Neoadjuvant Chemotherapy Regimen Research Articles

The Safety and Efficacy of Intra-Arterial versus Intravenous Neoadjuvant Chemotherapy in Patients with Locally Advanced Cervical Cancer: A Meta-Analysis.

Objective The aim of this study was to evaluate the safety and efficacy of intra-arterial versus intravenous neoadjuvant chemotherapy for the management of patients with locally advanced cervical cancer. Methods The PubMed, EMBASE, PMC, Web of Science, and Cochrane databases were searched to identify correlational studies published in English. Prospective controlled studies that evaluated the treatment effect of intra-arterial neoadjuvant chemotherapy or intravenous neoadjuvant chemotherapy in patients with locally advanced cervical cancer were pooled for a meta-analysis. Results A total of three eligible studies with 112 patients with locally advanced cervical cancer were eventually included in this analysis. The baseline regimen of neoadjuvant chemotherapy was platinum-based chemotherapy. The total clinical response rate was 71.4%, and the overall pathological complete response (CR) rate was 11.5%. The grade 3/4 toxicity rate was 27.2%. In the intra-arterial group, the response rate was 83.1% (CR, 22.0%; partial response (PR), 61.0%), which was significantly higher than 58.5% (CR, 11.3%; PR, 47.2%) in the intravenous group (P=0.01). The pathological CR rate was 15.5% in the intra-arterial group, which was higher than 6.5% in the intravenous group. The grade 3/4 toxicity rate was 17.2% in the intra-arterial group, which was higher than the rate of 13.8% in the intravenous group. Conclusion Platinum-based neoadjuvant chemotherapy was well tolerated in patients with locally advanced cervical cancer and showed moderate response activity. Compared to intravenous neoadjuvant chemotherapy, intra-arterial neoadjuvant chemotherapy had an evident advantage in terms of the clinical response while maintaining a similar toxicity rate. The clinical efficacy of intra-arterial neoadjuvant chemotherapy deserves further evaluation.

Preoperative neoadjuvant chemotherapy on surgical condition and oncogene expression in advanced gastric cancer.

Objective:To evaluate the effect of preoperative neoadjuvant chemotherapy regimen of XELOX (capecitabine combined with oxaliplatin) on surgical condition and oncogene expression in advanced gastric cancer.Methods:From January 2015 to July 2016, 124 patients with advanced gastric cancer who were admitted to our hospital were selected. Random number table method was used to divide them into an observation group and a control group, 62 each group. The observation group received two courses of neoadjuvant chemotherapy (XELOX) before operation, and the control group received surgery. The operation condition, expression of oncogenes in gastric cancer lesions, occurrence of adverse reactions and the long-term prognosis were compared between the two groups.Results:The R0 resection rate of the observation group was significantly higher than that of the control group, and the difference was statistically significant (P<0.05). The operation time of the observation group was shorter than that of the control group, the amount of intraoperative bleeding and the amount of postoperative drainage of the observation group were less than that of the control group, and the differences were statistically significant (P<0.05). The mRNA expression of gastrokine 1, multiple tumor suppressor protein, Wilms tumor gene on the X chromosome (WTX gene) and gene of phosphate and tension homology deleted on chromosome ten (PTEN gene) in the observation group after treatment was significantly higher than that in the control group before treatment, and the increase amplitude of the observation group was more obvious than that of the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). In terms of long-term prognosis, the disease-free survival time and average survival time of the observation group during the two-year follow-up period were significantly better than those of the control group, and the recurrence rate of the observation group was significantly lower than that of the control group; the differences were statistically significant (P<0.05).Conclusion:Preoperative XELOX for advanced gastric cancer patients can effectively increase the proportion of radical surgery, reduce the risk of surgery, and significantly regulate the expression of oncogene, thus improving the long-term prognosis of patients.

Gastric leiomyosarcoma: A common tumor in an uncommon location

A previously healthy 51-year-old female presented with gradually worsening, 10/10 non-radiating epigastric abdominal pain associated with nausea, bilious vomiting, and weight loss. Computed tomography (CT) of the abdomen with intravenous contrast showed a large 10.7 × 9.5 cm exophytic mass in the antrum/body of the stomach (Figure 1A). An upper endoscopic evaluation revealed a large fungating, infiltrative, and ulcerated mass in the gastric body (Figure 1B). Histopathology of the biopsied mass was notable for spindle cells with a fascicular pattern, moderate nuclear atypia, abundant eosinophilic cytoplasm, and numerous mitotic figures. Immunohistochemistry analysis revealed that the tumor was diffusely positive for smooth muscle actin (SMA) (Figure 2A), desmin (Figure 2B), and calponin (Figure 2C). Ki-67 stain (Figure 2D) showed a high labeling index of 60% indicating a high-grade leiomyosarcoma. There was a complete lack of reactivity with DOG-1 and CD-117 (c-KIT) which excluded the diagnosis of a gastrointestinal stromal tumor (GIST). No evidence of metastatic disease and no lymph node involvement were noted in the head, abdomen, or thorax on the respective CT scans which were done for staging. Due to the large size of the tumor, the patient was started on a neoadjuvant chemotherapy regimen consisting of doxorubicin, ifosfamide, and mesna to reduce tumor burden with a future plan for surgical excision.

P1250 Thymoma invading the right atrium - multimodality imaging and its importance for managing and therapeutics

Abstract Introduction Thymoma is the most common primary neoplasm of the anterior mediastinum. Most invasive thymomas are limited to the pericardium. Only few cases of transcaval extension with intracardiac involvement have been reported. Case report We present the case of a 15-year-old boy with previous history of infectious cerebelitis without neurologic sequelae. He presented with interscapular pain for 6 weeks (not improving with symptomatic therapy) and fever for 3 days. On admission, chest radiograph exhibited an opacification in the right hilum (Figure A). He was discharged with antibiotic prescription for presumptive pneumonia. Due to persistence of complaints he was revaluated after 5 days. Signs of superior vena cava (SVC) syndrome were noted. A computerized tomography showed a large soft tissue mass of the anterior mediastinum, in right antero-lateral topography, measuring 12.5x10x9.5 cm with central calcification and extension to the right lung (Figure B). Transthoracic and transoesophageal echocardiography showed an anterior mass compressing the pulmonary artery branch (PA) and SVC with marginal invasion of the right atrium (RA) (Figure C and D). Cardiac MRI confirmed a large mass of the anterior mediastinum with extension and invasion of the right superior lobe, invasion of the superior vena cava with extension into the RA (Figure E). Transthoracic core-needle biopsy was performed and histopathological diagnosis confirmed an invasive thymoma. The case was discussed at joint cardiothoracic surgery and oncology multidisciplinary meeting and it was agreed to neoadjuvant chemotherapy regimen followed by surgery. Intraoperatively, a large tumor invading the SVC and proximal RA was found, in accordance with the echocardiographic and MRI findings. Due to unforeseen metastatic implants on the adventitia of the main PA and ascending aorta, resection of the tumor was not performed. Palliative decompression of the venous system was performed with interposition of a ringed vascular prosthesis between the left brachiocephalic vein and the right atrial appendage. (Figure F). The patient received postoperative radiotherapy and is asymptomatic without signs of SVC syndrome for 3 months. Discussion and conclusion This report illustrates a rare case of an invasive thymoma with extension to cardiac structures. Multimodality imaging for quality decision-making was imperative in the management and for surgical planning of this case. Transthoracic and transoesophageal echocardiography remain the exams of choice for the diagnosis of intracardiac disease. As demonstrated, a high index of suspicion is needed because clinical symptoms are unspecific and late diagnosis of potentially resectable tumors are associated with a poor prognosis. Abstract P1250 Figure. Multimodality imaging

Dynamic monitoring of CD45-/CD31+/DAPI+ circulating endothelial cells aneuploid for chromosome 8 during neoadjuvant chemotherapy in locally advanced breast cancer

Background:Neoadjuvant chemotherapy (NCT) is the standard treatment for patients with locally advanced breast cancer (LABC). The aim of this study was to verify this relationship, and to estimate the clinical value of aneuploid circulating endothelial cells (CECs) in LABC patients with different NCT responses.Methods:Breast cancer patients received an EC4-T4 NCT regimen. Peripheral blood mononuclear cells were obtained before NCT, and after the first and last NCT courses. A novel subtraction enrichment and immunostaining fluorescence in situ hybridization (SE-iFISH) strategy was applied for detection of circulating rare cells (CRCs). CECs (CD45–/CD31+/DAPI+) and circulating tumor cells (CTCs) with different cytogenetic abnormalities related to chromosome 8 aneuploidy were analyzed in LABC patients subjected to NCT.Results:A total of 41 patients were enrolled. Firstly, CD31+/EpCAM+ aneuploid endothelial-epithelial fusion cells were observed in LABC patients. Further, aneuploid CECs in the peripheral blood showed a biphasic response during NCT, as they initially increased and then decreased, whereas a strong positive correlation was observed between aneuploid CECs and CTC numbers.Conclusion:We determined that aneuploid CEC dynamics vary in patients with different response to chemotherapy. Elucidating the potential cross-talk between CTCs and aneuploid CECs may help characterize the process associated with the development of chemotherapy resistance and metastasis.

Adjuvant addition of capecitabine to early-stage triple-negative breast cancer patients receiving standard chemotherapy: a meta-analysis.

Triple-negative breast cancer (TNBC) pertains to a breast cancer subtype that has the highest metastatic and recurrence rates. The effectiveness of capecitabine as adjuvant chemotherapy for TNBC has remained unclear. This study conducted a meta-analysis of the efficacy of capecitabine as adjuvant chemotherapy for early-stage TNBC treated with taxane-/anthracycline-based chemotherapy. We identified relevant research reports in online databases until May 2019. We finally included seven randomized clinical trials to perform this meta-analysis. Altogether, the seven trials enrolled 3151 early-stage TNBC patients, with 1552 receiving standard (neo)adjuvant chemotherapy regimens and 1599 receiving addition of capecitabine in the adjuvant settings besides standard regimens. A meta-analysis of the seven trials revealed a significant increase in disease-free survival (DFS) with the addition of capecitabine (Hazard ratio (HR) = 0.77, 95% CI 0.66-0.90). This improvement in DFS was significant both in trials conducted in America-Europe and in Asia. In trials involving six to eight cycles of capecitabine addition, we observed a significant improvement in DFS. Furthermore, in the meta-analysis of six trials, we detected a significant increase in overall survival (OS) favoring capecitabine (HR = 0.69, 95% CI 0.56-0.85). Adjuvant addition of capecitabine to early-stage TNBC patients receiving standard chemotherapy showed significant DFS and OS improvement. Future studies involving the selection of patients that may have the highest survival benefit from adding capecitabine are warranted.

Оценка интенсифицированных режимов неоадъювантной химиотерапии местнораспространенного рака шейки матки

Оценка интенсифицированных режимов неоадъювантной химиотерапии местнораспространенного рака шейки матки

Dose-dense paclitaxel and carboplatin vs. conventional paclitaxel and carboplatin as neoadjuvant chemotherapy for advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer: a retrospective study.

The purpose of this study was to determine the optimal regimen of neoadjuvant chemotherapy (NAC) for advanced epithelial ovarian, fallopian tube, and peritoneal cancers. A clinical information survey involving 171 patients with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer was conducted. These patients underwent NAC followed by interval debulking surgery at the Hyogo Cancer Center (Hyogo, Japan) between January 2006 and December 2015. The median observation period was 41 (range 4-138) months. Dose-dense paclitaxel and carboplatin (TC) was administered in 101 patients (59%); tri-weekly TC was administered 70 patients (41%). Median progression-free survival was 21 [95% confidence interval (CI) 18-23] months and 15 (95% CI 13-17) months in the dose-dense TC and conventional-TC group [hazard ratio (HR) = 0.69, 95% CI 0.46-0.96; p = 0.02], respectively. The median overall survival was 59 (95% CI 46-72) and 40 (95% CI 32-57) months in the dose-dense TC group and conventional-TC group (HR = 0.72, 95% CI 0.48-1.06; p = 0.09). Multivariate analysis for progression-free survival demonstrated that dose-dense TC represented an independent prognostic factor (HR = 0.70, 95% CI 0.50-0.99; p = 0.04). Dose-dense TC is a promising regimen of NAC for advanced epithelial ovarian cancer.

Effect of neoadjuvant chemotherapy in patients undergoing radical cystectomy for muscle-invasive bladder cancer: a retrospective, multi-institutional study.

We evaluated the effect of neoadjuvant chemotherapy in patients undergoing radical cystectomy for urothelial bladder cancer. We retrospectively examined 140 consecutive patients with muscle-invasive bladder cancer (clinical stage T2 to T4 and N0) who underwent radical cystectomy with or without neoadjuvant chemotherapy at four academic institutions between January 2006 and December 2016. Patients were categorized into the neoadjuvant chemotherapy group (those who underwent treatment with any neoadjuvant chemotherapy regimen; n=69) and the non-neoadjuvant chemotherapy group (those who did not receive any neoadjuvant chemotherapy regimen; n=71). The primary outcome measure was overall survival. The 5-year overall survival rates were 58.0% and 61.8% in the neoadjuvant chemotherapy and non-neoadjuvant chemotherapy groups, respectively (P=0.320). The 5-year overall survival rates for the neoadjuvant chemotherapy and non-neoadjuvant chemotherapy groups were 64.8% and 68.4%, respectively, among cT2N0 patients (P=0.688) and 38.6% and 21.6%, respectively, among cT3-4aN0 patients (P=0.290). When patients with cT3-4aN0 disease in the neoadjuvant chemotherapy group were divided into responders (<pT2) and non-responders (pT2-pT4), responders (<pT2) to neoadjuvant chemotherapy had a better 5-year overall survival rate (83.6%) than non-responders (pT2-pT4; 23.1%; P<0.05); this was also observed in the non-neoadjuvant chemotherapy group (21.6%; P<0.05). On multivariate analysis, the pathological T stage (<pT2 vs. ≥pT2) was a significant predictor of overall survival in the neoadjuvant chemotherapy group. Among cT3-4aN0 patients, survival outcomes were significantly better in responders (<pT2) to neoadjuvant chemotherapy than in non-responders (≥pT2) and in patients in the non-neoadjuvant chemotherapy group. Among patients with advanced stage disease (cT3 or 4), responders (<pT2) to neoadjuvant chemotherapy had a significant survival benefit.

1354 The Safety and Efficacy Of Intra-Arterial Versus Intra-Venous Neoadjuvant Chemotherapy in Patients with Locally Advanced Cervical Cancer: A Meta-Analysis

Study Objective The aim of this study was to evaluate the safety and efficacy of intra-arterial (NCIA) versus intravenous (NCIV) neoadjuvant chemotherapy in managing patients with locally advanced cervical cancer (LACC). Design The PubMed, EMBASE, PMC, Web of Science and Cochrane databases were searched to identify correlational studies published in English. Prospective controlled studies that evaluated the treatment effect of NCIA or NCIV in patients with LACC were pooled for a meta-analysis. Setting N/A Patients or Participants N/A Interventions N/A Measurements and Main Results A total of three eligible studies with 112 LACC patients were eventually included in this analysis. The baseline regimen of neoadjuvant chemotherapy (NACT) was platinum-based chemotherapy. The total clinical response rate (RR) was 71.4%, and the pathological complete response (PCR) was 11.5% overall. The grade 3/ 4 toxicity rate was 27.2%. In the NCIA group, the RR was 83.1% (complete response [CR], 22.0%; partial response [PR], 61.0%), which was significantly higher than the 58.5% RR (CR, 11.3%; PR, 47.2%) in the NCIV group (P=0.005). The PCR was 15.5% in the NCIA group, which was slightly higher than 6.5% PCR in the NCIV group (P=0.43). The grade 3/4 toxicity rate was 17.2% in the NCIA group, which was slightly higher than the 13.8% toxicity rate in the NCIV group (P=0.38). Conclusion Platinum-based NACT was well tolerated in patients with LACC and showed moderate response activity. Compared to NCIV, NCIA showed an evident advantage in the clinical response with a similar toxicity rate. The clinical efficacy of NCIA deserves further evaluation.

Predicting lateral pelvic lymph node metastasis based on magnetic resonance imaging before and after neoadjuvant chemotherapy for patients with locally advanced lower rectal cancer.

We examined the association between pathological lateral pelvic lymph node (LPLN) metastasis and the LPLN diameter in patients with locally advanced rectal cancer (LARC) who received a neoadjuvant chemotherapy (NAC) regimen based on oxaliplatin as induction chemotherapy. We aimed to determine whether or not the LPLN size predicts LPLN metastasis in NAC cases. We retrospectively examined data from 3 institutes for 60 patients with LARC who received mesorectal excision and LPLN dissection after NAC. We evaluated the LPLN size on magnetic resonance imaging (MRI) scans acquired before and after NAC. We performed multivariate analyses to analyze the relationship between the LPLN size and clinicopathological factors. For patients with visible LPLNs, the median short-axis diameter (SA) was significantly reduced from 5.1mm (range 2.0-17.4) before NAC to 3.7mm (range 2.1-19.0) after NAC (p = 0.0479). SA diameters were significantly larger in pathological LPLNs than in healthy LPLNs, both before (p = 0.0002) and after NAC (p < 0.0001). A SA cut-off value of 7mm before NAC was able to independently predict lymph node metastasis (p = 0.0178). We showed that MRI-based evaluations of LPLN size were able to predict metastasis in patients who underwent NAC for LARC. This finding might be useful when considering selective LPLN dissection in NAC cases.

Pathological response and outcome after neoadjuvant chemotherapy with DOC (docetaxel, oxaliplatin, capecitabine) or EOF (epirubicin, oxaliplatin, 5-fluorouracil) for clinical T3-T4 non-metastatic gastric cancer

PurposeIn this prospective observational study, we sought to compare the efficacy and safety of docetaxel + oxaliplatin + capecitabine (DOC) with epirubicin + oxaliplatin + 5-fluouracil (EOF) as neoadjuvant chemotherapy (NAC) for clinical T3 or T4 non-metastatic gastric cancer (GC) patients. MethodsThe DOC NAC consisted of docetaxel 35 mg/m2 (days 1–8), oxaliplatin 85 mg/m2 (day 1), and capecitabine 750 mg/m2 twice daily (days 1–14), every 3 weeks. The EOF NAC consisted of intravenous (IV) epirubicin 50 mg/m2 combined with IV oxaliplatin 130 mg/m2 on day 1 and continuous infusion 5-fluouracil 750 mg/m2 on days 1–5, every 3 weeks. After 4 cycles of NAC or upon progression during chemotherapy, patients underwent gastrectomy with standard D2 or D3 lymphadenectomy. Pathological complete response rate per Becker tumor regression grading system was the primary endpoint and the secondary endpoints included progression-free survival (2-yr PFS) and 2-year overall survival (2-yr OS) and tolerability. ResultsOverall, we identified 63 patients with T3-4 non-metastatic GC starting either NAC regimen between January 2010 and December 2017 at our Institution: 34 in the DOC group and 29 in EOF group. Thirty patients (88%) in the DOC group and 22 (76%) in the EOF group completed the 4 planned cycles of NAC. Fifty-seven patients received surgery. Results indicated no statistical significant differences between the two groups, and only a trend for some better data in favour of the DOC group. The R0 resection rate was 90.6% and 88.0% for the DOC and EOF cohorts, respectively. The pathological complete response rate was 6.2% in the DOC group and 4.0% in the EOF group. Becker 1–2 pathological response was found in 46.8% of the DOC cohort and 28.0% of the EOF cohort (p = .14). The 2-yr PFS rate was 54.1% for DOC vs. 41.4% for EOF (p = .14) and the 2-yr OS rate was 80.8% for DOC vs. 58.6% for EOF (p = .05). Neutropenia was the most common grade ≥3 toxicity and occurred in 8 (23.5%) patients of the DOC group and 10 (34.4%) patients of the EOF group (p = .33). ConclusionsThese findings seem to confirm the feasibility of NAC for clinically T3 and T4 non-metastatic GC and, despite no statistical significant difference was documented, suggest a trend for better activity and tolerability for the docetaxel-based regimen (DOC) compared to the epirubicin-based combination (EOF).

773P - Effects of preoperative preparation time on efficacy of neoadjuvant chemotherapy (SOX) in patients with advanced gastric cancer

BackgroundThe aim of this study was to analyze the safety and effectiveness of different preoperative preparation time in the neoadjuvant chemotherapy (SOX) regimen in patients with advanced gastric cancer. MethodsFrom June 1 2010 to June 1 2017, 120 patients aged from 25 to 80 with clinical stage IIA-IIIC gastric cancer received neoadjuvant chemotherapy with S-1 and oxaliplatin and radical gastrectomy in Chinese PLA General Hospital. They were eligible for inclusion and they were randomly assigned to either the 3-weeks group, which received radical gastrectomy 3 weeks after neoadjuvant chemotherapy (n=60), or the 5-weeks group, which received radical gastrectomy 5 weeks after neoadjuvant chemotherapy (n=60). We compared short-term surgical outcomes between the two groups. ResultsThere were no significant differences between the two groups regarding the clinical pathological characteristics. However, the 5-weeks group had less intraoperative blood loss (229ml vs 240ml, P=0.031) and less Clavien-Dindo grade II to IV complications (P=0.006) than the 3-weeks group. Baseline clinicopathologic characteristics, and short-term outcomes of the patients treated in the two groups were similar. ConclusionsPatients with advanced gastric cancer undergoing advanced neoadjuvant chemotherapy after neoadjuvant chemotherapy require a certain amount of time to adjust and prepare for gastrectomy. Considering the general condition of the patients, the preoperative interval can be shortened and the efficacy can be improved. Legal entity responsible for the studyWangxinxin. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

788P - A phase I study of docetaxel/oxaliplatin/S-1 (DOS) combination neoadjuvant chemotherapy for patients with locally advanced adenocarcinoma of the esophagogastric junction

BackgroundA triple chemotherapeutic regimen including docetaxel, oxaliplatin, and S-1 (DOS) for a neoadjuvant setting has a promising efficacy for locally advanced adenocarcinoma of the esophagogastric junction (AEG). However, the optimal dose of each drug in Japanese population remained to be clarified. The aim of this phase I study is to determine a recommended dose for a triweekly combination neoadjuvant DOS chemotherapy for patients with locally advanced AEG. MethodsPatients with cT3 or more advanced AEG without distant metastasis were eligible for this study. The planned dosages of docetaxel (mg/m2, day 1), oxaliplatin (mg/m2, day 1), and S-1 (mg/day, days 1–14) were 50/100/80–120 at level 1, and 60/100/80–120 at level 2. The treatment cycle was repeated every 3 weeks, and patients were assessed for response to the treatment after 2 and 3 cycles. This study was registered with UMIN Clinical Trial Registry (UMIN 000022210). ResultsTwelve patients with locally advanced AEG were enrolled in this study. At dose level 1, one of six patients experienced dose-limiting toxicity (DLT) of grade 3 febrile neutropenia. At dose level 2, two of the next six patients experienced the same DLT of need for withdrawal of chemotherapy due to serious adverse events. Based on these results, level 2 was considered the recommended dose for this regimen. Total or proximal gastrectomy plus lower esophagectomy, or subtotal esophagectomy was performed in all the 12 patients with the R0 resection rate of 92% (11/12). Histological response evaluation based on the classification defined by Japanese Gastric Cancer Association revealed four patients with grade 1a, two with grade 1b, three with grade 2, and three with Grade 3. ConclusionsRecommended doses for a neoadjuvant DOS chemotherapy regimen for locally advanced AEG were determined as Docetaxel: 60mg/m2, Oxaliplatin: 100mg/m2 on day 1, S-1: <1.25m2, 80mg; 1.25–1.5m2, 100mg; >1.5m2, 120mg twice a day on days 1–14. DOS chemotherapy showed good preliminary efficacy with acceptable toxicity in this study warranting a further phase II trial to investigate the efficacy of the DOS regimen. Clinical trial identificationUMIN 000022210. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Clinical Application Effect of Paclitaxel Combined with Cisplatin Neoadjuvant Chemotherapy in Treatment of Early and Mid Stage Cervical Cancer

Objective: To study the application effect and value of paclitaxel combined with cisplatin neoadjuvant chemotherapy in treatment of early and mid stage cervical cancer. Methods: A total of 92 patients with early and mid stage cervical cancer admitted to our department from 2016 to 2018 were enrolled in the study. The patients were divided into two groups according to random number table. Reference group (n=46) was treated with cervical cancer radical resection combined with postoperative chemotherapy. On the same basis, experimental group (n=46) was given neoadjuvant chemotherapy regimen of paclitaxel combined with cisplatin. Total effective rate, adverse reaction and score of life quality of the two groups were compared. Results: Total effective rate of experimental group was 76.09% which was higher than reference group, 41.30%. Score of life quality of the experimental group was higher than that of reference group, the comparison between two groups showed P&lt;0.05. There was no difference in incidence of adverse reaction between the two groups, P&gt;0.05. Conclusion: Application of neoadjuvant chemotherapy of paclitaxel combined with cisplatin had ideal tumor controlling effect for early and mid stage cervical cancer with lesser adverse reaction. Postoperative quality of life was high. It should be promoted in clinics.

Impact of the time from the completion of neoadjuvant chemotherapy to surgery on the outcomes of patients with gastric cancer.

BackgroundGastrectomy is usually recommended within 5 to 6 weeks after the completion of neoadjuvant chemotherapy (NCT). However, the optimal timing of surgery is not clearly defined.MethodsThis study retrospectively reviewed the clinical records of 229 patients with locally advanced gastric cancer (GC) who underwent curative gastrectomy after NCT between 2006 and 2016. The effect of the time to surgery (TTS), defined as ≤4, 5–6, and >6 weeks, on patient outcomes was examined. Descriptive statistics and Cox proportional hazards models were used.ResultsSeventy of 229 patients (30.6%) had surgery within 4 weeks after their last dose of NCT, 103 (45.0%) within 5–6 weeks, and 56 (24.5%) after 6 weeks. The median age was 56.0 [interquartile range (IQR), 47.0–63.0] years, and the median TTS was 34.0 (IQR, 26.0–42.0) days. The three groups did not significantly differ regarding most surgical and histopathological characteristics except for the NCT regimen (P=0.010), number of cycles of NCT (P=0.017) and pathological stage (P=0.015). The NCT regimen was the only independent factor associated with TTS >6 weeks (P=0.015). The 3-year progression-free survival (PFS) estimates were 41.9%, 42.8% and 61.7% in patients who underwent surgery in ≤4, 5–6, and >6 weeks after NCT, respectively (P=0.044). The 3-year overall survival (OS) estimates were 57.7%, 58.0% and 68.2% in the three groups, respectively (P=0.202). According to multivariable analysis, compared with the interval of ≤4 weeks, patients who underwent surgery at 5–6 or >6 weeks had equivalent PFS and OS.ConclusionsThe NCT-surgery interval time has no impact on patient outcomes.

Effect of Neoadjuvant SBRT or Chemoradiation on Nodal Positivity for Resected Pancreatic Adenocarcinoma

Stereotactic body radiotherapy (SBRT) has emerged as an alternative to conventional chemoradiotherapy (CRT) as a neoadjuvant treatment option for pancreatic cancer. The volume of irradiation is smaller for SBRT than CRT. The impact of SBRT on pathologic lymph node positivity (pN+) in resected pancreatic cancer has not been studied in comparison with CRT. The National Cancer Data Base (NCDB) was queried for patients diagnosed with AJCC clinical stage T1-4, N0-1, M0 pancreatic adenocarcinoma from 2006-2014. We included patients treated with neoadjuvant chemotherapy and radiotherapy followed by definitive surgical resection. Patients with < 6 nodes examined and/or R2 resection margins were excluded. Patients were stratified into SBRT or CRT cohorts with SBRT defined as 1-5 treatments with a cumulative dose of 2000-7000 cGy and dose/fraction ≥500 cGy. CRT included those receiving ≥10 fractions with a total dose of 3000-7000 cGy. Multivariable logistic regression with covariates of interest was used to predict pathologic nodal status. Propensity score matching (PSM) was used to reduce treatment selection bias. Of the 1471 patients that met inclusion criteria, 179 (12%) underwent SBRT and 1292 (88%) underwent CRT. The median age was 64 (range 27-90) and a majority of patients were white (87%), Charlson-Deyo=0 (66%), and had cancer of the pancreatic head (80%). The clinical stage was cT4 in 18% and cN1 in 31%. Utilization of SBRT increased from 5% in 2006-2008 to 17% in 2012-2014 (p<0.001) and was similar for both clinical stage N0 (11%) and N1 patients (14%) (p=0.1). Multiagent chemotherapy use was more common in the SBRT group (86% vs. 48%, p<0.001). For both SBRT and CRT, positive margin rate was 15% (p=0.872) and overall pN+ rate was 40%. The mean lymph node yield was higher for SBRT than CRT (mean 21.2 vs. 17.6, p<0.001). Using 1:3 PSM to control for multiagent chemotherapy use, clinical N stage, LVI, CA19-9 and tumor size, no difference in the pN+ rate was identified between the SBRT and CRT groups (OR for SBRT 1.56 [95% confidence interval 0.92 – 2.66], p=0.102). The lymph node ratio was >0.15 in 14% with no difference between groups. Median overall survival was 25 months for the entire study population. When compared to neoadjuvant CRT, SBRT was not associated with increased rate of positive surgical margins or lymph node positivity. The regimen of neoadjuvant multiagent chemotherapy and SBRT followed by surgery for pancreatic adenocarcinoma merits further study.

Efficacy and safety of neoadjuvant chemotherapy regimens for triple-negative breast cancer: a network meta-analysis.

Different neoadjuvant chemotherapies are available for triple-negative breast cancer (TNBC). Here, we performed a network meta-analysis to evaluate the pathological complete response (pCR) benefit and safety of treatment regimens. Pairwise and Bayesian network meta-analyses were performed to compare direct and indirect evidence, respectively. Twenty-three studies involving 12 regimens namely standard chemotherapeutic agents, bevacizumab (B)-, platinum salts (P)-, B plus P (BP)-, poly(ADP-ribose) polymerase inhibitors (Pi)-, P plus Pi (PPi)-, capecitabine (Ca)-, gemcitabine (Ge)-, zoledronic acid (Za)-, everolimus (E)-, P plus E (PE)-, and gefitinib (G)-containing regimens. The results showed that P-, B-, PPi-, and Za-containing regimens achieved higher pCR than standard chemotherapeutic agents. BP-containing regimens had a better pCR than B-containing regimens. In indirect comparisons, Za-, BP-, P-, and B-containing regimens were the top four strategies with the highest probability for pCR. Benefit-risk analysis showed that B-containing regimens had the highest acceptability of being the best treatment for better pCR achievement with fewer SAEs. The addition of P, B, BP, PPi, and Za to standard chemotherapeutic agents enhanced the pCR, but a balance between efficacy and safety should be carefully considered. B-containing regimens might be the best choice for neoadjuvant chemotherapy due to its better efficacy and tolerability.

Inclusion of Platinum Agents in Neoadjuvant Chemotherapy Regimens for Triple-Negative Breast Cancer Patients: Development of GRADE (Grades of Recommendation, Assessment, Development and Evaluation) Recommendation by the Italian Association of Medical Oncology (AIOM).

In the absence of identified therapeutic targets, chemotherapy is the main systemic treatment option for triple-negative breast cancer (TNBC). The achievement of a pathological complete response (pCR) after neoadjuvant chemotherapy leads to good outcome, whereas patients not achieving a pCR are at high risk of relapse. Various trials have evaluated the inclusion of platinum in neoadjuvant chemotherapy regimens for TNBC, leading to non-univocal results. The panel of the Italian Association of Medical Oncology (AIOM) Guidelines on Breast Cancer developed a clinical recommendation on the addition of platinum to anthracycline/taxane-based neoadjuvant chemotherapy for TNBC by using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology and the Evidence to Decision framework (EtD). Five studies were eligible. The panel identified the following outcomes of benefit: pCR (critical), disease/event-free survival (DFS/EFS, critical), and overall survival (OS, critical). The panel identified febrile neutropenia (critical), serious adverse events (critical), anemia grade 3–4 (important), thrombocytopenia grade 3–4 (important) as outcomes of harms. The probability of pCR was higher in the platinum-based chemotherapy group versus control group (RR = 1.45, 95%CI 1.28–1.64); however, no impact on long-term outcome was observed. Neoadjuvant treatment regimens containing platinum resulted in a non-significant increase in the risk of febrile neutropenia and in a significant increase in the risk serious adverse events, G3–G4 anemia and G3–G4 thrombocytopenia: 11.3% versus 0.8%, RR = 15.66 (95%CI 6.38–38.44). The panel judged uncertain/favorable the benefit/harms balance. The panel’s final recommendation was conditional in favor of the inclusion of platinum in anthracycline/taxane-based neoadjuvant regimens for TNBC.

Exceptional response to chemotherapy followed by concurrent radiotherapy and immunotherapy in a male with primary retroperitoneal serous Adenocarcinoma: a case report and literature review

BackgroundPrimary retroperitoneal serous adenocarcinoma (PRSA) is an extremely uncommon malignancy exclusively reported in females. Due to the rarity of the disease, it is difficult to establish a standardized treatment.Case presentationWe describe a unique case of PRSA in a 71-year-old male who presented with right-sided lower back pain and numbness. Magnetic resonance imaging identified a mass invading the adjacent psoas muscle and twelfth rib. Tissue biopsy confirmed poorly differentiated PRSA. Patient was initially treated with neoadjuvant carboplatin and paclitaxel chemotherapy regimen. This resulted in complete radiological resolution of the tumor. However, 12 weeks later, rapid recurrence was noted on follow-up CT scan. The patient was then treated with external radiotherapy with concurrent nivolumab, an anti-PD-1 antibody. The patient displayed a positive response to treatment with reduction in primary tumor and metastases and had a sustained disease control.ConclusionTreatment with radiotherapy in combination with anti-PD-1 antibody could be an effective modality of management for PRSA.