Pancreatic metastasis from a colorectal cancer: a case-report

Les métastases pancréatiques d’origine colorectale sont très rares. Nous rapportons dans cette observation le cas d’une patiente âgée de 73 ans, ayant un adénocarcinome rectal avec des métastases hépatiques et pulmonaires traité chirurgicalement, et qui présente, 46 mois après la fin de la chimiothérapie palliative, une métastase pancréatique métachrone de l’adénocarcinome rectal. Il s’agissait d’une lésion pancréatique localement avancée, et la patiente a eu une chimiothérapie par FOLFIRI et Bevacizumab ayant permis d’obtenir une stabilisation tumorale avec une survie de 18 mois par rapport au diagnostic de la métastase pancréatique.Pancreatic metastases from colorectal cancer are rare. We report the case of a 73-years-old patient presented with a metachronous pancreatic metastasis from rectal cancer. It was a locally advanced pancreatic lesion and the patient was treated by chemotherapy (FOLFIRI and Bevacizumab) which allow a survival of 18 months

Prediction of survival with second-line therapy in biliary tract cancer: Actualisation of the AGEO CT2BIL cohort and European multicentre validations

BACKGROUND: The benefit of second-line chemotherapy (L2) over standard first-line (L1) gemcitabine plus cisplatin (GEMCIS) or oxaliplatin (GEMOX) chemotherapy in advanced biliary tract cancer (aBTC) is unclear. Our aim was to identify and validate prognostic factors for overall survival (OS) with L2 in aBTC to guide clinical decisions in this setting. METHODS: We performed a retrospective analysis of four prospective patient cohorts: a development cohort (28 French centres) and three validation cohorts from Italy, UK and France. All consecutive patients with aBTC receiving L2 after GEMCIS/GEMOX L1 between 2003 and 2016 were included. The association of clinicobiological data with OS was investigated in univariate and multivariate Cox analyses. A simple score was derived from the multivariate model. RESULTS: The development cohort included 405 patients treated with L1 GEMOX (91%) or GEMCIS. Of them, 55.3% were men, and median age was 64.8 years. Prior surgical resection was observed in 26.7%, and 94.8% had metastatic disease. Performance status (PS) was 0, 1 and 2 in 17.8%, 52.4% and 29.7%, respectively. Among 22 clinical parameters, eight were associated with OS in univariate analysis. In multivariate analysis, four were independent prognostic factors (p < 0.05): PS, reason for L1 discontinuation, prior resection of primary tumour and peritoneal carcinomatosis. The model had the Harrell's concordance index of 0.655, a good calibration and was validated in the three external cohorts (N = 392). CONCLUSION: We validated previously reported predictive factors of OS with L2 and identified peritoneal carcinomatosis as a new pejorative factor in nearly 800 patients. Our model and score may be useful in daily practice and for future clinical trial design

Adjuvant therapy of localized gastrointestinal stromal tumors

Le risque de récidive d’une tumeur stromale gastro-intestinale (GIST) localisée après résection R0 doit actuellement être évalué par la classification AFIP (Armed Forces Institute of Pathology) qui tient compte de la localisation, la taille, et l’index mitotique de la tumeur. Une étude randomisée réalisée chez 713 patients, comparant imatinib postopératoire et placebo pendant 1 an, a montré une diminution significative du risque de récidive chez les patients traités par imatinib. Cette amélioration de la survie sans rechute était observée dans les sous-groupes à risque modéré ou élevé de la classification de l’AFIP, mais pas dans les sous-groupes à faible et très faible risque de récidive. L’imatinib a obtenu récemment une AMM en situation adjuvante, mais l’impact du traitement à long terme, les indications thérapeutiques précises et la durée optimale du traitement ne sont pas clairement établis. Les études en cours devraient permettre de mieux préciser la place de l’imatinib en situation adjuvante.The risk of recurrence after resection of a localized GastroIntestinal Stromal Tumor (GIST) should nowadays be estimated according to the AFIP (Armed Forces Institute of Pathology) classification, which takes into account the location, the size and the mitotic index of the tumor. A clinical trial in which 713 patients were randomly assigned to receive either imatinib or a placebo for one year after R0 resection of a localized GIST, showed a significant decrease of recurrence in patients treated by imatinib. The benefit was observed in patients with high or moderate risk of recurrence, but not in case of low or very low risk. Imatinib was recently approved for adjuvant therapy in GIST, but the long term benefit of this treatment, its optimal duration and indications are not precisely defined. Ongoing studies should allow to precise the place of imatinib as adjuvant therapy in GIST

Neoadjuvant sorafenib combined with gemcitabine plus oxaliplatin in advanced hepatocellular carcinoma

This paper reports the first case of a patient with hepatocellular carcinoma with lymph node metastasis treated by sorafenib combined with gemcitabine plus oxaliplatin, with a partial response and normalization of α fetoprotein, which allowed curative surgery. The potential synergy between these three drugs needs to be confirmed, and is currently being investigated in a randomized phase II trial