Efficacy and Safety of Apatinib in Treating Advanced Colorectal Cancer / 中国医学科学院学报

Objective To assess the efficacy and safety of apatinib in the treatment of advanced colorectal cancer(CRC). Methods The clinical data of 16 CRC patients treated with apatinib after failure of prior lines of treatment were retrospectively analyzed in terms of objective response rate,disease control rate,progression-free survival,overall survival,adverse events,and prognostic factors. Results The efficacy was evaluable in 14 patients,among whom the objective response rate was 7.1% and the disease control rate was 50%.The median progression-free survival was 3 months(95%CI=1.57-4.42),and the median overall survival was 6.5 months(95%CI=4.10-8.89).The safety was evaluable in 16 patients,among whom the most common grade 3 adverse events were hypertensinon(37.5%)and proteinuria(25%).No grade 4 adverse event was observed.Multivariate analysis did not show any factor directly related to survival.Conclusion Apatinib may be effective in treating advanced CRC,with tolerable side effects.

Efficiency of Sunitinib in Chinese Patients with Advanced Progressive Pancreatic Neuroendocrine Tumor / 中国医学科学院学报

Objective To explore the efficiency of sunitinib in Chinese pancreatic neuroendocrine tumors (pNET) patients. Methods Advanced pNET patients who had accepted sunitinib treatment in the oncology department of PUMC Hospital from January 2009 to June 2015 after disease progression were enrolled in this study. Data collection included clinicopathological characteristics,medical therapies and outcomes. Results Eighteen pNET patients were collected. The overall response rate (ORR) was 27.7% and the disease control rate (DCR) was 83.3%. Nine patients received sunitinib as the first-line therapy and 9 as the second/post-second line. The median progression-free survival (mPFs)(12 month vs. 12 month;HR:0.92,95%CI:0.31-2.75,P=0.88),ORR (22.2% vs.33.3%;Χ(2)=0.055,P=0.98),and DCR (88.9% vs.77.8%;Χ(2)=0.4,P=0.98)showed no significant difference between first-line therapy and post-second line therapy. The mPFS of Ki-67≥10% and Ki-67<10% group patients was not significantly different (8 months vs. 13 months;HR:1.13,95% CI:0.34-3.77,P=0.845). The commonly reported adverse events included bone marrow suppression,diarrhea,roteinuria,hypertension,and rash. Conclusions First-line or second/post-second line sunitinib treatment has certain antitumor activity in Chinese patients with advanced pNET. The efficiency and commonly reported adverse events of Sunitinib are consistent with the known Western data.

Folfox4 regimen administered through combined hepatic arterial and systemic infusion for treatment of colorectal cancer with unresectable liver metastases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hepatic arterial infusion chemotherapy for liver metastases is under evaluation because of the high target dose and low general toxicity. To investigate the efficacy and safety of a Folfox4 regimen administered through a combined hepatic arterial and systemic infusion for the first-line treatment of colorectal cancer (CRC) with unresectable liver metastases.</p><p><b>METHODS</b>Twenty-seven CRC patients with unresectable hepatic metastases and no prior chemotherapy were enrolled into the study. They received a Folfox4 regimen; 1st day: HAI of oxaliplatin 85 mg/m(2) and L-folinic acid 200 mg/m(2), followed by a bolus hepatic arterial injection of 5-fluorouracil 400 mg/m(2), then continuous HAI of 5-FU 600 mg/m(2); 2nd day: infusion of L-folinic acid 200 mg/m(2) i.v. followed by an intravenous bolus injection of 5-Fluorouracil 400 mg/m(2), then continuous infusion of 5-fluorouracil 600 mg/m(2) i.v. The patients received HAI during the odd cycles, and the intravenous administration of the same Folfox4 regimen during the even cycles.</p><p><b>RESULTS</b>A total of 236 treatment cycles were given with a median of 10 cycles. The therapy generated the following results after six treatment cycles: complete response (CR) 1/27 (3.7%), partial response (PR) 17/27 (63.0%), stable disease (SD) 6/27 (22.2%), and progress disease (PD) 3/27 (11.1%). Five patients had hepatectomy. The serum levels of both carcinoembryonic antigen (CEA) and CA19-9 were significantly reduced (P < 0.05). A median time to progression of 11 months and a median overall survival of 24 months were documented. The major adverse events included grade 1/2 nausea/vomiting, upper abdominal pain, peripheral neuropathy, and neutropenia/thrombocytopenia.</p><p><b>CONCLUSIONS</b>The Folfox4 regimen administered through combined hepatic arterial and systemic infusions is efficacious and safe for the treatment of CRC with unresectable liver metastases, and it facilitates the control of local lesions.</p>

Clinical pathological characteristics and treatment patterns of breast cancer in elderly women / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize the clinical pathological characteristics and treatment patterns of breast cancer in elderly women.</p><p><b>METHODS</b>A total of 87 patients (≥ 60 years) admitted to our hospital between January and December 2007 were included in this retrospective study. The patients were divided into 60-69-year group and ≥ 70-year group, and their clinical pathological data and treatment modes were summarized and compared.</p><p><b>RESULTS</b>The tumor size (T2-T3), number of involved axillary lymph nodes,and positive rates of estrogen/progesterone receptors,over-expression of epidermal growth factor receptor 2, and ≥ 2 complication were not significantly different between two groups (P > 0.05). The ≥ 70-year group tended to have similar p53 gene mutation and Ki-67 labeling index with the 60-69-year group, although the P values were close to 0.05 (P = 0.09, P = 0.08,respectively). In the ≥ 70-year group, 33.3% of patients underwent extended resection,while in the 60-69-year group, all patients received modified radical treatment (P < 0.005). The percentages of adjuvant chemotherapy were 25% and 56.9% in the ≥ 70-year group and the 60-69-year group (0.005). The percentages of adjuvant endocrine therapy applied after surgery were similar in 2 groups (77.8% and 68.6% separately, P=0.347). Binary logistic regression showed that age,number of involved axillary lymph nodes,and estrogen receptor-positive rate were independently associated with adjuvant chemotherapy,while the pathological tumor size and complication were irrelevant. The 2-year disease-free survival rates of 2 groups were not significantly different.</p><p><b>CONCLUSIONS</b>The clinical pathological characteristics of breast cancer were similar in elderly patients who are 60-69 years old or ≥ 70 years. In the treatment pattern,patients who are ≥ 70 years tend to receive endocrine therapy rather than adjuvant chemotherapy.</p>

Clinical characteristics of gastric cancer in the elderly patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the clinical manifestations,treatment,and prognosis of gastric cancer in the elderly patients.</p><p><b>METHOD</b>A total of 252 patients with gastric cancer who admitted to the Oncology Department of Peking Union Medical College Hospital were divided into elderly group (≥ 65 years) and non-elderly group (< 65 years) and the clinical characteristics of these two groups were analyzed and compared.</p><p><b>RESULTS</b>The elderly accounted for 36.0% of all gastric cancer patients in our department. The proportion of male was significantly higher in elderly group than non-elderly group (male:female = 3.74:1, P=0.020). Abdominal satiety and pain were the most common symptoms,which were significantly lower in elderly group (43.3% vs. 61.7%, P=0.005). However,the frequency of weight loss was significantly higher in the elderly group (15.6% vs. 6.2%, P = 0.015). Significantly more elderly patients with gastric cancer were found the second tumors (12.2% vs. 2.5%, P=0.002). The most common tumor location was cardia (36.7%) in elderly group and antrum (34.6%) in non-elderly group. A small proportion (2.2%) of elderly patients had multi-original lesions, which was not found in non-elderly group. The overall rate of surgery and R0 resection rate were 77.8% and 70.9% respectively, which were similar in both groups. The overall rate of chemotherapy was 98%. The ratio was one third compared with younger patients who received three and more than three lines chemotherapy (3.3% vs. 9.3%), but did not reach statistical difference. More elderly patients chose FOLFOX / XELOX regimen (73.3%) compared with younger arm. The median survival time was 26.5 months in elderly group and 28.0 months in non-elderly group (P=0.835). Subgroup analysis showed that the median survival time of stage 4 gastric cancer was longer in elderly group than in non-elderly group (22.7 months and 16.1 months, respectively; P=0.057), which was marginally statistically significant.</p><p><b>CONCLUSIONS</b>More old men may get gastric cancer. More elderly patients may present with weight loss. Cardia is the most common tumor location. The ratio of multi-original lesions and secondary tumors is higher for elderly patients. Elderly patients with good performance status can receive surgery and chemotherapy safely. The resection rate is similar between elderly and non-elderly patients. Elderly patients receive more two-drug combination regimens. The overall prognoses are similar between elderly patients and non-elderly patients.</p>

Solid malignancies complicated with pulmonary embolism: clinical analysis of 120 patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pulmonary embolism, a potentially fatal event, occurs more frequently in cancer patients than in the general population. To offer an accurate diagnosis and effective treatment to such patients in China, we analyzed the incidence rate and clinical features of pulmonary embolism in patients with solid tumor hospitalized in the Peking Union Medical College (PUMC) Hospital.</p><p><b>METHODS</b>A retrospective analysis was made of the hospitalized patients with solid malignancies complicated with pulmonary embolism who had been admitted into the PUMC Hospital from January 2002 to December 2008.</p><p><b>RESULTS</b>The incidence of pulmonary embolism in hospitalized patients with solid malignancies was 0.27% (120/43 967). The median age at diagnosis was 57.5 years. The male to female ratio was 1.0:1.4 (49:71). Patients with non-small-cell lung cancer (NSCLC) constituted the largest proportion of the 120 patients (37.5%), followed by patients with breast (9.2%), ovarian (8.3%), pancreatic (6.7%), and liver cancer (6.7%). Eighty patients (66.7%) had stage IV cancer. Bone was the most common site of distant metastasis (46.3%). D-dimer level was elevated in 90.9% of the 66 tested patients. The incidence of bleeding due to anti-coagulation therapy was 3.6%. Thirty-six (30.0%) of the 120 patients had concurrent deep venous thrombosis in the lower extremities. Seventeen patients developed acute pulmonary embolism within 2 weeks after surgery, 3 of whom died suddenly. Four patients presented with deep venous thrombosis and 1 with pulmonary embolism prior to the identification of malignancy.</p><p><b>CONCLUSIONS</b>Patients with cancer of the lung, ovarian, breast, pancreas, and liver are more likely to be complicated with pulmonary embolism than those with other types of solid tumors. Patients with distant metastasis are at a higher risk of pulmonary embolism. Pulmonary embolism without concurrent deep venous thrombosis is more frequently observed than concurrence of both disorders in the clinical setting.</p>