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Background: Metastatic esophagogastric cancers (EGCs) have a poor prognosis with an approximately 5% 5‐year survival. Additional treatment approaches are needed. c‐MET gene‐amplified tumors are an uncommon but potentially targetable subset of EGC. Clinical characteristics and outcomes were evaluated in patients with MET‐amplified EGC and compared with those without MET amplification to facilitate identification of these patients and possible treatment approaches. Patients and Methods: Patients with locally advanced or metastatic MET‐amplified EGC at Massachusetts General Hospital (MGH) were identified using fluorescent in situ hybridization analysis, with a gene‐to‐control ratio of ≥2.2 defined as positive. Non–MET‐amplified patients identified during the same time period who had undergone tumor genotyping and treatment at MGH were evaluated as a comparison group. Results: We identified 233 patients evaluated for MET amplification from 2002 to 2019. MET amplification was seen in 28 (12%) patients versus 205 (88%) patients without amplification. Most MET‐amplified tumors occurred in either the distal esophagus (n = 9; 32%) or gastroesophageal junction (n = 10; 36%). Of MET‐amplified patients, 16 (57%) had a TP53 mutation, 5(18%) had HER2 co‐amplification, 2 (7.0%) had EGFR co‐amplification, and 1 (3.5%) had FGFR2 co‐amplification. MET‐amplified tumors more frequently had poorly differentiated histology (19/28, 68.0% vs. 66/205, 32%; p =.02). Progression‐free survival to initial treatment was substantially shorter for all MET‐amplified patients (5.6 vs. 8.8 months, p =.026) and for those with metastatic disease at presentation (4.0 vs. 7.6 months, p =.01). Overall, patients with MET amplification had shorter overall survival (19.3 vs. 24.6 months, p =.049). No difference in survival was seen between low MET‐amplified tumors (≥2.2 and <25 MET copy number) compared with highly amplified tumors (≥25 MET copy number). Conclusion: MET‐amplified EGC represents a distinct clinical entity characterized by rapid progression and short survival. Ideally, the identification of these patients will provide opportunities to participate in clinical trials in an attempt to improve outcomes. Implications for Practice: This article describes 233 patients who received MET amplification testing and reports (a) a positivity rate of 12%, similar to the rate of HER2 positivity in this data set; (b) the clinical characteristics of poorly differentiated tumors and nodal metastases; and (c) markedly shorter progression‐free survival and overall survival in MET‐amplified tumors. Favorable outcomes are reported for patients treated with MET inhibitors. Given the lack of published data in MET‐amplified esophagogastric cancers and the urgent clinical importance of identifying patients with MET amplification for MET‐directed therapy, this large series is a valuable addition to the literature and will have an impact on future practice. New treatment approaches are needed for esophagogastric cancer. c‐MET gene‐amplified tumors are a potential new target. This article compares patients with and without MET‐amplified esophagogastric cancer to identify possible treatment approaches. [ABSTRACT FROM AUTHOR]

The objective of our retrospective institutional experience is to report the overall response rate, R0 resection rate, progression free survival, and safety/toxicity of neoadjuvant FOLFIRINOX (5- fluorouracil [5-FU], oxaliplatin, irinotecan, and leucovorin) and chemoradiation in patients with locally advanced pancreatic cancer (LAPC). Patients with LAPC treated with FOLFIRINOX were identified via the Massachusetts General Hospital Cancer Center pharmacy database. Demographic information, clinical characteristics, and safety/tolerability data were compiled. Formal radiographic review was performed to determine overall response rates (ORRs). Twenty-two patients with LAPC began treatment with FOLFIRINOX between July 2010 and February 2012. The ORR was 27.3%, and the median progression- free survival was 11.7 months. Five of 22 patients were able to undergo R0 resections following neoadjuvant FOLFIRINOX and chemoradiation. Three of the five patients have experienced distant recurrence within 5 months. Thirty two percent of patients required at least one emergency department visit or hospitalization while being treated with FOLFIRINOX. FOLFIRINOX possesses substantial activity in patients with LAPC. The use of FOLFIRINOX was associated with conversion to resectability in >20% of patients. However, the recurrences following R0 resection in three of five patients and the toxicities observed with the use of this regimen raise important questions about how to best treat patients with LAPC. [ABSTRACT FROM AUTHOR]

Purpose: To assess factors associated with better overall survival (OS) and progression-free survival (PFS) following chemoembolization with doxorubicin-eluting microspheres for inoperable hepatocellular carcinoma (HCC) MATERIALS AND METHODS: Data of 130 patients (104 men; median age, 62 y) with inoperable HCC who underwent successful DEB chemoembolization with 100-300 -μm LC Bead particles loaded with 50 mg doxorubicin per vial were reviewed following human research committee approval. Effects of various clinical, imaging, and response factors on OS and PFS were assessed by univariate Kaplan-Meier survival analysis. Multiple Cox regression with backward elimination was performed for terms found significant (P ≤ .05) on univariate analysis., Results: The number of DEB chemoembolization procedures per patient ranged from one to four (mean, 2 ± 1). The median PFS and OS were 5.7 months (95% confidence interval, 4.6-7.6 mo) and 14.7 months (95% confidence interval, 12.3-19.7 mo), respectively. On multivariate Cox regression, Cancer of the Liver Italian Program (CLIP) score of 1 or lower, necrosis of more than 50%, and response or stable disease per Response Evaluation Criteria In Solid Tumors after DEB chemoembolization were associated with better PFS. CLIP score of 1 or lower, Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 1 or lower, absence of portal vein (PV) thrombosis, and necrosis greater than 50% following DEB chemoembolization were associated with better OS., Conclusions: CLIP score of 1 or lower and necrosis of more than 50% are independent variables affecting PFS and OS after DEB chemoembolization, whereas absence of PV thrombosis and ECOG PS of 1 or lower affected OS but not PFS., (Copyright © 2013. Published by Elsevier Inc.)

Purpose: Research on patient-reported outcomes (PROs) in rectal cancer is limited. We examined whether dose-volume parameters of the small bowel and large bowel were associated with patient-reported gastrointestinal (GI) symptoms during 5-fluorouracil (5-FU)-based chemoradiation treatment for rectal cancer., Methods and Materials: 66 patients treated at the Brigham & Women's Hospital or Massachusetts General Hospital between 2006 and 2008 were included. Weekly during treatment, patients completed a questionnaire assessing severity of diarrhea, urgency, pain, cramping, mucus, and tenesmus. The association between dosimetric parameters and changes in overall GI symptoms from baseline through treatment was examined by using Spearman's correlation. Potential associations between these parameters and individual GI symptoms were also explored., Results: The amount of small bowel receiving at least 15 Gy (V15) was significantly associated with acute symptoms (p = 0.01), and other dosimetric parameters ranging from V5 to V45 also trended toward association. For the large bowel, correlations between dosimetric parameters and overall GI symptoms at the higher dose levels from V25 to V45 did not reach statistical significance (p = 0.1), and a significant association was seen with rectal pain from V15 to V45 (p < 0.01). Other individual symptoms did not correlate with small bowel or large bowel dosimetric parameters., Conclusions: The results of this study using PROs are consistent with prior studies with physician-assessed acute toxicity, and they identify small bowel V15 as an important predictor of acute GI symptoms during 5-FU-based chemoradiation treatment. A better understanding of the relationship between radiation dosimetric parameters and PROs may allow physicians to improve radiation planning to optimize patient outcomes., (Copyright © 2012 Elsevier Inc. All rights reserved.)