Palliative primary tumor resection provides survival beneits for the patients with metastatic colorectal cancer and low circulating levels of dehydrogenase and carcinoembryonic antigen

Background: It remains controversial whether palliative primary tumor resection(PPTR) can provide survival benefits to the patients with metastatic colorectal cancer(m CRC) who have unresectable metastases. The aim of this study was to evaluate whether PPTR could improve the survival of patients with m CRC.Methods: We conducted a retrospective study on consecutive m CRC patients with unresectable metastases who were diagnosed at Sun Yat?sen University Cancer Center in Guangzhou, Guangdong, China, between January 2005 and December 2012. Overall survival(OS) and progression?free survival(PFS) after first?line chemotherapy failure were compared between the PPTR and non?PPTR patient groups.Results: A total of 387 patients were identified, including 254 who underwent PPTR and 133 who did not. The median OS of the PPTR and non?PPTR groups was 20.8 and 14.8 months(P < 0.001), respectively. The median PFS after first?line chemotherapy was 7.3 and 4.8 months(P < 0.001) in the PPTR and non?PPTR groups, respectively. A larger proportion of patients in the PPTR group(219 of 254, 86.2%) showed local progression compared with that of patients in the non?PPTR group(95 of 133, 71.4%; P < 0.001). Only patients with normal lactate dehydrogenase(LDH) levels and with carcinoembryonic antigen(CEA) levels <70 ng/m L benefited from PPTR(median OS, 22.2 months for the PPTR group and 16.2 months for the non?PPTR group; P < 0.001).Conclusions: For m CRC patients with unresectable metastases, PPTR can improve OS and PFS after first?line chemo?therapy and decrease the incidence of new organ involvement. However, PPTR should be recommended only for patients with normal LDH levels and with CEA levels <70 ng/m L.

Pemetrexed Monotherapy and Pemetrexed Plus Platinum Combination Therapy as Non-First-Line Treatments for Advanced Non-Small Cell Lung Cancer

OBJECTIVE Data on the efficacy profiles of pemetrexed mono- therapy and pemetrexed plus platinum combination therapy in the non-first-line setting for patients with advanced non-small cell lung cancer （NSCLC） are limited, and previous studies have reported contradictory results. This study investigated and compared the efficacy and toxicity profiles of these two regimens to provide a broader understanding of their dynamics. METHODS Previously treated patients with advanced and/or recurrent NSCLC who received pemetrexed monotherapy or peme- trexed plus platinum combination therapy between January 1, 2006, and December 31, 2009, at Sun Yat-sen University Cancer Center were evaluated. The primary endpoint of this study was progres- sion-free survival （PFS）, whereas the secondary endpoints were overall response rate （ORR）, disease control rate （DCR）, overall survival （OS）, and toxicity. Survival was analyzed using the Kaplan- Meier method. Univariate analysis was performed to identify the factors potentially influencing OS, and chi-square analysis was carried out to compare ORR and DCR. RESULTS Forty-six patients with advanced and/or recurrent NSCLC were analyzed; of these patients, 25 were given pemetrexed monotherapy and 21 received pemetrexed plus platinum combina- tion therapy. The following correspond to the rates recorded for the pemetrexed monotherapy group and the pemetrexed plus platinum group： median PFS, 1.97 and 2.3 months （P=0.565）; median OS, 30.93 and 30.33 months （P=0.877）; ORR, 8% （2/25） and 9.5% （2/21） （P=0.857）; and DCR, 32% （8/25） and 57.1% （12/21） （P=0.09）. Univariate analysis revealed that no factor was correlated with OS from NSCLC （P〉0.05 for all）. Gastrointestinal toxicity in the pemetrexed plus platinum group was modestly higher than that in the pemetrexed monotherapy group （P=0.034）, but other adverse events were similar between the groups. CONCLUSION Compared with pemetrexed monotherapy, peme- trexed plus platinum combination therapy causes more gastro- intestinal toxicities and does not exhibit improved efficacy, in terms of ORR, DCR, PFS, and OS, in the non-first-line setting for NSCLC. However, further research with a higher patient population is necessary to validate this finding.

Initial Progression-Free Survival after Non-First Line TKIs Therapy Potentially Guides Immediate Treatment after Its Failure in Advanced Non-Small Cell Lung Cancer

Objective The standard therapy alter failure of the initial non-first line epidermal growth factor receptor tyrosine kinase inhibitor （EGFR-TK1） treatment in advanced non-small cell lung cancer （NSCLC） has not yet been established. The aim of the current study was to identify whether the 2nd TKI treatment or chemotherapy （paclitaxel-containing or non-paclitaxel regimen） is the appropriate treatment for patients with NSCLC based on the efficacy of the initial TKls. Methods Seventy-two advanced NSCLC patients who had accepted 2nd TKIs or chemotherapy immediately alter failure of the initial TKIs in non-first line setting from May 1, 2004 to January 31, 2010 at the Sun Yat-sen University Cancer Center were enrolled. The primary endpoint [2nd progression-free survival （PFS）] and the second endpoint loverall survival （OS）] were compared among the 2＇＇d TKI and chemotherapy groups as well as their subgroups. Results （1） Twenty-one patients were treated with 2 TKIs, and 51 patients were administered chemotherapy after failure of the initial non-first line TKI treatment. There was nonsignificant difference in the responses （P=0.900） [2nd PFS （P=0.833） and OS （P=0.369）] between the 2nd TKI and chemotherapy groups. （2） In tile 2nd TKI group, 9 patients exhibited PFS_〉7 months. The initial TKI treatment group exhibited a longer 2＂d PFS than the other 12 patients with an initial PFS〈7 months （7 months vs. 2 months, P=0.019）. However, these groups had nonsignificantly different OS （P=0.369）. （3） In the chemotherapy group, patients with PFS〈5 months exhibited longer 2＇1~ PFS than those with PFS 〉 5 months in the initial TKI treatment （3 months vs. 2 months, P=0.039）. （4） In the chemotherapy group, nd patients treated with paclitaxel-containing regimen showed longer 2 PFS than those treated with non-paclitaxel regimen （, months t,s. 2.3 months, P=0.043）. Conclusions Patients with PFS_〉7 months or 〈5 months under the initial TKI treatment potentially benefit from the 2nd TK1 treatment or chemotherapy immediately after failure of the non-first line TKIs. The paclitaxel-containing regimen may improve the 2na PFS. However, more patient samples are urgently needed to validate these findings.