After the session, he discussed several topics in colorecal cancer patients with peritoneal metastasis with Oncology Frontier(肿瘤瞭望).
 |
| David Ryan, MD Clinical Director, Cancer Center Massachusetts General Hospital Harvard Medical School Photo provided by: Oncology Frontier |
What do you think of the role and status of EPIC or HIPC in colorectal cancer patients with peritoneal metastasis after undergoing cytoreductive surgery?
Dr Ryan: We are starting to view this similarly to those patients with isolated liver or lung metastases.
In other words, we think that a subset of patients who have isolated peritoneal disease may be cured where it can be completely resected.
It remains an open question whether these patients benefit from intraoperative heated intraperitoneal chemotherapy (HIPEC) or early postoperative intraperitoneal chemotherapy (EPIC).
That question is open to debate and the Prodige 7 study will hopefully answer that question because everybody in the study receives cytoreductive surgery and then patients were randomized to either receive intraperitoneal chemotherapy or not.
What kinds of patients can be selected to undergo HIPEC or EPIC treatment?
Dr Ryan: Right now, many of the surgeons who do this type of surgery, consider it a package program.
If you are going to do cytoreductive surgery, it is followed by intraperitoneal chemotherapy. It is then a local or institutional preference whether it is HIPEC or EPIC.
Several clinical trials indicated that compared with the postoperative observation group, patients who underwent preoperative neoadjuvant chemoradiation therapy do not get benefit from receiving fluorouracil-based adjuvant chemotherapy. What do you think is the reason recent adjuvant chemotherapy clinical trials have been consistently negative?
Dr Ryan: I don’t think they are consistently negative. These are retrospective series of patients who have a wide array of competing mortality risks in terms of what line of chemotherapy they have had and whether they are sensitive or not to chemotherapy.
So I think we need more randomized controlled studies to help guide us in terms of how much intraperitoneal chemotherapy is necessary, whether intraperitoneal chemotherapy is necessary and whether we need to heat that intraperitoneal chemotherapy.
My experience in the United States is that almost all of the patients I see who subsequently go on to get cytoreductive surgery, the surgeons are insisting that patients get preoperative chemotherapy with either FOLFOX-based chemotherapy or FOLFIRI-based chemotherapy.
What has been the take home message from ASCO 2015 for you?
Dr Ryan: The take home message for patients with peritoneal carcinomatosis is that cytoreductive surgery may actually cure a subset of patients, and it is more likely to be curative where the patient is rendered free of all disease at the time of surgery.
It remains an open question how beneficial any intraperitoneal chemotherapy is postoperatively. Thankfully, the study that will answer that, the Prodige 7 study from France, has completed accrual and those results should be reported in 2-3 years.
Reproduced from Oncology Frontier
No comments:
Post a Comment