Preoperative Combination Chemotherapy Research Articles

Abstract OT1-02-03: Trastuzumab deruxtecan (T-DXd; DS-8201) vs trastuzumab emtansine (T-DM1) in high-risk patients with HER2-positive, residual invasive early breast cancer after neoadjuvant therapy: A randomized, phase 3 trial (DESTINY-Breast05)

Abstract Background Preoperative chemotherapy in combination with trastuzumab and pertuzumab is a preferred regimen for treating patients (pts) with HER2-positive, invasive, early breast cancer (BC). Pts who have received such treatment but still have residual invasive disease in the breast or lymph nodes at surgery are at greater risk for disease recurrence or death than those with a pathological complete response. The antibody-drug conjugate (ADC) T-DM1 is approved as a postneoadjuvant treatment for pts with residual invasive disease (in the breast and/or axillary nodes) after optimal neoadjuvant chemotherapy and trastuzumab (or trastuzumab with pertuzumab). T-DXd is a potent HER2-targeted ADC with a humanized HER2 antibody attached to a membrane-permeable topoisomerase I inhibitor payload by a cleavable tetrapeptide-based linker and a drug-to-antibody ratio of ≈8. T-DXd is approved globally for the treatment of adult pts with HER2-positive, unresectable or metastatic BC who have received ≥2 prior anti-HER2-based regimens in the metastatic setting or had prior chemotherapy and are refractory to or intolerant of standard treatments. These approvals have been supported by results from DESTINY-Breast01, an open-label, international, multicenter, phase 2 study of T-DXd in patients with HER2-positive metastatic BC. In an updated data cutoff (June 8, 2020), T-DXd demonstrated an objective response rate (ORR) of 61.4% (113/184 pts) and a duration of response of 20.8 months in pts with HER2-positive (IHC 3+ or ISH+), unresectable or metastatic BC previously treated with T-DM1 (Modi et al. Cancer Res. 2021;81[4 suppl]:PD3-06). Yet, further unmet need exists in patients who do not achieve pathologic complete response to neoadjuvant treatment, as these patients have increased risk of recurrence. Here, we describe a randomized phase 3 trial evaluating T-DXd vs T-DM1 as postneoadjuvant treatment for high-risk pts with HER2-positive primary BC who have residual invasive disease following neoadjuvant therapy. Study Description DESTINY-Breast05 is a multicenter, open-label, randomized, phase 3 trial comparing the efficacy and safety of T-DXd with those of T-DM1 in pts with HER2-positive (IHC 3+ or ISH+, centrally confirmed on pretreatment biopsy), invasive BC with pathologic evidence of residual invasive disease in the breast or axillary lymph nodes after neoadjuvant therapy. Additionally, pts must have a higher residual risk for recurrence, following standard T-DM1, defined as either presenting with inoperable disease (clinical stages T4, N0-3, M0 or T1-3, N2-3, M0) or operable BC at presentation (clinical stages T1-3, N0-1, M0) with axillary node-positive disease after neoadjuvant chemotherapy and anti-HER2 treatment. Approximately 1600 pts will be randomly assigned (1:1) to T-DXd or T-DM1 from ≈ 400 sites globally. Randomization is stratified by operative status at presentation, hormone receptor status, pathologic nodal status following neoadjuvant therapy, and type of HER2-targeted neoadjuvant therapy (single vs dual). T-DXd 5.4 mg/kg or T-DM1 3.6 mg/kg will be administered intravenously once every 3 weeks for 14 cycles. Invasive disease-free survival based on investigator assessment is the primary efficacy endpoint. Secondary endpoints are overall survival, disease-free survival, distant recurrence-free interval, and brain metastasis-free interval. The pharmacokinetics of T-DXd, biomarkers, and health-related quality of life will also be evaluated (NCT04622319). Citation Format: Charles E Geyer, Jr, Michael Untch, Aleix Prat, Priya Rastogi, Naoki Niikura, Elton Mathias, Lee Anne McLean, Yibin Wang, Sibylle Loibl. Trastuzumab deruxtecan (T-DXd; DS-8201) vs trastuzumab emtansine (T-DM1) in high-risk patients with HER2-positive, residual invasive early breast cancer after neoadjuvant therapy: A randomized, phase 3 trial (DESTINY-Breast05) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT1-02-03.

Results of complex treatment of patients with operable pancreatic head cancer using preoperative intra-arterial chemotherapy in combination with radiation therapy in multifractionation mode

The aim of this study was to assess the safety and efficacy of treating patients with operable pancreatic cancer after preoperative intra-arterial infusion of chemotherapy combined with conformal radiation therapy in a multi-fractionation mode. Patients (n = 40) were randomized into two groups: the main one – intra-arterial infusion of chemotherapy + radiation therapy + surgery (n = 20), and control – intra-arterial infusion of chemotherapy + surgery (n = 20). Neoadjuvant therapy consisted of intra-arterial infusion of chemotherapy (chemoembolization of a pancreatic head tumor with oxaliplatin 85 mg/m2) followed by intra-arterial chemo infusion with gemcitabine 1000 mg/m2. In the main group, radiation therapy was also carried out in two fractions per day, 2 Gy with an interval of 4–6 hours, 5 days a week, up to a total dose of 50 Gy. In the main group, the lower incidence of postoperative pancreatitis and the pancreatic fistulas were statistically confirmed, the incidence of grade 2 therapeutic pathomorphisis increased, as well as the median life expectancy.

Preoperative Chemotherapy for Limited-stage Small Cell Carcinoma of the Esophagus

BackgroundThe optimal treatment approach for limited-stage small cell carcinoma of the esophagus remains uncertain. This study aimed to evaluate the efficacy and safety of preoperative chemotherapy in combination with surgery vs upfront surgery in those patients. MethodsFrom June 2001 to June 2015, a total of 280 patients with limited-stage small cell carcinoma of the esophagus were screened from 60 131 patients with esophageal cancer. Outcome analysis of those patients who underwent preoperative chemotherapy in combination with surgery or upfront surgery was conducted. The primary end point was overall survival, and secondary end points included progression-free survival and safety. ResultsOf the 280 patients, 200 were men (71.4%), the median age was 64 years (range, 42-75 years), 171 patients (61.1%) patients had preoperative chemotherapy in combination with surgery, and 109 patients (38.9%) underwent upfront surgery. A pathologic complete response rate of 8.8% was noted in patients who received preoperative chemotherapy. Compared with the upfront surgery group, the preoperative chemotherapy group had a better median overall survival (26.0 months vs 19.5 months, respectively; hazard ratio, 0.69; 95% CI, 0.51 to 0.92; P = .011) and a prolonged progression-free survival (16.0 months vs 13.0 months, respectively; hazard ratio, 0.75; 95% CI, 0.57 to 0.99; P = .039). Postoperative complications and peritreatment mortality were comparable between both groups. ConclusionsCompared with upfront surgery, preoperative chemotherapy in combination with surgery improves overall survival in patients with limited-stage small cell carcinoma of the esophagus.

Long-term outcomes and safety of radical transmediastinal esophagectomy with preoperative docetaxel, cisplatin, and 5-fluorouracil combination chemotherapy for locally advanced squamous cell carcinoma of the thoracic esophagus

BackgroundIt is unknown whether transmediastinal esophagectomy (TME) is an acceptable surgical procedure for locally advanced esophageal squamous cell carcinoma (ESCC). Therefore, we investigated the feasibility of long-term survival after TME with neoadjuvant docetaxel, cisplatin, and 5-fluorouracil combination chemotherapy (DCF therapy).MethodsThis retrospective, observational study included locally advanced resectable ESCC. All patients received two cycles of preoperative DCF therapy (60 mg/m2 of docetaxel and cisplatin on day 1 and 700 mg/m2/day of 5-FU on days 1–5 in each cycle) followed by radical TME. The main outcomes were survival and the rate of adverse events of chemotherapy and surgery.ResultsSixteen patients were included in this study. All patients received two cycles of DCF therapy, followed by surgery. The median follow-up duration of the 16 patients was 35.4 months. The 2-year overall survival (OS) was 93.3% (95% confidence interval [CI], 61.3–99.0), and the 3-year OS was 78.8% (95% CI, 47.3–92.7). The 2-year and 3-year relapse-free survivals were both 73.3% (95% CI, 43.6–89.1). Leukopenia and neutropenia occurred in most patients; however, they were controllable. Fifteen patients completed TME, and one was converted to open transthoracic esophagectomy because of tracheal injury. Three-field dissection was performed for 12 of 16 patients (75%), and R0 resection was achieved in 15 of 16 patients (93.8%). Three cases of grade IIIb chylothorax were observed. There was no mortality in this study.ConclusionCombined neoadjuvant DCF and TME for locally advanced ESCC was safe and less invasive than traditional therapies and had a satisfactory long-term prognosis.

Postoperative Outcomes and Functional Recovery After Preoperative Combination Chemotherapy for Pancreatic Cancer: A Propensity Score-Matched Study.

Introduction: Previous studies show encouraging oncologic outcomes for neoadjuvant chemotherapy (NACT) in the setting of pancreatic ductal adenocarcinoma (PDAC). However, recent literature reported an increased clinical burden in patients undergoing pancreaticoduodenectomy (PD) following NACT. Therefore, the aim of our study was to assess the impact of NACT on postoperative outcomes and recovery after PD.Methods: A retrospective propensity score-matched study was performed including all patients who underwent PD for PDAC in a single center between 2015 and 2018. Patients treated with NACT for resectable, borderline resectable or locally advanced PDAC were matched based on nearest neighbor propensity scores in a 1:1 ratio to patients who underwent upfront resection. Propensity scores were calculated using 7 perioperative variables, including gender, age, BMI, ASA score, Charlson-Deyo comorbidity score, fistula risk score (FRS), vascular resection. Primary outcome was the number and severity of complications at 90-days after surgery measured by the comprehensive complication index (CCI). Data are reported as median (IQR) or number of patients (%).Results: Of 283 resected patients, 95 (34%) were treated with NACT. Before matching, NACT patients were younger, had less comorbidities (Charlson-Deyo score 0 vs. 1, p = 0.04), similar FRS [2 (0–3) for both groups], and more vascular resections performed [n = 28 (30%) vs. n = 26 (14%), p < 0.01]. After propensity-score matching, preoperative and intraoperative characteristics were comparable. Postoperatively, CCI was similar between groups [8.7 (0–29.6) for both groups, p = 0.59]. NACT patients had a non-statistically significant increase in superficial incisional surgical site infections [n = 12 (13%) vs. 6 (6%), p = 0.14], while no difference was found for overall infectious complications and organ-space SSI. The occurrence of clinically-relevant pancreatic fistula was similar between groups [10 (11%) vs. 13 (14%), p = 0.51]. No difference was found between groups for length of hospital stay [8 (7–15) vs. 8 (7–14) days, p = 0.62], and functional recovery outcomes.Conclusion: After propensity score adjustment for perioperative risk factors, NACT did not worsen postoperative outcomes and functional recovery following PD for PDAC compared to upfront resection.

Neoadjuvant chemotherapy in combination with surgery in the treatment of local advanced breast cancer.

Objective:To investigate the effect of neoadjuvant chemotherapy combined with surgery on locally advanced breast cancer and its prognosis.Methods:One hundred and fifty-four patients with locally advanced breast cancer who were admitted to our hospital from February 2014 to April 2015 were selected as the study subjects. They were divided into an observation group and a control group according to the principle of random equalization, 77 each group. The observation group was treated with TAC scheme, neoadjuvant chemotherapy combined with modified radical resection, and continuously treated with the same scheme after operation until the end of the course of treatment. The control group was treated with modified radical resection and TAC scheme. The clinical efficacy of the two groups was observed, and the perioperative indications, prognosis and occurrence of adverse reactions were compared between the two groups.Results:The total effective rate of the observation group was 76.62%, significantly higher than that of the control group (55.84%, P<0.05). The observation group had shorter operation time and hospitalization time and less bleeding amount compared to the control group (P<0.05). The metastasis rate and recurrence rate of the observation group were significantly lower than those of the control group (P<0.05); there was a significant difference between the two groups (P<0.05). The one-year and three-year survival rates of the observation group were significantly higher than those of the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups after operation (P>0.05).Conclusion:Preoperative neoadjuvant chemotherapy in combination with TAC scheme can reduce the difficulty of operation, improve the curative effect of patients, significantly improve the prognosis of patients and prolong the survival time, which is worth clinical application.

МУЛЬТИМОДАЛЬНЫЙ ПОДХОД К ЛЕЧЕНИЮ РАКА ПИЩЕВОДА

Objective: To study the effectiveness and tolerability of preoperative chemotherapy (CHT) in combination with radical surgery in patients with esophageal squamous cell carcinoma (ESCC) II-III stages Methods: The results of the combined and surgical treatment of 43 patients with ESCC II-III stages are presented. The main group consisted of 22 patients who were assigned two courses of CHT before surgery (gemcitabine/cisplatin), followed by a radical surgery. The control group included 21 patients who received only surgical treatment. Results: Preoperative CHT in one (4.5±4.6%) patient gave a complete regression of the tumor, incomplete regression was in ten (45.5±11.1%) and stabilization is established in nine (40.9±10.9%) patients. The therapy had satisfactory tolerability and low toxicity, most patients observed the restoration of a full enteral nutrition. Postoperative complications in both groups of observations developed in 18.2±8.6% and 23.8±9.5% respectively (p&gt;0.05). Preoperative CHT in the combined treatment of ESCC II-III stages has significantly improved two-year relapse-free and overall survival (80,9±8,7% and 85,7±7,8%) compared to the control group (35.0±10.6% and 55.0±11.1%) (p&lt;0.05). Conclusion: The multimodal approach in the treatment of patients in II-III stages ESCC has pronounced damaging effect on the tumor and allows to significantly increase two-year relapse-free and overall survival rate compared to patients who have undergone only surgical treatment. Keywords: Esophageal squamous cell carcinoma, combined treatment, preoperative chemotherapy, short-term and long-term results.

Value of Dynamic Contrast-enhanced and Diffusion-weighted MR Imaging in the Detection of Pathologic Complete Response in Cervical Cancer after Neoadjuvant Therapy: A Retrospective Observational Study.

Purpose To evaluate the association between dynamic contrast material-enhanced (DCE) and diffusion-weighted (DW) magnetic resonance (MR) imaging with pathologic complete response after preoperative combined chemotherapy and radiation therapy for cervical carcinoma and evaluate the risk of local recurrence. Materials and Methods The institutional ethics committee approved the study and waived the requirement to obtain informed consent. The study comprised 52 patients with locally advanced carcinoma, treated first with combined chemotherapy and radiation therapy, who underwent MR imaging before final surgery between June 2011 and July 2015. Three radiologists evaluated conventional, DW, and DCE MR images to identify a complete response. The standard of reference was surgical-pathologic findings. Results An initial increase in signal intensity on DCE MR images that was greater in the cervical lesion than in the myometrium was defined as time-signal intensity curve type B and showed a significant association with incomplete response (P = .0004). DCE MR imaging parameters (ie, maximum slope enhancement, area under the gadolinium concentration-time curve during the first 90 seconds after gadolinium injection [AUGC90], and volume transfer constant [Ktrans]) and a low signal intensity on apparent diffusion coefficient (ADC) maps were significantly associated with an incomplete response (P = .027, P = .041, P = .037, and P = .032, respectively). A mean ADC of 0.0014 m2/sec or less (hazard ratio [HR] = 8.3), low ADC signal intensity (HR = 7.3), high signal intensity at DW imaging (HR = 7.1), and time-signal intensity curve type B (HR = 4.3) were associated with earlier recurrence (P < .05). Excellent agreement between readers was found for time-signal intensity curve analysis (κ > 0.9) and the following parameters: AUGC90, Ktrans, and maximum slope enhancement (intraclass correlation coefficient, >0.9). Conclusion DCE MR imaging parameters, especially the time-signal intensity curve, and DW imaging are associated with complete response and incomplete response and could potentially help oncologists with management decisions. Moreover, DCE and DW MR imaging could help oncologists accentuate the follow-up for patients with a high risk of local recurrence to assess for recurrence. © RSNA, 2017 Online supplemental material is available for this article.

Adjuvant Second-Dose Chemotherapy before Surgery for Patients with Locally Advanced Rectal Malignancy Is Not Beneficial: A Systematic Review and Meta-Analysis.

Background Preoperative chemoradiotherapy is the standard treatment for patients with locally advanced rectal cancer, although tumor responses vary widely; some patients may achieve a pathologic complete response rate (pCR) after chemoradiotherapy. Controversy exists with regard to the efficacy of different preoperative combination chemotherapy regimens and neoadjuvant chemoradiotherapy, compared with chemoradiotherapy alone. Methods PubMed, the Cochrane Library, and Embase databases were searched for comparative studies of patients with locally advanced rectal cancer that were published between January 1991 and January 2016. Efficacies of different preoperative combination chemotherapy regimens and neoadjuvant chemoradiotherapy (group A) were compared with chemoradiotherapy alone (group B) in a meta-analysis using Review Manager v5.2. Results Three prospective randomized controlled trials and two prospective nonrandomized controlled trials comprising 444 cases were eligible for analysis. No significant difference was detected in the rate of pCR (50/223, 22.4% versus 35/223, 15.7%; relative risk, RR: 1.42 [95% confidence interval, CI: 0.97–2.09], p = 0.07) between the two groups. The rate of tumor regression was similar for both groups (122/203, 60.1% versus 111/203, 54.7%; RR: 1.11 [95% CI: 0.94–1.29], p = 0.22). Conclusions Adjuvant chemotherapy with preoperative chemoradiotherapy did not significantly improve the rate of pCR nor the rate of T and N downstaging.

Borderline resectable (BRPC) and locally advanced unresectable (LAPC) pancreas cancer treatment: A single Institution experience.

e15260 Background: There is growing interest in preoperative combination chemotherapy (CC) regimens [Fluorouracil, Irinotecan, Oxaliplatin (FOLFIRINOX) and gemcitabine/nab-paclitaxel] in BRPC and L...

Clinical analysis of twenty cases of cervical cancer associated with pregnancy.

The objectives are to investigate the therapeutic methods and prognosis of cervical cancer associated with pregnancy. Combined with a literature review, we analyzed the clinical characteristics, diagnosis and treating process, and prognosis of 20 cases of cervical cancer associated with pregnancy admitted in our hospital from 2000 to 2009. Fifteen cases were treated with surgery, four cases with radiotherapy or synchronous chemoradiation, and one case with palliative systemic chemotherapy. Fourteen cases were disease-free survivals, five cases died of distant metastasis, and one case was lost to follow-up. Also, for survival, there were seven in eight cases of early pregnancy, two in four cases of mid-pregnancy, one in two cases of late pregnancy, four in six postpartum cases, and one in three cases of vaginal delivery. There was a close relationship between clinical stage, diagnosis time, delivery method, and the prognosis of cervical cancer associated with pregnancy. For late pregnancy and postpartum cervical cancer surgery, preoperative and postoperative combination chemotherapy might improve the prognosis.

Preoperative Chemotherapy Plus Bevacizumab and Morbidity after Resection of Colorectal Cancer Liver Metastases

Aims and background: The addition of bevacizumab to preoperative chemotherapy is a common therapeutic practice in patients with colorectal liver metastases. The aim of the present study was to assess the effect of bevacizumab on postoperative complications after liver resection. Methods:A retrospective analysis was performed including patients who underwent liver resection for colorectal liver metastases after receiving chemotherapy with or without bevacizumab in two hospitals. Univariate logistic regression models were used to identify predictors of postoperative morbidity in both groups of patients. Results: A total of 76 patients were analyzed: 22 patients did not receive preoperative chemotherapy (control group), 21 patients received preoperative chemotherapy alone and 33 patients received preoperative chemotherapy in combination with bevacizumab. The median number of chemotherapy cycles received was 4 (range, 1-23) for the chemotherapy group and 7 (range, 2-36) for the chemotherapy plus bevacizumab group Morbidity rate was similar in the three groups of patients considered: 54.5 %, 47.6% and 39.4, respectively. The most common complications were infections and wound complications. The number of preoperative chemotherapy cycles received was the only clinical variable that was significantly correlated with postoperative comorbidity. Conclusions: Our results support the evidence that the addition of bevacizumab to preoperative chemotherapy does not increase the risk of complications following surgery of colorectal liver metastases.

TS-1 and docetaxel followed by 5-FU/epirubicin/cyclophosphamide (FEC) as preoperative treatment in women with stage II/III breast cancer: A phase II study.

124 Background: The sequential combination of anthracycline and docetaxel (TXT) is one of the standard regimen in the preoperative setting, however, the adverse events of TXT such as febrile neutropenia, fatigue, edema is not low at all. Several reports showed a synergistic effect of combination chemotherapy with 5-FU and TXT through down-regulation of dihydropyrimidine dehydrogenase (DPD) and thymidine synthetase (TS). (Suto et al., Oncol Rep 2006) Okazaki et al. reported the trial of pre-operative combination chemotherapy of TS-1 (80mg/m2) and TXT (40mg/m2) with 13% of pCR rates (HER2-negative), and less adverse events. This study's purpose was to determine the efficacy of TS-1 and TXT followed by FEC in preoperative setting. Methods: This was a single-arm, clinical study evaluating the patients with stage II/III and HER2 negative breast cancer received 4 cycles of TS-1 (TS-1 80 mg/m2 on days 1-14 and docetaxel 40 mg/m2 on day 1 every 3 weeks), followed by 4 cycles of FEC (fluorouracil 500 mg/m2, epirubicin 100 mg/m2, cyclophosphamide 500 mg/m2on day 1 every 3 weeks). The primary end point was the pCR rate. The secondary end points were the clinical response rate, adverse drug reactions. The sample size of this study (55 patients) was calculated based on pCR rate obtained in previous studies of the sequential combination of anthracycline and TXT in preoperative setting (HER2-negative). Results: From November 2009 to April 2010, 55 patients were enrolled and 50 patients were assessable for clinical and pathologic responses. The overall response rate (caliper) was 82.0%. The pCR rate was 12.0% (6/50). The breast-conserving rate in patients whose tumor size was larger than 3 cm was 53.3%. PgR status was significantly correlated with pCR. (p=0.024) Grade 4 neutropenia was observed in one patient (2.0%) at the first cycle. The most common grade 3/4 non-hematologic adverse event was hand-foot syndrome, observed in 12 patients (24.5%). One patient (2.0%) showed grade 4 diarrhea. Conclusions: These results indicate that the sequential combination of TS-1 and docetaxel followed by FEC is a well-tolerated, effective neoadjuvant treatment for stage II/III breast cancer.

682P - A Multicenter Phase II Study of Neoadjuvant Chemotherapy (NAC) Combined with Docetaxel, Cisplatin and S-1 (DCS) for Locally advanced Gastric Cancer (AGC)

ABSTRACT Background We have previously reported the recommended dose of preoperative combination chemotherapy with intravenous administration of docetaxel and cisplatin (35mg/m2 on days 1 and 15), and oral S-1 (40mg/m2 twice daily on days 1-14) in the phase I study. This regimen also provided surprisingly high pathological responses in 12 pts. Therefore, we conducted a multicenter phase II trial to evaluate efficacy and safety of divided DCS therapy for patients (pts) with locally AGC. Methods The study included pts with histological confirmation of gastric cancer, no prior chemotherapy, adequate organ function, ECOG PS 0-1, age 20-75, clinical T3-4, cM0 and CY0 (Japanese Classification), and documented informed consent. This treatment was conducted 2 courses every 4 weeks followed by standard D2 surgery within 8 weeks. The primary endpoint was histological response and secondary endpoints included clinical response, R0 resectability, surgery related morbidity, adverse events and overall survival. Results From July 2009 to June 2011, 56 pts (median age 63.5, male/female 43/13, PS0/1 50/6) were enrolled and received DCS therapy. But 8 pts stopped chemotherapy after one course (6 of them proceeded surgery but 2 pts refused treatment). Forty eight pts completed 2 courses of chemotherapy. Therefore, 54 pts were evaluable response to chemotherapy and pathological analysis. The histological response rate was 74.1% in primary tumor with grade 1b; 10 lesions, grade 2; 24 lesions and grade3; 6 lesions, and 70.2% in lymph node with grade 1b; 9 cases, grade 2; 10 cases and grade 3; 14 cases, respectively. Surgery related morbidity was 13.0% and R0 resection rate was 98.1% (53/54). Grade 3/4 adverse events were acceptable such as leucopenia (8.9%), neutropenia (17.9%), febrile neutropenia (7.1%), anorexia (10.7%), and diarrhea (8.9%). There was no treatment related death and no major surgical complications except for one. Conclusions Neoadjuvant DCS chemotherapy demonstrated a high histological response rate, acceptable feasibility and a sufficient R0 resection rate. This divided DCS regimen is attractive as NAC for pts with locally AGC. Disclosure All authors have declared no conflicts of interest.

Chemotherapy and target therapy as neo-adjuvant approach for initially unresectable colorectal liver metastases.

Although surgery is the most effective treatment for liver metastases in colorectal cancer patients, only 15–20% of these patients are suitable for a radical surgical approach, and metastases recurrence may occur at follow up. In the last decade, the use of pre-operative chemotherapy in combination with new biological drugs has been introduced. We reviewed data of neo-adjuvant chemotherapy strategies aimed at increasing the resection rate of liver metastases in colorectal cancer patients who were initially considered unresectable.

Chemotherapy and target therapy as neo-adjuvant approach for initially unresectable colorectal liver metastases

Although surgery is the most effective treatment for liver metastases in colorectal cancer patients, only 15-20% of these patients are suitable for a radical surgical approach, and metastases recurrence may occur at follow up. In the last decade, the use of pre-operative chemotherapy in combination with new biological drugs has been introduced. We reviewed data of neo-adjuvant chemotherapy strategies aimed at increasing the resection rate of liver metastases in colorectal cancer patients who were initially considered unresectable.

Efficacy and safety of docetaxel/cisplatin/5-fluorouracil preoperative combination chemotherapy in esophageal cancer patients with extended lymph node metastases

Aim We retrospectively investigated the efficacy and safety of combination chemotherapy with 5-fluorouracil (5-FU) and cisplatin plus docetaxel (DCF) as preoperative chemotherapy.

The impact of combined preoperative and postoperative regional intra-arterial infusion chemotherapy on the survival of low rectal cancer

直肠癌术后复发和转移制约着根治性切除后患者5年生存率的提高.术前区域动脉灌注化疗可提高进展期直肠癌的根治性切除率[1],术后区域动脉灌注化疗可抑制直肠癌根治性切除后盆腔局部复发和肝转移[2].笔者通过对术前辅助肠系膜下动脉及肝动脉灌注化疗、术后辅助双侧髂内动脉及肝动脉灌注化疗加常规静脉化疗的pT3-4N0-2M0期中低位直肠癌患者临床资料的回顾性分析,探讨手术前后联合区域动脉灌注化疗对直肠癌患者复发和远期生存的影响。

Preoperative chemotherapy with weekly docetaxel plus low-dose cisplatin and 5-fluorouracil for stage II/III squamous cell carcinoma of the esophagus

Background Docetaxel is a powerful anticancer agent for esophageal cancer. Preoperative combined chemotherapy with weekly docetaxel plus low-dose cisplatin and 5-fluorouracil (DFP) followed by surgery is expected to improve the survival of patients with resectable esophageal squamous cell carcinoma.

Long-term activation of the pro-coagulant response after neoadjuvant chemoradiation and major cancer surgery

Background:The association between cancer, major surgery and venous thromboembolism (VTE) is well established. Multimodal therapy is increasingly being used as standard treatment for localised gastrointestinal cancer. The aim of this study was to examine the markers of pro-coagulation response and VTE risk in an exemplar multimodal model of pre-operative combination chemotherapy and radiation therapy, followed by complex cancer surgery.Methods:Consecutive patients (n=36) with localised oesophageal cancer were studied at baseline after the first and second cycles of chemoradiation, and on post-operative days 1–28, and at 3, 6 and 9 months. Factors regulating the pro- and anti-coagulant response, as well as pro-inflammatory markers including NFκB activation in peripheral blood mononuclear cells, were examined. All patients received enoxaparin 40 mg s.c. postoperatively up to discharge, and underwent pulmonary CT-pulmonary angiography and venography on day 10 postoperatively.Results:Four (11%) non-fatal thromboembolic events were documented, all after hospital discharge. Neoadjuvant therapy before surgery activated factor VIII (FVIII) and pro-inflammatory NFκB, and increased D-dimers, pro-thrombin fragment 1+2 (F1+2) and the thrombin-anti-thrombin complex (TAT). Surgery significantly (P<0.05) increased pro-thrombin time (PT), activated partial thromboplastin time, fibrinogen, D-dimers, TAT, F1+2 and FVIII up to 6 months.Conclusion:These data highlight the linked pro-coagulant and immunoinflammatory pathways in the multimodal management of oesophageal cancer, and suggest that the duration of current standard thromboprophylaxis regimens warrants further study.