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Clinical analysis of HCPT plus FOLFOX4 regimen as salvage therapy for patients with advanced gastric cancer

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The Chinese-German Journal of Clinical Oncology 2008年第12期7卷 698-700页

作者： Xiaoqiang Fan Xijian Zhou Xiangyong Li Xinyu Tang Rengui Zhou Dejian Pan Department of Hematology ＆ Oncology 101 Hospital of PLA Wuxi 214044 China

Objective: To evaluate the therapeutic as well as side effects of hydroxycamptothecin (HCPT) plus FOLFOX4 regimen as salvage therapy for patients with advanced gastric cancer. Methods: A total of 19 patients with advanced gastric cancer received HCPT plus FOLFOX4 as salvage therapy, in detail, Oxaliplatin 85 mg/m2 was given intravenously on day 1, CF 200 mg/m2, 5-Fu 400 mg/m2 given in bolus immediately after CF, days 1-2; 5-Fu 600 mg/m2 given continuously after bolus for 22 h on day 1, day 2, HCPT given intravenously at dosage of 10 mg/m2 on days 1-2. Therapeutic effects were evaluated at least after two cycles of treatment. Results: 17 cases among the 19 patients were valid for response evaluation, with CR 1 , PR 6, SD 4, PD 6. The response rate was 41.2%. For the 12 patients with liver metastasis, response rate of the liver foci was 50%. The main toxicities were bone marrow suppression, nausea and vomiting, and peripheral neuropathy; there were no chemotherapy-related deaths. Conclusion: The combination regimen with HCPT plus FOFLOX4 regimen was effective as salvage therapy for patients with advanced gastric cancer, with particularly high response rate for liver metastasis, and the side effects were tolerable and manageable.

关键词： hydroxycamptothecin (HCPT) FOLFOX4 salvage therapy advanced gastric cancer

Repeat peroral endoscopic myotomy with simultaneous submucosal and muscle dissection as a salvage option for recurrent achalasia

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World Journal of Gastroenterology 2023年第15期29卷 2349-2358页

作者： Yun-Juan Lin Sheng-Zhen Liu Long-Song Li Ke Han Bo-Zong Shao En-Qiang Linghu Ning-Li Chai Department of Gastroenterology and Hepatology Chinese PLA General Hospital and Chinese PLA Medical SchoolBeijing 100853China Department of Gastroenterology and Hepatology The First Medical CenterChinese PLA General HospitalBeijing 100853China

BACKGROUND For recurrent achalasia after initial peroral endoscopic myotomy(POEM)failure,repeat POEM(Re-POEM)has been reported as a treatment ***,severe esophageal interlayer adhesions caused by previous procedures impede the successful establishment of a submucosal tunnel and lead to aborted Re-POEM *** team previously described POEM with simultaneous submucosal and muscle dissection(POEM-SSMD)as a feasible solution for achalasia with severe interlayer *** To investigate the effectiveness and safety of Re-POEM with simultaneous submucosal and muscle dissection(Re-POEM-SSMD).METHODS A total of 1049 patients with achalasia who underwent successful endoscopic myotomy at the Digestive Endoscopic Center of Chinese PLA General Hospital from December 2014 to May 2022 were *** with recurrent achalasia who experienced initial POEM clinical failure were retrospectively included in this *** primary endpoint was retreatment clinical success,defined as an Eckardt score≤3 during the postretreatment follow-up and no need for additional ***-related adverse events,changes in manometric lower esophageal sphincter(LES)pressure and reflux complications,as well as procedure-related parameters,were *** Sixteen patients underwent Re-POEM(9 patients)or Re-POEM-SSMD(7 patients)successfully at a median of 45.5 mo(range,4-95 mo)after initial *** a median followup period of 31 mo(range,7-96 mo),clinical success(Eckardt score≤3)was achieved in 8(88.9%)and 6(85.7%)patients after Re-POEM and Re-POEM-SSMD,respectively(P=0.849).The median Eckardt score dropped from 4(range,3-8)at preretreatment to 1(range,0-5)at postretreatment in the Re-POEM group(P=0.025)and from 5(range,2-8)to 2(range,0-4)in the Re-POEM-SSMD group(P<0.001).The mean manometric LES pressure decreased from 23.78±9.04 mmHg to 11.45±5.37 mmHg after Re-POEM(P<0.001)and from 26.80±7.48 mmHg to 11.05±4.38 mmHg after Re-POEM-SSMD(P<0.001).No serious

关键词： Esophageal achalasia Recurrence Peroral endoscopic myotomy Simultaneous submucosal and muscle dissection Interlayer adhesion salvage therapy

salvage locoregional therapies for recurrent hepatocellular carcinoma

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World Journal of Gastroenterology 2023年第3期29卷 413-424页

作者： Cody R Criss Mina S Makary Heritage College of Osteopathic Medicine Ohio UniversityAthensOhio 45701United States Department of Radiology The Ohio State University Wexner Medical CenterColumbusOhio 43210United States

Hepatocellular carcinoma(HCC)is the second most common cause of cancerrelated death *** the advent of screening efforts and algorithms to stratify patients into appropriate treatment strategies,recurrence rates remain *** contrast to first-line treatment for HCC,which relies on several factors,including clinical staging,tumor burden,and liver function,there is no consensus or general treatment recommendations for recurrent HCC(R-HCC).Locoregional therapies include a spectrum of minimally invasive liver-directed treatments which can be used as either curative or neoadjuvant therapy for ***,we provide a comprehensive review of recent evidence using salvage loco-regional therapies for R-HCC after failed curative-intent.

关键词： Recurrent hepatocellular carcinoma Locoregional therapy Transarterial chemoembolization Transarterial embolization Transarterial radioembolization Ablation salvage therapy

Chidamide,Decitabine,Cytarabine,Aclarubicin,and Granulocyte Colony-stimulating Factor therapy for Patients with Relapsed/Refractory Acute Myeloid Leukemia:A Retrospective Study from a Single-Center

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Current Medical Science 2023年第6期43卷 1151-1161页

作者： Fan-cong KONG Ling QI Yu-lan ZHOU Min YU Wen-feng HUANG Fei LI Center of Hematology The First Affiliated Hospital of Nanchang UniversityNanchang330006China Jiangxi Clinical Research Center for Hematologic Diseases Nanchang330006China

Objective Preclinical evidence and clinical trials have suggested synergistic effects of epigenetic modifiers in combination with cytotoxic agents for the treatment of ***,their efficacy in patients with relapsed/refractory acute myeloid leukemia(R/R AML)remains *** Clinical data of R/R AML patients who received a CDCAG regimen(chidamide,decitabine,cytarabine,aclarubicin,and granulocyte colony-stimulating factor)from July 1,2018 to October 31,2021 at our center were retrospectively assessed,and the safety and efficacy of the CDCAG regimen were *** were followed up until November 30,2021,with a median follow-up of 21.6 months(95%CI:10.0–33.2 months).Results A total of 67 patients were *** patients died within 3 weeks after the initiation,and therefore only 65 patients underwent the assement for clinical response and *** was found that 56.9%patients achieved complete remission with a median overall survival(OS)of 9.6 *** median OS of responders was 25.9 months,while that of non-responders was 5.0 months(P<0.0001).Patients with gene mutations had a superior overall response rate(ORR)(80.4%vs.45.5%,P=0.043)compared to those without gene *** presence of DNA methyltransferase 3 A(DNMT3A),ten-eleven translocation-2(TET2),and isocitrate dehydrogenase 1/2(IDH1/2)mutations did not affect the response rate(88.2%vs.68.9%,P=0.220)and reflected a better OS(not attained vs.9.0 months,P=0.05).The most common non-hematologic adverse events were pulmonary infection(73.1%),followed by febrile neutropenia(23.9%)and sepsis(19.4%).Conclusions The CDCAG regimen was effective and well-tolerated in R/R AML patients,increasing the potential for allogeneic hematopoietic stem cell ***,patients with DNMT3A,TET2,and IDH1/2 mutations might benefit from this regimen.

关键词： relapsed/refractory acute myeloid leukemia histone deacetylase inhibitor DNA methyltransferase inhibitor salvage therapy

PhaseⅠ/Ⅱtrial evaluating concurrent carbon-ion radiotherapy plus chemotherapy for salvage treatment of locally recurrent nasopharyngeal carcinoma

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Chinese Journal of Cancer 2016年第12期35卷 743-753页

作者： Lin Kong Jing Gao Jiyi Hu Weixu Hu Xiyin Guan Rong Lu Jiade J.Lu Department of Radiation Oncology Shanghai Proton and Heavy Ion CenterFudan University Shanghai Cancer HospitalShanghai 200321P.R.China. Department of Radiation Oncology Shanghai Proton and Heavy Ion CenterShanghai 200321P.R.China. Department of Outpatient Clinic Shanghai Proton and Heavy Ion CenterShanghai 200321P.R.China. Shanghai Proton and Heavy Ion Center 4365 Kangxin RoadPudongShanghai 201315P.R.China.

Background: After deinitive chemoradiotherapy for non-metastatic nasopharyngeal carcinoma(NPC), more than 10% of patients will experience a local recurrence. salvage treatments present signiicant challenges for locally recurrent NPC. Surgery, stereotactic ablative body radiotherapy, and brachytherapy have been used to treat locally recurrent NPC. However, only patients with small-volume tumors can beneit from these treatments. Re-irradiation with X-ray—based intensity-modulated radiotherapy(IMXT) has been more widely used for salvage treatment of locally recurrent NPC with a large tumor burden, but over-irradiation to the surrounding normal tissues has been shown to cause frequent and severe toxicities. Furthermore, locally recurrent NPC represents a clinical entity that is more radioresistant than its primary counterpart. Due to the inherent physical advantages of heavy-particle therapy, precise dose delivery to the target volume(s), without exposing the surrounding organs at risk to extra doses, is highly feasible with carbon-ion radiotherapy(CIRT). In addition, CIRT is a high linear energy transfer(LET) radiation and provides an increased relative biological efectiveness compared with photon and proton radiotherapy. Our prior work showed that CIRT alone to 57.5 Gy E(gray equivalent), at 2.5 Gy E per daily fraction, was well tolerated in patients who were previously treated for NPC with a deinitive dose of IMXT. The short-term response rates at 3–6 months were also acceptable. However, no patients were treated with concurrent chemotherapy. Whether the addition of concurrent chemotherapy to CIRT can beneit locally recurrent NPC patients over CIRT alone has never been addressed. It is possible that the beneits of high-LET CIRT may make radiosensitizing chemotherapy unnecessary. We therefore implemented a phase I/II clinical trial to address these questions and present our methodology and *** and design: The maximal tolerated dose(MTD) of re-treatment usi

关键词： Recurrent nasopharyngeal cancer Carbon ion radiotherapy Re-irradiation salvage therapy Chemotherapy

Difficult treatment decisions in autoimmune hepatitis

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World Journal of Gastroenterology 2010年第8期16卷 934-947页

作者： Albert J Czaja Division of Gastroenterology and Hepatology Mayo Clinic College of Medicine

Treatment decisions in autoimmune hepatitis are complicated by the diversity of its clinical presentations,uncertainties about its natural history,evolving opinions regarding treatment end points,varied nature of refractory disease,and plethora of alternative immu-nosuppressive agents. The goals of this article are to review the difficult treatment decisions and to provide the bases for making sound therapeutic judgments. The English literature on the treatment problems in au-toimmune hepatitis were identifi ed by Medline search up to October 2009 and 32 years of personal experi-ence. Autoimmune hepatitis may have an acute severe presentation,mild in? ammatory activity,lack autoan-tibodies,exhibit atypical histological changes (centri-lobular zone 3 necrosis or bile duct injury),or have variant features reminiscent of another disease (overlap syndrome). Corticosteroid therapy must be instituted early,applied despite the absence of symptoms,or modified in an individualized fashion. Pursuit of normal liver tests and tissue is the ideal treatment end point,but this objective must be tempered against the risk of side effects. Relapse after treatment withdrawal requires long-term maintenance therapy,preferably with azathioprine. Treatment failure or an incomplete response warrants salvage therapy that can include conventional medications in modified dose or empiricaltherapies with calcineurin inhibitors or mycophenolate mofetil. Liver transplantation supersedes empirical drug therapy in decompensated patients. Elderly and pregnant patients warrant treatment modifications. Difficult treatment decisions in autoimmune hepatitis can be simplified by recognizing its diverse manifestations and individualizing treatment,pursuing realistic goals,applying appropriate salvage regimens,and identifying problematic patients early.

关键词： Autoimmune hepatitis Fulminant hepatitis salvage therapy Treatment end points

CLAG-M chemotherapy followed by umbilical cord blood stem cell transplantation for primary refractory acute myeloid leukaemia in a child:A case report

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World Journal of Clinical Cases 2020年第22期8卷 5603-5610页

作者： Jie Huang Xiao-Yun Yang Liu-Cheng Rong Yao Xue Jun Zhu Yong-Jun Fang Department of Haematology and Oncology Children’s Hospital of Nanjing Medical UniversityNanjing 210008Jiangsu ProvinceChina

BACKGROUND The prognosis of paediatric primary refractory/relapsed acute myeloid leukaemia(R/R AML)remains *** therapy is typically used as salvage treatment for those with R/R *** data are currently available about the use of the CLAG-M protocol as salvage therapy in paediatric patients with R/R *** SUMMARY An 8-year-old patient was diagnosed with acute myeloid leukaemia by bone marrow morphology and *** patient showed poor response to two cycles of induction therapy with 60%blast cells in the bone marrow after the second induction *** patient achieved complete remission after being treated with the CLAG-M protocol as salvage therapy before undergoing umbilical cord blood stem cell *** complete remission with haematological recovery has hitherto been maintained over 4 *** gene mutations detected at diagnosis were undetectable after haematopoietic stem cell *** Here we present a paediatric patient with primary refractory acute myeloid leukaemia who was successfully treated with the CLAG-M *** the positive results of the presented patient,large-scale clinical studies are required to assess the role of the CLAG-M protocol in the salvage treatment of refractory or relapsed AML in childhood.

关键词： Acute myeloid leukaemia CLAG-M protocol salvage therapy Refractory child Case report

Second and third line treatment options for Helicobacter pylori eradication

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World Journal of Gastroenterology 2014年第6期20卷 1517-1528页

作者： Mingjun Song Tiing Leong Ang Department of Gastroenterology Changi General Hospital

Helicobacter pylori is a highly successful bacterium with a high global prevalence and the infection carries significant disease burden. It is also becoming increasingly difficult to eradicate and the main reason for this is growing primary antibiotic resistance rates in a world where antibiotics are frequently prescribed and readily available. Despite knowing much more about the bacterium since its discovery, such as its genomic makeup and pathogenesis, we have seen declining treatment success. Therefore, clinicians today must be prepared to face one, two or even multiple treatment failures, and should be equipped with sufficient knowledge to decide on the appropriate salvage therapy when this happens. This article discusses the factors contributing to treatment failure and reviews the second and thirdline treatment strategies that have been investigated. Established empiric second line treatment options include both bismuth based quadruple therapy and levofloxacin based triple therapy. Antibiotic testing is recommended prior to initiating third line treatment. In the event that antibiotic susceptibility testing is unavailable, third line treatment options include rifabutin, rifaximin and sitafloxacin based therapies.

关键词： Helicobacter pylori Treatment failure salvage therapy Drug resistance Microbial Bismuth Ofloxacin Moxifloxacin Metronidazole Rifabutin Rifaximin Sitafloxacin

Early oral tongue cancer initially managed with surgery alone:Treatment of recurrence

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2016年第4期2卷 -页

作者： Jeffrey C Liu Dennis S Sopka Ranee Mehra Miriam N Lango Christopher Fundakowski John A Ridge Thomas J Galloway Department of 0tolaryngology Temple University School of Medicine Philadelphia PA USA Department of Radiation 0ncology Fox Chase Cancer Center Philadelphia PA USA Medical 0ncology Fox Chase Cancer Center Philadelphia PA USA Head and Neck Surgery Fox Chase Cancer Center Philadelphia PA USA

Objective:To report T1-2N0 tongue cancer recurrences initially treated with sur-gery alone. Methods:Between 1990 and 2010, 27 patients at tertiary hospital referral center institution were treated with curative intent for locoregional recurrence after initial glossectomy with or without neck dissection for T1-2N0 tongue cancer. None had received adjuvant postopera-tive radiation as a component of the original treatment. Results:Median time to locoregional recurrence was 12 months (range 5e39 months) and 78%of failures occurred in the first 2 years. Most treatment failures were local (63%). salvage strat-egy was risk-adapted by individual patient. The 5-year disease specific survival (DSS) was 61%. Patients with local recurrences alone fared significantly better than those with regional recur-rences (5-yr DSS:86%vs. 22%, P Z 0.0018). Local recurrences were usually treated by surgery alone, while regional recurrences were more commonly treated with combined modality treat-ment (PZ 0.005).Conclusions:Recurrence of early stage oral tongue cancer can be successfully salvaged in a majority of cases. Patients developing regional recurrence have significantly worse prognosis than those with local failures.

关键词： Oral cancer Head and neck cancer Tongue neoplasms salvage therapy