M. Di Marco

Hypersensitivity reactions related to oxaliplatin (OHP)

Patients treated with platinum compounds are subject to hypersensitivity reactions. Our study has highlighted the reactions related to oxaliplatin (OHP) infusion. One hundred and twenty-four patients affected by advanced colorectal cancer were treated with different schedules containing OHP, at the Institute of Haematology and Medical Oncology ‘L. and A. Seragnoli’ of Bologna and at the Medical Oncology Division of Livorno Hospital. Seventeen patients (13%) showed hypersensitivity reactions after a few minutes from the start of the OHP infusion. Usually, these reactions were seen after 2–17 exposures to OHP (Mean±s.e.: 9.4±1.07). No patient experienced allergic reactions at his/her first OHP infusion. Eight patients developed a mild reaction consisting of flushing and swelling of the face and hands, itching, sweating and lachrymation. The remaining nine patients showed a moderate–severe reaction with dyspnoea, wheezing, laryngospasm, psycho-motor agitation, tachycardia, precordial pain, diffuse erythema, itching and sweating. Six patients out of 17 were re-exposed to the drug with premedication of steroids and all except one developed the hypersensitivity reaction again. The cumulative dose, the time of exposure to OHP and the clinical features are variable and unpredictable. The risk of developing hypersensitivity reactions in patients treated with a short infusion of OHP cannot be underestimated.

Folate and prevention of colorectal cancer in ulcerative colitis

Patients with ulcerative colitis are at greater risk of developing colorectal cancer than the general population. Prophylactic colectomy is the only certain method of avoiding this risk. To avoid indiscriminate surgery, efforts have focused on colonoscopic surveillance in order to select for prophylactic surgery only patients at ultra-high risk. However this policy has not always been proven to reduce mortality for colorectal cancer in these patients. Recently, there has been growing interest in chemoprevention using folate. Folate maintains the normal DNA methylation process and steady-state levels of DNA precursors. These properties indicate that folate has potential as chemopreventive agent.

Is adjuvant systemic chemotherapy after resection of metastases from colorectal cancer suitable

3654 Background: In patients affected by metastatic colorectal cancer surgical resection of metastases improves the overall survival (OS) and represents the only potentially curative therapy in spite of the high 2 years-recurrence rate of disease. Adjuvant chemotherapy via hepatic arterial infusion (HAI) after resection of liver metastases has shown its efficacy in terms of disease free survival (DFS) but not for OS. On the contrary, the role of adjuvant systemic chemotherapy after metastases resection (ASCMR) was rarely investigated in randomised trials. This retrospective analysis has considered the role of ASCMR on DFS in patients submitted to radical resection of lung or liver metastases (synchronous or metachronous at first recurrence) from colorectal cancer between June 1996 and January 2003 in our centre. METHODS 48 patients were eligible; 32 received ASCMR (M19; F 13) and 16 did not receive any therapy (M 8; F 8). ASCMR used regimens were: 9 pts Mayo clinic (mean number of infusion 6,2 range 3-12); 10 pts Folfox-4 (6,2 range 3-11); 4 pts Folfiri (6,5 range 5-9); 9 pts De Gramont (6,5 range 6-10).The characteristics of patients and lesions are reported in Tab 1 Results: Results are reported in Tab 1 Conclusions: The features of the disease in the two groups of patients (treated with ASCMR and not) are not different. DFS is statistically higher for patients submitted to ASCMR (in particular for lung metastases). In conclusions the adjuvant systemic chemotherapy after resection of metastases from colorectal cancer could prolong DFS, but large prospective studies are needed to define overall survival. [Figure: see text] No significant financial relationships to disclose.

Prognostic factors for recurrence in resected pancreatic adenocarcinoma: A single-center experience.

e14541 Background: The aim of the study was to determine prognostic factors for recurrence in resected pancreatic cancer. METHODS We analyzed retrospectively 47 patients who underwent pancreatic resection for pancreatic ductal adenocarcinoma, from January 2006 to July 2010. Demographic (age, sex), surgical (type of resection), pathological data (grading, TNM stage, lymph node ratio, presence of metastatic lymph nodes, number of lymph nodes harvested, R status, perineural and vascular invasion) and type of therapy (surgery alone versus surgery plus adjuvant treatment) were evaluated. RESULTS Adjuvant chemotherapy was performed in 28 patients: 23 received gemcitabine (GEM) alone (1,000 mg/mq die 1-8-15 every 28) and 5 GEM plus cisplatin (CDDP) (75 mg/mq die 1 every 28). Radiotherapy was preformed only in 9 patients: 6 associated with GEM alone and 3 with GEM plus CDDP. Median follow-up was 16 months. Total recurrences were 34 out of 47 patients (72.3%): local relapse were 10 (29.4 %) and distant metastases were 24 (70.6%). Median OS and DFS were 27.1 ± 2.9 and 15.7 ± 2.1 months, respectively. At univariate analysis patients who underwent total pancreatectomy (P=0.024), with adenocarcinoma on intraductal papillary mucinous neoplasm of the pancreas (IPMN) (P=0.017), low grading (P=0.017), low lymph nodes ratio (P=0.002), low number of metastatic lymph nodes (P=0.001), absence of metastatic lymph nodes (P<0.001) had a statistical significant long disease-free survival. At multivariate analysis the only independent factors related to an increased risk of recurrence were high grading (OR 1.7 CI 95% 1-2.9; P=0.050) and the presence of metastatic node (OR 9.6 CI 95% 2.2-41.8 P=0.002). CONCLUSIONS Grading and lymph nodes metastasis are the most important factors influencing local or distant recurrence after pancreatic resection for pancreatic ductal adenocarcinoma.

Neoadjuvant therapy for resectable pancreatic adenocarcinoma: An interim report of a prospective randomized study.

e14604 Background: We compare neoadjuvant chemoradiation therapy plus surgery versus surgery alone in patients with resectable pancreatic adenocarcinoma (RPA) in a prospective, controlled, randomized study. The primary end-point was to evaluate the R0 resection rate in the two groups and secondary was safety/efficacy of neoadjuvant therapy, postoperative mortality, morbidity, lymph node-ratio and pTNM stage. Methods: Patients with RPA were randomized to receive either neoadjuvant therapy plus surgery (group A) or surgery alone (group B). In group A, patients received gemcitabine (1,000 mg/m2) on days 1,8 every 21, followed by radiation therapy (45 Gy plus boost of 9 Gy) plus gemcitabine 50 mg/m2 biweekly, for 6 weeks. A CT scan restaging was performed before surgery. Results: From March 2007 we enrolled 19 consecutive patients (9 male and 8 female). Seventeen among the eligible patients 7 (41%) were randomized in group A and 10 (59%) in group B. After neoadjuvant therapy one patient (14.3%) had a progress...