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Beyond first-line chemotherapy for advanced pancreatic cancer:An expanding array of therapeutic options?

World Journal of Gastroenterology 2014年第9期20卷 2224-2236页

作者： Evan J Walker Andrew H Ko University of California Helen Diller Family Comprehensive Cancer Center San Francisco CA 94115 United States

While an increasing number of therapeutic options are now available for the first-line treatment of locally advanced or metastatic pancreatic cancer,the optimal choice for treatment in the second-line setting and beyond is less well defined.A variety of cytotoxic agents,either alone or in combination,have been evaluated,although primarily in the context of small single-arm or retrospective studies.Most regimens have been associated with median progression-free survival rates in the range of 2-4 mo and overall survival rates between 4-8mo,highlighting the very poor prognosis of patients who are candidates for such treatment.Targeted therapies studied in this chemotherapy-refractory setting,meanwhile,have produced even worse efficacy results.In the current article,we review the clinical evidence for treatment of refractory disease,primarily in patients who have progressed on front-line gemcitabine-based chemotherapy.In the process,we highlight the limitations of the available data to date as well as some of the challenges in designing appropriate clinical trials in this salvage setting,including how to select an appropriate control arm given the absence of a wellestablished reference standard,and the importance of incorporating predictive biomarkers and quality of life measures whenever possible into study design.

关键词： Pancreatic cancer Refractory Second-line chemother

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Prognostic significance of the lymphocyte-to-monocyte ratio in patients with metastatic colorectal cancer

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World Journal of Gastroenterology 2015年第34期21卷 9966-9973页

作者： Masatsune Shibutani Kiyoshi Maeda Hisashi Nagahara Hiroshi Ohtani Katsunobu Sakurai Sadaaki Yamazoe Kenjiro Kimura Takahiro Toyokawa Ryosuke Amano Hiroaki Tanaka Kazuya Muguruma Kosei Hirakawa Department of Surgical Oncology Osaka City University Graduate School of Medicine

AIM:To evaluate the prognostic significance of the lymphocyte to monocyte ratio(LMR) in patients with unresectable metastatic colorectal cancer who received palliative chemotherapy.METHODS:A total of 104 patients with unresectable metastatic colorectal cancer who underwent palliative chemotherapy were enrolled. The LMR was calculated from blood samples by dividing the absolute lymphocyte count by the absolute monocyte count. Pretreatment LMR values were measured within one week before the initiation of chemotherapy,while posttreatment LMR values were measured eight weeks after the initiation of chemotherapy.RESULTS:The median pre-treatment LMR was 4.16(range:0.58-14.06). We set 3.38 as the cut-off level based on the receiver operating characteristic curve. Based on the cut-off level of 3.38,66 patients were classified into the high pre-treatment LMR group and 38 patients were classified into the low pretreatment LMR group. The low pre-treatment LMR group had a significantly worse overall survival rate(P = 0.0011). Moreover,patients who demonstrated low pre-treatment LMR and normalization after treatmentexhibited a better overall survival rate than the patients with low pre-treatment and post-treatment LMR values.CONCLUSION:The lymphocyte to monocyte ratio is a useful prognostic marker in patients with unresectable metastatic colorectal cancer who receive palliative chemotherapy.

关键词： Colorectal cancer Prognosis Unresectable chemother

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