124 results on '"Common Bile Duct Neoplasms drug therapy"'
Search Results
2. Outcomes of Palliative Chemotherapy for Ampulla of Vater Adenocarcinoma: A Multicenter Cohort Study.
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Jang DK, Kim SJ, Chung HH, Lee JM, Yoon SB, Lee JC, Shin DW, Hwang JH, Jung MK, Lee YS, Lee HS, and Park JK
- Subjects
- Humans, Male, Middle Aged, Female, Retrospective Studies, Aged, Cisplatin administration & dosage, Cisplatin therapeutic use, Capecitabine administration & dosage, Capecitabine therapeutic use, Treatment Outcome, Progression-Free Survival, Ampulla of Vater pathology, Palliative Care methods, Adenocarcinoma drug therapy, Adenocarcinoma mortality, Adenocarcinoma pathology, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms mortality, Common Bile Duct Neoplasms pathology, Deoxycytidine analogs & derivatives, Deoxycytidine administration & dosage, Deoxycytidine therapeutic use, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Gemcitabine, Oxaliplatin therapeutic use, Oxaliplatin administration & dosage
- Abstract
Background/aims: : Palliative chemotherapy (PC) is not standardized for patients with advanced ampulla of Vater adenocarcinoma (AA). This multicenter, retrospective study evaluated first-line PC outcomes in patients with AA., Methods: : Patients diagnosed with AA between January 2010 and December 2020 who underwent PC were enrolled from 10 institutions. Overall survival (OS) and progression-free survival (PFS) according to the chemotherapy regimen were analyzed., Results: : Of 255 patients (mean age, 64.0±10.0 years; male, 57.6%), 14 (5.5%) had locally advanced AA and 241 (94.5%) had metastatic AA. Gemcitabine plus cisplatin (GP) was administered as first-line chemotherapy to 192 patients (75.3%), whereas capecitabine plus oxaliplatin (CAPOX) was administered to 39 patients (15.3%). The median OS of all patients was 19.8 months (95% confidence interval [CI], 17.3 to 22.3), and that of patients who received GP and CAPOX was 20.4 months (95% CI, 17.2 to 23.6) and 16.0 months (95% CI, 11.2 to 20.7), respectively. The median PFS of GP and CAPOX patients were 8.4 months (95% CI, 7.1 to 9.7) and 5.1 months (95% CI, 2.5 to 7.8), respectively. PC for AA demonstrated improved median outcomes in both OS and PFS compared to conventional bile duct cancers that included AA., Conclusions: : While previous studies have shown mixed prognostic outcomes when AA was analyzed together with other biliary tract cancers, our study unveils a distinct clinical prognosis specific to AA on a large scale with systemic anticancer therapy. These findings suggest that AA is a distinct type of tumor, different from other biliary tract cancers, and AA itself could be expected to have a favorable response to PC.
- Published
- 2024
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3. Challenges and Advancements in Palliative Chemotherapy for Ampullary Adenocarcinoma.
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Kim EJ
- Subjects
- Humans, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Palliative Care methods, Adenocarcinoma drug therapy, Ampulla of Vater, Common Bile Duct Neoplasms drug therapy
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- 2024
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4. Preliminary response to Tislelizumab plus chemotherapy drugs in patient with periampullary carcinoma: a report of one case and a literature review.
- Author
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Tang C, Kong Y, Xu L, Duan C, Fu X, Fang L, and Liang B
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- Humans, Male, Treatment Outcome, Middle Aged, Deoxycytidine analogs & derivatives, Deoxycytidine administration & dosage, Deoxycytidine therapeutic use, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms therapy, Gemcitabine, Pancreaticoduodenectomy, Female, Aged, Antibodies, Monoclonal, Humanized therapeutic use, Antibodies, Monoclonal, Humanized administration & dosage, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Ampulla of Vater pathology
- Abstract
Periampullary carcinoma is a malignant gastrointestinal tumor originating from the head of the pancreas, distal bile duct, duodenum, or the ampulla of Vater. Currently, surgery remains the primary treatment option, yet the postoperative recurrence rate remains high. Chemotherapy is the main approach for controlling postoperative recurrence. Histologically, periampullary carcinoma is categorized into two types: intestinal (IN) and pancreaticobiliary (PB) subtype. Each subtype requires different therapeutic approaches, with the PB type primarily treated with gemcitabine and the IN type with 5-FU. Despite these options, patient outcomes are still unsatisfactory. In recent years, the feasibility of immunotherapy in tumor treatment has been increasingly evidenced, although research on its efficacy in periampullary carcinoma treatment is still limited. In this report, we present a case of a periampullary carcinoma patient who experienced recurrence and metastasis after undergoing radical pancreatoduodenectomy and receiving gemcitabine-based chemotherapy post-surgery. Through next-generation sequencing (NGS), we identified high expression levels of programmed cell death-ligand 1 (PD-L1) with a combined positive score (CPS) of 35, high tumor mutation burden (TMB-H), and high microsatellite instability (MSI-H) in this patient. Therefore, we implemented a combination therapy using Tislelizumab and chemotherapy. According to the latest follow-up, the tumors are effectively controlled. Our utilization of immunotherapy combined with chemotherapy holds significant implication for the treatment of periampullary carcinoma., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Tang, Kong, Xu, Duan, Fu, Fang and Liang.)
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- 2024
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5. The road to tailored adjuvant chemotherapy for all four non-pancreatic periampullary cancers: An international multimethod cohort study.
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Uijterwijk BA, Lemmers DH, Ghidini M, Wilmink JW, Zaniboni A, Fusai GK, Zerbi A, Koerkamp BG, Luyer M, Ghorbani P, Salvia R, White S, Ielpo B, Goh BKP, Boggi U, Kazemier G, House MG, Mavroeidis VK, Björnsson B, Mazzola M, Serradilla M, Korkolis D, Alseidi A, Roberts KJ, Soonawalla Z, Pessaux P, Fisher WE, Koek S, Kent TS, Vladimirov M, Bolm L, Jamieson N, Dalla Valle R, Kleeff J, Mazzotta A, Suarez Muñoz MA, Cabús SS, Ball CG, Berger AC, Ferarri C, Besselink MG, and Hilal MA
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- Humans, Male, Female, Chemotherapy, Adjuvant, Middle Aged, Aged, Cholangiocarcinoma drug therapy, Cholangiocarcinoma pathology, Cholangiocarcinoma surgery, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Ampulla of Vater pathology, Pancreaticoduodenectomy, Cohort Studies, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms surgery, Common Bile Duct Neoplasms pathology, Common Bile Duct Neoplasms mortality, Bile Duct Neoplasms drug therapy, Bile Duct Neoplasms pathology, Bile Duct Neoplasms surgery, Retrospective Studies, Capecitabine therapeutic use, Capecitabine administration & dosage, Adenocarcinoma drug therapy, Adenocarcinoma pathology, Duodenal Neoplasms drug therapy, Duodenal Neoplasms pathology, Duodenal Neoplasms surgery
- Abstract
Background: Despite differences in tumour behaviour and characteristics between duodenal adenocarcinoma (DAC), the intestinal (AmpIT) and pancreatobiliary (AmpPB) subtype of ampullary adenocarcinoma and distal cholangiocarcinoma (dCCA), the effect of adjuvant chemotherapy (ACT) on these cancers, as well as the optimal ACT regimen, has not been comprehensively assessed. This study aims to assess the influence of tailored ACT on DAC, dCCA, AmpIT, and AmpPB., Patients and Methods: Patients after pancreatoduodenectomy for non-pancreatic periampullary adenocarcinoma were identified and collected from 36 tertiary centres between 2010 - 2021. Per non-pancreatic periampullary tumour type, the effect of adjuvant chemotherapy and the main relevant regimens of adjuvant chemotherapy were compared. The primary outcome was overall survival (OS)., Results: The study included a total of 2866 patients with DAC (n = 330), AmpIT (n = 765), AmpPB (n = 819), and dCCA (n = 952). Among them, 1329 received ACT, and 1537 did not. ACT was associated with significant improvement in OS for AmpPB (P = 0.004) and dCCA (P < 0.001). Moreover, for patients with dCCA, capecitabine mono ACT provided the greatest OS benefit compared to gemcitabine (P = 0.004) and gemcitabine - cisplatin (P = 0.001). For patients with AmpPB, no superior ACT regime was found (P > 0.226). ACT was not associated with improved OS for DAC and AmpIT (P = 0.113 and P = 0.445, respectively)., Discussion: Patients with resected AmpPB and dCCA appear to benefit from ACT. While the optimal ACT for AmpPB remains undetermined, it appears that dCCA shows the most favourable response to capecitabine monotherapy. Tailored adjuvant treatments are essential for enhancing prognosis across all four non-pancreatic periampullary adenocarcinomas., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)
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- 2024
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6. Real-world efficacy and safety of capecitabine with oxaliplatin in patients with advanced adenocarcinoma of the ampulla of Vater.
- Author
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Lee S, Park SJ, Shin K, Hong TH, Kim IH, and Lee MA
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- Humans, Male, Female, Middle Aged, Aged, Adult, Retrospective Studies, Progression-Free Survival, Treatment Outcome, Capecitabine therapeutic use, Capecitabine administration & dosage, Capecitabine adverse effects, Oxaliplatin therapeutic use, Oxaliplatin administration & dosage, Oxaliplatin adverse effects, Ampulla of Vater pathology, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Antineoplastic Combined Chemotherapy Protocols adverse effects, Adenocarcinoma drug therapy, Adenocarcinoma pathology, Adenocarcinoma mortality, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms pathology, Common Bile Duct Neoplasms mortality
- Abstract
Background: Adenocarcinoma of the ampulla of Vater (AoV) is one of the rare periampullary cancers, and due to its anatomical location, it is categorized into various histologic subtypes. Its rarity and diversity pose challenges in treatment decision-making for patients with advanced AoV carcinoma. This study investigated the efficacy and safety of the combined regimen of capecitabine and oxaliplatin (CAPOX) in a real-world clinical setting., Methods: This investigation encompassed patients with advanced AoV carcinoma who underwent CAPOX treatment. Histologic phenotypes were identified through a combination of histopathological analysis and protein expression markers, including MUC1, CDX2, CK20, and MUC2. The correlation between histopathological determinants and survival outcomes was explored, in addition to an evaluation of the safety profile of CAPOX therapy., Results: From January 2010 to June 2023, 42 patients received CAPOX. Of these, 14 patients (33.3%) had not received any prior palliative chemotherapy, while 28 patients (66.7%) had undergone one prior line of chemotherapy. At a median follow up of 9.0 months, the median progression-free survival (PFS) was 4.38 months (95% CI, 2.78-5.69) and the median overall survival (OS) was 9.57 months (95% CI 7.56-11.6). The objective response and disease control rates were 38.1% and 61.9%, respectively. Patients who received CAPOX as a second-line treatment had poorer PFS (HR = 2.62; 95% CI, 1.49-4.90, p = 0.003) and OS (HR = 2.82, 95% CI, 1.47-5.38, p = 0.001) compared to those who received CAPOX as a first-line chemotherapy. There were no statistically significant differences in PFS (p = 0.185) and OS (p = 0.097) between groups based on histologic subtypes. Neutropenia (14.3%) emerged as the predominant grade 3-4 toxicity. Notably, treatment cessation occurred in select instances owing to grade 3 fatigue (9.5%) and peripheral neuropathy (9.5%)., Conclusions: This study confirmed the therapeutic efficacy and safety of CAPOX in a real-world setting, consistent with prior phase II trial results. While CAPOX proved feasible for advanced AoV carcinoma regardless of histologic subtype, its reduced effectiveness in second-line settings necessitates further research to determine its optimal palliative use., (© 2024. The Author(s).)
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- 2024
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7. Adjuvant Chemotherapy and Effect on Long-Term Survival in Ampullary Adenocarcinoma: A Multicenter Cohort Study.
- Author
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Shin DW, Lee JM, Lee JC, Lee HS, Yoon SB, Jang DK, Park JK, Jung MK, Lee YS, and Hwang JH
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- Humans, Chemotherapy, Adjuvant, Cohort Studies, Retrospective Studies, Ampulla of Vater, Adenocarcinoma drug therapy, Adenocarcinoma surgery, Pancreatic Neoplasms, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms surgery
- Abstract
Background: The role of adjuvant chemotherapy (AC) in patients with ampullary adenocarcinoma (AA) remains controversial. This study aimed to determine if AC could improve the prognosis of patients with resected AA., Study Design: This study enrolled patients diagnosed with AA at 9 tertiary teaching hospitals. Patients who did and did not receive AC were matched 1:1 using propensity score. The overall survival (OS) and recurrence-free survival (RFS) were compared between the 2 groups., Results: Of the 1,057 patients with AA, 883 underwent curative-intent pancreaticoduodenectomy, and 255 received AC. Because patients with advanced-stage AA received AC more frequently, the no AC group unexpectedly had a longer OS (not reached vs 78.6 months; p < 0.001) and RFS (not reached vs 18.7 months; p < 0.001) than did the AC group in the unmatched cohort. In the propensity score-matched cohort (n = 296), no difference between the 2 groups in terms of OS (95.9 vs 89.8 months, p = 0.303) and RFS (not reached vs 25.5 months; p = 0.069) was found. By subgroup analysis, patients with advanced stage (pT4 or pN1-2) showed longer OS in the AC group than in the no AC group (not reached vs 15.7 months, p = 0.007: 89.8 vs 24.2 months, p = 0.006, respectively). There was no difference in RFS according to AC in the propensity score-matched cohort., Conclusions: Given its favorable long-term outcomes, AC can be recommended for patients with resected AA, especially those in the advanced stage (pT4 or pN1-2)., (Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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8. Invited Commentary: Adjuvant Chemotherapy Is Beneficial in Stage III Ampullary Adenocarcinoma.
- Author
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Premji AM and Donahue TR
- Subjects
- Humans, Chemotherapy, Adjuvant, Neoplasm Staging, Retrospective Studies, Ampulla of Vater surgery, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms surgery, Adenocarcinoma drug therapy, Adenocarcinoma surgery
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- 2023
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9. Granulomatous peritoneal disease associated with oxaliplatin-based chemotherapy for ampullary adenocarcinoma: a case report.
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Vermeersch G, Cruyt N, D'Hondt E, Geers J, Hertveldt K, Stockman A, and Lambrecht G
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- Humans, Oxaliplatin adverse effects, Antineoplastic Combined Chemotherapy Protocols adverse effects, Ampulla of Vater pathology, Adenocarcinoma pathology, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms etiology, Common Bile Duct Neoplasms pathology, Peritoneal Diseases
- Abstract
Adenocarcinomas of the ampulla of Vater represent only 0.2% of all gastrointestinal cancers. Due to the low incidence no large clinical trials evaluating efficacy of treatments are available. Adjuvant therapy is often administered in patients with stage IB or higher. Oxaliplatin is considered as an effective and well tolerated therapeutic option. Adverse events associated with this therapy include cardio-, neuro-, nephrotoxicity and myelosuppression. Previously granulomatous pulmonary and liver manifestations have been described in oxaliplatin-based chemotherapy. In this report peritoneal manifestation of granulomatous disease associated with oxaliplatin is described for the first time. Sarcoidlike reactions may be misinterpreted as tumour progression or metastatic disease, and may consequently result in over-treatment., (© Acta Gastro-Enterologica Belgica.)
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- 2023
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10. Controversial benefit of 5-fluorouracil/leucovorin-based adjuvant chemotherapy for ampullary cancer: a propensity score-matched analysis.
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Kang J, Lee W, Shin J, Park Y, Kwon JW, Jun E, Song KB, Lee JH, Hwang DW, Park SY, and Kim SC
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- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Chemotherapy, Adjuvant, Fluorouracil administration & dosage, Humans, Leucovorin administration & dosage, Neoplasm Staging, Propensity Score, Ampulla of Vater pathology, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms surgery
- Abstract
Background: Although surgery is the primary treatment for ampullary cancer (AC), the benefit of adjuvant chemotherapy (CTx) has not yet been confirmed., Methods: AC patients who were administered 5-fluorouracil(FU)/leucovorin(LV)-based CTx after curative intent surgery between 2011 and 2019 were included. Prognosis was compared between the observation (OB) and CTx groups after propensity score matching (PSM) using perioperative variables to control differences in patient characteristics., Results: Before PSM, of 475 patients, those in the CTx group (n = 281) had worse 5-year overall survival (OS) (82.1% vs. 78.5%, p = 0.017) and worse 5-year recurrence-free survival (RFS) (54.9% vs. 75.7%, p < 0.001) than those in the OB group (n = 194). In addition, the CTx group had a higher rate of poor prognostic factors such as a high T stage (p < 0.001), node metastasis (p < 0.001), and poor differentiation (p < 0.001). After PSM, perioperative outcomes were comparable. In addition, there were no significant differences in OS (hazard ratio [HR], 1.085; 95% confidence interval [CI], 0.688-1.710; p = 0.726) or RFS (HR, 0.883; 95% CI, 0.613 1.272; p = 0.505) between the CTx (n = 123) and OB (n = 123) groups even after stratification by TNM stage. Intestinal subtype showed better 5-year OS (83.7% vs 33.2%, p = 0.015) and RFS (46.5% vs 24.9%, p = 0.035) rate compared with pancreatobiliary/mixed subtype., Conclusion: Patients who received adjuvant chemotherapy based on 5-FU/LV showed comparable oncologic outcomes to patients in the OB group even after stratification by tumor stage. The patients with intestinal subtype showed oncologic benefit for adjuvant 5-FU/LV CTx compared with pancreatobiliary or mixed subtypes., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2022
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11. Molecular Characterization of Biliary Tract Cancer Predicts Chemotherapy and Programmed Death 1/Programmed Death-Ligand 1 Blockade Responses.
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Yoon JG, Kim MH, Jang M, Kim H, Hwang HK, Kang CM, Lee WJ, Kang B, Lee CK, Lee MG, Chung HC, Choi HJ, and Park YN
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- Adult, Aged, Aged, 80 and over, Ampulla of Vater, B7-H1 Antigen antagonists & inhibitors, Bile Duct Neoplasms drug therapy, Bile Duct Neoplasms genetics, Bile Ducts, Extrahepatic, Bile Ducts, Intrahepatic, Biliary Tract Neoplasms genetics, Carcinoma genetics, Cholangiocarcinoma drug therapy, Cholangiocarcinoma genetics, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms genetics, Female, Gallbladder Neoplasms drug therapy, Gallbladder Neoplasms genetics, Humans, Isocitrate Dehydrogenase genetics, Lymphocytes, Tumor-Infiltrating, Male, Middle Aged, Programmed Cell Death 1 Receptor antagonists & inhibitors, Proto-Oncogene Proteins p21(ras) genetics, Smad4 Protein genetics, Treatment Outcome, Tumor Microenvironment, Tumor Suppressor Proteins genetics, Ubiquitin Thiolesterase genetics, Antineoplastic Agents therapeutic use, Biliary Tract Neoplasms drug therapy, Carcinoma drug therapy, Immune Checkpoint Inhibitors therapeutic use
- Abstract
Background and Aims: Biliary tract cancer (BTC) exhibits diverse molecular characteristics. However, reliable biomarkers that predict therapeutic responses are yet to be discovered. We aimed to identify the molecular features of treatment responses to chemotherapy and immunotherapy in BTCs., Approach and Results: We enrolled 121 advanced BTC patients (68 cholangiocarcinomas [33 intrahepatic, 35 extrahepatic], 41 gallbladder cancers, and 12 Ampulla of Vater cancers) whose specimens were analyzed by clinical sequencing platforms. All patients received first-line palliative chemotherapy; 48 patients underwent programmed death 1 (PD-1)/programmed death-ligand 1 (PD-L1) blockade therapy after failed chemotherapy. Molecular and histopathological characterization was performed using targeted sequencing and immunohistochemical staining to investigate treatment response-associated biomarkers. Genomic analysis revealed a broad spectrum of mutational profiles according to anatomical location. Favorable responses to chemotherapy were observed in the small-duct type compared with the large-duct type intrahepatic cholangiocarcinoma, with frequent mutations in BRCA1-associated protein-1/isocitrate dehydrogenase 1/2 and KRAS proto-oncogene, GTPase/SMAD family member 4 genes, respectively. The molecular features were further analyzed in BTCs, and transforming growth factor beta and DNA damage response pathway-altered tumors exhibited poor and favorable chemotherapy responses, respectively. In PD-1/PD-L1 blockade-treated patients, KRAS alteration and chromosomal instability tumors were associated with resistance to immunotherapy. The majority of patients (95.0%) with these resistance factors show no clinical benefit to PD-1/PD-L1 blockade and low tumor mutational burdens. Low tumor-infiltrating lymphocyte (TIL) density in tumors with these resistance factors indicated immune-suppressive tumor microenvironments, whereas high intratumoral TIL density was associated with a favorable immunotherapy response., Conclusions: This study proposes predictive molecular features of chemotherapy and immunotherapy responses in advanced BTCs using clinical sequencing platforms. Our result provides an intuitive framework to guide the treatment of advanced BTCs benefiting from therapeutic agents based on the tumors' molecular features., (© 2021 by the American Association for the Study of Liver Diseases.)
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- 2021
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12. Oncologic outcomes in resected ampullary cancer: Relevance of histologic subtype and adjuvant chemotherapy.
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Affi Koprowski M, Sutton TL, Brinkerhoff BT, Grossberg A, Sheppard BC, and Mayo SC
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- Adenocarcinoma drug therapy, Adenocarcinoma pathology, Adult, Aged, Aged, 80 and over, Combined Modality Therapy, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms pathology, Disease-Free Survival, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, Survival Analysis, Treatment Outcome, Adenocarcinoma surgery, Ampulla of Vater pathology, Ampulla of Vater surgery, Chemotherapy, Adjuvant methods, Common Bile Duct Neoplasms surgery
- Abstract
Background: Outcomes in ampullary cancer (AC) may differ by pathologic subtype. No guidelines exist for the administration of adjuvant therapy (AT). We sought to evaluate the effect of subtype and AT on survival., Methods: An institutional review of patients undergoing resection for AC from 2008-17 was performed. Recurrence-free (RFS) and overall survival (OS) were assessed by Kaplan-Meier and Cox proportional hazards modeling., Results: Of 53 patients, two-thirds (62%) were stage III. Histologic subtype was evenly split between intestinal and pancreatobiliary (43% and 40%). Half of patients received AT. RFS and OS were 25 (95% CI 16-32) and 41 (CI 22-60) months, respectively, without significant difference by subtype. Stage II/III disease was associated with worse OS (HR 3.7, P = 0.03), which was improved with receipt of AT (HR 0.44, P < 0.05)., Conclusion: Stage is the primary determinant of survival in AC, which may be improved with AT., Competing Interests: Declaration of competing interest None of the authors have any conflict of interest to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
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13. Survival Outcomes of Gemcitabine Plus S-1 Adjuvant Chemotherapy after Surgical Resection for Advanced Biliary Tract Cancer.
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Hosoda K, Fukushima K, Shimizu A, Motoyama H, Kubota K, Notake T, Sugenoya S, Hayashi H, Yasukawa K, Kobayashi R, and Soejima Y
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- Adult, Aged, Aged, 80 and over, Common Bile Duct Neoplasms mortality, Deoxycytidine adverse effects, Disease-Free Survival, Drug Combinations, Female, Follow-Up Studies, Gallbladder Neoplasms mortality, Humans, Klatskin Tumor mortality, Male, Middle Aged, Neoplasm Recurrence, Local prevention & control, Propensity Score, Survival Rate, Gemcitabine, Antimetabolites, Antineoplastic adverse effects, Antineoplastic Combined Chemotherapy Protocols adverse effects, Biliary Tract Surgical Procedures methods, Chemotherapy, Adjuvant adverse effects, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms surgery, Deoxycytidine analogs & derivatives, Gallbladder Neoplasms drug therapy, Gallbladder Neoplasms surgery, Klatskin Tumor drug therapy, Klatskin Tumor surgery, Oxonic Acid adverse effects, Tegafur adverse effects
- Abstract
Introduction: The usefulness of adjuvant chemotherapy in biliary tract cancer (BTC) is poorly reported. This study aimed to evaluate the effectiveness and safety of adjuvant gemcitabine plus S-1 (GS) chemotherapy after curative surgical resection for BTC., Methods: 225 BTC patients who underwent surgical resection between January 2006 and May 2019 were enrolled in this study. Twenty-seven patients received adjuvant chemotherapy with GS (GS group), whereas 67 patients underwent surgery alone (S group). Twenty-three matching pairs were derived through propensity score (PS) matching analysis. Patients received 12 cycles of adjuvant chemotherapy (70 mg/m2 oral S-1 for 7 consecutive days plus intravenous gemcitabine 1,000 mg/m2 on day 7). The primary end point was recurrence-free survival (RFS). The secondary end points were the 1-, 2-, and 3-year RFS and overall survival (OS) rates, tolerability, and frequency of grade 3/4 toxicity., Results: The completion rate was 81.5%; no treatment-related deaths were observed. Grade 3/4 adverse events were seen in 40.7% of the patients. RFS (3-year RFS rate: 59.3% vs. 39.1%, p = 0.049) and OS (3-year OS rate: 71.7% vs. 53.4%, p = 0.008) were significantly better in the GS group than in the S group among PS-matched pairs., Discussion/conclusion: GS chemotherapy after curative surgery was well tolerated, showed better clinical benefit in the adjuvant setting, and can effectively reduce BTC recurrence., (© 2021 S. Karger AG, Basel.)
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- 2021
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14. Gemcitabine-based adjuvant chemotherapy in subtypes of ampullary adenocarcinoma: international propensity score-matched cohort study.
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Moekotte AL, Malleo G, van Roessel S, Bonds M, Halimi A, Zarantonello L, Napoli N, Dreyer SB, Wellner UF, Bolm L, Mavroeidis VK, Robinson S, Khalil K, Ferraro D, Mortimer MC, Harris S, Al-Sarireh B, Fusai GK, Roberts KJ, Fontana M, White SA, Soonawalla Z, Jamieson NB, Boggi U, Alseidi A, Shablak A, Wilmink JW, Primrose JN, Salvia R, Bassi C, Besselink MG, and Abu Hilal M
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma pathology, Adenocarcinoma surgery, Aged, Chemotherapy, Adjuvant mortality, Common Bile Duct Neoplasms pathology, Common Bile Duct Neoplasms surgery, Deoxycytidine therapeutic use, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Pancreaticoduodenectomy, Propensity Score, Proportional Hazards Models, Retrospective Studies, Survival Analysis, Gemcitabine, Adenocarcinoma drug therapy, Ampulla of Vater pathology, Ampulla of Vater surgery, Antimetabolites, Antineoplastic therapeutic use, Chemotherapy, Adjuvant methods, Common Bile Duct Neoplasms drug therapy, Deoxycytidine analogs & derivatives
- Abstract
Background: Whether patients who undergo resection of ampullary adenocarcinoma have a survival benefit from adjuvant chemotherapy is currently unknown. The aim of this study was to compare survival between patients with and without adjuvant chemotherapy after resection of ampullary adenocarcinoma in a propensity score-matched analysis., Methods: An international multicentre cohort study was conducted, including patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma between 2006 and 2017, in 13 centres in six countries. Propensity scores were used to match patients who received adjuvant chemotherapy with those who did not, in the entire cohort and in two subgroups (pancreatobiliary/mixed and intestinal subtypes). Survival was assessed using the Kaplan-Meier method and Cox regression analyses., Results: Overall, 1163 patients underwent pancreatoduodenectomy for ampullary adenocarcinoma. After excluding 187 patients, median survival in the remaining 976 patients was 67 (95 per cent c.i. 56 to 78) months. A total of 520 patients (53·3 per cent) received adjuvant chemotherapy. In a propensity score-matched cohort (194 patients in each group), survival was better among patients who received adjuvant chemotherapy than in those who did not (median survival not reached versus 60 months respectively; P = 0·051). A survival benefit was seen in patients with the pancreatobiliary/mixed subtype; median survival was not reached in patients receiving adjuvant chemotherapy and 32 months in the group without chemotherapy (P = 0·020). Patients with the intestinal subtype did not show any survival benefit from adjuvant chemotherapy., Conclusion: Patients with resected ampullary adenocarcinoma may benefit from gemcitabine-based adjuvant chemotherapy, but this effect may be reserved for those with the pancreatobiliary and/or mixed subtype., (© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd.)
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- 2020
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15. Treatment of pembrolizumab-induced cutaneous lesions with ruxolitinib.
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Chen CY, Chiu CF, and Bai LY
- Subjects
- Adenocarcinoma secondary, Aged, Ampulla of Vater, Antibodies, Monoclonal, Humanized administration & dosage, Arm, Common Bile Duct Neoplasms pathology, Drug Eruptions etiology, Glucocorticoids therapeutic use, Histamine Antagonists therapeutic use, Humans, Liver Neoplasms secondary, Male, Nitriles, Paclitaxel administration & dosage, Prednisolone therapeutic use, Pyrimidines, Scrotum, Thigh, Torso, Adenocarcinoma drug therapy, Antibodies, Monoclonal, Humanized adverse effects, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Common Bile Duct Neoplasms drug therapy, Drug Eruptions drug therapy, Janus Kinase Inhibitors therapeutic use, Liver Neoplasms drug therapy, Pyrazoles therapeutic use
- Published
- 2019
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16. [Cholangiocellular cancer: the state of the problem and ways to improve the results of surgical treatment].
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Patyutko YI, Polyakov AN, Podluzhnyi DV, Syskova AY, Sagaidak IV, Kotel'nikov AG, Sergeeva ON, and Pokataev IA
- Subjects
- Antineoplastic Agents therapeutic use, Bile Duct Neoplasms drug therapy, Bile Duct Neoplasms pathology, Bile Ducts, Intrahepatic pathology, Chemotherapy, Adjuvant, Cholangiocarcinoma drug therapy, Cholangiocarcinoma pathology, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms pathology, Hepatectomy, Humans, Lymph Node Excision, Pancreaticoduodenectomy, Portal Vein pathology, Portal Vein surgery, Treatment Outcome, Bile Duct Neoplasms surgery, Bile Ducts, Intrahepatic surgery, Cholangiocarcinoma surgery, Common Bile Duct Neoplasms surgery
- Abstract
Aim: To improve the outcomes in patients with resectable biliary cancer., Material and Methods: There were 263 procedures for cholangiocellular carcinoma (CCC) for the period 1998—2017. Adjuvant chemotherapy was performed in 102 (38.8%) patients. Extensiveliver resections (78.9%) prevailed for intrahepatic cholangiocellular carcinoma (n=128), 6 (4.7%) patients required vascular resection. Seventy-seven pancreatoduodenectomies were performed for common bile duct cancer, portal vein resection was done in 8 (10.4%) patients. In case of Klatskin tumor (n=58) liver resection combined with bile duct resection (n=52) prevailed. Portal vein resection was done in 16 (27.6%) patients., Results: Postoperative morbidity in patients with intrahepatic CCC was revealed in 68 (53.1%) cases, mortality — in 5 (3.9%) cases. Among patients with Klatskin tumor morbidity was revealed in 51 (87.9%) cases, mortality — in 6 (10.3%) cases. In patients with common bile duct cancer morbidity was revealed in 53 (68.8%) cases, mortality — in 4 (5.2%) cases. In whole cohort median overall survival was 30 months. R0-resection was associated with better long-term results (median 37 months) compared with R1—R2 resection (20 months; p=0.01). Lymph node involvement is associated with significantly worse prognosis (p=0.016), however 5-year survival is observed (25.6%). Adjuvant chemotherapy in R0-resection significantly improved long-term results: median was 46 months (vs. 30 in group without chemotherapy; p=0.02). In intrahepatic CCC patients multiple lesions or mechanical jaundice did not aggravate long-term results., Conclusion: R0-resection including lymphadenectomy, resection of adjacent organs and vessels is advisable for CCC. Isolated bile duct resection should be used as an exception. Adjuvant therapy improved long-term results. Multiple lymph node lesion or bile duct infiltration are not contraindications to surgery in intrahepatic CCC patients.
- Published
- 2018
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17. Prognostic relevance of lymph node status for patients with ampullary adenocarcinoma after radical resection followed by adjuvant treatment.
- Author
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Kwon J, Kim K, Chie EK, Kim BH, Jang JY, Kim SW, Oh DY, and Bang YJ
- Subjects
- Adenocarcinoma drug therapy, Adult, Aged, Anastomotic Leak etiology, Chemoradiotherapy, Adjuvant adverse effects, Common Bile Duct Neoplasms drug therapy, Disease-Free Survival, Female, Humans, Lymph Nodes surgery, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Peripheral Nerves pathology, Prognosis, Retrospective Studies, Survival Rate, Adenocarcinoma secondary, Adenocarcinoma surgery, Ampulla of Vater, Common Bile Duct Neoplasms pathology, Common Bile Duct Neoplasms surgery, Lymph Node Excision, Lymph Nodes pathology
- Abstract
Purpose: Attempts have been made to revise the nodal stage due to simplicity of current N staging system in ampullary adenocarcinoma. However, because of the disease rarity, there have only been a few studies assessing the prognostic impact of lymph node (LN) parameters., Methods: We retrospectively analyzed 120 patients who underwent radical resection followed by adjuvant chemoradiotherapy for ampullary adenocarcinoma. The effect of LN parameters (number of total harvest LNs, number of metastatic LN (MLN), lymph node ratio (LNR), and log odds of positive LNs (LODDS)) on overall survival (OS), locoregional relapse-free survival (LRFS) and distant metastasis-free survival were evaluated. Cutoff points of MLN, LNR and LODDs were determined using maximal χ
2 method., Results: Fifty-seven patients (48%) were staged as pN1 and their survival was not significantly decreased compared with pN0 patients. There was also no significant difference between patients with MLN 0 vs. 1. In univariate analyses, MLN (0-1 vs. ≥2), LNR (≤17% vs. >17%) and perineural invasion were common prognosticators for OS and LRFS. Distant metastasis-free survival was not influenced by LN status. In addition, multivariate analysis revealed that among the LN parameters, LNR was able to independently predict both OS and LRFS., Conclusions: LNR performs better than other LN related parameters for predicting survival. After radical resection followed by adjuvant treatment, survival of patients with one positive LN does not seem to differ from patients without LN metastasis., (Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)- Published
- 2017
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18. Meta-analysis of adjuvant therapy following curative surgery for periampullary adenocarcinoma.
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Acharya A, Markar SR, Sodergren MH, Malietzis G, Darzi A, Athanasiou T, and Khan AZ
- Subjects
- Adenocarcinoma mortality, Chemoradiotherapy, Adjuvant, Chemotherapy, Adjuvant, Common Bile Duct Neoplasms mortality, Duodenal Neoplasms mortality, Humans, Survival Rate, Adenocarcinoma drug therapy, Adenocarcinoma surgery, Ampulla of Vater surgery, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms surgery, Duodenal Neoplasms drug therapy, Duodenal Neoplasms surgery
- Abstract
Background: Periampullary cancers are uncommon malignancies, often amenable to surgery. Several studies have suggested a role for adjuvant chemotherapy and chemoradiotherapy in improving survival of patients with periampullary cancers, with variable results. The aim of this meta-analysis was to determine the survival benefit of adjuvant therapy for periampullary cancers., Methods: A systematic review was undertaken of literature published between 1 January 2000 and 31 December 2015 to elicit and analyse the pooled overall survival associated with the use of either adjuvant chemotherapy or chemoradiotherapy versus observation in the treatment of surgically resected periampullary cancer. Included articles were also screened for information regarding stage, prognostic factors and toxicity-related events., Results: A total of 704 titles were screened, of which 93 full-text articles were retrieved. Fourteen full-text articles were included in the study, six of which were RCTs. A total of 1671 patients (904 in the control group and 767 who received adjuvant therapy) were included. The median 5-year overall survival rate was 37·5 per cent in the control group, compared with 40·0 per cent in the adjuvant group (hazard ratio 1·08, 95 per cent c.i. 0·91 to 1·28; P = 0·067). In 32·2 per cent of patients who had adjuvant therapy, one or more WHO grade 3 or 4 toxicity-related events were noted. Advanced T category was associated worse survival (regression coefficient -0·14, P = 0·040), whereas nodal status and grade of differentiation were not., Conclusion: This systematic review found no associated survival benefit for adjuvant chemotherapy or chemoradiotherapy in the treatment of periampullary cancer., (© 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.)
- Published
- 2017
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19. Bevacizumab combined with capecitabine and oxaliplatin in patients with advanced adenocarcinoma of the small bowel or ampulla of vater: A single-center, open-label, phase 2 study.
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Gulhati P, Raghav K, Shroff RT, Varadhachary GR, Kopetz S, Javle M, Qiao W, Wang H, Morris J, Wolff RA, and Overman MJ
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma pathology, Adult, Aged, Bevacizumab administration & dosage, Capecitabine administration & dosage, Common Bile Duct Neoplasms mortality, Common Bile Duct Neoplasms pathology, Comorbidity, Female, Humans, Intestinal Neoplasms mortality, Intestinal Neoplasms pathology, Male, Middle Aged, Neoplasm Grading, Neoplasm Metastasis, Neoplasm Staging, Organoplatinum Compounds administration & dosage, Oxaliplatin, Treatment Outcome, Adenocarcinoma drug therapy, Ampulla of Vater pathology, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Common Bile Duct Neoplasms drug therapy, Intestinal Neoplasms drug therapy, Intestine, Small pathology
- Abstract
Background: Capecitabine with oxaliplatin (CAPOX) has previously demonstrated clinical activity in patients with small bowel adenocarcinoma (SBA) and ampullary adenocarcinoma (AAC). Herein, the authors conducted a phase 2 trial to evaluate the benefit of adding bevacizumab to CAPOX., Methods: In this phase 2, single-arm, single-center, open-label study, patients aged ≥18 years with untreated, advanced SBA or AAC were recruited. Patients received capecitabine at a dose of 750 mg/m
2 orally twice daily on days 1 to 14, oxaliplatin at a dose of 130 mg/m2 intravenously on day 1, and bevacizumab at a dose of 7.5 mg/kg intravenously on day 1 of a 21-day cycle. The primary endpoint was progression-free survival (PFS) at 6 months. Secondary objectives included response rate, overall PFS, overall survival, and toxicity., Results: Between August 2011 and November 2014, a total of 30 patients were enrolled into the study (male/female ratio of 13/17; median age of 63 years [range, 33-78 years]; and 7 patients with an Eastern Cooperative Oncology Group performance status [ECOG PS] of 0, 20 patients with an ECOG PS of 1, and 3 patients with an ECOG PS of 2). Of the 30 patients, 23 (77%) had SBA (18 of duodenal origin and 5 of jejunal/ileal origin) and 7 patients (23%) had AAC (5 of pancreaticobiliary subtype, 1 of mixed subtype, and 1 of intestinal subtype). The most common grade 3 toxicities observed were fatigue and hypertension (7 patients each [23%]), neutropenia (6 patients [20%]), and diarrhea (3 patients [10%]) (toxicity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0]). The probability of PFS at 6 months was 68% (95% confidence interval [95% CI], 52% to 88%). The response rate was 48.3%, with 1 complete response and 13 partial responses; 10 patients achieved stable disease. At a median follow-up of 25.9 months, the median PFS was 8.7 months (95% CI, 4.9-10.5 months) and the median overall survival was 12.9 months (95% CI, 9.2-19.7 months)., Conclusions: The results of the current study indicate that CAPOX with bevacizumab is an active and well-tolerated regimen for patients with SBA and AAC. These findings support the need for further investigation into the clinical benefit of targeting angiogenesis in patients with SBA and AAC. Cancer 2017;123:1011-17. © 2016 American Cancer Society., (© 2016 American Cancer Society.)- Published
- 2017
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20. [A Case of Liver Metastasis of Ampullary Carcinoma That Developed Postoperatively That Was Effectively Treated with Gemcitabine plus Cisplatin].
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Miyazaki Y, Yamabe K, Hayashi N, Michiura T, Nakagawa T, Okubo K, Fujita S, and Nagaoka M
- Subjects
- Aged, Cisplatin administration & dosage, Common Bile Duct Neoplasms pathology, Common Bile Duct Neoplasms surgery, Deoxycytidine administration & dosage, Deoxycytidine analogs & derivatives, Duodenal Neoplasms pathology, Duodenal Neoplasms surgery, Fatal Outcome, Humans, Liver Neoplasms secondary, Male, Pancreaticoduodenectomy, Gemcitabine, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Common Bile Duct Neoplasms drug therapy, Duodenal Neoplasms drug therapy, Liver Neoplasms drug therapy
- Abstract
A 75-year-oldman presenting with obstructive jaundice was referredto our hospital. Basedon a diagnosis of carcinoma of the ampulla of Vater, we performed pancreatoduodenectomy. Postoperative histopathological examination revealed a welldifferentiated papillotubular adenocarcinoma, T3, N0, M0, Stage III . Six months after surgery, an isolatedliver metastasis in S6 was identifiedon CT scan andMRI; therefore, we administeredgemcitabine plus cisplatin chemotherapy. After 6 courses of this regimen, a clinical complete response(CR)was obtained. After 12 courses, the clinical CR continued; however, grade 3 lower-extremity peripheral neuropathy appeared. Therefore, gemcitabine monotherapy was administered as second line chemotherapy. However, multiple liver metastases appearedandthe patient passedaway owing to exacerbation of the disease 2 years after initiating chemotherapy. Although recurrent ampullary carcinoma is difficult to treat, our patient had a long-term survival. Here we report the details of our case and review the relevant literature.
- Published
- 2016
21. A pilot study of concurrent chemoradiotherapy with gemcitabine and cisplatin in patients with locally advanced biliary tract cancer.
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Lee KJ, Yi SW, Cha J, Seong J, Bang S, Song SY, Kim HM, and Park SW
- Subjects
- Adult, Aged, Antimetabolites, Antineoplastic administration & dosage, Antineoplastic Agents administration & dosage, Antineoplastic Combined Chemotherapy Protocols adverse effects, Biliary Tract Neoplasms diagnostic imaging, Chemoradiotherapy adverse effects, Cholangiocarcinoma drug therapy, Cholangiocarcinoma radiotherapy, Cisplatin administration & dosage, Combined Modality Therapy, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms radiotherapy, Deoxycytidine administration & dosage, Deoxycytidine analogs & derivatives, Disease-Free Survival, Female, Gallbladder Neoplasms drug therapy, Gallbladder Neoplasms radiotherapy, Humans, Klatskin Tumor drug therapy, Klatskin Tumor radiotherapy, Male, Middle Aged, Pilot Projects, Tomography, X-Ray Computed, Treatment Outcome, Gemcitabine, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Biliary Tract Neoplasms drug therapy, Biliary Tract Neoplasms radiotherapy, Chemoradiotherapy methods
- Abstract
Purpose: Combination chemotherapy with gemcitabine and cisplatin is a standard treatment for patients with advanced biliary tract cancer. This study aimed to evaluate the efficacy and safety of gemcitabine- and cisplatin-based concurrent chemoradiotherapy in patients with unresectable biliary tract cancer., Methods: Patients with pathologically proven, unresectable, non-metastatic biliary tract cancer were enrolled. Gemcitabine was administered intravenously at a dose of 1000 mg/m(2) on days 1, 8, and 15. Cisplatin was administered intravenously at a dose of 70 mg/m(2) on day 1. All the patients underwent concurrent radiotherapy with 45 Gy in 1.8-Gy daily fractions. After treatment completion, tumor response was evaluated by using computed tomography., Results: Eighteen patients were enrolled between June 2007 and October 2011. Their median age was 61 years (range, 38-72 years). Eight patients (44.5 %) were diagnosed with gallbladder cancer, six (33.3 %) with Klatskin's tumor, and four (22.2 %) with distal common bile duct cancer. After treatment completion, partial response was achieved in five patients (27.8 %) and stable disease in 13 patients (72.2 %). The overall response rate was 27.8 %, and the disease stabilization rate was 100 %. No grade 4 adverse events or treatment-related deaths occurred. The most common grade 3 adverse events were thrombocytopenia (33.3 %) and anemia (11.1 %). The median progression-free and overall survival times were 6.8 months (range, 4.5-19.8 months) and 9.6 months (5.4-30.4 months), respectively., Conclusions: This study shows that gemcitabine- and cisplatin-based concurrent chemoradiotherapy is feasible and tolerable in patients with unresectable and non-metastatic biliary tract cancer.
- Published
- 2016
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22. Expression of Bcl-2 19-kDa interacting protein 3 predicts prognosis after ampullary carcinoma resection.
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Fujimoto T, Ohtsuka T, Date K, Kimura H, Matsunaga T, Mori Y, Miyasaka Y, Mochidome N, Oda Y, and Nakamura M
- Subjects
- Adult, Aged, Aged, 80 and over, Ampulla of Vater pathology, Biliary Tract Surgical Procedures methods, Biopsy, Needle, Chemotherapy, Adjuvant, Cohort Studies, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms mortality, Common Bile Duct Neoplasms pathology, Deoxycytidine administration & dosage, Deoxycytidine analogs & derivatives, Disease-Free Survival, Drug Combinations, Female, Genes, bcl-2, Humans, Immunohistochemistry, Japan, Kaplan-Meier Estimate, Male, Middle Aged, Oxonic Acid administration & dosage, Predictive Value of Tests, Prognosis, Rare Diseases, Retrospective Studies, Risk Assessment, Survival Analysis, Tegafur administration & dosage, Gemcitabine, Ampulla of Vater surgery, Biomarkers, Tumor analysis, Common Bile Duct Neoplasms surgery, Membrane Proteins metabolism, Proto-Oncogene Proteins metabolism, Thymidylate Synthase metabolism
- Abstract
Background: An adequate management strategy for ampullary carcinoma (AC), a rare neoplasm, has yet to be determined. The aim of this study was to identify specific molecular markers allowing for the adequate management of AC., Methods: The clinicopathological data of 41 patients who underwent curative resection of AC were reviewed retrospectively. The expression of thymidylate synthase (TS) and Bcl-2 19-kDa interacting protein 3 (BNIP3), two sensitive markers for S-1 and gemcitabine, respectively, was evaluated immunohistochemically. The relationship between the expression levels of these markers and the clinicopathological data were then investigated., Results: The 5-year overall survival rate in the study population was 62%. In univariate and multivariate analyses, lymph node metastasis, neural invasion, lymphatic invasion, and the high-level BNIP3 expression were significant predictive factors for a poor postoperative prognosis. Neither TS nor BNIP3 expression were able to predict survival or the disease recurrence rate in patients who received postoperative adjuvant chemotherapy for AC., Conclusions: BNIP3 expression may serve as a prognostic marker for patients with AC, but neither TS nor BNIP3 contributes to the selection criteria for adjuvant chemotherapy for AC, at least with respect to current drug regimens., (© 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)
- Published
- 2016
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23. MEK inhibitor treatment is effective in a patient with metastatic carcinoma of the ampulla of Vater with BRAF and NRAS mutations shown by next-generation sequencing.
- Author
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Tahover E, Bar Shalom R, Bogot N, Kelsen D, and Gabizon A
- Subjects
- Aged, 80 and over, Ampulla of Vater pathology, Common Bile Duct Neoplasms diagnostic imaging, Common Bile Duct Neoplasms pathology, Female, High-Throughput Nucleotide Sequencing, Humans, Pyridones adverse effects, Pyridones therapeutic use, Pyrimidinones adverse effects, Pyrimidinones therapeutic use, Common Bile Duct Neoplasms drug therapy, GTP Phosphohydrolases genetics, MAP Kinase Kinase Kinases antagonists & inhibitors, Membrane Proteins genetics, Protein Kinase Inhibitors therapeutic use, Proto-Oncogene Proteins B-raf genetics
- Abstract
Here, we present a case of an 84-year-old woman who developed obstructive jaundice and was diagnosed with nonoperable adenocarcinoma originating from the ampulla of Vater, a lethal disease with a median overall survival of less than a year. Her tumor was examined by next-generation sequencing, which showed BRAF and NRAS mutations. To target these mutations, a MEK inhibitor was chosen for treatment. The patient has been treated with a MEK inhibitor for the last 12 months since diagnosis, with clinical and laboratory improvement and manageable side effects. PET-computed tomography imaging has shown stable disease or improvement in the primary and metastatic lesions. This is the first case report of an ampulla of a Vater cancer patient with NRAS and BRAF mutations, identified in next-generation sequencing, and treated successfully with a MEK inhibitor.
- Published
- 2016
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24. Survival Outcomes According to Adjuvant Treatment and Prognostic Factors Including Host Immune Markers in Patients with Curatively Resected Ampulla of Vater Cancer.
- Author
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Ha HR, Oh DY, Kim TY, Lee K, Kim K, Lee KH, Han SW, Chie EK, Jang JY, Im SA, Kim TY, Kim SW, and Bang YJ
- Subjects
- Adult, Aged, Aged, 80 and over, Chemotherapy, Adjuvant, Common Bile Duct Neoplasms drug therapy, Female, Humans, Lymphocytes immunology, Male, Middle Aged, Neoplasm Staging, Neutrophils immunology, Prognosis, Survival Analysis, Treatment Outcome, Ampulla of Vater immunology, Ampulla of Vater surgery, Biomarkers, Tumor metabolism, Common Bile Duct Neoplasms immunology, Common Bile Duct Neoplasms surgery
- Abstract
Background: Ampulla of Vater cancer (AoV Ca) is a rare tumor, and its adjuvant treatment has not been established. The purpose of this study was to find out prognostic factors including host immunity and role of adjuvant treatment in AoV Ca., Methods and Findings: We reviewed 227 AoV Ca patients with curative resection. Clinical characteristics, adjuvant treatment, disease-free survival (DFS) and overall survival (OS) were analyzed. Among all patients, 63.9, 36.1 and 33.9% had T1/T2, T3/T4 stage and lymph node-positive disease (LN+), respectively. OS of all patients was 90.9 months (95% CI: 52.9-129.0). OS was different according to neutrophil-to-lymphocyte ratio (HR 1.651, 95% CI: 1.11-2.47), platelet-to-lymphocyte ratio (HR 1.488, 95% CI: 1.00-2.21) and systemic inflammatory index (HR 1.669, 95% CI: 1.13-2.47). In multivariate analysis, adverse prognostic factors for OS included vascular invasion (HR 2.571, 95% CI: 1.20-5.53) and elevated CA 19-9 (HR 1.794, 95% CI: 1.07-3.05). A total of 104 patients (46.3%) received adjuvant treatment (25 out of 111of T1/T2 & LN (-), 79 out of 116 of T3/T4 or LN (+)). In T3/T4 or LN (+) stage, adjuvant CCRT with maintenance chemotherapy provided the longest OS (5-year OS rate: 47.0 vs. 41.4%)., Conclusions: Vascular invasion and elevated CA 19-9 were adverse prognostic factors in resected AoV Ca. In T3/T4 or LN (+) stage, adjuvant CCRT with maintenance chemotherapy provided the best survival outcome. Adjuvant treatment should be further defined in AoV Ca, especially with poor prognostic factors.
- Published
- 2016
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25. Advances in Molecular Pathology and Treatment of Periampullary Cancers.
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Chandrasegaram MD, Chen JW, Price TJ, Zalcberg J, Sjoquist K, and Merrett ND
- Subjects
- Ampulla of Vater metabolism, Ampulla of Vater pathology, Animals, Biomarkers, Tumor metabolism, Chemotherapy, Adjuvant, Common Bile Duct Neoplasms genetics, Common Bile Duct Neoplasms metabolism, Common Bile Duct Neoplasms pathology, DNA Mutational Analysis, Duodenal Neoplasms genetics, Duodenal Neoplasms metabolism, Duodenal Neoplasms pathology, Genetic Predisposition to Disease, Humans, Molecular Targeted Therapy, Pancreatic Neoplasms genetics, Pancreatic Neoplasms metabolism, Pancreatic Neoplasms pathology, Patient Selection, Phenotype, Precision Medicine, Predictive Value of Tests, Treatment Outcome, Ampulla of Vater drug effects, Antineoplastic Agents therapeutic use, Biomarkers, Tumor genetics, Common Bile Duct Neoplasms drug therapy, Duodenal Neoplasms drug therapy, Mutation, Pancreatic Neoplasms drug therapy
- Abstract
Objectives: Periampullary cancers (PACs) include the following 4 traditional anatomic subtypes: pancreatic, ampullary, biliary, or duodenal cancers. This review was performed to highlight recent advances in the genomic and molecular understanding of each PAC subtype and the advances in chemotherapeutic and molecular trials in these cancer subtypes., Results: Recent advances have highlighted differences in the genomic and molecular features within each PAC subtype. Ampullary cancers can now be further defined accurately into their intestinal and pancreatobiliary subtypes using histomolecular profiling. K-ras mutation, which occurs in most pancreatic cancers, is found to occur less frequently in ampullary (42%-52%), biliary (22%-23%), and duodenal cancers (32%-35%), suggesting crucial differences in targetable mutations in these cancer subtypes.Ampullary cancers of intestinal subtype and duodenal cancers seem to share similarities with colorectal cancer, given that they respond to similar chemotherapeutic regimens. This has potential implications for clinical trials and treatment selection, where PACs are often considered together., Conclusions: Future trials should be designed in view of our increased understanding of the different anatomic and histomolecularly profiled subtypes of PAC cancers, which respects their individual molecular characteristics, phenotype, and response to treatment.
- Published
- 2016
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26. Adenocarcinoma of the ampulla of Vater: what treatment options are available?
- Author
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Senatore FJ, Ynson ML, and Dasanu CA
- Subjects
- Adenocarcinoma pathology, Adenocarcinoma surgery, Aged, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Chemotherapy, Adjuvant methods, Common Bile Duct Neoplasms pathology, Common Bile Duct Neoplasms surgery, Female, Fluorouracil administration & dosage, Humans, Treatment Outcome, Adenocarcinoma drug therapy, Ampulla of Vater pathology, Common Bile Duct Neoplasms drug therapy
- Abstract
The scientific literature on adenocarcinoma of the ampulla (papilla) of Vater suggests that it either represents a distinct entity or is more closely related to small bowel adenocarcinoma than to the biliary malignancies. The ambiguity surrounding this rare cancer has kindled research exploring its immunohistochemistry aspects and gene expression profiling. While the basis of management for resectable disease remains surgical intervention, the role of adjuvant chemotherapy is not clear. A recent large phase 3 clinical trial conducted in patients with resected ampulla of Vater adenocarcinoma favored adjuvant chemotherapy over observation alone. The standards of therapy for the advanced small bowel adenocarcinoma and biliary cancer are fluoropyrimidine derivatives and gemcitabine-based combinations, respectively. In addition, new biologic and targeted agents may enhance clinical results seen in this cancer type. Therefore, diligently designed clinical trials are necessary to establish its optimal treatment strategies. We describe herein a patient with ampulla of Vater adenocarcinoma who had an exceptional response to fluoropyrimidine-based chemotherapy. We further include a discussion reviewing the clinicopathologic aspects of this neoplasm as well as focus on currently available and future therapeutic options., (© The Author(s) 2014.)
- Published
- 2015
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27. Histomorphologic and molecular phenotypes predict gemcitabine response and overall survival in adenocarcinoma of the ampulla of Vater.
- Author
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Schiergens TS, Reu S, Neumann J, Renz BW, Niess H, Boeck S, Heinemann V, Bruns CJ, Jauch KW, and Kleespies A
- Subjects
- Adenocarcinoma drug therapy, Adenocarcinoma genetics, Adenocarcinoma mortality, Adult, Aged, Aged, 80 and over, Ampulla of Vater physiology, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms genetics, Common Bile Duct Neoplasms mortality, Databases, Factual, Deoxycytidine therapeutic use, Female, Humans, Immunohistochemistry, Male, Middle Aged, Phenotype, Survival Analysis, Tissue Array Analysis, Gemcitabine, Adenocarcinoma pathology, Ampulla of Vater pathology, Antimetabolites, Antineoplastic therapeutic use, Common Bile Duct Neoplasms pathology, Deoxycytidine analogs & derivatives
- Abstract
Background: The need for adjuvant chemotherapy after resection of ampullary cancer (PapCa) remains undefined. Recent data suggest that a different epithelial origin of PapCa might be associated with different tumor biology. The aim of the present study was to assess the clinical value of morphologic and immunohistochemic subclassification of PapCa into intestinal-type (IT) and pancreaticobiliary-type (PT) to predict chemotherapy response and overall survival (OS)., Methods: Via a prospective database, 112 PapCa were identified, of which 95 could be included in the present study. Those were compared with 206 matching patients with periampullary pancreatic cancer (ie, pancreatic ductal adenocarcinoma, PDAC). IT and PT PapCa were classified morphologically, and tissue microarray was prepared with immunohistochemistry for CK7, CK20, MUC2, CDX2, ß-Catenin, and Villin. Multivariate survival analysis was performed., Results: OS of PT patients was less compared with IT patients (25 vs 98 months; P < .001), whereas it was comparable with patients with PDAC (25 vs 14 months; P = .123). PT patients receiving adjuvant gemcitabine chemotherapy featured improved OS (32 vs 13 months; P = .013), whereas gemcitabine tended to be associated with decreased OS in IT patients (35 vs 112 months; P = .193). Besides histopathologic classification, expression of CK7 and MUC2 were important prognostic variables. PT patients with CK7-positivity or MUC2-negativity were segregated into an even poorer prognostic group., Conclusion: PapCa is not a separate tumor entity. We demonstrate important differences between IT-PapCa and PT-PapCa not only in long-term survival but also in response to adjuvant gemcitabine. Tumor biology and clinical course of PT tumors resemble those of PDAC. PT tumors should therefore be treated like PDAC., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
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28. Adjuvant chemoradiotherapy in periampullary cancers--Where does it stand with conformal radiotherapy: A single institution experience.
- Author
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Kapoor R, Bahl A, Bhattacharyya T, Gupta R, and Oinam AS
- Subjects
- Adult, Aged, Aged, 80 and over, Ampulla of Vater drug effects, Ampulla of Vater radiation effects, Chemoradiotherapy, Adjuvant methods, Deoxycytidine administration & dosage, Deoxycytidine analogs & derivatives, Disease-Free Survival, Female, Humans, Male, Middle Aged, Neoplasm Recurrence, Local drug therapy, Neoplasm Recurrence, Local radiotherapy, Organoplatinum Compounds administration & dosage, Oxaliplatin, Postoperative Care, Radiotherapy Dosage, Radiotherapy, Adjuvant methods, Radiotherapy, Conformal methods, Retrospective Studies, Young Adult, Gemcitabine, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms radiotherapy
- Abstract
Background: Treatment of periampullary cancer involves Whipple surgery, followed by adjuvant radiotherapy and chemotherapy. Postoperative radiotherapy is particularly useful in managing high-risk patients (tumors involving the pancreas, poorly differentiated histology, involved lymph nodes and positive margins). Here, we review our results of treatment of 84 patients treated by surgery and adjuvant radiotherapy and chemotherapy., Material and Methods: A retrospective analysis of 84 patients of periampullary cancers treated in our department between January 2007 and December 2012 was carried out. All patients underwent Whipples surgery followed by postoperative radiotherapy 45-50 Gy/25-28 number in those presenting with high-risk features. Radiotherapy was delivered using three-dimensional conformal technique with 6 MV photons using three field treatment plans. Chemotherapy was given for 6 cycles using gemcitabine and oxaliplatin regimen repeated 2 weekly., Results: Eighty four postoperative patients with high-risk features were available for the final analysis. There were 69 males and 15 female patients. There were 34.5% stage I, 57.1% stage II and 8.3% stage III patients. At end of adjuvant treatment with radiotherapy and chemotherapy 70% patients had a complete response, 7.5% had residual disease, 15% showed progressive disease, 5% were dead and 2.5% defaulted the treatment. The mean number of chemotherapy cycles received was 2.6. At 1 year follow-up the probability of disease free survival was 80% for node-negative patients versus 73% for node-positive disease (P = 0.27). Patients with stage up to IIA had a 1 year disease free survival of 83% versus 40% for patients with stage beyond IIA (P = 0.024)., Conclusions: Our results showed a trend favoring lymph node negative status with disease free survival. With computed tomography based planning, adequate delineation of draining nodes is possible, and radiation toxicity has significantly decreased. Adequate coverage of nodal basins during radiotherapy planning is important, and stage of the disease seems to be an important prognostic factor.
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- 2015
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29. [Therapeutic results of carcinoma of the papilla of Vater--a comparison of Japanease and overseas results].
- Author
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Ohtsuka M, Shimizu H, Kato A, Yoshitomi H, and Miyazaki M
- Subjects
- Combined Modality Therapy, Databases, Factual, Humans, Japan, Ampulla of Vater, Antineoplastic Agents therapeutic use, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms surgery
- Published
- 2015
30. [Present status and future prospect of the chemotherapy for ampullary cancer].
- Author
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Imai H and Ishioka C
- Subjects
- Chemotherapy, Adjuvant, Common Bile Duct Neoplasms genetics, Common Bile Duct Neoplasms surgery, Humans, Molecular Targeted Therapy, Prognosis, Ampulla of Vater, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Common Bile Duct Neoplasms drug therapy
- Published
- 2015
31. [Prognostic factors associated with the long-term survival].
- Author
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Kuboki S, Shimizu H, Ohtsuka M, Kato A, and Miyazaki M
- Subjects
- Combined Modality Therapy, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms surgery, Humans, Lymphatic Metastasis, Neoplasm Invasiveness, Prognosis, Ampulla of Vater, Common Bile Duct Neoplasms diagnosis
- Published
- 2015
32. Gemcitabine and oxaliplatin with or without cetuximab in advanced biliary-tract cancer (BINGO): a randomised, open-label, non-comparative phase 2 trial.
- Author
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Malka D, Cervera P, Foulon S, Trarbach T, de la Fouchardière C, Boucher E, Fartoux L, Faivre S, Blanc JF, Viret F, Assenat E, Seufferlein T, Herrmann T, Grenier J, Hammel P, Dollinger M, André T, Hahn P, Heinemann V, Rousseau V, Ducreux M, Pignon JP, Wendum D, Rosmorduc O, and Greten TF
- Subjects
- Adult, Aged, Alanine Transaminase blood, Antibodies, Monoclonal, Humanized adverse effects, Antineoplastic Combined Chemotherapy Protocols adverse effects, Aspartate Aminotransferases blood, Bile Duct Neoplasms genetics, Carcinoma drug therapy, Carcinoma genetics, Cetuximab, Cholangiocarcinoma genetics, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms genetics, Deoxycytidine administration & dosage, Deoxycytidine analogs & derivatives, Disease-Free Survival, Female, Gallbladder Neoplasms genetics, Humans, Intention to Treat Analysis, Male, Middle Aged, Mutation, Neutropenia chemically induced, Organoplatinum Compounds administration & dosage, Oxaliplatin, Peripheral Nervous System Diseases chemically induced, Proto-Oncogene Proteins genetics, Proto-Oncogene Proteins B-raf genetics, Proto-Oncogene Proteins p21(ras), ras Proteins genetics, Gemcitabine, Antibodies, Monoclonal, Humanized administration & dosage, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bile Duct Neoplasms drug therapy, Bile Ducts, Intrahepatic, Cholangiocarcinoma drug therapy, Gallbladder Neoplasms drug therapy
- Abstract
Background: Gemcitabine plus a platinum-based agent (eg, cisplatin or oxaliplatin) is the standard of care for advanced biliary cancers. We investigated the addition of cetuximab to chemotherapy in patients with advanced biliary cancers., Methods: In this non-comparative, open-label, randomised phase 2 trial, we recruited patients with locally advanced (non-resectable) or metastatic cholangiocarcinoma, gallbladder carcinoma, or ampullary carcinoma and a WHO performance status of 0 or 1 from 18 hospitals across France and Germany. Eligible patients were randomly assigned (1:1) centrally with a minimisation procedure to first-line treatment with gemcitabine (1000 mg/m(2)) and oxaliplatin (100 mg/m(2)) with or without cetuximab (500 mg/m(2)), repeated every 2 weeks until disease progression or unacceptable toxicity. Randomisation was stratified by centre, primary site of disease, disease stage, and previous treatment with curative intent or adjuvant therapy. Investigators who assessed treatment response were not masked to group assignment. The primary endpoint was the proportion of patients who were progression-free at 4 months, analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00552149., Findings: Between Oct 10, 2007, and Dec 18, 2009, 76 patients were assigned to chemotherapy plus cetuximab and 74 to chemotherapy alone. 48 (63%; 95% CI 52-74) patients assigned to chemotherapy plus cetuximab and 40 (54%; 43-65) assigned to chemotherapy alone were progression-free at 4 months. Median progression-free survival was 6·1 months (95% CI 5·1-7·6) in the chemotherapy plus cetuximab group and 5·5 months (3·7-6·6) in the chemotherapy alone group. Median overall survival was 11·0 months (9·1-13·7) in the chemotherapy plus cetuximab group and 12·4 months (8·6-16·0) in the chemotherapy alone group. The most common grade 3-4 adverse events were peripheral neuropathy (in 18 [24%] of 76 patients who received chemotherapy plus cetuximab vs ten [15%] of 68 who received chemotherapy alone), neutropenia (17 [22%] vs 11 [16%]), and increased aminotransferase concentrations (17 [22%] vs ten [15%]). 70 serious adverse events were reported in 39 (51%) of 76 patients who received chemotherapy plus cetuximab (34 events in 19 [25%] patients were treatment-related), whereas 41 serious adverse events were reported in 25 (35%) of 71 patients who received chemotherapy alone (20 events in 12 [17%] patients were treatment-related). One patient died of atypical pneumonia related to treatment in the chemotherapy alone group., Interpretation: The addition of cetuximab to gemcitabine and oxaliplatin did not seem to enhance the activity of chemotherapy in patients with advanced biliary cancer, although it was well tolerated. Gemcitabine and platinum-based combination should remain the standard treatment option., Funding: Institut National du Cancer, Merck Serono., (Copyright © 2014 Elsevier Ltd. All rights reserved.)
- Published
- 2014
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33. Predictors of long-term survival following resection for ampullary carcinoma: a large retrospective French multicentric study.
- Author
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Robert PE, Leux C, Ouaissi M, Miguet M, Paye F, Merdrignac A, Delpero JR, Schwarz L, Carrere N, Muscari F, Gayet B, Dussart D, Hamy A, and Regenet N
- Subjects
- Adult, Aged, Aged, 80 and over, Chemotherapy, Adjuvant, Combined Modality Therapy, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms pathology, Disease-Free Survival, Female, Follow-Up Studies, France, Humans, Kaplan-Meier Estimate, Lymphatic Metastasis, Male, Middle Aged, Multivariate Analysis, Neoplasm Recurrence, Local, Neoplasm Staging, Outcome Assessment, Health Care statistics & numerical data, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms pathology, Prognosis, Proportional Hazards Models, Retrospective Studies, Time Factors, Ampulla of Vater, Common Bile Duct Neoplasms surgery, Pancreatic Neoplasms surgery
- Abstract
Objectives: Ampullary carcinoma is a rare tumor. There are neither sufficient available data related to management after resection of the neoplasm of the ampulla of Vater, nor any international recommendations. The aim of this study was to identify factors associated with recurrence and survival after curative resection., Methods: A retrospective follow-up study was conducted including patients with ampullary carcinoma who underwent resection with curative intent in 12 French surgical centers between January 1990 and November 2011., Results: In this study, 319 patients underwent surgical resection for an ampullary neoplasm. Disease recurred in 120 patients (37.6%), and the 5- and 10-year disease-free survival rates were 48.9% and 40.4%, respectively. In multivariable Cox regression, preoperative bilirubin, T stage, pancreaticobiliary histology subtype, and lymph node involvement were each significantly associated with the risk of recurrence., Conclusions: Ampullary carcinomas are a heterogeneous group that can be classified as intestinal and pancreaticobiliary subtypes. Our findings indicate that pancreaticobiliary differentiation, advanced stage, and lymph node involvement are predictors of both poor disease-free and poor overall survival. It is still unclear what adjuvant treatment after curative resection of ampullary carcinoma is optimal. It would be informative to evaluate adjuvant therapy according to histological subtype.
- Published
- 2014
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34. Twenty-six cases of advanced ampullary adenocarcinoma treated with systemic chemotherapy.
- Author
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Shoji H, Morizane C, Hiraoka N, Kondo S, Ueno H, Ohno I, Shimizu S, Mitsunaga S, Ikeda M, and Okusaka T
- Subjects
- Adenocarcinoma mortality, Adult, Aged, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Cisplatin administration & dosage, Common Bile Duct Neoplasms mortality, Disease-Free Survival, Doxorubicin administration & dosage, Female, Fluorouracil administration & dosage, Humans, Male, Medical Records, Middle Aged, Neoplasm Recurrence, Local mortality, Neoplasm Staging, Oxonic Acid administration & dosage, Prognosis, Pyridines administration & dosage, Retrospective Studies, Tegafur administration & dosage, Treatment Outcome, Adenocarcinoma drug therapy, Adenocarcinoma pathology, Ampulla of Vater pathology, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms pathology
- Abstract
Objective: Ampullary adenocarcinoma is a rare disease entity and little information regarding these tumors is available. The aim of the present study was to clarify the treatment outcome of systemic chemotherapy in patients with advanced ampullary adenocarcinoma., Methods: This study consisted of a retrospective review of data obtained from patients diagnosed as having advanced ampullary adenocarcinoma who received non-surgical treatment at a single institution between 1997 and 2010., Results: We identified 26 patients (15 men, 11 women; median age, 62.0 years) who received treatment for advanced ampullary adenocarcinoma. Twelve patients had Stage IV disease and 14 had recurrences. The chemotherapy regimens consisted of 5-fluorouracil-based regimens (5-fluorouracil + cisplatin, n = 3; tegafur-uracil + doxorubicin, n = 5 and tegafur, gimeracil and oteracil potassium, n = 3) and gemcitabine-based regimens (gemcitabine, n = 10 and gemcitabine + cisplatin, n = 5). The overall response rate was 7.7%. The median progression-free survival period was 3.2 months (2.5 months in the 5-fluorouracil group vs. 3.5 months in the gemcitabine group), and the median overall survival time was 9.1 months (8.0 months in the 5-fluorouracil group vs. 12.3 months in the gemcitabine group). The median overall survival was significantly longer in stage IV disease than in recurrent disease. The histological phenotype was determined in 10 of the 26 patients. Eight patients had intestinal-type adenocarcinomas and remaining two patients had pancreatobiliary-type adenocarcinomas., Conclusions: The treatment outcome of patients with advanced ampullary adenocarcinoma was poor. Further development of novel treatments is necessary to improve the prognosis.
- Published
- 2014
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35. Adjuvant chemotherapy using gemcitabine for resected distal bile duct and ampullary cancers.
- Author
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Suzuki S, Kaji S, Koike N, Harada N, Suzuki M, and Hayashi T
- Subjects
- Adult, Aged, Aged, 80 and over, Antimetabolites, Antineoplastic adverse effects, Bile Ducts surgery, Chemotherapy, Adjuvant, Deoxycytidine adverse effects, Deoxycytidine therapeutic use, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Retrospective Studies, Gemcitabine, Antimetabolites, Antineoplastic therapeutic use, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms surgery, Deoxycytidine analogs & derivatives
- Abstract
Background/aims: This retrospective study aimed to evaluate adjuvant chemotherapy using gemcitabine for resected distal bile duct and ampullary cancers., Methodology: Thirty-seven patients who had curative surgery for distal bile duct and ampullary cancers were classified into two groups: A, 19, surgery alone, and B, 18, surgery plus gemcitabine adjuvant chemotherapy between 2004 and 2010. Outcomes, including backgrounds, overall survival (OS), disease free survival (DFS), and adverse events are reported., Results: There were no differences in characteristics between patients of groups A and B for age, gender, location of tumor, UICC stage, UICC pT factor, UICC pN factor, curability, and operative procedures. For all stages, except stage II, there was no difference between groups A and B for OS and DFS. For stage II however, groups A and B showed significant differences in median survival times for OS and DFS. Grade 3 or 4 adverse events included 5.6% with leucopenia., Conclusions: Adjuvant chemotherapy using gemcitabine showed the potential of contributing to prolonged OS and DFS in stage II resected distal bile duct and ampullary cancers. However, a large cohort will be needed to confirm the overall efficacy in all stages of resected BTC's.
- Published
- 2014
36. Ampulla of vater adenocarcinoma in a BRCA2 germline mutation carrier.
- Author
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Aburjania N, Truskinovsky AM, Overman MJ, and Lou E
- Subjects
- Adenocarcinoma drug therapy, Adenocarcinoma genetics, Adult, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms genetics, Female, Heterozygote, Humans, Lymphatic Metastasis, Male, Middle Aged, Prognosis, Adenocarcinoma secondary, Ampulla of Vater pathology, Antineoplastic Combined Chemotherapy Protocols therapeutic use, BRCA2 Protein genetics, Common Bile Duct Neoplasms pathology, Germ-Line Mutation genetics
- Published
- 2014
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37. [V. Current status of chemotherapy for carcinoma of the ampulla open Vater].
- Author
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Kawai M and Yamagami Y
- Subjects
- Clinical Trials as Topic, Combined Modality Therapy, Common Bile Duct Neoplasms pathology, Humans, Ampulla of Vater, Antineoplastic Agents therapeutic use, Common Bile Duct Neoplasms drug therapy
- Published
- 2013
38. Lethal cardiotoxicity, steatohepatitis, chronic pancreatitis, and acute enteritis induced by capecitabine and oxaliplatin in a 36-year-old woman.
- Author
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Gurzu S, Jung I, Comsulea M, Kadar Z, Azamfirei L, and Molnar C
- Subjects
- Acute Disease, Adenocarcinoma pathology, Adenocarcinoma surgery, Adult, Ampulla of Vater pathology, Ampulla of Vater surgery, Autopsy, Capecitabine, Chemical and Drug Induced Liver Injury diagnosis, Chemical and Drug Induced Liver Injury therapy, Chemotherapy, Adjuvant, Common Bile Duct Neoplasms pathology, Common Bile Duct Neoplasms surgery, Deoxycytidine adverse effects, Deoxycytidine analogs & derivatives, Enteritis diagnosis, Enteritis therapy, Fatal Outcome, Fatty Liver diagnosis, Fatty Liver therapy, Female, Fluorouracil adverse effects, Fluorouracil analogs & derivatives, Heart Diseases diagnosis, Heart Diseases therapy, Humans, Multiple Organ Failure chemically induced, Neoplasm Staging, Organoplatinum Compounds adverse effects, Oxaliplatin, Oxaloacetates, Pancreaticoduodenectomy, Pancreatitis, Chronic diagnosis, Pancreatitis, Chronic therapy, Adenocarcinoma drug therapy, Ampulla of Vater drug effects, Antineoplastic Combined Chemotherapy Protocols adverse effects, Chemical and Drug Induced Liver Injury etiology, Common Bile Duct Neoplasms drug therapy, Enteritis chemically induced, Fatty Liver chemically induced, Heart Diseases chemically induced, Pancreatitis, Chronic chemically induced
- Abstract
A 36-year-old female was hospitalized with symptoms suggesting intestinal occlusion. She was diagnosed with adenocarcinoma of the ampulla of Vater (pT4N0 stage) and underwent cephalic duodenopancreatectomy 8 months ago. Five cycles of postoperative chemotherapy were administrated using capecitabine and oxaliplatin (CAPOX or XELOX), the last one being completed 1 month ago. During the present hospitalization, because of normal computed tomography and ultrasound abdominal examination, rehydration and antibiotherapy were administrated. However, 4 days after hospital admission, the patient died. At autopsy and histological examination, we found a severe myocardial sclerosis with large scarring areas, severe steatohepatitis, chronic pancreatitis with large fibrotic areas, and acute enteritis. Alcohol consumption was denied. The patient died due to associated heart, liver and pancreatic failure. This multiorgan toxicity and death following CAPOX regimen had not yet been reported in the literature., Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/6472150549833105.
- Published
- 2013
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39. Photodynamic therapy for high-grade dysplasia of bile duct via a choledochoscope.
- Author
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Zhou JJ, Xiong L, Li QL, Gu Y, Wen Y, Deng XF, and Miao XY
- Subjects
- Hematoporphyrins therapeutic use, Humans, Male, Middle Aged, Photosensitizing Agents therapeutic use, Common Bile Duct Neoplasms drug therapy, Photochemotherapy methods
- Abstract
When a distal common bile duct neoplasm is at the stage of carcinoma in situ or high-grade dysplasia, it is difficult for the surgeon to decide whether to perform pancreaticoduodenectomy. Here we describe a patient with a progressive dysplastic lesion in the common bile duct, which developed from moderate-high to high-grade dysplasia in approximately 2 mo. The patient refused major surgery. Therefore, endoscopic-assisted photodynamic therapy was performed. The result at follow-up using a trans-T-tube choledochoscope showed that the lesion was completely necrotic. This report is the first to describe the successful treatment of high-grade dysplasia of the distal bile duct using photodynamic therapy via a choledochoscope.
- Published
- 2013
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40. A retrospective study of ampullary adenocarcinomas: overall survival and responsiveness to fluoropyrimidine-based chemotherapy.
- Author
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Jiang ZQ, Varadhachary G, Wang X, Kopetz S, Lee JE, Wang H, Shroff R, Katz M, Wolff RA, Fleming J, and Overman MJ
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma surgery, Antimetabolites, Antineoplastic therapeutic use, Common Bile Duct Neoplasms surgery, Deoxycytidine analogs & derivatives, Deoxycytidine therapeutic use, Duodenal Neoplasms surgery, Female, Humans, Male, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms mortality, Pancreatic Neoplasms surgery, Retrospective Studies, Survival, Treatment Outcome, Gemcitabine, Adenocarcinoma drug therapy, Ampulla of Vater pathology, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms mortality, Duodenal Neoplasms drug therapy, Duodenal Neoplasms mortality, Pyrimidines therapeutic use
- Abstract
Background: Whether carcinomas of the ampulla of Vater should be classified with biliary tract tumors and treated in a similar manner remains unknown. We sought to compare the outcomes of similarly staged periampullary adenocarcinomas (AAs) and analyze the chemotherapy responsiveness of AAs., Patients and Methods: A total of 905 patients with resected periampullary adenocarcinomas were identified from a prospective surgical registry from 1988 to 2010. A second cohort of 64 metastatic AA patients from 1992 to 2009 who received either front-line fluoropyrimidine-based or gemcitabine-based chemotherapy was also identified., Results: Overall survival (OS) for AAs was similar to survival with duodenal adenocarcinomas, but was significantly different from both extrahepatic biliary and pancreatic adenocarcinomas (P < 0.001 for each comparison). In multivariate analysis, AAs had a significantly improved OS in comparison with extrahepatic biliary adenocarcinomas (HR = 1.97, P = 0.006). Fluoropyrimidine-based as opposed to gemcitabine-based chemotherapy for metastatic AAs resulted in a significant improvement in time to progression (P = 0.001) but only a trend toward benefit for OS (P = 0.07) in multivariate analysis., Conclusions: Differences in the natural history of ampullary and extrahepatic biliary adenocarcinomas exist. Analyses of metastatic ampullary adenocarcinomas suggest that fluoropyrimidine-based chemotherapy may represent a more appropriate front-line chemotherapy approach.
- Published
- 2013
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41. Better outcome of XELOX chemotherapy in patients with advanced intestinal-type adenocarcinoma of the ampulla of Vater.
- Author
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Kim HS, Shin SJ, Kim JH, Kim H, and Choi HJ
- Subjects
- Adenocarcinoma pathology, Adult, Aged, Antineoplastic Agents adverse effects, Antineoplastic Combined Chemotherapy Protocols adverse effects, Capecitabine, Common Bile Duct Neoplasms pathology, Demography, Deoxycytidine adverse effects, Deoxycytidine therapeutic use, Disease Progression, Female, Fluorouracil adverse effects, Fluorouracil therapeutic use, Humans, Immunohistochemistry, Kaplan-Meier Estimate, Male, Middle Aged, Neoplasm Staging, Oxaloacetates, Treatment Outcome, Adenocarcinoma drug therapy, Ampulla of Vater pathology, Antineoplastic Agents therapeutic use, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Common Bile Duct Neoplasms drug therapy, Deoxycytidine analogs & derivatives, Fluorouracil analogs & derivatives, Intestines pathology
- Abstract
Adenocarcinoma arising from the ampulla of Vater is a rare disease and has limited data regarding outcome of chemotherapy. The ampulla of Vater is a heterogeneous junctional structure located at the union of the common bile duct, the pancreatic duct, and the small intestine. Thus, ampullary adenocarcinoma is classified as either intestinal type or pancreatobiliary type. We investigated the efficacy of the XELOX (capecitabine plus oxaliplatin) chemotherapy in patients with recurrent or metastatic ampullary adenocarcinoma, and analyzed the histopathologic features and outcomes. From November 2009 to December 2011, 21 patients were treated with XELOX regimen. XELOX was administered in outpatient clinic every 3 weeks according to the following protocol: oral administration of capecitabine 750 mg/m² twice a day on days 1-14 and intravenous injection of oxaliplatin 130 mg/m² on day 1. With follow-up of median 16.6 months, median time to progression (TTP) was 7.6 months (95% confidence interval [CI], 6.7-8.5), and median overall survival was 19.7 months (95% CI, 14.8-23.6). Two patients (9%) achieved complete response and 6 patients (29%) showed partial response. In subgroup analysis with tissue specimens obtained from 17 patients, median TTP was longer among patients with the intestinal-type adenocarcinoma (n = 7), compared to those with the pancreatobiliary type (n = 10) (13.1 vs. 6.4 months, P = 0.038). The most common grade 3-4 adverse event was neutropenia (27%), and most events were mild. XELOX chemotherapy shows favorable efficacy with manageable toxicity for advanced intestinal-type ampullary adenocarcinoma.
- Published
- 2013
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42. Long-term survival of a patient with neuroendocrine carcinoma of the ampulla of vater with lymph node micrometastasis.
- Author
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Watanabe Y, Yamada D, Ogawa Y, Fujino M, Kobayashi K, Ryu S, and Tanaka M
- Subjects
- Antineoplastic Agents therapeutic use, Carcinoma, Neuroendocrine drug therapy, Carcinoma, Neuroendocrine surgery, Chemotherapy, Adjuvant, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms surgery, Humans, Lymphatic Metastasis, Male, Middle Aged, Pancreaticoduodenectomy, Survivors, Ampulla of Vater pathology, Carcinoma, Neuroendocrine pathology, Common Bile Duct Neoplasms pathology, Neoplasm Micrometastasis
- Published
- 2013
43. Homeopathic approach for cancer treatment: my experience.
- Author
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Pal SK
- Subjects
- Female, Humans, Common Bile Duct Neoplasms drug therapy, Gallbladder Neoplasms drug therapy, Homeopathy, Liver Neoplasms drug therapy, Materia Medica therapeutic use
- Published
- 2013
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44. Phase II trial of combination chemotherapy with gemcitabine, 5-fluorouracil and cisplatin for advanced cancers of the bile duct, gallbladder, and ampulla of Vater.
- Author
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Sohn BS, Yuh YJ, Kim KH, Jeon TJ, Kim NS, and Kim SR
- Subjects
- Adenocarcinoma secondary, Adult, Aged, Anemia chemically induced, Bile Duct Neoplasms pathology, Cisplatin administration & dosage, Cisplatin adverse effects, Common Bile Duct Neoplasms drug therapy, Creatinine blood, Deoxycytidine administration & dosage, Deoxycytidine adverse effects, Deoxycytidine analogs & derivatives, Drug Administration Schedule, Drug Synergism, Drug-Related Side Effects and Adverse Reactions epidemiology, Female, Fluorouracil administration & dosage, Fluorouracil adverse effects, Gallbladder Neoplasms pathology, Hospitals, University, Humans, Incidence, Male, Middle Aged, Nausea chemically induced, Neoplasm Staging, Neutropenia chemically induced, Peripheral Nervous System Diseases chemically induced, Republic of Korea epidemiology, Severity of Illness Index, Stomatitis chemically induced, Thrombocytopenia chemically induced, Vomiting chemically induced, Gemcitabine, Adenocarcinoma drug therapy, Ampulla of Vater, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Antineoplastic Combined Chemotherapy Protocols adverse effects, Bile Duct Neoplasms drug therapy, Drug-Related Side Effects and Adverse Reactions chemically induced, Gallbladder Neoplasms drug therapy, Neoplasm Recurrence, Local drug therapy
- Abstract
Aims and Background: For advanced cancers of the bile duct, gallbladder and ampulla of Vater, there are only a few treatment options. We explored the efficacy of the combination of gemcitabine, 5-fluorouracil and cisplatin for advanced biliary cancers., Methods: From September 2003 to April 2010, 28 patients with recurrent or metastatic biliary tract cancer were enrolled. A treatment regimen consisting of gemcitabine (800 mg/m² at a fixed dose rate on days 1 and 8), 5-fluorouracil (1 g/m²/day continuous infusion for 4 days) and cisplatin (60 mg/m² on day 2) was repeated every 3 weeks., Results: One (3.6%) patient showed complete response, 8 (28.6%) partial response, 14 (50%) stable disease and 5 (17.9%) disease progression. Overall, the objective response rate was 32.1% (95% CI, 17.9-50.6%) and the disease control rate was 82.1% (95% CI, 64.4-92.1%). Median progression-free survival and overall survival were 7.6 months (95% CI, 5.5-9.7) and 11.2 months (95% CI, 6.8-15.5), respectively. G3/4 neutropenia was observed in 44 (24.3%) of 181 cycles and G3/4 thrombocytopenia in 48 (26.5%) of 181 cycles. There was no treatment-related mortality., Conclusions: The combined regimen of gemcitabine, 5-fluorouracil and cisplatin has comparable activity for patients with advanced cancer of the bile duct, gallbladder and ampulla of Vater. Toxicity was tolerable but substantial.
- Published
- 2013
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45. Adjuvant chemotherapy for resected periampullary adenocarcinoma.
- Author
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Overman M, Wang H, and Varadhachary GR
- Subjects
- Female, Humans, Male, Adenocarcinoma drug therapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Common Bile Duct Neoplasms drug therapy, Watchful Waiting
- Published
- 2012
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46. Signet ring cell adenocarcinoma of the ampulla of Vater: a rare pathology.
- Author
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Lesquereux-Martínez L, Fernández-Pérez A, and Bustamante-Montalvo M
- Subjects
- Aged, Ampulla of Vater surgery, Antimetabolites, Antineoplastic therapeutic use, Carcinoma, Signet Ring Cell diagnosis, Carcinoma, Signet Ring Cell drug therapy, Carcinoma, Signet Ring Cell surgery, Combined Modality Therapy, Common Bile Duct Neoplasms diagnosis, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms surgery, Deoxycytidine analogs & derivatives, Deoxycytidine therapeutic use, Diagnostic Imaging, Female, Humans, Lymphatic Metastasis, Pancreaticoduodenectomy, Gemcitabine, Ampulla of Vater pathology, Carcinoma, Signet Ring Cell pathology, Common Bile Duct Neoplasms pathology
- Published
- 2012
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47. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial.
- Author
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Neoptolemos JP, Moore MJ, Cox TF, Valle JW, Palmer DH, McDonald AC, Carter R, Tebbutt NC, Dervenis C, Smith D, Glimelius B, Charnley RM, Lacaine F, Scarfe AG, Middleton MR, Anthoney A, Ghaneh P, Halloran CM, Lerch MM, Oláh A, Rawcliffe CL, Verbeke CS, Campbell F, and Büchler MW
- Subjects
- Adenocarcinoma surgery, Aged, Ampulla of Vater, Chemotherapy, Adjuvant, Common Bile Duct Neoplasms surgery, Deoxycytidine administration & dosage, Deoxycytidine analogs & derivatives, Female, Fluorouracil administration & dosage, Humans, Leucovorin administration & dosage, Male, Middle Aged, Prognosis, Survival Analysis, Gemcitabine, Adenocarcinoma drug therapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Common Bile Duct Neoplasms drug therapy, Watchful Waiting
- Abstract
Context: Patients with periampullary adenocarcinomas undergo the same resectional surgery as that of patients with pancreatic ductal adenocarcinoma. Although adjuvant chemotherapy has been shown to have a survival benefit for pancreatic cancer, there have been no randomized trials for periampullary adenocarcinomas., Objective: To determine whether adjuvant chemotherapy (fluorouracil or gemcitabine) provides improved overall survival following resection., Design, Setting, and Patients: The European Study Group for Pancreatic Cancer (ESPAC)-3 periampullary trial, an open-label, phase 3, randomized controlled trial (July 2000-May 2008) in 100 centers in Europe, Australia, Japan, and Canada. Of the 428 patients included in the primary analysis, 297 had ampullary, 96 had bile duct, and 35 had other cancers., Interventions: One hundred forty-four patients were assigned to the observation group, 143 patients to receive 20 mg/m2 of folinic acid via intravenous bolus injection followed by 425 mg/m2 of fluorouracil via intravenous bolus injection administered 1 to 5 days every 28 days, and 141 patients to receive 1000 mg/m2 of intravenous infusion of gemcitabine once a week for 3 of every 4 weeks for 6 months., Main Outcome Measures: The primary outcome measure was overall survival with chemotherapy vs no chemotherapy; secondary measures were chemotherapy type, toxic effects, progression-free survival, and quality of life., Results: Eighty-eight patients (61%) in the observation group, 83 (58%) in the fluorouracil plus folinic acid group, and 73 (52%) in the gemcitabine group died. In the observation group, the median survival was 35.2 months (95%% CI, 27.2-43.0 months) and was 43.1 (95%, CI, 34.0-56.0) in the 2 chemotherapy groups (hazard ratio, 0.86; (95% CI, 0.66-1.11; χ2 = 1.33; P = .25). After adjusting for independent prognostic variables of age, bile duct cancer, poor tumor differentiation, and positive lymph nodes and after conducting multiple regression analysis, the hazard ratio for chemotherapy compared with observation was 0.75 (95% CI, 0.57-0.98; Wald χ2 = 4.53, P = .03)., Conclusions: Among patients with resected periampullary adenocarcinoma, adjuvant chemotherapy, compared with observation, was not associated with a significant survival benefit in the primary analysis; however, multivariable analysis adjusting for prognostic variables demonstrated a statistically significant survival benefit associated with adjuvant chemotherapy., Trial Registration: clinicaltrials.gov Identifier: NCT00058201.
- Published
- 2012
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48. Cutaneous relapse of an ampullary carcinoma: an unusual presentation.
- Author
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Lamarca A, Martinez-Marin V, and Feliu J
- Subjects
- Aged, Carcinoma, Signet Ring Cell drug therapy, Carcinoma, Signet Ring Cell surgery, Chemotherapy, Adjuvant, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms surgery, Humans, Lymphatic Metastasis, Male, Skin Neoplasms diagnosis, Carcinoma, Signet Ring Cell secondary, Common Bile Duct Neoplasms pathology, Skin Neoplasms secondary
- Abstract
This is the first ever reported case about a cutaneous relapse of small bowel adenocarcinoma. The ampulla of Vater is the area of the small bowel that presents more frequently malignant transformation, nevertheless ampullary adenocarcinomas are rare but aggressive diseases. However, distant metastases are infrequent. Cutaneous metastases constitute the 5.3% of skin tumours, and are usually found in the 12% of malignancies. Their management usually includes local treatment if they are unique and systemic treatment when they are multiple. Chemotherapy schemes used in ampullary adenocarcinoma are those used in cholangiocarcinomas, pancreas and tumours of the gallbladder; nevertheless, given the intestinal origin of these tumours combinations of capecitabine and oxaliplatin are commonly used.
- Published
- 2012
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49. [A case of lung metastases of carcinoma of the ampulla of vater effectively treated with S-1].
- Author
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Hashida H, Inoue Y, Hattori K, Kadono K, Yoshimura M, Yoshida M, Abe S, Miyake M, Yoshitomi M, Nomura A, Ueda S, Terajima H, and Osaki N
- Subjects
- Aged, Common Bile Duct Neoplasms pathology, Common Bile Duct Neoplasms surgery, Drug Combinations, Duodenal Neoplasms pathology, Duodenal Neoplasms surgery, Female, Humans, Lung Neoplasms secondary, Pancreatic Neoplasms pathology, Pancreatic Neoplasms surgery, Tomography, X-Ray Computed, Ampulla of Vater, Antimetabolites, Antineoplastic therapeutic use, Common Bile Duct Neoplasms drug therapy, Duodenal Neoplasms drug therapy, Lung Neoplasms drug therapy, Oxonic Acid therapeutic use, Pancreatic Neoplasms drug therapy, Tegafur therapeutic use
- Abstract
A 70-year-old female patient underwent pylorus-preserving pancreaticoduodenectomy for carcinoma of the ampulla of Vater in March 2007. In April 2009, multiple lung metastases were detected by CT scanning. The patient was treated with S-1 (80mg/day, day 1-28, followed by 2-weeks withdrawal)from April 2009. The shrinkage of lung metastases was diagnosed as a complete response based on the Response Evaluation Criteria in Solid Tumors(RECIST). No severe toxicities were observed. S-1 is an effective and safe anti-cancer agent available for lung metastases of carcinoma of the ampulla of Vater.
- Published
- 2012
50. A homeopathic approach to treat patients with advanced gallbladder, periampullary, and liver carcinomas: a report of 3 cases.
- Author
-
Chatterjee A and Biswas J
- Subjects
- Aged, Female, Humans, Materia Medica administration & dosage, Middle Aged, Neoplasm Staging, Quality of Life, Common Bile Duct Neoplasms drug therapy, Gallbladder Neoplasms drug therapy, Homeopathy, Liver Neoplasms drug therapy, Materia Medica therapeutic use
- Abstract
Objectives: The authors present 3 cases of various pathologically confirmed malignancies (one gallbladder, one periampullary, and one liver). These patients underwent Psorinum therapy as the primary cancer treatment. Psorinum therapy is a homeopathic approach to treat patients with cancer., Subjects: According to the American Joint Committee on Cancer tumor, nodes, metastasis system, all 3 patients were diagnosed at Stage IV. Their Karnofsky performance status was between 20% and 50% and their Eastern Cooperative Oncology Group score status was between 3 and 4. In these cases, conventional cancer treatments could not be initiated due to the advanced stage of their disease, poor general health performance status, and their financial constraints., Interventions and Outcome: In these patients, Psorinum-6x was administered orally at a dose of 0.02 mL/kg body weight/day on an empty stomach for a complete course duration of 2 years, along with allopathic and homeopathic supportive treatment. According to the Response Evaluation Criteria in Solid Tumors criteria, complete tumor response occurred in 1 case and partial tumor response occurred in the other 2 cases. All 3 patients remained alive and maintained a stable quality of life for at least 2 years. The patients reported no adverse side-effects from Psorinum-6x., Conclusions: This report indicates the clinical efficacy of Psorinum therapy in treating those 3 patients. Thorough basic research and well-designed clinical trials should be conducted for further investigation of this homeopathic cancer treatment in order to integrate it into the mainstream of oncology treatments.
- Published
- 2012
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