REOX: Evaluation of the Efficacy of Retreatment With an Oxaliplatin-containing Regimen in Metastatic Colorectal Cancer: A Retrospective Single-center Study.

BACKGROUND: Treatment of metastatic colorectal adenocarcinoma (mCRC) has evolved, and survival is over 30 months in contemporary trials. Nevertheless, there is a paucity of effective regimes after the first or second-line treatment. Thus, reexposure to previously used drugs has become a treatment strategy for some patients. We aimed to evaluate the efficacy of retreatment with an oxaliplatin-containing regimen in mCRC and correlate this with clinicopathologic features. PATIENTS AND METHODS: We retrospectively analyzed 83 patients with mCRC who underwent reexposure to oxaliplatin (REOX). REOX was defined as a second trial of an oxaliplatin-containing regimen after a previous failure. Primary endpoint was time to treatment failure (TTF). RESULTS: The median age was 53.5 years, and the female/male ratio was 51.8%/48.2%. The site of the primary tumor was colon (67.5%) and rectal (32.5%). KRAS was mutated in 39.8%. Liver-limited metastasis was found in 19.3% of patients. The main regimen was 5-fluorouracil, levoleucovorin, and oxaliplatin (mFOLFOX6) (84.3%). Bevacizumab and cetuximab were used in 42.2% and 6% of patients, respectively. REOX was used in the third and fourth lines in 48.2% and 25.3% of patients, respectively. The median TTF after REOX was 6.04 months. Overall survival (OS) was 10.04 months. Disease control (complete response + partial response + stable disease) was observed in 56.6%, whereas 42.2% had progressive disease. Partial response + complete response to previous oxaliplatin was predictive of prolonged OS. Patients who attained disease control had better median OS compared with those with progressive disease (14.5 vs. 6.24 months; P < .0001). CONCLUSION: In the setting of heavily pretreated patients with mCRC, REOX was an effective treatment, with mTTF of 6.04 months in our cohort. Selection of patients with the longest time since previous oxaliplatin can translate in better outcome. Further studies should be conducted to confirm our data.

Nonalcoholic fatty liver disease associated with obstructive sleep apnea: just a coincidence?

BACKGROUND: Obesity is associated with obstructive sleep apnea (OSA) and nonalcoholic fatty liver disease (NAFLD). It has been shown that OSA could be an independent risk factor for NAFLD. OSA could cause not only insulin resistance but worse NAFLD through nocturnal hypoxemia. This study aimed to evaluate the frequency of OSA and NAFLD in obese patients and the relationship between OSA, insulin resistance, and severity of steatohepatitis (nonalcoholic steatohepatitis (NASH)). METHODS: Forty obese patients submitted to bariatric surgery were evaluated. Sleep studies, fasting blood glucose, serum insulin, homeostasis model assessment (HOMA-IR), and liver enzymes were measured. Liver biopsies were evaluated for features of NAFLD including degrees of steatosis, inflammation, cellular ballooning, and fibrosis. NASH was diagnosed in those with steatosis + ballooning or steatosis + fibrosis. The diagnosis of OSA was based on an apnea/hypopnea index (AHI) ≥ 5 events/hours. RESULTS: OSA was present in 32 (80.0%), NAFLD in 33 (82.5%), and NASH in 32 (80.0%) patients. Patients with AHI ≥ 15 ev/h had higher serum insulin levels (30.0 ± 12.8 vs. 22.6 ± 17.3 µU/ml; p = 0.015) and HOMA-IR (7.5 ± 4.0 vs. 5.4 ± 4.1; p = 0.016) when compared with those with AHI < 15 ev/h, but no association was found between AHI and NASH (81.0% vs. 78.9%; p = 1.000) or oxihemoglobin desaturation <84% and NASH (81.2% vs. 70.8%; p = 0.709) when these groups were compared. CONCLUSIONS: Obese patients had elevated OSA and NAFLD frequencies. OSA was associated with insulin resistance but not with the severity of NASH.