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Background: Although irinotecan and oxaliplatin are both standard treatments for advanced colon cancer, it remains unknown whether either is effective for patients with resectable synchronous colon cancer and liver-confined metastasis (SCCLM) after curative surgery., Patients and Methods: A population-based cohort of patients diagnosed with de novo SCCLM between 2004 and 2009 was established by searching the database of the Taiwan Cancer Registry and the National Health Insurance Research Database of Taiwan. Patients who underwent curative surgery as their first therapy followed by chemotherapy doublets were classified into the irinotecan group or oxaliplatin group accordingly. Patients who received radiotherapy or did not receive chemotherapy doublets were excluded., Results: We included 6,533 patients with de novo stage IV colon cancer. Three hundred and nine of them received chemotherapy doublets after surgery; 77 patients received irinotecan and 232 patients received oxaliplatin as adjuvant chemotherapy. The patients in both groups exhibited similar overall survival (median: not reached vs. 40.8 months, p=0.151) and time to the next line of treatment (median: 16.5 vs. 14.3 months, p=0.349) in both univariate and multivariate analyses. Additionally, patients with resectable SCCLM had significantly shorter median overall survival than patients with stage III colon cancer who underwent curative surgery and subsequent adjuvant chemotherapy, but longer median overall survival than patients with de novo stage IV colon cancer who underwent surgery only at the primary site followed by standard systemic chemotherapy (p<0.001)., Conclusion: Irinotecan and oxaliplatin exhibited similar efficacy in patients who underwent curative surgery for resectable SCCLM., (Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: The prognosis of patients with advanced hepatocellular carcinoma (HCC) is poor despite treatment with sorafenib or other anti-angiogenic targeted-therapies. Patients with advanced HCC with prolonged survival may exhibit unique clinical characteristics., Patients and Methods: We reviewed patients with Barcelona Clinic Liver Cancer stage C HCC, who were enrolled in six clinical trials for first-line anti-angiogenic targeted-therapy between May 2005 and December 2010 in a single Institute. Patients with prolonged survival were identified as those who exhibited overall survival (OS) of more than two years; their clinical variables were analyzed., Results: Of the 189 enrolled patients, 22 (11.6%) patients with prolonged survival were identified. Their median OS was 58.7 (range=24.6-88.4) months, compared to an OS of 7.1 months for the overall patient cohort. A multivariate analysis showed that the patients with prolonged survival were less likely to have chronic hepatitis B virus infection, α-fetoprotein level >400 ng/ml, and liver involvement than were the remaining patients. In addition, the patients with prolonged survival experienced significantly higher response rates (50.0%) and disease control rates (86.4%) to the first-line targeted-therapy, and received more additional therapies than did the other patients. Seven patients remained disease-free for a median of 27.0 (range, 4.5-64.6) months after receiving additional locoregional therapies., Conclusion: Patients with advanced HCC who experienced prolonged survival exhibited certain clinical features and strong treatment responses to first-line anti-angiogenic targeted-therapies. Additional locoregional therapies could contribute to the long-term disease-free status in selected patients.

Background/aim: Biomarker studies using immunohistochemical (IHC) staining have not been successful for advanced hepatocellular carcinoma (HCC). We aimed to examine whether the tissue procurement process influences the protein expression levels detected by IHC., Materials and Methods: Forty-two tissue pairs of HCC that had been both preoperatively biopsied and then surgically resected were included in the study. IHC staining was used to determine expression of target molecules, all of which were graded according to the percentage of positively stained tumor cells. The expression of beta-catenin was analyzed according to the localization of positive staining., Results: Biopsied and surgically resected tissues exhibited dissimilar phosphorylated extracellular signal regulated kinase (p-ERK) and phosphorylated AKT expression levels (kappa=0.025 and 0.153, respectively). On the contrary, p53 exhibited similar expression levels, and beta-catenin exhibited similar staining localization patterns in biopsied and surgically resected tissues (kappa=0.729 and 0.654, respectively)., Conclusion: Biopsied HCC tissues and their corresponding resected HCC tissues have inconsistent IHC-detected ERK and AKT expressions.

Background: The current standard treatment for patients with metastatic gastric cancer (MGC) is systemic chemotherapy. For gastric cancer patients with ovarian metastases, i.e. Krukenberg tumors, it is not known whether metastasectomy is associated with additional benefits., Patients and Methods: All patients who were diagnosed with gastric cancer and ovarian metastases between March 2000 and July 2010 in a medical center were included in the current study. The clinicopathological features and the treatment records were reviewed in detail and their association with overall survival (OS) was analyzed., Results: A total of 85 patients were identified. Thirty five (41.2%) and 50 (58.8%) patients did and did not undergo metastasectomy of Krukenberg tumors, respectively. The performance status and the proportion of patients receiving subsequent systemic therapy were well-matched between the two groups. Regarding disease status, patients who underwent metastasectomy had significantly larger Krukenberg tumors, pronounced bilateral disease and less extensive metastases outside the ovaries than patients who did not undergo metastasectomy. Patients who underwent metastasectomy had a better OS [median=14.1 months; 95% confidence interval (CI)=8.6-19.6 months] than patients who did not undergo metastasectomy (median OS=8 months; 95% CI=5.6-10.4 months, p=0.001). There was no aberrant postoperative morbiditie rate observed, and the median length of hospital stay after metastasectomy alone was 6 days. Based on multivariate analysis, metastasectomy remained an independent predictor of better OS (hazard ratio=0.36, p=0.002). The administration of subsequent systemic therapy, the use of platinum-based chemotherapy, and a better performance status also predict a better OS., Conclusion: Metastasectomy of Krukenberg tumors may be associated with survival benefits in patients with MGC. Further prospective studies are warranted.

Background: Hepatitis B virus (HBV) infection is one of the main etiologies of hepatocellular carcinoma (HCC). We explored the impact of HBV DNA levels on the prognosis of patients with advanced HCC., Patients and Methods: The study was based on patients with advanced HCC and chronic HBV infection enrolled into three phase II trials evaluating first-line antiangiogenic therapy. Pre-treatment HBV DNA levels were measured by real-time quantitative polymerase chain reaction., Results: Seventy-two patients were included. Patients with detectable HBV DNA levels had poorer median overall survival (OS) compared to patients without detectable levels (4.8 vs. 9.3 months, p=0.037). After adjusting for other clinicopathologic variables, the baseline HBV DNA level was an independent predictor of poor OS (p=0.014). Baseline HBV DNA levels were not correlated with progression-free survival or disease control rate., Conclusion: Baseline HBV DNA levels were associated with the prognosis of patients with chronic HBV infection receiving antiangiogenic therapy for advanced HCC.

Bowel perforation is a rare but life-threatening complication of bevacizumab, a new anticancer treatment. Patients with bowel perforation usually present with acute abdominal symptoms. Here a case history is presented to highlight a pancreatic cancer patient on bevacizumab chemotherapy who developed empyema as the first manifestation of gastric perforation. This unusual presentation warns physicians that bevacizumab-related bowel perforation can arise as a thoracic complication, without typical gastrointestinal manifestations, in an advanced cancer patient.

Oxaliplatin-related thrombocytopenia is considered rare and mostly self-limited. We present the first reported fatal case due to this complication. A 64-year-old patient with metastatic colon cancer was admitted for his 24th course of chemotherapy with oxaliplatin and 24-hour infusion of fluorouracil and leucovorin. Consciousness changed on the next evening and deteriorated to deep coma within hours. Computed tomography revealed large intracranial hemorrhage with brain herniation. Hemogram showed severe thrombocytopenia, which was considered to be associated with oxaliplatin. The patient died six days later. The incidence of oxaliplatin-related thrombocytopenia may have been underestimated and its severity long neglected. Other hypersensitivity reactions may precede its onset. Early hemogram examination during hypersensitivity reaction to oxaliplatin may provide early diagnosis and the prevention of the possible fatal consequences.