Yongkun Sun

S-1 and Cisplatin With or Without Nimotuzumab for Patients With Untreated Unresectable or Metastatic Gastric Cancer: A Randomized, Open-Label Phase 2 Trial

Abstract This open-label, randomized phase II trial was performed to compare the efficacy and safety of nimotuzumab plus S-1 and cisplatin (NCS) versus S-1 and cisplatin (CS) alone in patients with untreated unresectable or metastatic gastric cancer in the first-line setting. Eligible participants were randomly assigned (1:1) to receive either NCS or CS. The treatment consisted of 3-week cycles of twice-daily S-1 40 mg/m2 (on days 1–14) and intravenous cisplatin 30 mg/m2 (on days 1, 2), with or without weekly nimotuzumab (200 mg/m2). The primary endpoint was objective response rate (ORR). The second endpoint included progression-free survival (PFS), overall survival (OS), safety and association between efficacy and tumor epidermal growth factor receptor (EGFR) expression. Between October, 2009, and February, 2012, we enrolled 62 patients in Cancer Hospital Chinese Academy of Medical Sciences (CAMS). The ORR for 31 patients allocated NCS was 54.8% compared with 58.1% for 31 patients who were allocated to receive CS alone (P = 0.798). Median PFS for patients in CS arm was significantly improved than that in NCS arm [7.2 months vs. 4.8 months HR = 2.136 (95% CI 1.193–3.826), P = 0.011]. There was also a trend toward better overall survival for patients in CS arm compared with NCS arm [14.3 months vs. 10.2 months; HR = 1.776 (95% CI 0.972–3.246), P = 0.062]. In the EGFR 2+/3+ subgroup, adding nimotuzumab also failed to show additional benefit than chemotherapy alone. Both groups were well tolerated. Less than 10% of patients in both arms developed grade 3/4 toxicity. Combination of nimotuzumab and S-1-cisplatin provided no additional benefit than chemotherapy alone in the first-line treatment of unresectable or metastatic gastric cancer.

Effects of retrograde autologous priming on blood transfusion and clinical outcomes in adults: a meta-analysis.

Objective: Reducing the priming volume is an effective means of decreasing hemodilution and blood transfusion during cardiopulmonary bypass (CPB). The patient’s own blood was used to replace the crystalloid in the CPB circuit by retrograde autologous priming (RAP) in order to decrease the priming volume. Therefore, we performed a meta-analysis to investigate whether RAP could reduce blood transfusion and improve clinical outcomes. Materials and Methods: A comprehensive search was conducted for randomized, controlled trials (RCTs) exploring RAP in PubMed, Embase, The Cochrane Library, Google Scholar and Chinese literature databases (WanFang, WeiPu and CNKI). Clinical parameters and outcomes were focused on the lowest hematocrit (Hct) during CPB, the number of patients transfused blood intraoperatively, the number of patients transfused blood perioperatively, the number of blood units transfused, 24-hour chest tube drainage, hours to extubation, length of ICU stay, and length of hospital stay. Results: Ten trials, with a total of 1123 patients, were included. The number of patients transfused blood intraoperatively (RR = 0.39, 95% CI = [0.29, 0.53], p<0.00001, I2 = 40%) and perioperatively (RR = 0.53, 95% CI = [0.43, 0.66], p<0.00001, I2 = 0%) and the number of blood units transfused (SMD = -0.53, 95% CI = [-0.73, -0.33], p<0.00001, I2 = 14%) were all significantly reduced in the RAP group. No differences in the hours to extubation (SMD = -0.11, 95% CI = [-0.33, 0.12], p=0.37, I2 = 0%) and the length of ICU stay (SMD = -0.17, 95% CI = [-0.41, 0.08], p=0.18, I2 = 0%) were observed between the two groups. Conclusion: Compared to conventional priming, RAP could reduce transfusion in adults significantly, but had no effect on clinical outcomes, comparing to conventional priming. Further studies involving RAP are expected to investigate if this technique is beneficial to the patient.

Randomized, single-centered, phase II clinical trial of nimotuzumab plus cisplatin and S-1 as first-line therapy in patients with advanced gastric cancer.

e21021 Background: Nimotuzumab, a humanized IgG1 anti-EGFR monoclonal antibody, has demonstrated efficacy associated with an absence of severe skin toxicity in many phase I/II cancer trials. METHODS This is a single-center, randomized, parallel assignment and open-label study of nimotuzumab (N: 200 mg iv on day 1, 8 and 15, repeat every 3 weeks) + cisplatin (C: 30mg/m2/day, on day 1 and day 2, repeat every 3 weeks) + S-1 (S: 80mg/m2/day, twice daily on day 1-14, followed 7 days off), vs cisplatin (C: 30mg/m2/day, on day 1 and day 2, repeat every 3 weeks) + S-1 (S: 80mg/m2/day, twice daily on day 1-14, followed 7 days off) as first line in patients with advanced or metastatic gastric cancer. If tumor control was achieved, NCS and CS were continued until unacceptable toxicity or disease progression. The primary endpoint was ORR and the secondary endpoints included TTP, PFS, 1-year survival rates and safety. RESULTS 40 patients, 27 men and 13 women, median age 54 years (21-74 years) ECOG PS 0-2 were treated with NCS (n = 20) or CS (n = 20). Up to 2011-01-14, 36 patients (NCS 19 cases compared with CS 17) have undergone efficacy assessment. The objective response rate (ORR) was 63.2% (12/19) in NCS group compared with 64.7% (11/17) in CS group. Until the same day, 18 patients have achieved progression in both groups (NCS 10 vs. FCS 8), median TTP was 5.5 months in NCS group compared with 3 months in CS group, and average TTP was 5.3 months in NCS group compared with 3.1 months in CS group. The incidence of adverse events was similar between both groups. No adverse events of grade 3 skin rash or grade 3 infusion-related reactions were observed. CONCLUSIONS Initial results have demonstrated benefit in TTP improvement and showed a potential improvement of OS. This study supports that nimotuzumab combine with cisplatin and S-1 has better outcomes compare to cisplatin and S-1. The further study is ongoing.

Is microplegia really superior to standard blood cardioplegia? The results from a meta-analysis

Background: Microplegia (whole blood cardioplegia with reduced volume) retains all the advantages of blood cardioplegia (such as superior oxygen-carrying capacity, better osmotic properties and antioxidant capability, etc.) without the potential disadvantages of hemodilution (such as myocardial edema). We sought to perform a systematic review and meta-analysis to compare microplegia and standard blood cardioplegia on the cardioprotective effects for patients undergoing coronary artery bypass grafting (CABG). Methods: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched for relevant controlled trials published in English, from their inception up to May 15th, 2013. Data on low output syndrome, spontaneous return to sinus rhythm, volume of cardioplegia and perioperative myocardial infarction were analyzed. Results: Five studies, totaling 296 patients, were included out of 77 retrieved citations. The microplegia group used less volume of cardioplegia (WMD, -514.79 ml, 95%CI: -705.37 ml to -324.21 ml) when compared with the standard blood cardioplegia group. There were no statistical differences in the incidence of low output syndrome (RR, 0.95, 95%CI: 0.55 to 1.62), spontaneous return to sinus rhythm (RR, 1.64, 95%CI: 0.61 to 4.41) and perioperative myocardial infarction (RR, 0.62, 95%CI: 0.19 to 2.08). Conclusions: Microplegia was associated with less volume of cardioplegia, whereas the incidence of spontaneous return to sinus rhythm and perioperative myocardial infarction were similar, but large controlled randomized trials are still needed to confirm this.

Comparison of 627 patients with right- and left-sided colon cancer in China: Differences in clinicopathology, recurrence, and survival

Objective Recent studies have reported increased mortality for right-sided colon cancers; however, the results are conflicting for different stage tumors. We examined the differences in clinicopathology between right- and left-sided colon cancers and the relationships between colon cancer location (right- and left-side) and 5-year disease-free survival (DFS) and overall survival (OS). Methods We identified patients from 2005 to 2008 with stage II/III colon cancer who underwent surgery for curative intent. We explored the impact of the tumor location on the postoperative DFS and OS using univariate and multivariate analyses. Results Of 627 patients, 50.6% (317/627) had right-sided colon cancer. These patients were more likely to have weight loss, second primary tumor, elevated preoperative carbohydrate antigen 19-9 (CA19-9), increased incidence of non-adenocarcinoma, more poorly differentiated tumors, vascular invasion, defective mismatch repair, and a lighter smoking history (P < 0.05). Right-sided colon cancer had a higher recurrence incidence compared with left-sided cancer (30.6% vs. 23.2%, P = 0.037), particularly with multiple metastatic sites in the first recurrence (17.5% vs. 5.6%, P = 0.020). Kaplan–Meier survival curves demonstrated a significant difference in the 5-year DFS rate between right- and left-sided cancers across all stages (68.1% vs. 75.2%, P = 0.043). However, there was no significant difference in the 5-year OS rate between the two groups (73.8% vs. 79.0%, P = 0.103). Subgroup analysis demonstrated that patients with left-sided colon cancer had a significantly better 5-year DFS and OS rates compared with those with right-sided disease at stage III (64.3% vs. 46.8%, P = 0.002; 69.5% vs. 53.5%, P = 0.006, respectively); there were no significant differences in the 5-year DFS and OS rates at stage II (85.2% vs. 85.9%, P = 0.819; 89.8% vs. 88.5%, P = 0.803, respectively). Adjusted Cox regression analysis showed no significant differences in the 5-year OS and DFS rates for stage II [hazard ratio (HR) = 1.203, 95% confidence interval (CI): 0.605–2.391, P = 0.598; HR = 0.980, 95% CI: 0.542–1.774, P = 0.948, respectively] or all stages combined (HR = 0.867, 95% CI: 0.613–1.227, P = 0.421; HR = 0.832, 95% CI: 0.606–1.142, P = 0.255, respectively). However, stage III left-sided cancer had higher 5-year OS and DFS rates (HR = 0.626, 95% CI: 0.414–0.948, P = 0.027; HR = 0.630, 95% CI: 0.428–0.926, P = 0.019, respectively). Conclusion We found that right- and left-sided colon cancers had significantly different clinicopathological characteristics. Right-sided colon cancer had a higher incidence of recurrence than left-sided disease. Patients with stage III right-sided colon cancer had a worse prognosis compared with those with stage III left-sided colon cancer.

A study on the association between hyperlipidemia and hypothyroidism and the response to TKIs in metastatic renal cell carcinoma

Vascular endothelial growth facto receptor–tyrosine kinase inhibitors (VEGFR–TKIs) are widely used for metastatic renal cell carcinoma (mRCC). The aim of this study was to investigate the association between the response to VEGFR–TKIs and hyperlipidemia and hypothyroidism.

Establishment of a novel rat model without blood priming during normothermic cardiopulmonary bypass

Objective: An effective animal model was needed for research on the pathophysiology of cardiopulmonary bypass (CPB). Rat models were considered suitable for research into CPB, recently. The aim of the article is to establish a simple and safe CPB model without blood priming in rats, containing the advantages of controlling temperature precisely, being similar to the clinical process and laying the foundation for the further study of a deep hypothermic circulatory arrest (DHCA) model. Materials and Methods: Ten Sprague-Dawley rats, divided into a CPB group (n=7) and a sham group (n=3), received sevoflurane inhalation anesthesia and were maintained in an anesthesia state by intubation. The entire CPB circuit consisted of a reservoir, a membrane oxygenator, a roller pump, a heat exchanger and a heat cooler, all of which were connected via silicon tubes. The volume of the priming solution, composed of 6% HES130/0.4 and 125 IU heparin, was less than 12 ml. In the CPB group, a 22G catheter was placed in the left femoral artery for monitoring arterial blood pressure, a 20G catheter was placed in a tail artery for arterial inflow and a homemade, multiorificed catheter was inserted into a right jugular vein for venous drainage. After 90 minutes, the CPB process was terminated when vital signs were stable. In the sham group, the same surgical process was conducted except for the venous drainage. Post-oxygenator blood gas and hemodynamic parameters were measured at each time point before CPB, during CPB and after CPB. Results: All CPB processes were successfully achieved. Blood gas analysis and hemodynamic parameters of each time point were in accordance with normal ranges. The vital signs of all rats were stable. Conclusion: The establishment of CPB without blood priming in rats can be achieved successfully. The rat model could be used to study short-term or long-term organ injury mechanisms caused by CPB. Furthermore, on the basis of the precise control of temperature and the depth of anesthesia, the DHCA model in rats could be developed further to study pathophysiological changes of neurological and other organ functions in the future.

Impact of Cytoreductive Nephrectomy on Survival in Patients with Metastatic Renal Cell Carcinoma Treated by Targeted Therapy.

Background: The metastatic renal cell carcinoma (mRCC) patients treated with upfront cytoreductive nephrectomy combined with &agr;-interferon yields additional overall survival (OS) benefits. It is unclear whether mRCC patients treated with vascular endothelial growth factor receptor-tyrosine kinase inhibitor (VEGFR-TKI) will benefit from such cytoreductive nephrectomy either. The aim of the study was to identify variables for selection of patients who would benefit from upfront cytoreductive nephrectomy for mRCC treated with VEGFR-TKI. Methods: Clinical data on 74 patients enrolled in 5 clinical trials conducted in Cancer Hospital (Institute), Chinese Academy of Medical Sciences from January 2006 to January 2014 were reviewed retrospectively. The survival analysis was performed by the Kaplan–Meier method. Comparisons between patient groups were performed by Chi-square test. A Cox regression model was adopted for analysis of multiple factors affecting survival, with a significance level of &agr; = 0.05. Results: Fifty-one patients underwent cytoreductive nephrectomy followed by targeted therapy (cytoreductive nephrectomy group) and 23 patients were treated with targeted therapy alone (noncytoreductive nephrectomy group). The median OS was 32.2 months and 23.0 months in cytoreductive nephrectomy and noncytoreductive nephrectomy groups, respectively (P = 0.041). Age ⩽45 years (P = 0.002), a low or high body mass index (BMI <19 or >30 kg/m2) (P = 0.008), a serum lactate dehydrogenase (LDH) concentration >1.5 × upper limit of normal (P = 0.025), a serum calcium concentration >10 mg/ml (P = 0.034), and 3 or more metastatic sites (P = 0.023) were independent preoperative risk factors for survival. The patients only with 0–2 risk factors benefited from upfront cytoreductive nephrectomy in terms of OS when compared with the patients treated with targeted therapy alone (40.0 months vs. 23.2 months, P = 0.042), while those with more than 2 risk factors did not. Conclusions: Five risk factors (age, BMI, LDH, serum calcium, and number of metastatic sites) seemed to be helpful for selecting patients who would benefit from undergoing upfront cytoreductive nephrectomy.

Anlotinib for the Treatment of Patients with Locally Advanced or Metastatic Medullary Thyroid Cancer

BACKGROUND The prognosis of advanced or metastatic medullary thyroid carcinoma (MTC) is poor, and there are few therapeutic options. Anlotinib has previously shown promising antitumor activity on MTC in preclinical models and a Phase I study. This Phase II clinical trial was devised to confirm the antitumor activity of anlotinib in patients with advanced or metastatic MTC. METHODS Patients with unresectable locally advanced or metastatic MTC received once daily oral anlotinib 12 mg, two weeks on/one week off, until disease progression, death, unacceptable toxicity, or withdrawal of consent for any reason. The dose was adjusted on the basis of observed toxicity. The primary endpoint was progression-free survival (PFS). RESULTS Fifty-eight patients received anlotinib treatment. The primary endpoint PFS has not yet been reached at the time of analysis. On the basis of investigator assessments, 56.9% of patients experienced a partial response. PFS rate at 48 weeks was 85.5%. Forty-five patients had a ≥50% decrease in serum calcitonin concentration from baseline. The most common adverse events were hand-foot syndrome, hypertriglyceridemia, cholesterol elevation, fatigue, and proteinuria. CONCLUSIONS Anlotinib demonstrated a durable antitumor activity with a manageable adverse event profile in locally advanced or metastatic MTC.

Safety and Efficacy of Anlotinib, a Multikinase Angiogenesis Inhibitor, in Patients With Refractory Metastatic Soft Tissue Sarcoma.

Purpose: The prognosis for patients with refractory soft-tissue sarcoma (STS) is dismal. Anlotinib has previously shown antitumor activity on STS in preclinical and phase I studies. Patients and Methods: Patients 18 years and older, progressing after anthracycline-based chemotherapy, naïve from angiogenesis inhibitors, with at least one measurable lesion according to RECIST 1.1, were enrolled. The main subtypes eligible were undifferentiated pleomorphic sarcoma (UPS), liposarcoma (LPS), leiomyosarcoma (LMS), synovial sarcoma (SS), fibrosarcoma (FS), alveolar soft-part sarcoma (ASPS), and clear cell sarcoma (CCS). Participants were treated with anlotinib. The primary endpoint was progression-free rate at 12 weeks (PFR12 weeks). Results: A total of 166 patients were included in the final analysis. Overall, the PFR12 weeks was 68%, and objective response rate was 13% (95% confidence interval, 7.6%–18%). The median progression-free survival (PFS) and overall survival (OS) were 5.6 and 12 months, respectively. The PFR12 weeks, median PFS and OS were: 58%, 4.1 and 11 months for UPS (n = 19); 63%, 5.6 and 13 months for LPS (n = 13); 75%, 11 and 15 months for LMS (n = 26); 75%, 7.7 and 12 months for SS (n = 47); 81%, 5.6 and 12 months for FS (n = 18); 77%, 21 and not reached for ASPS (n = 13); 54%, 11 and 16 months for CCS (n = 7); and 44%, 2.8 and 8.8 months for other sarcoma (n = 23), respectively. The most common clinically significant grade 3 or higher adverse events were hypertension (4.8%), triglyceride elevation (3.6%), and pneumothorax (2.4%). No treatment-related death occurred. Conclusions: Anlotinib showed antitumor activity in several STS entities. The toxicity was manageable. Clin Cancer Res; 24(21); 5233–8. ©2018 AACR.