Postchemoradiotherapy Pathologic Stage Classified by the American Joint Committee on the Cancer Staging System Predicts Prognosis of Patients with Locally Advanced Esophageal Squamous Cell Carcinoma

IntroductionTo determine whether the postchemoradiotherapy (post-CRT) pathologic stage predicts the outcomes of patients with locally advanced esophageal squamous cell carcinoma (ESCC) undergoing preoperative CRT followed by surgery.MethodsFrom three phase II trials of preoperative CRT for locally advanced ESCC, 140 patients were included. Preoperative CRT comprised twice weekly paclitaxel and cisplatin-based regimens and 40-Gy radiotherapy in 20 fractions. The post-CRT pathologic stage was classified according to the American Joint Committee on Cancer, 7th edition staging system. The prognostic effects of clinicopathologic factors were analyzed using Cox regression.ResultsWith a median follow-up of 61.9 months, the median progression-free survival (PFS) and overall survival (OS) of the entire cohort were 24.5 and 30.9 months, respectively. The post-CRT pathologic stage was 0 in 34.5%, I in 12.9%, II in 29.3%, III in 13.6%, and ypT0N1-2 in 6.4% of the patients. The median PFS was 47.2, 25.9, 16.0, 9.4, and 15.1 months, and the median OS was 57.4, 34.1, 26.2, 14.1, and 17.6 months for patients with post-CRT pathologic stage 0, I, II, III, and ypT0N1-2, respectively. In multivariate analysis, performance status (p < 0.001), tumor location (p = 0.016), and extranodal extension (p = 0.024) were independent prognostic factors for PFS, whereas performance status (p < 0.001) and post-CRT pathologic stage (p = 0.027) were independent prognostic factors for OS.ConclusionsThe post-CRT pathologic stage classified by American Joint Committee on Cancer, 7th edition staging system predicted the survival of locally advanced ESCC patients who underwent preoperative paclitaxel and cisplatin-based CRT followed by esophagectomy

Sequential gemcitabine and platinum versus first-line combination of gemcitabine and platinum for advanced pancreatic cancer treatment: a retrospective study

The purpose of this study was to investigate the impact of combinational versus sequential gemcitabine and platinum on prognosis of advanced pancreatic cancer. ;Two hundred and three patients with advanced pancreatic cancer were selected. They were divided into GemP (first-line gemcitabine and platinum), Gem-then-P (sequential gemcitabine and platinum), Gem/other (first-line gemcitabine-based therapy without subsequent platinum), and Gem (first-line gemcitabine-based therapy without subsequent systemic therapy) groups. The Kaplan-Meier method and log-rank test were used for survival analyses. Cox regression model and propensity score matching were used for prognostic analyses. ;The median survival was 12.5 months [95 % confidence interval (CI), 11.2-13.7] in the GemP group (N = 65), 8.3 months (95 % CI 5.0-11.7) in the Gem-then-P group (N = 35), 11.6 months (95 % CI 4.6-18.5) in the Gem/other group (N = 26), and 4.7 months (95 % CI 3.3-6.0) in the Gem group (N = 77) (P &lt; 0.001). Considering the GemP and Gem-then-P groups, performance status, serum creatinine, and response to first-line treatment were independent prognostic factors for overall survival in the multivariate analysis. No specific factors were identified for predicting the choice between GemP and Gem-then-P. ;First-line gemcitabine and platinum-based combinations were not superior to sequential gemcitabine and platinum for overall survival. The best sequence of chemotherapy for advanced pancreatic cancer should be explored in future clinical trials

Radiotherapy as salvage treatment after failure of tyrosine kinase inhibitors for a patient with advanced gastrointestinal stromal tumor

Gastrointestinal stromal tumors (GISTs) are c-Kit (CD117)-expressing mesenchymal tumors of the gastrointestinal tract. Understanding the molecular characteristics of these uncommon tumors has led to the use of c-Kit-targeting tyrosine kinase inhibitors in the treatment of patients with advanced GISTs. Although imatinib, sunitinib, and regorafenib have drastically improved survival in patients with advanced GISTs, there remains a need for salvage treatment options for patients whose tumors progress despite tyrosine kinase inhibitor treatment. Historically considered to be chemoresistant and radioresistant, a substantial amount of research has focused on the use of targeted therapies for patients with advanced GISTs. Herein, we present a patient with an advanced GIST who had clinical and radiographic responses to radiotherapy after failure of imatinib and sunitinib. Keywords: Gastrointestinal stromal tumors, Radiotherap

Postchemoradiotherapy Pathologic Stage Classified by the American Joint Committee on the Cancer Staging System Predicts Prognosis of Patients with Locally Advanced Esophageal Squamous Cell Carcinoma

Introduction: To determine whether the postchemoradiotherapy (post-CRT) pathologic stage predicts the outcomes of patients with locally advanced esophageal squamous cell carcinoma (ESCC) undergoing preoperative CRT followed by surgery. Methods: From three phase II trials of preoperative CRT for locally advanced ESCC, 140 patients were included. Preoperative CRT comprised twice weekly paclitaxel and cisplatin-based regimens and 40-Gy radiotherapy in 20 fractions. The post-CRT pathologic stage was classified according to the American Joint Committee on Cancer, 7th edition staging system. The prognostic effects of clinicopathologic factors were analyzed using Cox regression. Results: With a median follow-up of 61.9 months, the median progression-free survival (PFS) and overall survival (OS) of the entire cohort were 24.5 and 30.9 months, respectively. The post-CRT pathologic stage was 0 in 34.5%, I in 12.9%, II in 29.3%, III in 13.6%, and ypT0N1-2 in 6.4% of the patients. The median PFS was 47.2, 25.9, 16.0, 9.4, and 15.1 months, and the median OS was 57.4, 34.1, 26.2, 14.1, and 17.6 months for patients with post-CRT pathologic stage 0, I, II, III, and ypT0N1-2, respectively. In multivariate analysis, performance status (p &lt; 0.001), tumor location (p = 0.016), and extranodal extension (p = 0.024) were independent prognostic factors for PFS, whereas performance status (p &lt; 0.001) and post-CRT pathologic stage (p = 0.027) were independent prognostic factors for OS. Conclusions: The post-CRT pathologic stage classified by American Joint Committee on Cancer, 7th edition staging system predicted the survival of locally advanced ESCC patients who underwent preoperative paclitaxel and cisplatin-based CRT followed by esophagectomy

Programmed death-1 and programmed death ligand-1 blockade for advanced urothelial carcinoma

Immunotherapy with immune checkpoint inhibitors (ICIs) has changed the paradigm of anticancer therapy in many cancer types, including advanced urothelial carcinoma (UC). Two anti-programmed death-1 (PD-1) monoclonal antibodies (pembrolizumab and nivolumab) and three anti-PD ligand-1 (PD-L1) monoclonal antibodies (atezolizumab, durvalumab, and avelumab) have demonstrated their efficacy in the treatment of advanced UC. The response rate of the above ICIs in unselected patients with advanced UC is about 20%. Several on-going large-scale phase III studies explore whether different combinations with ICIs improve the efficacy. To date, there have been several phase I, II, and III studies that examined the efficacy of single-agent PD-1 or anti-PD-L1 blockade in platinum-failed advanced UC patients, and two phase II studies demonstrated the efficacy of PD-1/PD-L1 blockade as the first-line therapy in cisplatin-ineligible advanced UC patients. Here, we review and compare the efficacy and adverse events of the five ICIs in advanced UC

Different immune contextures underlie tumor site‐specific responses to immune checkpoint blockade in esophageal cancer

Abstract Immune checkpoint inhibitors (ICIs) have demonstrated efficacy in advanced esophageal squamous cell carcinoma (ESCC). Heterogeneous responses to ICIs have been reported previously. Here, we describe a patient with advanced ESCC exhibiting a response to durvalumab plus tremelimumab for more than 6 months except primary resistant esophageal tumor. The esophageal tumor had higher regulatory T cells, neutrophils, and mast cells scores estimated by NanoString platform than hepatic tumor. The immunohistochemistry study confirmed higher expression levels of Foxp3, and myeloperoxidase (MPO) in the esophageal tumor. The different immune contextures may underlie the heterogeneous responses to ICI combination in this ESCC patient