Clinical colorectal cancer
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Clin Colorectal Cancer · Dec 2018
Randomized Controlled Trial Multicenter StudyCost-effectiveness Analysis of Regorafenib and TAS-102 in Refractory Metastatic Colorectal Cancer in the United States.
Regorafenib and TAS-102 are standard treatment options in refractory metastatic colorectal cancer based on improvement in overall survival by 6 and 8 weeks, respectively, when compared with best supportive care alone (BSC). Given the small incremental clinical benefit, we evaluated their cost-effectiveness from a United States payer's perspective. ⋯ Neither TAS-102 nor regorafenib are cost-effective at standard willingness-to-pay thresholds (ie, $150,000 per QALY) relative to BSC. There is no clear evidence that either treatment has better relative value.
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Clin Colorectal Cancer · Dec 2018
Meta AnalysisShort-Course Radiotherapy in Neoadjuvant Treatment for Rectal Cancer: A Systematic Review and Meta-analysis.
To assess whether preoperative short-course radiotherapy (PSRT) could be the treatment of choice compared to preoperative long-course chemoradiotherapy (PLCRT) METHODS: The PubMed, Embase, and Web of Science Databases were searched to conduct a systematic review and meta-analysis. Perioperative and survival outcomes between PSRT and PLCRT were selected as end points for our meta-analysis. In addition, health-related quality-of-life outcomes were also systematically reviewed between PSRT and PLCRT. Finally, we also reviewed evidence of optimized regimens of PSRT (with delayed surgery or adding consolidation chemotherapy). ⋯ PSRT could be the treatment of choice compared to PLCRT when pCR is not the primary aim. PSRT with delayed surgery or adding consolidation may provide further possibilities for the future evolution of neoadjuvant therapies.
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Clin Colorectal Cancer · Dec 2018
Multicenter Study Observational StudyRole of Predictive Value of the Modified Glasgow Prognostic Score for Later-line Chemotherapy in Patients With Metastatic Colorectal Cancer.
Assessment of patient factors is essential for selecting later-line chemotherapy in patients with metastatic colorectal cancer (mCRC). The efficacy, prognosis, and safety of each treatment regimen according to nutritional and inflammatory status still remain to be elucidated. ⋯ The mGPS before later-line chemotherapy is strongly correlated with survival in patients with mCRC.
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Clin Colorectal Cancer · Dec 2018
ReviewRecent Advances in the Clinical Development of Immune Checkpoint Blockade Therapy for Mismatch Repair Proficient (pMMR)/non-MSI-H Metastatic Colorectal Cancer.
Metastatic colorectal cancer (mCRC) continues to be associated with a poor prognosis, and there remains a significant unmet need for novel agents and treatment regimens. Major breakthroughs have been made with immune checkpoint blockade therapy in several disease types, including DNA mismatch repair deficient/microsatellite instability-high (MSI-H) tumors. To date, however, immune checkpoint monotherapy has not shown significant clinical activity in the treatment of patients with mismatch repair proficient (pMMR)/non-MSI-H mCRC. ⋯ The combination of atezolizumab with cobimetinib had shown promising clinical activity in an early-phase clinical trial. Unfortunately, the IMblaze 370 (COTEZO) phase III trial of atezolizumab/cobimetinib combination in patients with mCRC failed to show significant improvement in overall survival in patients treated with the atezolizumab/combimetinib combination in comparison with regorafenib alone. This review summarizes the recent major advances in the clinical development of immunotherapy regimens for patients with pMMR/non-MSI-H mCRC.
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Clin Colorectal Cancer · Dec 2018
Observational StudyEfficacy and Safety of Regorafenib With 2/1 Schedule for Patients ≥ 75 Years With Metastatic Colorectal Cancer (mCRC) After Failure of 2 Lines of Chemotherapy.
In the CORRECT (patients with metastatic COloRectal Cancer treated with REgorafenib or plaCebo after failure of standard Therapy) trial, regorafenib was proven to extend survival of patients with metastatic colorectal cancer (mCRC) that progressed after all available therapies. Grade 3 to 4 toxicity occurred in 54% of patients, and data on the activity and tolerability of regorafenib in elderly patients were scarce. The aim of this study was to evaluate the efficacy and safety of an alternative schedule, 2-week-on treatment and 1 week-off (2/1 schedule), of regorafenib for elderly patients with mCRC. ⋯ Regorafenib administered with a modified 2/1 schedule to patients who were aged ≥ 75 years and non-frail with treatment-refractory mCRC seems to be tolerable and achieve encouraging results in terms of PFS and OS.