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Kazuhiro Yoshida - One of the best experts on this subject based on the ideXlab platform.

  • pathological complete response to mfolfox6 plus cetuximab Therapy for unresectable colon cancer with multiple paraaortic lymph node metastases
    Current Opinion in Clinical Nutrition and Metabolic Care, 2018
    Co-Authors: Tomonari Suetsugu, Toshiyuki Tanahashi, Satoshi Matsui, Hisashi Imai, Yoshihiro Tanaka, Nobuhisa Matsuhashi, Takao Takahashi, Kazuya Yamaguchi, Kazuhiro Yoshida
    Abstract:

    Pathological complete response is achievable with mFOLFOX6 plus cetuximab Therapy for unresectable colorectal cancer with multiple paraaortic lymph node metastases (mCRC) despite right-sided colonic origin. A 62-year-old woman with synchronous paraaortic lymph node metastases of transverse colon cancer was treated with mFOLFOX6 plus cetuximab as first-line Therapy. The tumor size was markedly decreased following 6 courses of chemoTherapy, and all lymph node metastases had disappeared. The patient then underwent conventional right hemicolectomy with D3 lymph node dissection plus sampling excision of the paraaortic lymph nodes. The pathological diagnosis was a complete response. The patient is currently alive 5 years after surgery with no signs of recurrence. The present study reported the apparent effectiveness of Conversion Therapy (surgery) with combination treatment with mFOLFOX6 plus cetuximab and radical surgery. We hypothesized that patients with different types of mCRC of right-sided colon origin may be effectively treated with anti-EGFR monoclonal antibodies.

  • is Conversion Therapy possible in stage iv gastric cancer the proposal of new biological categories of classification
    Gastric Cancer, 2016
    Co-Authors: Kazuhiro Yoshida, Toshiyuki Tanahashi, Kazuya Yamaguchi, Naoki Okumura, Yasuhiro Kodera
    Abstract:

    Conversion Therapy for gastric cancer (GC) has been the subject of much recent attention. It is defined as a surgical treatment aiming at an R0 resection after chemoTherapy for tumors that were originally unresectable or marginally resectable for technical and/or oncological reasons. However, the indications for resection remain to be clarified. In the present review, we focus on the biology and heterogeneous characteristics of stage IV GC and propose new categories of classification. Stage IV GC patients can be divided based on the absence (categories 1 and 2) or presence (categories 3 and 4) of macroscopically detectable peritoneal dissemination, which has a different biological outcome compared to hematological metastasis. Category 1 is defined oncologically as stage IV but the metastasis is technically resectable. Category 2 includes a marginally resectable metastasis or patients for whom the operation would not necessarily be the best choice. Category 3 includes a potentially unresectable metastasis of peritoneal dissemination that is only macroscopically detectable. Category 4 includes noncurable metastasis with peritoneal and other organ metastasis. The indications for Conversion Therapy might include the patients from category 2, some patients from category 3 and a very small number of patients from category 4. The longer survival can be expected for patients corresponding to categories 1, 2 and, to a lesser extent, 3, while the treatment of other patients focuses on “care.” The provision of Conversion Therapy for stage IV GC patients might be one of the main roles of surgical oncologists in the near future.

Akira Arimoto - One of the best experts on this subject based on the ideXlab platform.

K Kataoka - One of the best experts on this subject based on the ideXlab platform.

Sandro Barni - One of the best experts on this subject based on the ideXlab platform.

  • folfoxiri plus bevacizumab as Conversion Therapy for patients with initially unresectable metastatic colorectal cancer a systematic review and pooled analysis
    JAMA Oncology, 2017
    Co-Authors: Gianluca Tomasello, Fausto Petrelli, Michele Ghidini, Alessandro Russo, Rodolfo Passalacqua, Sandro Barni
    Abstract:

    Importance The combination of fluorouracil, oxaliplatin, and irinotecan plus bevacizumab (FOLFOXIRI-Bev) is an established and effective first-line chemoTherapy regimen for metastatic colorectal cancer. However, resection rates of metastases and overall survival with this schedule have never been systematically evaluated in published studies including, but not limited to, the TRIBE (TRIplet plus BEvacizumab) trial. Objective To assess the clinical efficacy of FOLFOXIRI-Bev, including outcomes and rates of surgical Conversions. Data Sources A systematic review was conducted in October 2016 in concordance with the PRISMA guidelines of PubMed, the Cochrane Central Register of Controlled Trials, SCOPUS, Web of Science, Google Scholar, CINAHL, Ovid, and EMBASE using the terms FOLFOXIRI and bevacizumab and (colorectal cancer). Study Selection Clinical trials, retrospective case series, and prospective case series that used FOLFOXIRI-Bev for the treatment of initially unresectable metastatic colorectal cancer in humans were included. Individual case reports and retrospective case series with fewer than 10 patients were excluded. Data Extraction and Synthesis Data were extracted independently by 2 reviewers on a predesigned, standardized form. Ultimately, data were aggregated to obtain the pooled effect size of efficacy, according to the random-effects model and weighted for the number of patients included in each trial. Main Outcomes and Measures Median overall survival and progression-free survival, overall response rates, and rates of R0 surgical Conversions and overall surgical Conversions. Results Eleven FOLFOXIRI-Bev studies published between 2010 and 2016 met the inclusion criteria and were pooled for analysis. The studies included 889 patients, with 877 patients clinically evaluable for overall response rates. The objective response rate to FOLFOXIRI-Bev was 69% (95% CI, 65%-72%; I 2  = 25%). The rate of overall surgical Conversions was 39.1% (95% CI, 26.9%-52.8%), and the rate of R0 surgical Conversions was 28.1% (95% CI, 18.1%-40.8%). Median pooled overall survival was 30.2 months (95% CI, 26.5-33.7 months) in 6 trials with data available, and progression-free survival was 12.4 months (95% CI, 10.0-14.3 months) in 9 trials with data available. In meta-regression analysis, variables significantly associated with Conversion surgery were disease limited to the liver and a higher median number of cycles (close to 12). Conclusions and Relevance For patients with surgically unresectable metastatic colorectal cancer, FOLFOXIRI-Bev is associated with a significant overall response rate. Such an effective regimen leads to a probability of surgical Conversion of distant metastases approaching 40%, with more than one-fourth of patients having an R0 resection.

Toshiyuki Tanahashi - One of the best experts on this subject based on the ideXlab platform.

  • pathological complete response to mfolfox6 plus cetuximab Therapy for unresectable colon cancer with multiple paraaortic lymph node metastases
    Current Opinion in Clinical Nutrition and Metabolic Care, 2018
    Co-Authors: Tomonari Suetsugu, Toshiyuki Tanahashi, Satoshi Matsui, Hisashi Imai, Yoshihiro Tanaka, Nobuhisa Matsuhashi, Takao Takahashi, Kazuya Yamaguchi, Kazuhiro Yoshida
    Abstract:

    Pathological complete response is achievable with mFOLFOX6 plus cetuximab Therapy for unresectable colorectal cancer with multiple paraaortic lymph node metastases (mCRC) despite right-sided colonic origin. A 62-year-old woman with synchronous paraaortic lymph node metastases of transverse colon cancer was treated with mFOLFOX6 plus cetuximab as first-line Therapy. The tumor size was markedly decreased following 6 courses of chemoTherapy, and all lymph node metastases had disappeared. The patient then underwent conventional right hemicolectomy with D3 lymph node dissection plus sampling excision of the paraaortic lymph nodes. The pathological diagnosis was a complete response. The patient is currently alive 5 years after surgery with no signs of recurrence. The present study reported the apparent effectiveness of Conversion Therapy (surgery) with combination treatment with mFOLFOX6 plus cetuximab and radical surgery. We hypothesized that patients with different types of mCRC of right-sided colon origin may be effectively treated with anti-EGFR monoclonal antibodies.

  • is Conversion Therapy possible in stage iv gastric cancer the proposal of new biological categories of classification
    Gastric Cancer, 2016
    Co-Authors: Kazuhiro Yoshida, Toshiyuki Tanahashi, Kazuya Yamaguchi, Naoki Okumura, Yasuhiro Kodera
    Abstract:

    Conversion Therapy for gastric cancer (GC) has been the subject of much recent attention. It is defined as a surgical treatment aiming at an R0 resection after chemoTherapy for tumors that were originally unresectable or marginally resectable for technical and/or oncological reasons. However, the indications for resection remain to be clarified. In the present review, we focus on the biology and heterogeneous characteristics of stage IV GC and propose new categories of classification. Stage IV GC patients can be divided based on the absence (categories 1 and 2) or presence (categories 3 and 4) of macroscopically detectable peritoneal dissemination, which has a different biological outcome compared to hematological metastasis. Category 1 is defined oncologically as stage IV but the metastasis is technically resectable. Category 2 includes a marginally resectable metastasis or patients for whom the operation would not necessarily be the best choice. Category 3 includes a potentially unresectable metastasis of peritoneal dissemination that is only macroscopically detectable. Category 4 includes noncurable metastasis with peritoneal and other organ metastasis. The indications for Conversion Therapy might include the patients from category 2, some patients from category 3 and a very small number of patients from category 4. The longer survival can be expected for patients corresponding to categories 1, 2 and, to a lesser extent, 3, while the treatment of other patients focuses on “care.” The provision of Conversion Therapy for stage IV GC patients might be one of the main roles of surgical oncologists in the near future.