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Real-world efficacy and safety of capecitabine with oxaliplatin in patients with advanced adenocarcinoma of the ampulla of Vater.
Lee, Seunghwan; Park, Se Jun; Shin, Kabsoo; Hong, Tae Ho; Kim, In-Ho; Lee, Myung Ah.
Affiliation
  • Lee S; Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Secho-gu, Seoul, Korea.
  • Park SJ; Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Secho-gu, Seoul, Korea.
  • Shin K; Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • Hong TH; Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Secho-gu, Seoul, Korea.
  • Kim IH; Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • Lee MA; Department of General Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
BMC Cancer ; 24(1): 634, 2024 May 23.
Article in En | MEDLINE | ID: mdl-38783256
ABSTRACT

BACKGROUND:

Adenocarcinoma of the ampulla of Vater (AoV) is one of the rare periampullary cancers, and due to its anatomical location, it is categorized into various histologic subtypes. Its rarity and diversity pose challenges in treatment decision-making for patients with advanced AoV carcinoma. This study investigated the efficacy and safety of the combined regimen of capecitabine and oxaliplatin (CAPOX) in a real-world clinical setting.

METHODS:

This investigation encompassed patients with advanced AoV carcinoma who underwent CAPOX treatment. Histologic phenotypes were identified through a combination of histopathological analysis and protein expression markers, including MUC1, CDX2, CK20, and MUC2. The correlation between histopathological determinants and survival outcomes was explored, in addition to an evaluation of the safety profile of CAPOX therapy.

RESULTS:

From January 2010 to June 2023, 42 patients received CAPOX. Of these, 14 patients (33.3%) had not received any prior palliative chemotherapy, while 28 patients (66.7%) had undergone one prior line of chemotherapy. At a median follow up of 9.0 months, the median progression-free survival (PFS) was 4.38 months (95% CI, 2.78-5.69) and the median overall survival (OS) was 9.57 months (95% CI 7.56-11.6). The objective response and disease control rates were 38.1% and 61.9%, respectively. Patients who received CAPOX as a second-line treatment had poorer PFS (HR = 2.62; 95% CI, 1.49-4.90, p = 0.003) and OS (HR = 2.82, 95% CI, 1.47-5.38, p = 0.001) compared to those who received CAPOX as a first-line chemotherapy. There were no statistically significant differences in PFS (p = 0.185) and OS (p = 0.097) between groups based on histologic subtypes. Neutropenia (14.3%) emerged as the predominant grade 3-4 toxicity. Notably, treatment cessation occurred in select instances owing to grade 3 fatigue (9.5%) and peripheral neuropathy (9.5%).

CONCLUSIONS:

This study confirmed the therapeutic efficacy and safety of CAPOX in a real-world setting, consistent with prior phase II trial results. While CAPOX proved feasible for advanced AoV carcinoma regardless of histologic subtype, its reduced effectiveness in second-line settings necessitates further research to determine its optimal palliative use.
Subject(s)
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Ampulla of Vater / Adenocarcinoma / Antineoplastic Combined Chemotherapy Protocols / Common Bile Duct Neoplasms / Capecitabine / Oxaliplatin Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: En Journal: BMC Cancer Journal subject: NEOPLASIAS Year: 2024 Document type: Article Country of publication: United kingdom

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Ampulla of Vater / Adenocarcinoma / Antineoplastic Combined Chemotherapy Protocols / Common Bile Duct Neoplasms / Capecitabine / Oxaliplatin Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: En Journal: BMC Cancer Journal subject: NEOPLASIAS Year: 2024 Document type: Article Country of publication: United kingdom