While an increasing number of therapeutic options are now available for the first-line treatment of locally advanced or metastatic pancreatic cancer,the optimal choice for treatment in the second-line setting and beyo...While an increasing number of therapeutic options are now available for the first-line treatment of locally advanced or metastatic pancreatic cancer,the optimal choice for treatment in the second-line setting and beyond is less well defined.A variety of cytotoxic agents,either alone or in combination,have been evaluated,although primarily in the context of small single-arm or retrospective studies.Most regimens have been associated with median progression-free survival rates in the range of 2-4 mo and overall survival rates between 4-8mo,highlighting the very poor prognosis of patients who are candidates for such treatment.Targeted therapies studied in this chemotherapy-refractory setting,meanwhile,have produced even worse efficacy results.In the current article,we review the clinical evidence for treatment of refractory disease,primarily in patients who have progressed on front-line gemcitabine-based chemotherapy.In the process,we highlight the limitations of the available data to date as well as some of the challenges in designing appropriate clinical trials in this salvage setting,including how to select an appropriate control arm given the absence of a wellestablished reference standard,and the importance of incorporating predictive biomarkers and quality of life measures whenever possible into study design.展开更多
AIM:To evaluate the prognostic significance of the lymphocyte to monocyte ratio(LMR) in patients with unresectable metastatic colorectal cancer who received palliative chemotherapy.METHODS:A total of 104 patients with...AIM:To evaluate the prognostic significance of the lymphocyte to monocyte ratio(LMR) in patients with unresectable metastatic colorectal cancer who received palliative chemotherapy.METHODS:A total of 104 patients with unresectable metastatic colorectal cancer who underwent palliative chemotherapy were enrolled. The LMR was calculated from blood samples by dividing the absolute lymphocyte count by the absolute monocyte count. Pretreatment LMR values were measured within one week before the initiation of chemotherapy,while posttreatment LMR values were measured eight weeks after the initiation of chemotherapy.RESULTS:The median pre-treatment LMR was 4.16(range:0.58-14.06). We set 3.38 as the cut-off level based on the receiver operating characteristic curve. Based on the cut-off level of 3.38,66 patients were classified into the high pre-treatment LMR group and 38 patients were classified into the low pretreatment LMR group. The low pre-treatment LMR group had a significantly worse overall survival rate(P = 0.0011). Moreover,patients who demonstrated low pre-treatment LMR and normalization after treatmentexhibited a better overall survival rate than the patients with low pre-treatment and post-treatment LMR values.CONCLUSION:The lymphocyte to monocyte ratio is a useful prognostic marker in patients with unresectable metastatic colorectal cancer who receive palliative chemotherapy.展开更多
AIM:To evaluate the clinicopathological features ofcolorectal cancer(CRC)with a v-Raf murine sarcomaviral oncogene homolog B1(BRAF)mutation and itsmolecular interaction with microsatellite instability(MSI)and v-Ki-ras...AIM:To evaluate the clinicopathological features ofcolorectal cancer(CRC)with a v-Raf murine sarcomaviral oncogene homolog B1(BRAF)mutation and itsmolecular interaction with microsatellite instability(MSI)and v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog(KRAS)in patients with advanced CRCs.METHODS:From October 2009 to December 2011,141 patients with stageⅢ(n=51)orⅣ(n=90)CRCs who were tested for the BRAF mutation at Severance Hospital were included.Among 141 patients,fivewere excluded due to follow-up loss.Therefore,136patients were included in the study.The clinicopathological data,MSI status,and KRAS/BRAF mutation status were reviewed retrospectively.In addition,to evaluating the value of BRAF mutation status,progressionfree survival and overall survival in all patients werecollected and compared between the BRAF wild-typegroup and BRAF mutation group.RESULTS:Of 136 patients,80(58.8%)were male and the mean age was 59 years.BRAF and KRAS mutations were detected in 9.6%and 35.3%of patients,respectively.Only 4.3%of patients had MSIhigh tumors and there were no MSI-high in tumors with a BRAF mutation.BRAF mutations tended to be more frequent in stageⅣthan in stageⅢ(11.76%vs 5.88%,P=0.370).Patients with a BRAF mutation had a lower incidence of KRAS mutation than those without(7.69%vs 38.21%,P=0.033).Overall survival was significantly shorter in the BRAF mutation group than in the BRAF wild-type group both by univariate analysis(P=0.041)and multivariate analysis(HR=2.195;95%CI:1.039-4.640;P=0.039),while progression-free survival was not different according to BRAF mutation status.CONCLUSION:CRCs with a BRAF mutation have distinct molecular features and resulted in a poor prognosis in Korean patients with advanced CRC.展开更多
文摘While an increasing number of therapeutic options are now available for the first-line treatment of locally advanced or metastatic pancreatic cancer,the optimal choice for treatment in the second-line setting and beyond is less well defined.A variety of cytotoxic agents,either alone or in combination,have been evaluated,although primarily in the context of small single-arm or retrospective studies.Most regimens have been associated with median progression-free survival rates in the range of 2-4 mo and overall survival rates between 4-8mo,highlighting the very poor prognosis of patients who are candidates for such treatment.Targeted therapies studied in this chemotherapy-refractory setting,meanwhile,have produced even worse efficacy results.In the current article,we review the clinical evidence for treatment of refractory disease,primarily in patients who have progressed on front-line gemcitabine-based chemotherapy.In the process,we highlight the limitations of the available data to date as well as some of the challenges in designing appropriate clinical trials in this salvage setting,including how to select an appropriate control arm given the absence of a wellestablished reference standard,and the importance of incorporating predictive biomarkers and quality of life measures whenever possible into study design.
文摘AIM:To evaluate the prognostic significance of the lymphocyte to monocyte ratio(LMR) in patients with unresectable metastatic colorectal cancer who received palliative chemotherapy.METHODS:A total of 104 patients with unresectable metastatic colorectal cancer who underwent palliative chemotherapy were enrolled. The LMR was calculated from blood samples by dividing the absolute lymphocyte count by the absolute monocyte count. Pretreatment LMR values were measured within one week before the initiation of chemotherapy,while posttreatment LMR values were measured eight weeks after the initiation of chemotherapy.RESULTS:The median pre-treatment LMR was 4.16(range:0.58-14.06). We set 3.38 as the cut-off level based on the receiver operating characteristic curve. Based on the cut-off level of 3.38,66 patients were classified into the high pre-treatment LMR group and 38 patients were classified into the low pretreatment LMR group. The low pre-treatment LMR group had a significantly worse overall survival rate(P = 0.0011). Moreover,patients who demonstrated low pre-treatment LMR and normalization after treatmentexhibited a better overall survival rate than the patients with low pre-treatment and post-treatment LMR values.CONCLUSION:The lymphocyte to monocyte ratio is a useful prognostic marker in patients with unresectable metastatic colorectal cancer who receive palliative chemotherapy.
文摘AIM:To evaluate the clinicopathological features ofcolorectal cancer(CRC)with a v-Raf murine sarcomaviral oncogene homolog B1(BRAF)mutation and itsmolecular interaction with microsatellite instability(MSI)and v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog(KRAS)in patients with advanced CRCs.METHODS:From October 2009 to December 2011,141 patients with stageⅢ(n=51)orⅣ(n=90)CRCs who were tested for the BRAF mutation at Severance Hospital were included.Among 141 patients,fivewere excluded due to follow-up loss.Therefore,136patients were included in the study.The clinicopathological data,MSI status,and KRAS/BRAF mutation status were reviewed retrospectively.In addition,to evaluating the value of BRAF mutation status,progressionfree survival and overall survival in all patients werecollected and compared between the BRAF wild-typegroup and BRAF mutation group.RESULTS:Of 136 patients,80(58.8%)were male and the mean age was 59 years.BRAF and KRAS mutations were detected in 9.6%and 35.3%of patients,respectively.Only 4.3%of patients had MSIhigh tumors and there were no MSI-high in tumors with a BRAF mutation.BRAF mutations tended to be more frequent in stageⅣthan in stageⅢ(11.76%vs 5.88%,P=0.370).Patients with a BRAF mutation had a lower incidence of KRAS mutation than those without(7.69%vs 38.21%,P=0.033).Overall survival was significantly shorter in the BRAF mutation group than in the BRAF wild-type group both by univariate analysis(P=0.041)and multivariate analysis(HR=2.195;95%CI:1.039-4.640;P=0.039),while progression-free survival was not different according to BRAF mutation status.CONCLUSION:CRCs with a BRAF mutation have distinct molecular features and resulted in a poor prognosis in Korean patients with advanced CRC.
