Bevacizumab Treatment for Metastatic Colorectal Cancer in Real-World Clinical Practice.

Background and Objectives: Colorectal cancer (CRC) is a leading cause of cancer-related mortality and morbidity worldwide. Bevacizumab was approved for the treatment of metastatic colorectal cancer (mCRC) based on favorable benefit-risk assessments from randomized controlled trials, but evidence on its use in the real-world setting is limited. The aim of the current study is to evaluate the outcomes and safety profile of bevacizumab in mCRC in a real-world setting in Romania. Patients and Methods: This was an observational, retrospective, multicentric, cohort study conducted in Romania that included patients with mCRC treated with bevacizumab as part of routine clinical practice. Study endpoints were progression-free survival, overall survival, adverse events, and patterns of bevacizumab use. Results: A total of 554 patients were included in the study between January 2008 and December 2018. A total of 392 patients (71%) received bevacizumab in the first line and 162 patients (29%) in the second line. Bevacizumab was mostly combined with a capecitabine/oxaliplatin chemotherapy regimen (31.6%). The median PFS for patients treated with bevacizumab was 8.4 months (interquartile range [IQR], 4.7-15.1 months) in the first line and 6.6 months (IQR, 3.8-12.3 months) in the second line. The median OS was 17.7 months (IQR, 9.3-30.6 months) in the first line and 13.5 months (IQR, 6.7-25.2 months) in the second line. Primary tumor resection was associated with a longer PFS and OS. The safety profile of bevacizumab combined with chemotherapy was similar to other observational studies in mCRC. Conclusions: The safety profile of bevacizumab was generally as expected. Although the PFS was generally similar to that reported in other studies, the OS was shorter, probably due to the less frequent use of bevacizumab after disease progression and the baseline patient characteristics. Patients with mCRC treated with bevacizumab who underwent resection of the primary tumor had a higher OS compared to patients with an unresected primary tumor.

Influence of the Primary Tumor Location on the Pattern of Synchronous Metastatic Spread in Patients with Stage IV Colorectal Carcinoma, According to the 8 th Edition of the AJCC Staging System.

BACKGROUND AND AIMS: The correlations between primary tumor location (right colon cancer - RCC, left colon cancer - LCC and rectal cancer - RC) and the incidence of metastatic sites are scarce and divergent. The current study is the first which compares the pattern of metastatic distribution (M1a: metastasis to one organ/site, excluding peritoneum; M1b: two or more metastatic sites; M1c: peritoneal metastases) between RCC, LCC and RC, respectively. METHODS: All patients operated for colorectal cancer (CRC) between January 2006 and December 2015 were analyzed to assess the primary tumor location, the presence and site of synchronous metastases. Univariate analysis determined the statistical significance of association between each CRC location and the metastatic pattern. Multinomial logistical regression model compared the prevalence of each metastatic pattern for each CRC location. RESULTS: Out of 5,107 patients, 1,318 (25.80%) had metastases on the moment of CRC diagnosis. There were no statistically significant association between the metastatic pattern and the patients' gender (M1a, p=0.321; M1b, p=0.539; M1c, p=0.417, Chi-square) or patients' age (p=0.616 Mann-Whitney U-test). RC had a significant higher relative risk for M1a (RR of 1.437, p=0.014) and a lower relative risk for M1c (RR of 0.564, p=0.001), compared to LCC. On the contrary, compared with LCC, the RCC showed a significant lower relative risk for M1a (RR of 0.673, p=0.006) and a higher relative risk for M1c (RR of 1.834, p=0.0001). CONCLUSION: There is a strong correlation between the primary location of CRC and the pattern of the metastatic spread, with potential prognostic implications.

Current Management of Gastric Cancer in Europe.

Gastric cancer is one the most common maligancies and a considerable health problem throughout the world. Multimodal approach, encompassing both radical surgery and perioperative chemotherapy provides the best chance to cure resectable gastric cancer. Data originating from well-conducted randomized trials demonstrate that chemotherapy improves survival in patients with metastatic disease. During the last years, two targeted therapies have been approved in metastatic setting. Based on promising clinical trials results, it is expected for the near future that immunotherapy to be incorporated in the multimodal treatment of gastric cancer.

Comparative Analysis between Simultaneous Resection and Staged Resection for Synchronous Colorectal Liver Metastases - A Single Center Experience on 300 Consecutive Patients.

Introduction: In synchronous colorectal liver metastases (SCLMs), simultaneous resection (SR) of the primary tumor and liver metastases has not gained wide acceptance. Most authors prefer staged resections (SgR), especially in patients presenting rectal cancer or requiring major hepatectomy. Methods: Morbidity, mortality, survival rates and length of hospital stay were compared between the two groups of patients (SR vs. SgR). A subgroup analysis was performed for patients with similar characteristics (e.g. rectal tumor, major hepatectomy, bilobar metastases, metastatic lymph nodes, preoperative chemotherapy). Results: Between 1995 and 2016, SR was performed in 234 patients, while 66 patients underwent SgR. Comparative morbidity (41% vs. 31.8%, respectively, p = 0.1997), mortality (3.8% vs. 3%, respectively, p = 1) and overall survival rates (85.8%, 51.3% and 30% vs. 87%, 49.6% and 22.5%, at 1-, 3- and 5-years, respectively, p = 0.386) were similar between the SR and SgR group. Mean hospital stay was significantly shorter in patients undergoing SR than SgR (15.11 ‚+- 8.60 vs. 19.42 ‚+- 7.36 days, respectively, p 0.0001). The characteristics of SR and SgR groups were similar, except the following parameters: rectal tumor (34.1% vs. 19.7%, respectively, p = 0.0245), metastatic lymph nodes (68.1% vs. 86.3%, respectively, p = 0.0383), bilobar liver metastases (22.6% vs. 37.8%, respectively, p = 0.0169), major hepatectomies (13.2% vs. 30.3%, respectively, p= 0.0025) and neo-adjuvant chemotherapy (13.2% vs. 77.2%, respectively, p 0.0001). A comparative analysis of morbidity, mortality and survival rates between SR and SgR was performed for subgroups of patients presenting these parameters. In each of these subgroups, SR was associated with similar morbidity, mortality and survival rates compared with SgR (p value 0.05). CONCLUSION: In patients with SCLMs, SR provides similar short-term and long-term outcomes as SgR, with a shorter hospital stay. Therefore, in most patients with SCLMs, SR might be considered the treatment of choice.

Fluoropyrimidines plus cisplatin versus gemcitabine/gemcitabine plus cisplatin in locally advanced and metastatic biliary tract carcinoma - a retrospective study.

AIM: This is a retrospective study of patients with advanced biliary tract carcinoma (BTC), who were treated with different regimens of chemotherapy. METHODS: We studied patients with advanced BTC registered at the Department of Oncology at the Fundeni Clinical Institute between 2004 and 2008. The following data were analyzed: rate of response, progression free survival (PFS) to first and second line of chemotherapy, overall survival (OS) and drug toxicity. Ninety-six patients were eligible having either advanced intra or extrahepatic cholangiocarcinoma, or gallbladder cancer with no prior chemotherapy. RESULTS: Out of 96 patients, 57 (59.4%) received fluoropyrimidines (FP)+cisplatin and 39 (40.6%) gemcitabine (Gem)+/-cisplatin. The median PFS for FP+cisplatin was 5.9 months (95%CI 5-6.9) and for Gem+/-cisplatin 6.3 months (95%CI 5.4-7.1), p=0.661. Median OS for FP+cisplatin was 10.3 months (95%CI 7.5-13.1) and for Gem+/-cisplatin 9.1 months (95%CI 7.0-11.2), p=0.098. On disease progression, 46 patients received second line CT (Gem or FP+/-platinum compounds). Median OS for patients with FP based first line and Gem+/-cisplatin in second line was 19 months (95%CI 8.9-29) higher than for the reverse sequence: 13.2 months (95%CI 12-14.4), but not statistically significant (p=0.830). All patients were evaluated for toxicities. Most patients (75.5%) reported at least one adverse event. CONCLUSION: Our results through direct comparison of FP+cisplatin with Gem+/-cisplatin as first line treatment did not show any statistical differences in terms of rate of response, PFS and OS. However, our study showed that FP+cisplatin as first line and Gem based second line therapy gave a better OS rate.

[Locally advanced or metastatic gastric cancer--new therapeutic solutions]. / Cancerul gastric local avansat sau metastazat--noi solutii terapeutice.

Gastric cancer represents a major health problem worldwide. It is often diagnosed at an advanced stage, because screening, which would help an early detection is performed only in Japan. Gastric cancer rates may be decreased by reducing smoking and alcohol consumption and by increasing the number of fresh fruits and vegetables eaten. Eradication of Helicobacter pylori may also decrease gastric cancer incidence. Seventy-five percent of the patients are diagnosed in unresectable stage. They represent a challenge for clinicians as they have to choose between a strictly supportive approach or to expose patients to the side-effects of a potentially ineffective treatment. The treatment of advanced gastric cancer is essentially palliative. Therapy's main aim in this common group of patients with unresectable or metastatic disease is to achieve good symptomatic control, to improve quality of life, to avoid tumor progression and to prolong survival.