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About half of all Danish cancer patients are 70 years or older at diagnosis. The incidence is expected to increase further over the coming years because of an increasing longevity. Therefore, this review recommends that the Danish health care system develops and implement models to ensure optimal care for older adults with cancer. We are still in need of knowledge about the optimal treatment, rehabilitation, palliation and care for older adults with cancer. We encourage the Danish health authorities to formulate a national strategy for this area.

Through many years the ability to suppress angiogenesis has been exploited in the field of oncology. The efficiency is well-documented and the indications are constantly growing, although the impact often is rather limited, as we argue in this review. Recent evidence suggests that inhibition of angiogenesis may be clinically meaningful through several lines of treatment but lack of biomarkers limits an individualised approach. The tumour microenvironment is anti-immune and a combination of anti-angiogenic drugs and immunotherapy has demonstrated impressive results and may alter the therapy in the years to come.

e15624 Background: There is no established 2nd line therapy for patients (pts) with advanced gastroesophageal (GE) cancer. In 2004, the Danish government initiated a national health programme for pts with advanced cancer. Non- proven therapy may be offered after approval by an expert panel appointed by the National Board of Health that subsequently finances the cost of treatment. This programme has had a major impact on the management of cancer pts in Denmark and has accelerated the introduction and implementation of new therapies. Inspired by the excellent results in colorectal cancer a combination of cetuximab and irinotecan (CetIri) was chosen for platinum-resistant GE cancer. While awaiting approval of a phase II protocol CetIri was offered at a single institution. We report our preliminary experience with biweekly CetIri as 2nd line therapy in pts with GE cancer. Methods: All pts had histologically confirmed GE cancer (adeno- or squamous cell carcinoma) and all pts had previously received first line platinum based therapy. Pts received CetIri (cetuximab 500 mg/m2and irinotecan 180 mg/m2day 1) every 2nd week until progression or unacceptable toxicity. Response rate was evaluated by the investigator according to RECIST every 8th week. Toxicity was prospectively evaluated according to NCIC-CTC 3.0. Results: From December 2007 to August 2008, 31 consecutive pts was treated with CetIri. Median age was 62 years (33–76). Median performance status was 1 (0–2). Localisation of primary was: Esophagus 10%, GE junction 64%, gastric 26%. Twenty-seven pts (87%) had adenocarcimona. Median number of cycles were 6 (1–21). Most important grade 2–4 toxicities were non-haematological toxicity as diarrhea (25%), nausea (21%) and vomiting (11%). Three pts (11%) had grade 3 leukopenia, 1 had febrile neutropenia. Two pts had PR. Median PFS was 3.2 months. Fourteen pts (45%) received at least 6 courses (3 month of therapy). After a median follow-up of 6 month 5 pts continue CetIri without sign of PD. Conclusions: Biweekly CetIri is a convenient and well-tolerated 2nd line regimen in pts with GE cancer. Predictive factors are needed to select which pts will benefit from therapy. A confirmatory phase II study is ongoing. [Table: see text]

e15011 Background: The combination of cetuximab and irinotecan (CetIri) given biweekly has shown remarkable efficacy in patients with chemo-resistent metastatic colorectal cancer (mCRC). At the time of PD to CetIri many patients are still in an excellent performance status and they are often requesting further therapy. Preclinical and clinical studies have shown an additive effect of inhibiting both the EGFR and the VEGF pathways. The Danish National Board of Health (DNBH) launched a national programme for experimental cancer therapy in 2004. According to this programme, non-proven therapy may be offered after approval by an expert panel appointed by DNBH that subsequently finances the cost of treatment. Inspired by BOND-2, we have offered dual-modulated therapy with a combination of biweekly CetIri with either bevacizumab 5 mg/kg (CIB) or sunitinib 25 mg/day continuously (CIS). Methods: Observational study designed to evaluate the toxicity and safety of CIB or CIS. From January 2007 to April 2008, 51 patients received either CIB (n=24) or CIS (n=27) at two oncologic departments. Therapy was approved by DNBH in each case. All patients had mCRC resistant to 5-FU, oxaliplatin, irinotecan and CetIri. CIB or CIS was offered independently of KRAS status and EGFR expression. Results: Results were updated December 1st 2008. Median duration of therapy was 30 weeks/10 weeks, response rate was 8%/0%, median PFS was 8.7/3.2 months and median OS was 12.1/8.7 months, respectively for CIB/CIS. Toxicity was comparable except for patients receiving CIS where fatigue and diarrhea were more common. Conclusions: Modulation of the VEGF pathway in combination with biweekly CetIri is a promising and tolerable treatment option for patients with mCRC refractory to CetIri. Some patients had extraordinary long PFS and OS. We are currently performing translation research into predictive markers. [Table: see text]

Udgivelsesdato: 2008-Feb-18

The survival of patients with colorectal cancer (CRC) has increased constantly for many years due to superior surgical techniques, improved postoperative care, regular follow-up and an increased use of effective systemic therapy in the adjuvant and the palliative setting [1,2]. All of these advancements are important, but the establishment of multidisciplinary teams which facilitate optimal selection of therapy for individual patients may have been the most important concept on its own. In recent years a number of biologically active substances attacking specific signalling pathways in cancer cells (targeted therapy) have been developed and included in the treatment of patients with CRC. Three monoclonal antibodies (cetuximab, panitumumab, bevacizumab) have by now been approved for therapy in metastatic CRC (mCRC) [2,3]. Angiogenesis is necessary in tumour development and controlled in part by the vascular endothelial growth system which is inhibited by bevacizumab (Avastin ®) and many other anti-angiogenic drugs. Cetuximab (Erbitux®) and panitumumab (Vectibix®) block the extracellular portion of the epidermal growth factor receptor (EGFR) and these two drugs will be discussed in detail in this chapter.

Pressurised intraperitoneal aerosol chemotherapy (PIPAC) was introduced in Denmark in 2015. More than 100 Danish patients with peritoneal metastases (PM) have received PIPAC-directed treatment within the PIPAC-OPC1 and PIPAC-OPC2 trials. PIPAC-directed treatment is feasible and safe, and there are no occupational risks for the involved healthcare professionals. An objective tumour response is seen in two out of three patients, and the survival data warrant further evaluation in large-scale randomised trials in patients with PM from different primary tumours.

The prognostic role of epidermal growth factor receptor (EGFR) remains controversial in patients with lung cancer. Previous assays for EGFR have primarily been qualitative or, at best, semiquantitative. In the present study, using fresh-frozen tissue from 190 unselected lung cancer patients, quantification of EGFR (EGFR(ELISA)) using a recently developed enzyme-linked immunosorbent assay (ELISA) technique was compared with results (EGFR(IHC)) obtained using immunohistochemistry (IHC). Correlation between results obtained by the two different techniques was highly significant (r(s) = 0.63, P < 0.001, n = 190). This correlation improved even further (r(s) = 0.76) when sections were estimated using an IHC score that took into account percentage staining, intensity and relative tumour area. Furthermore, the relationship between clinicopathological features and prognosis was identical for the two methods. The expression of EGFR was highest in squamous cell carcinomas, but it was not correlated with other characteristics such as age, sex, histological grading, stage or prognosis. We conclude that evaluation of EGFR content using IHC and ELISA produces comparable results.

Quality of life data from randomized trials are lacking in older patients with metastatic colorectal cancer (mCRC). In the randomized NORDIC9-study, reduced-dose S1+oxaliplatin (SOx) showed superior efficacy compared to full-dose S1 monotherapy. We hypothesized that treatment with SOx does not result in inferior quality of life. Patients with mCRC aged ≥ 70 years and that were not a candidate for standard combination chemotherapy were included and randomly assigned to receive either S1 or SOx. The EORTC QLQ-C30 questionnaire was completed at baseline, after 9, and 18 weeks. The primary endpoint was global Quality of Life (QoL) at 9 weeks. For statistical analysis, a non-inferiority design was chosen applying linear mixed effects models for repeated measurements. The results were interpreted according to statistical significance and anchor-based, clinically relevant between-group minimally important differences (MID). A total of 160 patients aged (median (Interquartile range (IQR))) 78 years (76–81) were included. The QLQ-C30 questionnaire was completed by 150, 100, and 60 patients at baseline, at 9, and 18 weeks, respectively. The difference at 9 weeks in global QoL was 6.85 (95%CI -1.94, 15.65) and 7.37 (0.70, 14.05) in the physical functioning domain in favor of SOx exceeding the threshold for MID. At 18 weeks, the between-group MID in physical functioning was preserved. Dose-reduced combination chemotherapy may be recommended in vulnerable older patients with mCRC, rather than full-dose monotherapy.

Introduction: Cancer treatment has become increasingly successful; however, many patients are not cured and prolonging life becomes an important goal of therapy. The perception of life changes when patients are informed that no curative treatment is available. This raises new dilemmas for patients with incurable cancer, but only sparse information is available about the thoughts of these patients. The aim of this study was to explore how the information affects and is experienced by older patients. Material and Methods: We used a qualitative approach and data were collected through semi-structured individual interviews conducted at the hospital or by telephone interviews by an experienced researcher. The study sample comprised eleven patients with incurable upper gastrointestinal cancer receiving first-line palliative chemotherapy (Median age 73 years). The thematic analysis was inspired by Braun & Clarke. Results: The interview findings were grouped around three main themes: hope of being cured, hearing but not comprehending, and desired milestones to reach. Further, it was determined that patients hid their feelings and avoided talking about their disease with the doctor due to fear of being told the truth. Conclusions: Receiving information about their incurable cancer by the doctor was an ongoing dilemma for the patients. Following the message, patients shared thoughts about reaching important milestones in life, spending time with their family, or hope for a cure to be found before it was too late. Most patients were afraid to talk with their doctor about the prognosis but still had hope for the nearest future.