scholarly journals Role of Intraductal RFA: A Novel Tool in the Palliative Care of Perihilar Cholangiocarcinoma

2021 ◽  
pp. 1-9
Author(s):  
Tobias J. Weismüller
Keyword(s):  
Palliative Care ◽  
Overall Survival ◽  
Prospective Studies ◽  
Liver Tumors ◽  
Perihilar Cholangiocarcinoma ◽  
Metal Stents ◽  
Tumor Control ◽  
Pancreatic Ducts ◽  
First Line ◽  
Stent Patency

<b><i>Background:</i></b> Patients with irresectable perihilar cholangiocarcinoma (PHC) have a limited prognosis with median survival times still less than 1 year. In addition to the current standard first-line systemic chemotherapy (gemcitabine and a platinum derivate), endoscopic treatment aims to ensure adequate drainage of the biliary system by placing biliary plastic or metal stents. Local ablative procedures like intraluminal biliary brachytherapy (ILBT) or photodynamic therapy (PDT) are used to improve local tumor control and to optimize the stent patency. <b><i>Summary:</i></b> Intraductal radiofrequency ablation (RFA) is another promising tool in the therapeutic armamentarium for the endoscopic management and tumor ablation of extrahepatic cholangiocarcinoma (eCCA). By applying thermal energy to the tissue through high-frequency alternating current, RFA induces coagulative necrosis and causes local destruction of the tumor. It is established as a first line percutaneous treatment of solid liver tumors, and since 2011 an endoscopic catheter is available that allows intraductal RFA in the biliary or pancreatic ducts. While the first pilot studies primarily evaluated this new method in patients with distal eCCA, there is now evidence accumulating also for PHC. Two retrospective and two prospective studies demonstrated a significantly improved overall survival and a longer stent patency with intraductal RFA, which overall had a favorable safety profile and was not associated with a significant increase in adverse events. However, prospective studies comparing the efficacy and safety of intraductal RFA, PDT, and/or ILBT are lacking. <b><i>Key Messages:</i></b> Recent studies suggest that intraductal RFA is an effective and well-tolerated additional treatment option with regard to stent patency but also overall survival. Since RFA has fewer systemic side effects and requires less logistical effort when compared to ILBT and PDT, intraductal RFA should be considered as another safe and feasible adjuvant method for the palliative care of patients with advanced PHC. Since comparative studies are lacking, the choice of the local ablative method remains in each case an individual decision.

scholarly journals A Systematic Review and Meta-Analysis of Nab-Paclitaxel Mono-Chemotherapy for Metastatic Breast Cancer.

2020 ◽  
Author(s):  
Haili Lu ◽  
Siluo Zha ◽  
Wei Zhang ◽  
Qiang Wang ◽  
Daozhen Jiang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Overall Survival ◽  
Clinical Trials ◽  
Metastatic Breast Cancer ◽  
Metastatic Breast ◽  
Tumor Control ◽  
First Line ◽  
Line Therapy ◽  
Mixed Line

Abstract Background: Various clinical trials and real-life studies have tried to explore the value of nab-paclitaxel mono-chemotherapy for metastatic breast cancer (MBC). The safety and efficacy of nab-paclitaxel needs to be systematically evaluated. Methods : Electronic searches for prospective clinical trials containing nab-paclitaxel monotherapy for MBC were performed. Requisite data were extracted, integrated and analyzed from the included studies according to different purposes using systematic review and meta-analysis.Results: 22 studies with 3287 MBC patients were included. 1685 MBC patients received nab-paclitaxel as first-line therapy, 640 patients as further-line therapy, and 962 patients as mixed-line therapy. 1966 MBC patients (60.40%) received nab-paclitaxel weekly, while 1190 patients (36.56%) received nab-paclitaxel triweekly and 99 patients (3.04%) biweekly. The overall incidence of all grades neutropenia, leukopenia, peripheral sensory neuropathy, and fatigue was 52% (95% CI, 38%-66%), 58% (95% CI, 43%-73%), 58% (95% CI, 48%-68%), and 49% (95% CI, 41%-56%) respectively. The overall response rate (ORR) was 40% (95% CI, 35%-45%) and the clinical benefit rate (CBR) was 66% (95% CI, 59%-73%) following nab-paclitaxel monotherapy. The median progression free survival (PFS) was 7.64 months (95% CI, 6.89-8.40 months) and the median overall survival (OS) was 24.51 months (95% CI, 21.25-27.78 months). According to the meta-regression analysis, grade 3/4 neutropenia occurred less frequently in Her-2 negative patients compared with all population (P=0.046). Patients who received first-line nab-paclitaxel monotherapy showed higher ORR (P=0.006) and longer PFS (P=0.045). Patients who received further-line therapy was demonstrated to have shorter median OS versus first- and mixed-line therapy. Efficacy outcomes were not affected by the administration schedule. However, patients appeared to have more superior ORR (P=0.044) and longer PFS (P=0.03) along with the increasing dosage of nab-paclitaxel under the same schedule. Conclusions: Both weekly and triweekly nab-paclitaxel mono-chemotherapy were proved to be effective for MBC with generally reasonable toxicity profiles. Higher ORR, longer PFS and OS would be achieved in patients treated with nab-paclitaxel as first line. Increasing nab-paclitaxel dosage would result in better tumor control (higher ORR and PFS). Changing nab-paclitaxel schedule had no benefit on ameliorating the overall survival.

Chemotherapy outcomes for the treatment of unresectable intrahepatic and hilar cholangiocarcinoma: A retrospective analysis.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 271-271 ◽  
Author(s):  
J. Weatherly ◽  
K. Eckmann ◽  
D. Patel ◽  
A. N. Landgraf ◽  
J. H. Slade ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hilar Cholangiocarcinoma ◽  
Relative Effectiveness ◽  
Primary Objective ◽  
Unknown Primary ◽  
Cancer Center ◽  
Tumor Control ◽  
First Line ◽  
Significant Difference ◽  
Duration Of Response

271 Background: Recent clinical trials for biliary cancers include a heterogenous group of patients with cholangiocarcinoma, gallbladder, and ampullary cancers. There are limited data regarding the relative effectiveness of known chemotherapeutic regimens specifically in intrahepatic or hilar cholangiocarcinoma. Methods: M. D. Anderson Cancer Center patients with unresectable intrahepatic and hilar cholangiocarcinoma who received first-line chemotherapy from January 1, 2005 to October 31, 2009 were reviewed. Eighty-five patients met inclusion criteria and were eligible for analysis. The primary objective of this project was to determine the overall tumor control rates with the chemotherapeutic regimens used for first-line treatment of unresectable intrahepatic and hilar cholangiocarcinoma. Secondary objectives included duration of response, overall survival, and prognostic factors. Results: The most commonly used regimen was gemcitabine/cisplatin (gem/cis; 53 patients, 62%), followed by oxaliplatin and capecitabine (14 patients, 16%). There was no significant difference between tumor control rates with gem/cis (72% PR/SD, 28% PD) and other regimens (69% PR/SD, 31% PD). There was also no significant difference between overall survival with the use of gem/cis (15.2 months) or alternative regimens (13.9 months). A decrease in overall survival was seen with elevated baseline CA 19-9 (p<0.0001), an initial diagnosis of unknown primary tumor (p=0.0001), and prior treatment with chemoradiation (p=0.0018). Conclusions: In this retrospective review, both gem/cis and alternative doublets (including capecitabine/oxaliplatin, gemcitabine/capecitabine, and gemcitabine/oxaliplatin) were effective regimens in maintaining disease control in the intrahepatic and hilar population. No significant financial relationships to disclose.

Sequence Therapy with FOLFIRINOX and Gemcitabine/Nab-Paclitaxel for Patients with Advanced Pancreatic Cancer – a Monocenter Retrospective Cohort Study

2021 ◽  
Author(s):  
Alexander Queck ◽  
Sharra Elango ◽  
Christine Koch ◽  
Dirk Walter ◽  
Jennifer Schmidt ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Progression Free Survival ◽  
Tumor Control ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Free Survival ◽  
Line Therapy ◽  
Response To Chemotherapy

Background & aims: While irresectable pancreatic cancer has still a dismal overall prognosis, evidence about the optimal chemotherapy sequence is scarce. After treatment with FOLFIRINOX in first-line, Gemcitabine-monotherapy was established for years. As a potential treatment alternative after failure of FOLFIRINOX therapy, combination of Gemcitabine and Nab-Paclitaxel is used. However, this combination has formally not yet been approved for second-line treatment and investigation of efficiency and treatment tolerance is the aim of this trial. Methods: Therefore, we investigated 225 patients with histologically confirmed local advanced or metastatic pancreatic cancer in this retrospective mono-centre study (November 2010 – July 2019). Of this, 44 patients received FOLFIRINOX therapy and outcome was further analysed. The primary end point of this cohort was overall survival, secondary end points included progression free survival, response rate, and safety. Results: In most of the patients FOLFIRINOX as first-line treatment of irresectable pancreatic cancer resulted in temporary cancer control (partial response (PR): 50% and stable disease (SD): 18%), whereas tumor progression was observed in 23% of the patients. The median progression-free survival (PFS) time for FOLFIRINOX treatment was 7.3 months and median overall survival 10.3 months. Seven (16%) patients received additional local radio chemotherapy of the pancreatic tumor. During first-line therapy 8 (18%) patients had laparotomy for proof of resectability. Hereby, in three patients R0-, in three patients R1 resection, and irresectability in another 2 patients were achieved. Twenty-five of the 44 patients (57%) received second line therapy, namely 24 patients Gemcitabine/ Nab-Paclitaxel and 1 patient Gemcitabine and Erlotinib. Hereby, Gemcitabine/ Nab-Paclitaxel led again to temporary tumor control in 46% of the patients (PR: 21%, SD: 25%), while in 29% of the patient’s disease progression was observed. Corresponding median PFS for Gemcitabine and Nab-Paclitaxel treatment was 3.5 months. Patients who received second-line treatment with Nab-Paclitaxel and Gemcitabine had a more favorable prognosis (median OS: 17.4 versus 9.2 months; HR 0.32 [0.14 – 0.70], p<0.001) than patients who were not eligible for second-line treatment. Moreover, in multivariate analyses association with patients’ survival and tumor response to chemotherapy in both therapeutic lines and µGT below 100 IU/L in first-line FOLFIRINOX chemotherapy were observed. Conclusion: These real-world data suggest that Gemcitabine / Nab-Paclitaxel may be feasible after FOLFIRINOX therapy in patients with irresectable pancreatic cancer. However, prospective randomized data about the superiority to Gemcitabine monotherapy are needed.

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