the dominant reason for discontinuation of therapy. The response rate in the present study was lower than the best published results, probably due to the fact that our soft tissue sarcoma patient material was unselected. Treatment with CYVADIC yields at least as high an response rate as the more recently described doxorubicin+ifosfamide combination, but third- and fourth-line therapy is not beneficial. Clinical trials with more active drugs are needed, as are more predictive and prognostic tests and a better selection of patient groups suited for different treatment options for soft tissue sarcomas.

Evaluation of Clinical Benefit of Chemotherapy in Patients with Upper Gastrointestinal Cancer

A new endpoint, the Clinical Benefit Response (CBR), was recently suggested as a means of measuring the effectiveness of palliative chemotherapy in patients with pancreatic cancer. We took advantage of extensive recordings of measurements of treatment effects in two trials in patients with gastrointestinal cancer in order to assess the relevance of CBR criteria. In 151 patients, 53 with pancreatic cancer, 37 with biliary cancer and 61 with gastric cancer, who were randomized between chemotherapy with best supportive care and best supportive care alone, CBR criteria were applied retrospectively to the evaluations of the effects on the patients' well-being made by the treating physician and by the patient in quality-of-life questionnaires, chiefly EORTC QLQ C-30. When compared with subjective response evaluations made by both the physician and the patients' questionnaire data, it was found that CBR overestimated the beneficial effects in certain patients and underestimated them in others. The reason for this overestimation was mainly that the adverse effects of the chemotherapy were not considered appropriately. The underestimation was mainly due to the fact that CBR in practice is dominated by pain assessment, and alterations in other symptoms are also clinically relevant. CBR did, however, show the same differences between the two randomized groups as the subjective response evaluations and the quality-of-life estimations. It is concluded that CBR can be used as a method of measuring the beneficial clinical impact of a treatment strategy in clinical trials, but its limitations in reflecting several important aspects influencing the overall well-being of patients do, however, restrict its use. The criteria designed for use in patients with pancreatic cancer cannot be immediately applied to patients with other cancer types.