Feasibility Of Preoperative Chemotherapy Research Articles

Preoperative chemotherapy usage experience for intrahepatic cholangiocarcinoma

Purpose of the study was to evaluate the safety and feasibility of preoperative chemotherapy in intrahepatic cholangiocarcinoma (IHCC).Patients and methods. A total of 171 liver resections for IHCC were performed between 2007 and 2021, of which 24 were preceded by preoperative therapy (14.0 %). Systemic therapy was conducted in 11 patients (45.8 %). Regional chemotherapy was provided to 13 patients (54.2 %). In two cases, regional chemotherapy was supplemented with systemic therapy.Results. A significant increase in the proportion of patients with clinical stage IIIb and higher was observed in the group of patients who had received preoperative therapy (83.3 % vs. 35.4 %, p < 0.0001). Complications of preoperative therapy occurred in 45.8 % of patients, with grade three and above complications identified in three patients (12.5 %). The incidence of postoperative complications (37.5 % vs. 42.9 %, p = 0.79), post‑resection liver failure (8.3 % vs. 13.6 %, p = 0.7) and postoperative mortality (4.2 % vs. 3.4 %, p = 0.68) in the preoperative therapy group were similar to those in the control group. The rate of radical resections was also identical, 83 % in both groups (p = 0.8). The relapses rates within the first six months after the surgery were similar: 25 % of patients in both groups (p = 0.62). The median OS reached 36 months in the main group and 32 months in the control one (p = 0.81).Conclusion. Since the main group predominantly included patients with more advanced stages of the disease and yet the treatment resulted in comparable immediate and long‑term outcomes, it can be concluded that preoperative therapy can be justified in patients with IHCC who have factors predisposing to poor prognosis. Randomized trials are necessary to determine the rationality, as well as the type and regimen of preoperative therapy to be used in patients with IHCC.

Feasibility and pathological response of TAS-118 + oxaliplatin as perioperative chemotherapy for patients with locally advanced gastric cancer (APOLLO-11).

351 Background: TAS-118 is a novel oral agent, containing S-1 and leucovorin. In the SOLAR study (NCT02322593), TAS-118 + oxaliplatin (OHP) significantly improved overall survival compared to S-1 + cisplatin for patients (pts) with advanced gastric cancer (GC). We conducted this open-label study to assess feasibility of perioperative adjuvant chemotherapy with TAS-118 + OHP in pts with locally advanced resectable GC with lymph node metastasis. (Clinical trial information: UMIN000024688). Methods: Eligible pts who had histopathologically confirmed GC with clinical T3-4N1-3M0 on image findings (14th Japanese classification of gastric carcinoma), age 20 to 79 years, were enrolled in this study. The protocol treatment consisted of preoperative 4 courses of TAS-118 (80-120 mg/body, days 1-7) + OHP (85 mg/m2, day 1) every 2 weeks, and gastrectomy with D2 lymphadenectomy, followed by postoperative 12 courses of TAS-118 alone (step1) or 8 cycles of TAS-118 + OHP (step2). The primary endpoints were tolerability of preoperative chemotherapy, gastrectomy and postoperative chemotherapy with TAS-118 plus OHP. Here, we report the feasibility of preoperative chemotherapy and gastrectomy, and pathological response. Results: Between December 2016 and April 2018, 45 pts with a median age of 61 years were enrolled. The numbers of pts with T stage (cT3/4a) and those with N stage (cN1/2/3) were 13/32 and 25/17/3, respectively. The completion rate of preoperative chemotherapy and gastrectomy was 88.9% ( 95% CI 78.0-95.5) and 95.6% (95% CI 86.7-99.2). The relative dose intensity of TAS-118 and OHP was 86.0% and 90.6%. During the 4 cycles of preoperative TAS-118 + OHP, 2 pts discontinued the treatment due to adverse event (AE). Major grade 3-4 AEs were diarrhea (17.8%) and neutropenia (8.9%). R0 resection rate was as high as 95.6%. One pts experienced grade 4 postoperative bleeding, but no treatment-related death was reported. pCR was achieved in 6/45 pts (13.3%) and other 7 pts (28.9%) showed near complete regression (<10 % residual tumor cells). Conclusions: Preoperative TAS-118 + OHP followed by D2 gastorectomy was well tolerated and showed promising efficacy. Clinical trial information: 000024688.

Foxtrot Collaborative Group (2012) Lancet Oncol 13:1152–60 Feasibility of Preoperative Chemotherapy for Locally Advanced, Operable Colon Cancer: the Pilot Phase of a Randomised Controlled Trial

Foxtrot Collaborative Group (2012) Lancet Oncol 13:1152–60 Feasibility of Preoperative Chemotherapy for Locally Advanced, Operable Colon Cancer: the Pilot Phase of a Randomised Controlled Trial

Feasibility of Preoperative Chemotherapy with Docetaxel, Cisplatin, and 5-Fluorouracil versus Adriamycin, Cisplatin, and 5-Fluorouracil for Resectable Advanced Esophageal Cancer

Background: Neoadjuvant chemotherapy for resectable advanced esophageal squamous cell carcinoma (ESCC) requires reassessment. We have conducted a trial aiming at the comparison between DCF and ACF concerning perioperative adverse events. Methods: Patients were randomly assigned to receive either DCF [docetaxel 70 mg/m², cisplatin 70 mg/m² on day 1, and 5-fluorouracil (5-FU) 700 mg/m² for 5 days] every 3 weeks or ACF (adriamycin 35 mg/m², cisplatin 70 mg/m² on day 1, and 5-FU 700 mg/m² for 7 days) every 4 weeks. Each group consisted of 81 patients. Two cycles of preoperative chemotherapy were planned, after which patients underwent subtotal esophagectomy via a right thoracotomy with lymphadenectomy. Chemotherapy- and surgery-related adverse effects were assessed. Results: Grade 3-4 neutropenia and febrile neutropenia occurred in 90 and 39% of patients, respectively, in the DCF group compared with 69 and 17% of patients, respectively, in the ACF group (p < 0.01). Perioperative complications did not differ significantly between the groups. The overall response rates of DCF and ACF were 61 and 40%, respectively, while the histopathological complete responses were 15 and 3%, respectively (p < 0.01). Conclusion: The DCF and ACF regimens were found to be equally feasible in patients with resectable advanced ESCC; however, DCF delivered an antitumor effect and therefore potentially improved the long-term outcomes.

Phase II trial of preoperative S-1 plus cisplatin followed by surgery for initially unresectable locally advanced gastric cancer

BackgroundThe aim of this study was to evaluate the efficacy and feasibility of preoperative chemotherapy with S-1 plus cisplatin in patients with initially unresectable locally advanced gastric cancer. MethodsWe enrolled patients with initially unresectable locally advanced gastric cancer because of severe lymph node metastases or invasion of adjacent structures. Preoperative chemotherapy consisted of S-1 at 80 mg/m2 divided in two daily doses for 21 days and cisplatin at 60 mg/m2 intravenously on day 8, repeated every 35 days. If a tumor decreased in size, patients received 1 or 2 more courses. Surgery involved radical resection with D2 lymphadenectomy. ResultsBetween December 2000 and December 2007, 27 patients were enrolled on the study. No CR was obtained, but PR was seen in 17 cases, and the response rate was 63.0%. Thirteen patients (48.1%) had R0 resections. There were no treatment related deaths. The median overall survival time (MST) and the 3-year overall survival (OS) of all patients were 31.4 months and 31.0%, respectively. Among the 13 patients who underwent curative resection, the median disease-free survival (DFS) and the 3-year DFS were 17.4 months and 23.1%, respectively. The MST and the 3-year OS were 50.1 months and 53.8%, respectively. The most common site of initial recurrence after the R0 resection was the para-aortic lymph nodes. ConclusionsPreoperative S-1 plus cisplatin can be safely delivered to patients undergoing radical gastrectomy. This regimen is promising as neoadjuvant chemotherapy for resectable gastric cancer. For initially unresectable locally advanced gastric cancer, new trials using more effective regimens along with extended lymph node dissection are necessary.