BACKGROUND Hyperbilirubinemia with hepatic metastases is a common complication and a poor prognostic factor for colorectal cancer(CRC).Effective drainage is often im-possible before initiating systemic chemotherapy,ow...BACKGROUND Hyperbilirubinemia with hepatic metastases is a common complication and a poor prognostic factor for colorectal cancer(CRC).Effective drainage is often im-possible before initiating systemic chemotherapy,owing to the liver’s diffuse metastatic involvement.Moreover,an appropriate chemotherapeutic approach for the treatment of hyperbilirubinemia is currently unavailable.CASE SUMMARY The patient,a man in his 50s,presented with progressive fatigue and severe jaundice.Computed tomography revealed multiple hepatic masses with thick-ened walls in the sigmoid colon,which was pathologically confirmed as a well-differentiated adenocarcinoma.No RAS or BRAF mutations were detected.The Eastern Cooperative Oncology Group(ECOG)performance status(PS)score was 2.Biliary drainage was impossible due to the absence of a dilated bile duct,and panitumumab monotherapy was promptly initiated.Subsequently,the bilirubin level decreased and then normalized,and the patient’s PS improved to zero ECOG score after four cycles of therapy without significant adverse events.CONCLUSION Anti-EGFR antibody monotherapy is a safe and effective treatment for RAS wild-type CRC and hepatic metastases with severe hyperbilirubinemia.展开更多
Irinotecan hydrochloride is a camptothecin derivative that exerts antitumor activity against a variety of tumors. SN-38 produced in the body by carboxylesterase is the active metabolite of irinotecan. After irinotecan...Irinotecan hydrochloride is a camptothecin derivative that exerts antitumor activity against a variety of tumors. SN-38 produced in the body by carboxylesterase is the active metabolite of irinotecan. After irinotecan was introduced for the treatment of metastatic colorectal cancer(CRC) at the end of the last century,survival has improved dramatically. Irinotecan is now combined with 5-fluorouracil,oxaliplatin and several molecularly-targeted anticancer drugs,resulting in the extension of overall survival to longer than 30 mo. Severe,occasionally life-threatening toxicity occurs sporadically,even in patients in relatively good condition who have a low risk of chemotherapyinduced toxicity,often causing the failure of irinotecanbased chemotherapy. Clinical pharmacological studies have revealed that such severe toxicity is related to exposure to SN-38 and genetic polymorphisms in UDPglucuronosyltransferase 1A1 gene. The large interand intra-patient variability in systemic exposure to SN-38 is determined not only by genetic factors but also by physiological and environmental factors. This review first summarizes the roles of irinotecan in chemotherapy for metastatic CRC and then discusses the optimal dosing of irinotecan based on the aforementioned factors affecting systemic exposure to SN-38,with the ultimate goal of achieving personalized irinotecan-based chemotherapy.展开更多
A 67-year-old man visited our hospital with a history of continuous hematochezia leading to hemorrhagic shock.An abdominal computed tomography scan re-vealed a large mass in the ascending colon invading the duodenum a...A 67-year-old man visited our hospital with a history of continuous hematochezia leading to hemorrhagic shock.An abdominal computed tomography scan re-vealed a large mass in the ascending colon invading the duodenum and pancreatic head as well as extra-vasation of blood from the gastroduodenal artery(GDA) into the colon.Colonoscopy revealed an irregular ulcerative lesion and stenosis in the ascending colon.Therefore,right hemicolectomy combined with pylorus-preser ving pancreaticoduodenectomy was performed.Histologically,the tumor was classified as a moderately differentiated adenocarcinoma.Moreover,cancer cells were mainly located in the colon but had also invaded the duode-num and pancreas and involved the GDA.Immunohistochemically,the tumor cells were positive for cytokeratin(CK)20 and carcinoembryonic antigen(CEA)but not forCK7 and carbohydrate antigen(CA)19-9.The patient died 23 d after the surgery because he had another episode of arterial bleeding from the anastomosis site.Although En bloc resection of the tumor with pancreatico duodenectomy and colectomy performed for locally advanced colon cancer can ensure long-term survival,patients undergoing these procedures should be carefully monitored,particularly when the tumor involves the main artery.展开更多
文摘BACKGROUND Hyperbilirubinemia with hepatic metastases is a common complication and a poor prognostic factor for colorectal cancer(CRC).Effective drainage is often im-possible before initiating systemic chemotherapy,owing to the liver’s diffuse metastatic involvement.Moreover,an appropriate chemotherapeutic approach for the treatment of hyperbilirubinemia is currently unavailable.CASE SUMMARY The patient,a man in his 50s,presented with progressive fatigue and severe jaundice.Computed tomography revealed multiple hepatic masses with thick-ened walls in the sigmoid colon,which was pathologically confirmed as a well-differentiated adenocarcinoma.No RAS or BRAF mutations were detected.The Eastern Cooperative Oncology Group(ECOG)performance status(PS)score was 2.Biliary drainage was impossible due to the absence of a dilated bile duct,and panitumumab monotherapy was promptly initiated.Subsequently,the bilirubin level decreased and then normalized,and the patient’s PS improved to zero ECOG score after four cycles of therapy without significant adverse events.CONCLUSION Anti-EGFR antibody monotherapy is a safe and effective treatment for RAS wild-type CRC and hepatic metastases with severe hyperbilirubinemia.
文摘Irinotecan hydrochloride is a camptothecin derivative that exerts antitumor activity against a variety of tumors. SN-38 produced in the body by carboxylesterase is the active metabolite of irinotecan. After irinotecan was introduced for the treatment of metastatic colorectal cancer(CRC) at the end of the last century,survival has improved dramatically. Irinotecan is now combined with 5-fluorouracil,oxaliplatin and several molecularly-targeted anticancer drugs,resulting in the extension of overall survival to longer than 30 mo. Severe,occasionally life-threatening toxicity occurs sporadically,even in patients in relatively good condition who have a low risk of chemotherapyinduced toxicity,often causing the failure of irinotecanbased chemotherapy. Clinical pharmacological studies have revealed that such severe toxicity is related to exposure to SN-38 and genetic polymorphisms in UDPglucuronosyltransferase 1A1 gene. The large interand intra-patient variability in systemic exposure to SN-38 is determined not only by genetic factors but also by physiological and environmental factors. This review first summarizes the roles of irinotecan in chemotherapy for metastatic CRC and then discusses the optimal dosing of irinotecan based on the aforementioned factors affecting systemic exposure to SN-38,with the ultimate goal of achieving personalized irinotecan-based chemotherapy.
文摘A 67-year-old man visited our hospital with a history of continuous hematochezia leading to hemorrhagic shock.An abdominal computed tomography scan re-vealed a large mass in the ascending colon invading the duodenum and pancreatic head as well as extra-vasation of blood from the gastroduodenal artery(GDA) into the colon.Colonoscopy revealed an irregular ulcerative lesion and stenosis in the ascending colon.Therefore,right hemicolectomy combined with pylorus-preser ving pancreaticoduodenectomy was performed.Histologically,the tumor was classified as a moderately differentiated adenocarcinoma.Moreover,cancer cells were mainly located in the colon but had also invaded the duode-num and pancreas and involved the GDA.Immunohistochemically,the tumor cells were positive for cytokeratin(CK)20 and carcinoembryonic antigen(CEA)but not forCK7 and carbohydrate antigen(CA)19-9.The patient died 23 d after the surgery because he had another episode of arterial bleeding from the anastomosis site.Although En bloc resection of the tumor with pancreatico duodenectomy and colectomy performed for locally advanced colon cancer can ensure long-term survival,patients undergoing these procedures should be carefully monitored,particularly when the tumor involves the main artery.
