28 research outputs found
Thromboembolic Disease in Advanced Colorectal Cancer Treated with Chemotherapy and Bevacizumab: A Case of Real “Pan-Thrombosis”
Lymph node evaluation and survival after curative-intent resection of duodenal adenocarcinoma: A matched cohort study
Lymph node (LN) metastasis in patients with duodenal adenocarcinoma is associated with poor prognosis; however, the optimal extent of LN assessment and the interaction between LN assessment and adjuvant systemic therapy is poorly understood.
Resected non-metastatic duodenal adenocarcinoma patients (n = 1743) were identified in the National Cancer Database (1998–2011). Logistic regression analysis identified covariates associated with LN metastasis. The influence of increasing LN cut-off points on overall survival (OS) was analysed using the log-rank test and Cox proportional hazards modelling. Adjuvant chemotherapy (AC) and surgery alone cohorts were matched (1:1) by propensity scores based on the likelihood of nodal metastasis or survival hazard on Cox modelling. OS in the matched cohort was compared by Kaplan–Meier estimates.
LN metastases were present in 865 (49.6%) patients. Increasing LN assessment was associated with an increased likelihood of nodal involvement (P = 0.008). In node-negative patients, increasing LN assessment was associated with a decreased risk of death, with the largest actuarial survival differences observed for ≥15 LN (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.48–0.82, P = 0.001). In the propensity score-matched cohort of node-negative patients, AC was associated with non-significant improvements in 5-year actuarial (66.1% versus 58.7%, HR 0.79, 95% CI 0.53–1.18, P = 0.249), and did not vary by adequacy of LN counts (<15 LNs: HR 0.79, 95% CI 0.51–1.24, P = 0.305; ≥15 LNs: HR 0.90, 95% CI 0.35–2.30, P = 0.900).
The extent of LN identification has prognostic significance in resected node-negative duodenal adenocarcinoma, but cannot be implicated in the selection of node-negative patients for AC.
By analysis of the United States National Cancer Database:•Duodenal adenocarcinoma is a rare gastrointestinal malignancy.•Prognostically relevant lymph node cut-points are associated with survival variations in resected patients.•Adjuvant systemic therapy does not provide a survival advantage for node-negative patients with ‘inadequate’ lymph node staging
Leucovorin, Fluorouracil, and Irinotecan (FOLFIRI) plus Bevacizumab for Metastatic Colorectal Cancer
Risk of Thromboembolism with the Angiogenesis inhibitor Bevacizumab in Metastatic Colo-Rectal Cancer Patients
Efficacité des agents antiangiogéniques dans les cancers colorectaux et autres tumeurs digestives
Metastatic Colorectal Cancer Outcomes by Age Among ARCAD First- and Second-Line Clinical Trials
Background: We evaluated the time to progression (TTP) and survival outcomes of second-line therapy for metastatic colorectal cancer among adults aged 70 years and older compared with younger adults following progression on first-line clinical trials. Methods: Associations between clinical and disease characteristics, time to initial progression, and rate of receipt of second-line therapy were evaluated. TTP and overall survival (OS) were compared between older and younger adults in first and second-line trials by Cox regression, adjusting for age, sex, Eastern Cooperative Oncology Group Performance Status, number of metastatic sites and presence of metastasis in the lung, liver, or peritoneum. All statistical tests were 2-sided. Results: Older adults comprised 16.4% of patients on first-line trials (870 total older adults aged >70 years; 4419 total younger adults less than 70 years, on first-line trials). Older adults and those with Eastern Cooperative Oncology Group Performance Status >0 were less likely to receive second-line therapy than younger adults. Odds of receiving second-line therapy decreased by 11% for each additional decade of life in multivariable analysis (odds ratio ¼ 1.11, 95% confidence interval ¼ 1.02 to 1.21, P ¼ .01). Older and younger adults enrolled in second-line trials experienced similar median TTP and median OS (median TTP ¼ 5.1 vs 5.2 months, respectively; median OS ¼ 11.6 vs 12.4 months, respectively). Conclusions: Older adults were less likely to receive second-line therapy for metastatic colorectal cancer, though we did not observe a statistical difference in survival outcomes vs younger adults following second-line therapy. Further study should examine factors affecting decisions to treat older adults with second-line therapy. Inclusion of geriatric assessment may provide better criteria regarding the risks and benefits of second-line therapy.Nadine J. McCleary, MD, MPH, William S. Harmsen, MS, Ellana Haakenstad, MPH, James M. Cleary, MD, PhD, Jeffrey A. Meyerhardt, MD, MPH, FASCO, John Zalcberg, PhD, MBBS, Richard Adams, MD, Axel Grothey, MD, Alberto F. Sobrero, MD, Eric Van Cutsem, MD, PhD, Richard M. Goldberg, MD, FASCO, Marc Peeters, MD, PhD, Josep Tabernero, MD, Matt Seymour, MD, Leonard B. Saltz, MD, Bruce J Giantonio, MD, Dirk Arnold, MD, Mace L. Rothenberg, MD, Miriam Koopman, MD, Hans-Joachim Schmoll, MD, Henry C. Pitot, MD, Paulo M. Hoff, MD, Niall Tebbutt, MD, Gianluca Masi, MD, John Souglakos, MD, PhD, Carsten Bokemeyer, MD, Volker Heinemann, MD, Takayuki Yoshino, MD, PhD, Benoist Chibaudel, MD, Aimery deGramont, MD, Qian Shi, PhD, Stuart M. Lichtman, M