Factors influencing choice of chemotherapy in metastatic colorectal cancer (mCRC)

Management of metastatic colorectal cancer requires a multimodal approach and must be performed by an experienced, multidisciplinary expert team. The optimal choice of the individual treatment modality, according to disease localization and extent, tumor biology, and patient clinical characteristics, will be one that can maintain quality of life and long-term survival, and even cure selected patients. This review is an overview of the different therapeutic approaches available in metastatic colorectal cancer, for the purpose of defining personalized therapeutic algorithms according to tumor biology and patient clinical features

Residual Site Radiotherapy After Immunochemotherapy in Primary Mediastinal B-Cell Lymphoma: A Monoinstitutional Retrospective Study

Aim: To evaluate the efficacy of residual site radiation therapy (RSRT) on local control (LC), progressionfree (PFS) and overall (OS) survival in patients with primary mediastinal lymphoma (PMBCL), following rituximab and chemotherapy treatment (ICHT). Patients and Methods: The study included 34 patients with PMBCL treated between 2006 and 2014 with ICHT with/without autologous stem cell transplantation and RSRT. Between the end of ICHT/stem cell transplantation and RSRT, patients were evaluated with F-18-fluorodeoxyglucose positron-emission tomography. The gross tumor volume included morphological mediastinal residual disease after ICHT/SCT. The percentage of LC, PFS and OS were assessed. Results: All patients received RSRT with a median dose of 30 Gy. Median follow-up was 82 months. One patient out of 34 (3%) showed progressive disease 9 months from diagnosis. The 10-year PFS and OS were 97% and 97% respectively. Conclusion: RSRT in patients with PMBCL treated with ICHT did not impact unfavorably on LC and patient survival

The role of BMI and age in chemotherapy-induced amenorrhea (CIA) in premenopausal breast cancer (PBC) patients treated with adjuvant FEC100 with or without docetaxel (D)

Background: Transitory or definitive amenorrhea (A) is a related side effect, specifically affecting young women diagnosed with breast cancer and treated with adjuvant chemotherapy (CT). Premature ovarian failure (POF) is often related to increased morbidity and mortality for heart disease and osteoporosis. In this study we analyzed the incidence of CIA in PBC patients and the correlation between their BMI and occurrence of A.Methods: 32 PBC patients, median age 44, were treated with adjuvant FEC±D. BMI was evaluated in all women. At accrual all the pts had normal menstrual activity (MA) and nobody received concomitant endocrine therapy. Results: 18 patients received FEC and 14 patients received FEC+D. In 27 patients A occurred during CT: in 89% of pts with FEC and 86% with FEC+D. In 62% of pts A occurred within first three cycles of CT. CIA occurred within the first two doses in 15/32 pts: in 44% treated with FEC and 50% with FEC+D. MA reappeared at the end of CT in 12% of pts (median age 44 years). 72% of pts had BMI25. In FEC group 14 pts had BMI<24.9 (61% experienced A) and 4 BMI>25 (100% experienced A); MA reappeared in 2 patients (43 and 44 ys), both with BMI<24.9. In FEC+D group 9 pts had BMI<24.9 (50% experienced A) and 5 had BMI>25 (100% experienced A); MA reappeared in 2 pts (35 and 47 years; 1 patient with BMI25). Conclusions: Our small experience showed that A occurs very frequently during FEC±D and that age is the strongest predictor for A occurrence. There was no difference in the incidence of CIA between the 2 subgroups of treatment. No correlation was observed between BMI and appearance of A

BODY MASS INDEX (BMI) AND AMENORRHEA IN PREMENOPAUSAL BREAST CANCER PATIENTS (PBC) TREATED WITH ADJUVANT ANTRACYCLINE AND CYCLOPHOSPAMIDE CHEMOTHERAPY (CT)

Background and aims: Amenorrhea often occurs during chemotherapy and it may reduce fertility and cause menopausal symptoms.The purpose of this study was to determine the incidence of CT-related amenorrhea (CRA) among breast cancer patients following adjuvant chemotherapy and the influence of their BMI. Methods: In this retrospective study we evaluated 18 PBC patients (pts), 43 median age years, treated with 6 cycles of adjuvant anthracycline-cyclophosphamide. BMI was evaluated in all women. Overall population (OP) had regular menstrual cycle (MC) and nobody began hormone therapy, at the same time. Results: Fifteen pts (83%) experienced amenorrhea during CT; the interruption of MC appeared during the first three cycles of CT in about 67% of pts and particularly 4 pts (27%) after 1 cycle, 4 pts (27%) after 2 cycles, 2 pts (13%) after 3 cycles e 5 pts (33%) in subsequent cycles. In OP, 14 pts (78%) had BMI25. MC reappeared at the end of CT in only 2 pts (13%), with a median age of 43 years and BMI<24.9. Three pts (17%) have not amenorrhea during CT; the median age was 34 years and BMI<24.9. Conclusions: In our small experience CRA occurs very frequently. Its incidence and persistence was higher in patients older than 40 years than in younger patients. BMI did not influence occurrence of amenorrhea

EFFICACY AND SAFETY PROFILES OF PEGFILGRASTIM (P) AND LENOGRASTIM (L) IN NON METASTATIC BREAST CANCER (NMBC) PATIENTS RECEIVING ADJUVANT FEC100

Background and aims: neutropenia (N) is common in patients receiving chemotherapy. In literature higher incidence of G3/G4-N was reported in first chemotherapy cycle. Febrile-N (FN) is associated with significant morbidity and mortality. Retrospectively, we evaluated efficacy and safety of single injection of P (6 mg) compared with daily L (263 μg) in primary prophylaxis of N, in NMBC and chemotherapy-naïve patients receiving adjuvant FEC100. Methods: 35 women (median age 54 years) underwent 6 cycles of chemotherapy. At every cycle, 17 patients received daily L from day 5 to 9 (5 total injections), while 18 patients received one dose of P on day 2. Incidence of N, FN and bone pain (NRS >7) were evaluated. Results: in overall population incidence of N was 66%, while G3/G4-N was 54%. In P arm, N was 50%, all G3/G4-N. In L arm N was 82%, of which 58% was G3/G4-N. One case of FN occurred in P arm. During first cycle, incidence of G3/G4-N was 33% and 41% in P and L arms, respectively; no G3/G4-N occurred during the last cycle. Incidence of bone pain was 11% in both arms. Chemotherapy reduction occurred in 50% and 29% in P and L arm, respectively. Conclusions: in our experience, a single injection of P was more effective than 5 daily administration of L, in particular for G3/G4-N incidence, also during first cycle. More dose reduction was made in P arm. The safety profiles of P and L were similar with the same incidence of bone pain

Single-center experience with pegfilgrastim (P) and lenograstim (L) in nonmetastatic breast cancer (NMBC) patients (pts) during adjuvant FEC100 or sequential FEC100 plus DOCETAXEL100 (D100)

Background: Neutropenia (N) is a common chemotherapy (CT) related adverse event and febrile N (FN) often requires hospitalization, being associated with morbidity and mortality. Primary prophylaxis with G-CSF is a common strategy to avoid the onset of FN. Methods: Retrospectively, we evaluated efficacy and safety of daily injections of L (263 μg) from day 5 to 9 (5 total injections) compared with a single injection of P (6 mg) on day 2 in 55 NMBC pts (median age 55 years) during 6 cycles of FEC100 (group A) or 3 cycles of FEC100 followed by further 3 cycles of D100 (group B). Incidence of N, FN and bone pain (BP) (NRS >7) were evaluated. In group A: 35 pts (median age 54 years) received 6 cycles of FEC100. At every cycle, 17 pts received L, while 18 pts one dose of P. In group B: 20 pts (median age 55.5 years) underwent 3 cycles of FEC100 plus 3 of D100. At every cycle, 12 and 8 pts received L and P, respectively. Results: In overall population incidence of N-G3/G4 was 54.5%. In group A: G3/G4-N was 50% and 58% in P and L arm, respectively. One case of FN occurred in P arm. During first cycle, incidence of G3/G4-N was 33% and 41% in P and L arms, respectively; no G3/G4-N occurred during the last cycle. Incidence of BP was 11% in both arms. CT reduction occurred in 50% and 29% in P and L arm, respectively. In group B: G3/G4-N was 25% in P arm and 83% in L arm. No case of FN occurred in both arms. During first cycle, incidence of G3/G4-N was 0% in P and 50% in L arm; while during last cycle no G3/G4-N occurred in the P arm and 25% in L arm. 37% and 50% of pts experienced BP in P and L arm, respectively. CT dose reductions were necessary in 50% of P arm and 58% of L arm. Conclusions: P showed an higher efficacy than L for preventing G3/G4-N in both groups, also in the first cycle, even if the only FN occurred in a patient who was assuming P. There was a higher frequency of BP for L arm in FEC100-D100. In pts assuming FEC100 incidence of CT dose reduction was higher in P arm, while those assuming FEC100-D100 the incidence was higher in L arm

A predictive model of polymetastatic disease from a multicenter large retrospectIve database on colorectal lung metastases treated with stereotactic ablative radiotherapy: The RED LaIT-SABR study

Aim: Stereotactic ablative radiotherapy (SABR) showed increasing survival in oligometastatic patients. Few studies actually depicted oligometastatic disease (OMD) evolution and which patient will remain disease-free and which will rapidly develop a polymetastatic disease (PMD) after SABR. Therefore, apart from the number of active metastases, there are no clues on which proven factor should be considered for prescribing local treatment in OMD. The study aims to identify predictive factors of polymetastatic evolution in lung oligome-tastatic colorectal cancer patients. Methods: This international Ethical Committee approved trial (Prot. Negrar 2019-ZT) involved 23 Centers and 450 lung oligometastatic patients. Primary end-point was time to the polymetastatic conversion (tPMC). Addi-tionally, oligometastases number and cumulative gross tumor volume (cumGTV) were used as combined pre-dictive factors of tPMC. Oligometastases number was stratified as 1, 2-3, and 4-5; cumGTV was dichotomized to the value of 10 cc. Results: The median tPMC in the overall population was 26 months. Population was classified in the following tPMC risk classes: low-risk (1-3 oligometastases and cumGTV 10 cc), with median tPMC of 13.9 months, and high-risk (4-5 oligometastases, any cumGTV) with median tPMC of 9.4 months (p = 0.000). Conclusion: The present study identified predictive factors of polymetastatic evolution after SABR in lung oli-gometastatic colorectal cancer. The results demonstrated that the sole metastases number is not sufficient to define the OMD since patients defined oligometastatic from a numerical point of view might rapidly progress to PMD when the cumulative tumor volume is high. A tailored approach in SABR prescription should be pursued considering the expected disease evolution after SABR, with the aim to avoid unnecessary treatment and toxicity in those at high risk of polymetastatic spread, and maximize local treatment in those with a favorable disease evolution