- Email: [email protected]
Chemotherapy improves survival in appendiceal cancer
News
New research suggests that adjuvant chemotherapy significantly increases overall survival in stage I–III adenocarcinomas of the appendix, irrespective of their histology. However, in patients with stage IV disease, the benefit of systemic chemotherapy varied according to the histology and grade of the tumour, “with patients with well differentiated, mucinous, appendiceal adenocarcinomas deriving no survival benefit from systemic chemotherapy”. Elliot Asare and colleagues did a retrospective analysis of a cohort of 11 871 patients who were diagnosed with cancers of appendix during 1985–2006. According to multivariable modelling in stage I to III disease, adjuvant chemotherapy significantly improved overall survival of patients with tumours with mucinous histology (hazard ratio [HR] 0·78 [95% CI 0·68–0·89],
p=0·0002) and non-mucinous histology (HR 0·83 [0·74–0·94], p=0·002]). The researchers also noted that in patients with stage IV disease, systemic chemotherapy substantially improved overall survival for nonmucinous histology (HR 0·72 [0·64– 0·82], p<0·0001), but not for mucinous histology (HR 0·95 [0·86–1·04], p=0·2), although the improvement was gradedependent. In patients with mucinous, well differentiated tumours, the median overall survival for chemotherapy versus no chemotherapy was 6·4 years versus 6·5 years (not significantly different); however, in patients with mucinous, poorly differentiated tumours, overall survival with chemotherapy was 1·6 years versus 1·0 years with no chemotherapy (p=0·0007). Study author Michael Overman (MD Anderson Cancer Center, TX, USA) commented, “The impact of grade and
mucinous histology is primarily related to the subset of well differentiated mucinous stage IV adenocarcinomas which demonstrate a very unique rather indolent biology, in which mucin accumulation represents the major concern”. He added, “In this subset of appendiceal adenocarcinomas, often referred to as pseudomyxoma peritonei, systemic chemotherapy does not appear to play a role, and as demonstrated in other datasets, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy represents the standard approach”. Swapan Jana (Midnapore Medical College, West Bengal, India) commented, “The study is impressive. The findings might lead to potential changes in clinical practice for patients with stage IV disease”.
CNRI/Science Photo Library
Chemotherapy improves survival in appendiceal cancer
Lancet Oncol 2015 Published Online November 5, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)00476-3 For the study by Asare and colleagues see http:// onlinelibrary.wiley.com/ doi/10.1002/cncr.29744/abstract
Sanjeet Bagcchi
www.thelancet.com/oncology Published online November 5, 2015 http://dx.doi.org/10.1016/S1470-2045(15)00476-3
1
New research suggests that adjuvant chemotherapy significantly increases overall survival in stage I–III adenocarcinomas of the appendix, irrespective of their histology. However, in patients with stage IV disease, the benefit of systemic chemotherapy varied according to the histology and grade of the tumour, “with patients with well differentiated, mucinous, appendiceal adenocarcinomas deriving no survival benefit from systemic chemotherapy”. Elliot Asare and colleagues did a retrospective analysis of a cohort of 11 871 patients who were diagnosed with cancers of appendix during 1985–2006. According to multivariable modelling in stage I to III disease, adjuvant chemotherapy significantly improved overall survival of patients with tumours with mucinous histology (hazard ratio [HR] 0·78 [95% CI 0·68–0·89],
p=0·0002) and non-mucinous histology (HR 0·83 [0·74–0·94], p=0·002]). The researchers also noted that in patients with stage IV disease, systemic chemotherapy substantially improved overall survival for nonmucinous histology (HR 0·72 [0·64– 0·82], p<0·0001), but not for mucinous histology (HR 0·95 [0·86–1·04], p=0·2), although the improvement was gradedependent. In patients with mucinous, well differentiated tumours, the median overall survival for chemotherapy versus no chemotherapy was 6·4 years versus 6·5 years (not significantly different); however, in patients with mucinous, poorly differentiated tumours, overall survival with chemotherapy was 1·6 years versus 1·0 years with no chemotherapy (p=0·0007). Study author Michael Overman (MD Anderson Cancer Center, TX, USA) commented, “The impact of grade and
mucinous histology is primarily related to the subset of well differentiated mucinous stage IV adenocarcinomas which demonstrate a very unique rather indolent biology, in which mucin accumulation represents the major concern”. He added, “In this subset of appendiceal adenocarcinomas, often referred to as pseudomyxoma peritonei, systemic chemotherapy does not appear to play a role, and as demonstrated in other datasets, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy represents the standard approach”. Swapan Jana (Midnapore Medical College, West Bengal, India) commented, “The study is impressive. The findings might lead to potential changes in clinical practice for patients with stage IV disease”.
CNRI/Science Photo Library
Chemotherapy improves survival in appendiceal cancer
Lancet Oncol 2015 Published Online November 5, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)00476-3 For the study by Asare and colleagues see http:// onlinelibrary.wiley.com/ doi/10.1002/cncr.29744/abstract
Sanjeet Bagcchi
www.thelancet.com/oncology Published online November 5, 2015 http://dx.doi.org/10.1016/S1470-2045(15)00476-3
1