Articles related to CHEMOTHERAPY

Neoadjuvant Chemotherapy and Upfront Surgery: A Comparative Study in Resectable Pancreatic Cancer In a recent study presented at the 2023 ASCO Annual Meeting, researchers found no significant survival benefit of neoadjuvant chemotherapy over upfront surgery in patients with resectable pancreatic cancer. Key Points: “Results of this trial do not support neoadjuvant FOLFIRINOX as standard of care in resectable pancreatic cancer.” Knut Jørgen Labori, MD, PhD, Oslo University Hospital, Norway

In a recent study presented at the American Association for Thoracic Surgery (AATS) Annual Meeting, researchers reported that more than 75% of patients who received neoadjuvant chemotherapy combined with an immune checkpoint inhibitor (ICI) were still alive and event-free at 1 year. The treatment was also well-tolerated, with a manageable rate of side effects. The 1-year event-free survival rate was 78.3%, and the 1-year overall survival rate was 88.0%. The postoperative complication rate was 35.6%, and the rate of grade 3 or higher treatment-related adverse events was 18.1%. The most common side effects were leukopenia, neutropenia, thrombocytopenia, anemia, and hyperglycemia. Overall, the results of this study suggest that neoadjuvant chemotherapy combined with an ICI is a safe and effective treatment option for patients with resectable esophageal cancer. The treatment was associated with a high rate of pCR and R0 resection, and the side effects were generally manageable.

Dr. Jyoti Mayadev, a professor of Radiation Medicine at University of California San Diego, discussed the treatment of patients with 1B3 cervical cancer at the Society of Gynecological Oncology’s Annual Meeting on Women’s Cancer. The discussion centered around whether to treat patients with primary chemoradiation and brachytherapy or radical surgery. Dr. Mayadev recommends a multidisciplinary approach, but notes that level 1 evidence data from Landoni et al. in 1997 showed no difference in progression-free survivals or overall survivals between radiation therapy and radical hysterectomy in patients with bulky disease, 1B3, and no lymph node disease. Dr. Mayadev discusses the benefits of chemoradiation, including potential toxicity reduction if a patient needs adjuvant therapy after surgery. She also notes that with technologically advanced radiation and brachytherapy, long-term toxicities can be minimized, including genitourinary toxicities at 6-8%, vaginal toxicities at 5%, and fistula at less than 2%. Dr. Mayadev believes that adaptive radiation therapy may further decrease toxicities and increase cure rates for patients with 1B3 cervical cancer. There are ongoing trials for novel therapeutics and adaptive radiation therapy, such as the ARTIA Cervical Trial, which aims to decrease toxicities and collect patient reported outcomes.

From November 15, 2015, to March 9, 2021, scientists conducted an open-label, phase 3 randomized clinical trial at 17 Spanish centers to assess the efficacy and safety of intraoperative HIPEC in patients with locally advanced colon cancer. The primary outcome was the 3-year locoregional control (LC) rate, which was defined as the proportion of patients who did not have peritoneal disease recurrence after adjusting for intention to treat. Patients included ranged in age from 18 to 75 years old and had been diagnosed with locally advanced primary colon cancer prior to surgery. They discovered that combining HIPEC with complete surgical resection for locally advanced colon cancer enhanced the 3-year LC rate compared to surgery alone, and they recommend that this strategy be evaluated for patients with locally advanced colorectal cancer.

The authors present the findings of a large retrospective cohort study that used national data from the SEER-Medicare-linked database to better understand the relationship between antibiotics and PDAC survival. They discovered that perichemotherapy antibiotics were associated with improved survival in patients treated with first-line gemcitabine but not fluorouracil, implying that perichemotherapy antibiotic treatment may have a role in patients with metastatic PDAC receiving gemcitabine. Prospective studies on the effect of perichemotherapy antibiotics with high pancreatic penetration and gram-negative coverage on survival in diverse populations of patients with metastatic PDAC treated with gemcitabine are recommended.

The findings of this randomized clinical trial support the notion that, despite improved DFS, patients 60 years or younger with intermediate-risk AML, as defined by Medical Research Council cytogenetic criteria, do not benefit from allo-HCT during first CR in terms of OS. Early identification of a suitable donor allows for the timely rescue of patients who have relapsed following conventional consolidation chemotherapy. Future research that uses longitudinal monitoring of residual disease dynamics will aid in personalizing the optimal time point for allo-HCT in the majority of patients.