Linitis plastica medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Linitis plastica}} | {{Linitis plastica}} | ||
{{CMG}};{{AE}}{{HM}} | {{CMG}}; {{AE}}{{HM}} | ||
==Overview== | ==Overview== | ||
The mainstay therapy for linitis plastica is surgical. However, in the case of linitis plastica adjuvant or neoadjuvant therapy is preferred concomitantly with surgery or prior to surgery to avoid future morbidities. | The mainstay therapy for linitis plastica is surgical. However, in the case of linitis plastica adjuvant or neoadjuvant therapy is preferred concomitantly with [[surgery]] or prior to surgery to avoid future morbidities. | ||
==Medical Therapy== | ==Medical Therapy== | ||
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===Linitis plastica=== | ===Linitis plastica=== | ||
FLOT regimen is recommended as neoadjuvant therapy in those with linitis plastica, since it has proven higher survival rates.<ref name="pmid27776843">{{cite journal| author=Al-Batran SE, Hofheinz RD, Pauligk C, Kopp HG, Haag GM, Luley KB et al.| title=Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of a multicentre, open-label, randomised phase 2/3 trial. | journal=Lancet Oncol | year= 2016 | volume= 17 | issue= 12 | pages= 1697-1708 | pmid=27776843 | doi=10.1016/S1470-2045(16)30531-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27776843 }}</ref><ref name="pmid23307258">{{cite journal| author=Anter AH, Abdel-Latif RM| title=The safety and efficacy of fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) combination in the front-line treatment for patients with advanced gastric or gastroesophageal adenocarcinoma: phase II trial. | journal=Med Oncol | year= 2013 | volume= 30 | issue= 1 | pages= 451 | pmid=23307258 | doi=10.1007/s12032-012-0451-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23307258 }}</ref> | *FLOT regimen is recommended as neoadjuvant therapy in those with linitis plastica, since it has proven higher survival rates.<ref name="pmid27776843">{{cite journal| author=Al-Batran SE, Hofheinz RD, Pauligk C, Kopp HG, Haag GM, Luley KB et al.| title=Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of a multicentre, open-label, randomised phase 2/3 trial. | journal=Lancet Oncol | year= 2016 | volume= 17 | issue= 12 | pages= 1697-1708 | pmid=27776843 | doi=10.1016/S1470-2045(16)30531-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27776843 }}</ref><ref name="pmid23307258">{{cite journal| author=Anter AH, Abdel-Latif RM| title=The safety and efficacy of fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) combination in the front-line treatment for patients with advanced gastric or gastroesophageal adenocarcinoma: phase II trial. | journal=Med Oncol | year= 2013 | volume= 30 | issue= 1 | pages= 451 | pmid=23307258 | doi=10.1007/s12032-012-0451-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23307258 }}</ref><ref name="pmid18669868">{{cite journal |vauthors=Al-Batran SE, Hartmann JT, Hofheinz R, Homann N, Rethwisch V, Probst S, Stoehlmacher J, Clemens MR, Mahlberg R, Fritz M, Seipelt G, Sievert M, Pauligk C, Atmaca A, Jäger E |title=Biweekly fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) for patients with metastatic adenocarcinoma of the stomach or esophagogastric junction: a phase II trial of the Arbeitsgemeinschaft Internistische Onkologie |journal=Ann. Oncol. |volume=19 |issue=11 |pages=1882–7 |year=2008 |pmid=18669868 |doi=10.1093/annonc/mdn403 |url=}}</ref> | ||
*The [[FLOT1|FLOT]] regimen is associated with a higher response rate (16 percent versus 8 percent), and has less toxicity which generally makes it more favorable. | |||
* '''1 Stage 1 - FLOT regimen''' | |||
* | ** 1.1 '''Stomach''' | ||
* | *** 1.1.1 '''Adult''' | ||
* | **** Preferred regimen (1):[[Docetaxel]] 50 mg/m<sup>2</sup> every 2 weeks for 4 cycles preoperative and post-operative | ||
**** Preferred regimen (2):[[Leucovorin]] 200 mg/m<sup>2</sup> every 2 weeks for 4 cycles preoperative and post-operative | |||
**** Preferred regimen (3): [[Oxaliplatin]]85 mg/m<sup>2</sup> every 2 weeks for 4 cycles preoperative and post-operative | |||
**** Preferred regimen (4): [[Fluorouracil]] 2600 mg/m<sup>2</sup> every 2 weeks for 4 cycles preoperative and post-operative | |||
**** Alternative regimen (1): FLOT regimen with [[Epirubicin]] 50 mg/m<sup>2</sup> every 2 weeks for 3 cycles preoperative and post-operative on day 1 | |||
**** Alternative regimen (2): FLOT regimen with [[Cisplatin]] 60 mg/m<sup>2</sup> every 2 weeks for 3 cycles preoperative and post-operative on day 1 | |||
{| class="wikitable" | {| class="wikitable" | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Drug | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Drug | ||
| Line 24: | Line 31: | ||
|- | |- | ||
|[[Leucovorin]] | |[[Leucovorin]] | ||
| | |200 mg/m2 [[Intravenous therapy|IV]] | ||
|- | |- | ||
|[[Fluorouracil]] | |[[Fluorouracil]] | ||
Latest revision as of 14:12, 18 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
The mainstay therapy for linitis plastica is surgical. However, in the case of linitis plastica adjuvant or neoadjuvant therapy is preferred concomitantly with surgery or prior to surgery to avoid future morbidities.
Medical Therapy
Pharmacologic medical therapy is recommended among patients with linitis plastica who are at higher risk for metastasis.
Linitis plastica
- FLOT regimen is recommended as neoadjuvant therapy in those with linitis plastica, since it has proven higher survival rates.[1][2][3]
- The FLOT regimen is associated with a higher response rate (16 percent versus 8 percent), and has less toxicity which generally makes it more favorable.
- 1 Stage 1 - FLOT regimen
- 1.1 Stomach
- 1.1.1 Adult
- Preferred regimen (1):Docetaxel 50 mg/m2 every 2 weeks for 4 cycles preoperative and post-operative
- Preferred regimen (2):Leucovorin 200 mg/m2 every 2 weeks for 4 cycles preoperative and post-operative
- Preferred regimen (3): Oxaliplatin85 mg/m2 every 2 weeks for 4 cycles preoperative and post-operative
- Preferred regimen (4): Fluorouracil 2600 mg/m2 every 2 weeks for 4 cycles preoperative and post-operative
- Alternative regimen (1): FLOT regimen with Epirubicin 50 mg/m2 every 2 weeks for 3 cycles preoperative and post-operative on day 1
- Alternative regimen (2): FLOT regimen with Cisplatin 60 mg/m2 every 2 weeks for 3 cycles preoperative and post-operative on day 1
- 1.1.1 Adult
- 1.1 Stomach
| Drug | Dose |
|---|---|
| Oxaliplatin | 85 mg/m2 IV |
| Leucovorin | 200 mg/m2 IV |
| Fluorouracil | 2600 mg/m2 as a 24-hour infusion |
| Docetaxel | 50 mg/m2 |
References
- ↑ Al-Batran SE, Hofheinz RD, Pauligk C, Kopp HG, Haag GM, Luley KB; et al. (2016). "Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of a multicentre, open-label, randomised phase 2/3 trial". Lancet Oncol. 17 (12): 1697–1708. doi:10.1016/S1470-2045(16)30531-9. PMID 27776843.
- ↑ Anter AH, Abdel-Latif RM (2013). "The safety and efficacy of fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) combination in the front-line treatment for patients with advanced gastric or gastroesophageal adenocarcinoma: phase II trial". Med Oncol. 30 (1): 451. doi:10.1007/s12032-012-0451-1. PMID 23307258.
- ↑ Al-Batran SE, Hartmann JT, Hofheinz R, Homann N, Rethwisch V, Probst S, Stoehlmacher J, Clemens MR, Mahlberg R, Fritz M, Seipelt G, Sievert M, Pauligk C, Atmaca A, Jäger E (2008). "Biweekly fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) for patients with metastatic adenocarcinoma of the stomach or esophagogastric junction: a phase II trial of the Arbeitsgemeinschaft Internistische Onkologie". Ann. Oncol. 19 (11): 1882–7. doi:10.1093/annonc/mdn403. PMID 18669868.