New approaches for peritoneal carcinomatosis


&nbps;&nbps;Peritoneal carcinomatosis is a type of secondary cancer that affects the lining of the abdominal cavity with median survival ranging between 6 and 8 [1].

&nbps;&nbps; Cytoreductive surgery (CRS) with perioperative intraperitoneal chemotherapy could achieve a substantially longer survival in a selected group of patients with PC [1].

Table 1. Pooled Results from 28 institutions

TreatmentPatient NoMorbidity rate Mortality rate Median survival Follow-up
50822.9%4%58-months
CRS+HIPEC 32.4-months
HIPEC (CRS impossible8.4 months

CONCLUSION

The therapeutic approach combining cytoreductive surgery with perioperative intraperitoneal chemotherapy achieved long-term survival in a selected group of patients with PC from colorectal origin with acceptable morbidity and mortality. The complete cytoreductive surgery was the most important prognostic indicator.

Table 2. Pooled Results from 19 Different Studies [2]

TreatmentPatient NoOverall survival5-year survival
CRS+HIPEC (Hyperthermic
(intraperitoneal chemotherapy)
1.08420 and 63 (median 33) months17% and 51% (median 40%)
Palliative surgery and/or
systemic chemotherapy
1.4085 and 24 (median 12.5) months 13% and 22% (median 13%).

CONCLUSION

Systemic therapies have not proved effective and randomised clinical trials have not sufficiently addressed patient subpopulations with metastatic disease of this entity. Current evidence have demonstrated the efficacy associated with CRS + HIPEC for which should now be embraced as the standard of care.

Monoclonal antibodies for treatment and diagnosis of pancreatic and colorectal cancer

Monoclonal antibodies for these cancer have been developed and in clinical phase IIB trials [3-.8]. In patients failed all treatment options, these antibodies achieved a minimal 6-8 month overall survival advantages over controls. Immunohistochemical staining shows that these antibodies detect all cancer and pre-cancer cells near the surgical margin [3-7].

References

1.Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004 Aug 15;22(16):3284-92
2.Chua TC, Esquivel J, Pelz JO, Morris DL. Summary of current therapeutic options for peritoneal metastases from colorectal cancer. J Surg Oncol. 2013 May;107(6):566-73. doi: 10.1002/jso. 23189. Epub 2012 Jun 11.
3.Arlen M1, Arlen P. Optimizing the immune system to achieve control of the metastatic malignant lesion. J Cancer. 2013 Jun 28;4(5):427-32. doi: 10.7150/jca.6572. Print 2013.
4.Arlen M1, Saric O, Wang X, Dubeykovskiy A, Arlen P. Nanocytology vs. Immunohistochemistry of Intestinal Colonocytes to Assess the Risk of Colon Cancer based on Field Cancerization - A Preliminary Report. J Cancer. 2013;4(2):165-9. doi: 10.7150/jca.5468.
5.Arlen M1, Wang X, Luka J, Gupta R, Saric O, Arlen PM. The use of specific monoclonal antibodies to target immunogenic tumor membrane proteins in patients with recurrent pancreatic and colon cancer. Curr Drug Deliv. 2012 Jan;9(1):52-6.
6.Arlen M1, Arlen P, Tsang A, Wang X, Gupta R. The therapeutic value of monoclonal antibodies directed against immunogenic tumor glycoproteins. J Cancer. 2010 Nov 3;1:209-22.
7. Arlen M1, Tsang A, Wang T. Immunotherapy of colon cancer using chimeric mAb 31.1. Crit Rev Immunol. 1998;18(1-2):133-8.  
8. Arlen M1, Hollinshead AC, Tsang KY. Identification and characterization of a colon tumor-associated antigen. Ann N Y Acad Sci. 1993 Aug 12;690:374-5.