Epidemiology of biliary duct cancers

Les cancers des voies biliaires sont rares et représentent 3 % des cancers digestifs. Leur progression est insidieuse, aboutissant souvent à un diagnostic tardif et à un pronostic sombre. L’incidence augmente dans les pays occidentaux au cours des trois dernières décennies. Les cholangiocarcinomes intra (60 %) et extra-hépatiques (25 %) sont à distinguer des cancers de la vésicule biliaire (15 %) dont la preuve histologique est souvent présente, la prédominance plutôt féminine et la répartition géographique différente. Les facteurs de risque sont assez similaires et agissent par l’intermédiaire de l’inflammation des tissus biliaires. Le traitement curatif est la chirurgie, et seule la chimiothérapie palliative des cholangiocarcinomes a fait, récemment, la preuve de sa modeste efficacité.Biliary tract cancers are rare and represent 3% of all digestive tract cancers. These tumors progress insidiously and involve a poor prognosis. Their incidence is increasing in Western countries during the last three decades. Cholangiocarcinoma can affect either the intrahepatic (60%) or extrahepatic (25%) biliary ducts and should be separated from gallbladder carcinoma. This latest is most common in women, gives frequently its histological proof and has different geographic localization. The risk factors induce cancer through inflammatory reaction on the biliary epithelium.Resection is the curative treatment and only palliative chemotherapy is proved efficient in cholangiocarcinoma

Adjuvant chemotherapy for biliary tract cancer

Le niveau de preuve de l’efficacité de la chimiothérapie adjuvante dans les tumeurs des voies biliaires reste faible et ne permet pas de proposer de recommandation en ce sens. La présence de facteurs de mauvais pronostic (et notamment une résection R1 ou un envahissement ganglionnaire) pourrait cependant constituer une indication de radiothérapie ou de radiochimiothérapie adjuvante. Ces stratégies doivent être discutées et validées dans des réunions de concertation multidisciplinaire. Malgré l’absence de validation de ces traitements, les études de pratiques suggèrent que plus de la moitié des patients sont traités en France. Seuls des essais prospectifs randomisés permettront de répondre à l’utilité de ces traitements adjuvants dans les cancers des voies biliaires résécables. Ils permettront en outre de déterminer des groupes à risque, peut-être plus susceptibles d’en bénéficier (localisation, statut R0 ou R1, statut ganglionnaire). Un essai français de phase III est en cours sous l’égide de la FFCD (Fédération Française de Cancérologie Digestive) et de la Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) (essai PRODIGE 12). Il évalue l’intérêt d’une chimiothérapie adjuvante associant la gemcitabine à l’oxaliplatine à une surveillance postopératoire.The efficacy level of proof of adjuvant chemotherapy in bile duct tumours remains low and no recommendations are therefore retainable. Bad prognosis factors, including R1 resection or lymph node invasion, could enforce the indication of adjuvant radiotherapy or radio chemotherapy. These strategies must be discussed thoroughly and validated by multidisciplinary meetings. In spite of the absence of validation of these treatments, medical practice investigations in France suggest that more than half of these patients are in fact being treated.Only prospective randomized trials would be able to answer the question of the effectiveness of these adjuvant treatments in resectable bile duct cancers. Moreover will allow to determine high risk groups (tumour localisation, R0 or R1 resection, lymph node involvement) of patients who could benefit from them. Under the aegis of both the French Digestive Cancer Federation (FFCD) and the Anti-Cancer Centers Federation (FNCLCC) a French phase III trial is ongoing (PRODIGE 12 trial) assessing the interest of a combined oxaliplatin and gemcitabin adjuvant regimen compared with only post operative monitoring

o 013safety and efficacy of trifluridine tipiracil in previously treated metastatic colorectal cancer mcrc preliminary results from the phase iiib international open label early access preconnect study

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First Characterization with Ultrasound Contrast Agent of a Fibrovascular Polyp Before Its Endoscopic Resection: A Case Report (with Videos)

We described for the first time the contrast enhancement of a giant fibrovascular esophageal polyp using ultrasound contrast agent, Sonovue® (Bracco, Milan, Italy) during echoendoscopy. Fine Doppler was unsuccessful in showing vascularization due to the mobile characteristic of the tumor. In contrast, via Sonovue®, tissue microcirculation was highlighted inside the entire head of the polyp, leading to better appreciate the risk of bleeding related to its resection. In a second part, we showed the feasibility of classic polypectomy for this giant polyp (5×5 cm) without complication and results of control endoscopy at 3 months. The present case is summarized in a video

Alpha-fetoprotein kinetics in patients with hepatocellular carcinoma receiving ramucirumab or placebo: An analysis of the phase 3 REACH study

Background: Post-hoc analyses of AFP response and progression and their relationship with objective measures of response and survival were performed in patients from REACH. Methods: Serum AFP was measured at baseline and every 3 cycles (2 weeks/cycle). Associations between AFP and radiographic progression and efficacy end points were analysed. Results: Median percent AFP increase from baseline was smaller in the ramucirumab than in the placebo arm throughout treatment. Time to AFP progression (HR 0.621; P < 0.0001) and to radiographic progression (HR 0.613; P < 0.0001) favoured ramucirumab. Association between AFP and radiographic progression was shown at 6 (OR 6.44, 95% CI 4.03, 10.29; P < 0.0001) and 12 weeks (OR 2.28, 95% CI 1.47, 3.53; P = 0.0002). AFP response was higher with ramucirumab compared with placebo (P < 0.0001). More patients in the ramucirumab arm experienced tumour shrinkage and AFP response compared with placebo. Survival was longer in patients with AFP response (13.6 months) than in patients without (6.2 months), irrespective of treatment (HR 0.457, P < 0.0001). Conclusions: Treatment with ramucirumab prolonged time to AFP progression, slowed AFP increase and was more likely to induce AFP response. Similar benefits in radiographic progression and response correlated with AFP changes

Metals distribution in colorectal biopsies: New insight on the elemental fingerprint of tumour tissue

International audienceBackground: Colorectal cancer is considered to be an environmental disease. In this context, the study of environmental risk factors associated with the presence of chemical elements is important, as well as improving our knowledge of the elemental fingerprint of tumor tissuecompared to non-cancer tissue.Aims: The objective was to evaluate the element distribution in colorectal adenocarcinoma biopsies, adjacent non-tumor tissues, and healthy controls (non-cancer colorectal biopsies including occlusion or ischemic colons).Methods: The study is a case-control study which compared the element distribution in colon biopsies from two groups of patients: with colorectal cancer and without colorectal cancer. Patients with colorectal cancer provided 2 different groups of samples: colorectal cancer biopsies and adjacent non-tumor tissues. 15 metal concentrations (Al, B, Cd, Cr, Cu, Fe, Mg, Mn, Ni, Pb, Se, Si, Ti, V, and Zn) in colorectal biopsies were quantified by using acid digestion procedures and then inductively coupled plasma (ICP) atomic emission spectrometry.Results: A total of 104 patients were included. 76 patients in the colorectal cancer group (i.e. tumor and adjacent non-tumor tissues) and 28 patients in the healthy control group (i.e. noncancer colorectal biopsies). Among the 15 elements analyzed by ICP spectrometry, only boron, chromium, zinc, silicon, and magnesium were found in colorectal tissue at clearly detectable concentrations. Our data indicated that colorectal tumor biopsies have significantly elevated concentrations of magnesium as compared to adjacent non-tumor or healthy tissues. Zinc concentration followed the same trend but differences were not statistically significant. In addition, silicon appears to be more accumulated in colorectal cancer tissue than in healthy non-cancer tissue, while chromium was mostly found in adjacent non-tumor tissue. Conclusion: Magnesium, chromium, zinc and silicon were found in noteworthy concentrations in colorectal tumor. Their potential role in colorectal carcinogenesis should be explored

International Preoperative Rectal Cancer Management: Staging, Neoadjuvant Treatment, and Impact of Multidisciplinary Teams

BACKGROUND: Little is known regarding variations in preoperative treatment and practice for rectal cancer (RC) on an international level, yet practice variation may result in differences in recurrence and survival rates. METHODS: One hundred seventy-three international colorectal centers were invited to participate in a survey of preoperative management of rectal cancer. RESULTS: One hundred twenty-three (71%) responded, with a majority of respondents from North America, Europe, and Asia. Ninety-three percent have more than 5 years' experience with rectal cancer surgery. Fifty-five percent use CT scan, 35% MRI, 29% ERUS, 12% digital rectal examination and 1% PET scan in all RC cases. Seventy-four percent consider threatened circumferential margin (CRM) an indication for neoadjuvant treatment. Ninety-two percent prefer 5-FU-based long-course neoadjuvant chemoradiation therapy (CRT). A significant difference in practice exists between the US and non-US surgeons: poor histological differentiation as an indication for CRT (25% vs. 7.0%, p = 0.008), CRT for stage II and III rectal cancer (92% vs. 43%, p = 0.0001), MRI for all RC patients (20% vs. 42%, p = 0.03), and ERUS for all RC patients (43% vs. 21%, p = 0.01). Multidisciplinary team meetings significantly influence decisions for MRI (RR = 3.62), neoadjuvant treatment (threatened CRM, RR = 5.67, stage II + III RR = 2.98), quality of pathology report (RR = 4.85), and sphincter-saving surgery (RR = 3.81). CONCLUSIONS: There was little consensus on staging, neoadjuvant treatment, and preoperative management of rectal cancer. Regular multidisciplinary team meetings influence decisions about neoadjuvant treatment and staging methods

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