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Impact of pathological response after neoadjuvant chemotherapy on adjuvant therapy decisions and patient outcomes in gastrointestinal cancers

BACKGROUND: Neoadjuvant chemotherapy (NAC) is frequently used in gastrointestinal cancers (GIC), and pathological, radiological, and tumor marker responses are assessed during and after NAC. AIM: To evaluate the relationship between pathologic, radiologic, tumor marker responses and recurrence‐free...

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Autores principales: Bhalla, Sheena, Zhu, Huili, Lin, Jung‐Yi, Özbek, Umut, Wilck, Eric J., Chang, Sanders, Chen, Xiuxu, Ward, Stephen, Harpaz, Noam, Polydorides, Alexandros D., Miller, William, Fiel, Maria Isabel, Modica, Ippolito, Fan, Wen, Zeizafoun, Nebras, Ang, Celina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8714550/
https://www.ncbi.nlm.nih.gov/pubmed/34032391
http://dx.doi.org/10.1002/cnr2.1412
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author Bhalla, Sheena
Zhu, Huili
Lin, Jung‐Yi
Özbek, Umut
Wilck, Eric J.
Chang, Sanders
Chen, Xiuxu
Ward, Stephen
Harpaz, Noam
Polydorides, Alexandros D.
Miller, William
Fiel, Maria Isabel
Modica, Ippolito
Fan, Wen
Zeizafoun, Nebras
Ang, Celina
author_facet Bhalla, Sheena
Zhu, Huili
Lin, Jung‐Yi
Özbek, Umut
Wilck, Eric J.
Chang, Sanders
Chen, Xiuxu
Ward, Stephen
Harpaz, Noam
Polydorides, Alexandros D.
Miller, William
Fiel, Maria Isabel
Modica, Ippolito
Fan, Wen
Zeizafoun, Nebras
Ang, Celina
author_sort Bhalla, Sheena
collection PubMed
description BACKGROUND: Neoadjuvant chemotherapy (NAC) is frequently used in gastrointestinal cancers (GIC), and pathological, radiological, and tumor marker responses are assessed during and after NAC. AIM: To evaluate the relationship between pathologic, radiologic, tumor marker responses and recurrence‐free survival (RFS), overall survival (OS), adjuvant chemotherapy (AC) decisions, and the impact of changing to a different AC regimen after poor response to NAC. METHODS AND RESULTS: Medical records of GIC patients treated with NAC at Mount Sinai between 1/2012 and 12/2018 were reviewed. One hundred fifty‐six patients (58.3% male, mean age 63 years) were identified. Primary tumor sites were: 43 (27.7%) pancreas, 62 (39.7%) gastroesophageal, and 51 (32.7%) colorectal. After NAC, 31 (19.9%) patients had favorable pathologic response (FPR; defined as College of American Pathologists [CAP] score 0–1). Of 107 patients with radiological data, 59 (55.1%) had an objective response, and of 113 patients with tumor marker data, 61 (54.0%) had a ≥50% reduction post NAC. FPR, but not radiographic or serological responses, was associated with improved RFS (HR 0.28; 95% CI 0.11–0.72) and OS (HR 0.13; 95% CI 0.2–0.94). Changing to a different AC regimen from initial NAC, among all patients and specifically among those with unfavorable pathological response (UPR; defined as CAP score 2–3) after NAC, was not associated with improved RFS or OS. CONCLUSIONS: GIC patients with FPR after NAC experienced significant improvements in RFS and OS. Patients with UPR did not benefit from changing AC. Prospective studies to better understand the role of pathological response in AC decisions and outcomes in GIC patients are needed.
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spelling pubmed-87145502022-01-05 Impact of pathological response after neoadjuvant chemotherapy on adjuvant therapy decisions and patient outcomes in gastrointestinal cancers Bhalla, Sheena Zhu, Huili Lin, Jung‐Yi Özbek, Umut Wilck, Eric J. Chang, Sanders Chen, Xiuxu Ward, Stephen Harpaz, Noam Polydorides, Alexandros D. Miller, William Fiel, Maria Isabel Modica, Ippolito Fan, Wen Zeizafoun, Nebras Ang, Celina Cancer Rep (Hoboken) Original Articles BACKGROUND: Neoadjuvant chemotherapy (NAC) is frequently used in gastrointestinal cancers (GIC), and pathological, radiological, and tumor marker responses are assessed during and after NAC. AIM: To evaluate the relationship between pathologic, radiologic, tumor marker responses and recurrence‐free survival (RFS), overall survival (OS), adjuvant chemotherapy (AC) decisions, and the impact of changing to a different AC regimen after poor response to NAC. METHODS AND RESULTS: Medical records of GIC patients treated with NAC at Mount Sinai between 1/2012 and 12/2018 were reviewed. One hundred fifty‐six patients (58.3% male, mean age 63 years) were identified. Primary tumor sites were: 43 (27.7%) pancreas, 62 (39.7%) gastroesophageal, and 51 (32.7%) colorectal. After NAC, 31 (19.9%) patients had favorable pathologic response (FPR; defined as College of American Pathologists [CAP] score 0–1). Of 107 patients with radiological data, 59 (55.1%) had an objective response, and of 113 patients with tumor marker data, 61 (54.0%) had a ≥50% reduction post NAC. FPR, but not radiographic or serological responses, was associated with improved RFS (HR 0.28; 95% CI 0.11–0.72) and OS (HR 0.13; 95% CI 0.2–0.94). Changing to a different AC regimen from initial NAC, among all patients and specifically among those with unfavorable pathological response (UPR; defined as CAP score 2–3) after NAC, was not associated with improved RFS or OS. CONCLUSIONS: GIC patients with FPR after NAC experienced significant improvements in RFS and OS. Patients with UPR did not benefit from changing AC. Prospective studies to better understand the role of pathological response in AC decisions and outcomes in GIC patients are needed. John Wiley and Sons Inc. 2021-05-25 /pmc/articles/PMC8714550/ /pubmed/34032391 http://dx.doi.org/10.1002/cnr2.1412 Text en © 2021 The Authors. Cancer Reports published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Bhalla, Sheena
Zhu, Huili
Lin, Jung‐Yi
Özbek, Umut
Wilck, Eric J.
Chang, Sanders
Chen, Xiuxu
Ward, Stephen
Harpaz, Noam
Polydorides, Alexandros D.
Miller, William
Fiel, Maria Isabel
Modica, Ippolito
Fan, Wen
Zeizafoun, Nebras
Ang, Celina
Impact of pathological response after neoadjuvant chemotherapy on adjuvant therapy decisions and patient outcomes in gastrointestinal cancers
title Impact of pathological response after neoadjuvant chemotherapy on adjuvant therapy decisions and patient outcomes in gastrointestinal cancers
title_full Impact of pathological response after neoadjuvant chemotherapy on adjuvant therapy decisions and patient outcomes in gastrointestinal cancers
title_fullStr Impact of pathological response after neoadjuvant chemotherapy on adjuvant therapy decisions and patient outcomes in gastrointestinal cancers
title_full_unstemmed Impact of pathological response after neoadjuvant chemotherapy on adjuvant therapy decisions and patient outcomes in gastrointestinal cancers
title_short Impact of pathological response after neoadjuvant chemotherapy on adjuvant therapy decisions and patient outcomes in gastrointestinal cancers
title_sort impact of pathological response after neoadjuvant chemotherapy on adjuvant therapy decisions and patient outcomes in gastrointestinal cancers
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8714550/
https://www.ncbi.nlm.nih.gov/pubmed/34032391
http://dx.doi.org/10.1002/cnr2.1412
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