Appendix cancer medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Medical therapy in appendix cancer could be either supportive, palliative, or curative. While carcinoid tumors rarely need chemotherapy, systemic chemotherapy as well as hyperthermic intraperitoneal chemotherapy plus/minus early postoperative intraperitoneal chemotherapy (EPIC) and/or concomitant intravenous chemotherapy are | Medical therapy in appendix cancer could be either supportive, palliative, or curative. While carcinoid tumors rarely need chemotherapy, systemic chemotherapy as well as hyperthermic intraperitoneal chemotherapy plus/minus early postoperative intraperitoneal chemotherapy (EPIC) and/or concomitant intravenous chemotherapy are mainstream of medical treatment in adenocarcinoma of appendix. Medical therapy is generally administered to control the symptoms in patients with carcionid tumors and carcinoid syndrome. | ||
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*'''Systemic chemotherapy''' | *'''Systemic chemotherapy''' | ||
*Systemic chemotherapy has not been generally recommended for carcionid tumors, but patients with noncacinoid tumors are usually receive chemotherapy. | *Systemic chemotherapy has not been generally recommended for carcionid tumors, but patients with noncacinoid tumors are usually receive chemotherapy. | ||
:*Nevertheless systemic chemotherapy for metastatic appendiceal adenocarcinoma has not been studied appropriately | :*Nevertheless systemic chemotherapy for metastatic appendiceal adenocarcinoma has not been studied appropriately. | ||
:*Many experts refer to current colorectal cancer chemotherapy approaches for adenocarcinoma of appendix | :*Many experts refer to current colorectal cancer chemotherapy approaches for adenocarcinoma of appendix. | ||
:*'''Current colon cancer chemotherapy agents''' | :*'''Current colon cancer chemotherapy agents are as follows:''' | ||
::*5-fluorouracil (5-FU) : Traditional active agent | ::*5-fluorouracil (5-FU) : Traditional active agent | ||
| Line 38: | Line 38: | ||
*'''FOLFOX6 has been widely recommended in patients with appendix adenocarcinoma.''' | *'''FOLFOX6 has been widely recommended in patients with appendix adenocarcinoma.''' | ||
:*Oxaliplatin, 5-FU and leucovorin or Capecitabine are active agents of the FOLFOX regime. | :*Oxaliplatin, 5-FU and leucovorin or Capecitabine are active agents of the FOLFOX regime. <math>\blacktriangledown</math> | ||
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:*Administer over 46 hours | :*Administer over 46 hours | ||
|} | |} | ||
:*'''''Cycle length 14 days''''' | :*'''''Cycle length is 14 days;''''' | ||
:*'''Doses should be recalculated if there is a 10 percent or more change in body weight.''' | :*'''Doses should be recalculated if there is a 10 percent or more change in body weight.''' | ||
*'''Prior to each treatment<math>\blacktriangledown</math>''' | *'''Prior to each treatment<math>\blacktriangledown</math>''' | ||
::* Assess changes in neurologic function | ::* Assess changes in neurologic function. | ||
::* Assess electrolytes and liver and renal function | ::* Assess electrolytes and liver and renal function. | ||
::* CBC with differential and platelet count | ::* CBC with differential and platelet count. | ||
*'''Common complications and approaches to complications''' | *'''Common complications and approaches to complications''' | ||
:* '''Diarrhea:''' | :* '''Diarrhea:''' | ||
::* Grade 2 or worse diarrhea <math>\blacktriangledown</math> | ::* Grade 2 or worse diarrhea: <math>\blacktriangledown</math> | ||
::** Withhold treatment | ::** Withhold treatment. | ||
::** Restart at a lower dose of FU after complete resolution | ::** Restart at a lower dose of FU after complete resolution. | ||
::* '''Severe diarrhea, mucositis, and myelosuppression after FU''' <math>\blacktriangledown</math> | ::* '''Severe diarrhea, mucositis, and myelosuppression after FU''':<math>\blacktriangledown</math> | ||
::** Evaluate for dihydropyrimidine dehydrogenase deficiency | ::** Evaluate for dihydropyrimidine dehydrogenase deficiency. | ||
:*'''Neurologic toxicity''' | :*'''Neurologic toxicity''' | ||
::*In order to decrease chance of developing Oxaliplatin induced neuropathy recommend patients to avoid exposure to cold up to 48 hours after each infusion. | ::*In order to decrease chance of developing Oxaliplatin induced neuropathy recommend patients to avoid exposure to cold up to 48 hours after each infusion. | ||
::*Transient grade 3 paresthesias/dysesthesias / grade 2 symptoms lasting longer than 1 week<math>\blacktriangledown</math> | ::*Transient grade 3 paresthesias/dysesthesias / grade 2 symptoms lasting longer than 1 week:<math>\blacktriangledown</math> | ||
::**Decrease oxaliplatin dose by 25 percent. | ::**Decrease oxaliplatin dose by 25 percent. | ||
::*Grade 4 or persistent grade 3 paresthesia/dysesthesia<math>\blacktriangledown</math> | ::*Grade 4 or persistent grade 3 paresthesia/dysesthesia:<math>\blacktriangledown</math> | ||
::**Discontinue oxaliplatin | ::**Discontinue oxaliplatin. | ||
:*'''Myelotoxicity''' | :*'''Myelotoxicity''' | ||
::*Total white blood cell count <3000 cells/mm <sup>3</sup> , absolute neutrophil count <1500 cells/mm <sup>3</sup> , or platelets <100,000 /mm <sup>3</sup> on the day of treatment<math>\blacktriangledown</math> | ::*Total white blood cell count <3000 cells/mm <sup>3</sup> , absolute neutrophil count <1500 cells/mm <sup>3</sup> , or platelets <100,000 /mm <sup>3</sup> on the day of treatment:<math>\blacktriangledown</math> | ||
::**Delay treatment cycle by one week | ::**Delay treatment cycle by one week. | ||
::*''If treatment is delayed for '''two weeks''' or delayed '''for one week on two separate occasions,''' eliminate FU bolus'' | ::*''If treatment is delayed for '''two weeks''' or delayed '''for one week on two separate occasions,''' eliminate FU bolus.'' | ||
::*''If occurred again''<math>\blacktriangledown</math> | ::*''If occurred again:''<math>\blacktriangledown</math> | ||
:::*Reduce infusional FU by 20 percent and | :::*Reduce infusional FU by 20 percent and | ||
:::*Reduce oxaliplatin dose from 65 mg/m <sup>2</sup> | :::*Reduce oxaliplatin dose from 65 mg/m <sup>2</sup> | ||
*'''Hyperthermic intraperitoneal chemotherapy'''<ref name="pmid21160924">González-Moreno S, González-Bayón LA, Ortega-Pérez G (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21160924 Hyperthermic intraperitoneal chemotherapy: Rationale and technique.] ''World J Gastrointest Oncol'' 2 (2):68-75. [http://dx.doi.org/10.4251/wjgo.v2.i2.68 DOI:10.4251/wjgo.v2.i2.68] PMID: [https://pubmed.gov/21160924 21160924]</ref> | *'''Hyperthermic intraperitoneal chemotherapy'''<ref name="pmid21160924">González-Moreno S, González-Bayón LA, Ortega-Pérez G (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21160924 Hyperthermic intraperitoneal chemotherapy: Rationale and technique.] ''World J Gastrointest Oncol'' 2 (2):68-75. [http://dx.doi.org/10.4251/wjgo.v2.i2.68 DOI:10.4251/wjgo.v2.i2.68] PMID: [https://pubmed.gov/21160924 21160924]</ref> | ||
:*Delivered in the operating room after cytoreductive surgery | :*Delivered in the operating room after cytoreductive surgery. | ||
:*in selected cases is accompanied by early postoperative intraperitoneal chemotherapy (EPIC) as well as Concomitant intravenous chemotherapy (CIVC). | :*in selected cases is accompanied by early postoperative intraperitoneal chemotherapy (EPIC) as well as Concomitant intravenous chemotherapy (CIVC). | ||
{| class="wikitable" | {| class="wikitable" | ||
| Line 122: | Line 122: | ||
*Mitomycin C, 3.3 mg//m <sup>2</sup>/L for 90 minutes without EPIC or CIVC | *Mitomycin C, 3.3 mg//m <sup>2</sup>/L for 90 minutes without EPIC or CIVC | ||
|} | |} | ||
*'''''Infuse the fluid at 43-45°Ci n order to maintain the intraperitoneal fluid temperature at 41-43°C''''' | *'''''Infuse the fluid at 43-45°Ci n order to maintain the intraperitoneal fluid temperature at 41-43°C.''''' | ||
*'''''To avoid renal toxicity maintain urine output higher than 100 cc (desirable 150 cc) every 15 min during HIPEC''''' | *'''''To avoid renal toxicity maintain urine output higher than 100 cc (desirable 150 cc) every 15 min during HIPEC.''''' | ||
Revision as of 01:01, 30 January 2019
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Appendix cancer Microchapters |
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Appendix cancer medical therapy On the Web |
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Risk calculators and risk factors for Appendix cancer medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]
Overview
Medical therapy in appendix cancer could be either supportive, palliative, or curative. While carcinoid tumors rarely need chemotherapy, systemic chemotherapy as well as hyperthermic intraperitoneal chemotherapy plus/minus early postoperative intraperitoneal chemotherapy (EPIC) and/or concomitant intravenous chemotherapy are mainstream of medical treatment in adenocarcinoma of appendix. Medical therapy is generally administered to control the symptoms in patients with carcionid tumors and carcinoid syndrome.
Medical Therapy
- Somatostatin analogs
- Octreotide or lanreotide
- Loperamide or diphenoxylate for primary diarrhea
- Somatostatin analogs for symptom control in patients with carcionid syndrome
- Curative and palliative chemotherapy
- Systemic chemotherapy
- Hyperthermic intraperitoneal chemotherapy[3]
- Systemic chemotherapy
- Systemic chemotherapy has not been generally recommended for carcionid tumors, but patients with noncacinoid tumors are usually receive chemotherapy.
- Nevertheless systemic chemotherapy for metastatic appendiceal adenocarcinoma has not been studied appropriately.
- Many experts refer to current colorectal cancer chemotherapy approaches for adenocarcinoma of appendix.
- Current colon cancer chemotherapy agents are as follows:
- 5-fluorouracil (5-FU) : Traditional active agent
- Irinotecan
- Oxaliplatin
- Vascular endothelial growth factor receptor inhibitors (bevacizumab)
- Epidermal growth factor receptor inhibitors (cetuximab and panitumumab),
- Aflibercept
- Regorafenib: inhibitor of angiogenic tyrosine kinases (including the VEGF receptors 1,2, and 3),
- Capecitabine or 5-FU with or without a platinum drug
- FOLFOX6 has been widely recommended in patients with appendix adenocarcinoma.
- Oxaliplatin, 5-FU and leucovorin or Capecitabine are active agents of the FOLFOX regime. <math>\blacktriangledown</math>
| Modified FOLFOX6[4][5] |
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- Cycle length is 14 days;
- Doses should be recalculated if there is a 10 percent or more change in body weight.
- Prior to each treatment<math>\blacktriangledown</math>
- Assess changes in neurologic function.
- Assess electrolytes and liver and renal function.
- CBC with differential and platelet count.
- Common complications and approaches to complications
- Diarrhea:
- Grade 2 or worse diarrhea: <math>\blacktriangledown</math>
- Withhold treatment.
- Restart at a lower dose of FU after complete resolution.
- Severe diarrhea, mucositis, and myelosuppression after FU:<math>\blacktriangledown</math>
- Evaluate for dihydropyrimidine dehydrogenase deficiency.
- Grade 2 or worse diarrhea: <math>\blacktriangledown</math>
- Neurologic toxicity
- In order to decrease chance of developing Oxaliplatin induced neuropathy recommend patients to avoid exposure to cold up to 48 hours after each infusion.
- Transient grade 3 paresthesias/dysesthesias / grade 2 symptoms lasting longer than 1 week:<math>\blacktriangledown</math>
- Decrease oxaliplatin dose by 25 percent.
- Grade 4 or persistent grade 3 paresthesia/dysesthesia:<math>\blacktriangledown</math>
- Discontinue oxaliplatin.
- Myelotoxicity
- Total white blood cell count <3000 cells/mm 3 , absolute neutrophil count <1500 cells/mm 3 , or platelets <100,000 /mm 3 on the day of treatment:<math>\blacktriangledown</math>
- Delay treatment cycle by one week.
- If treatment is delayed for two weeks or delayed for one week on two separate occasions, eliminate FU bolus.
- If occurred again:<math>\blacktriangledown</math>
- Reduce infusional FU by 20 percent and
- Reduce oxaliplatin dose from 65 mg/m 2
- Total white blood cell count <3000 cells/mm 3 , absolute neutrophil count <1500 cells/mm 3 , or platelets <100,000 /mm 3 on the day of treatment:<math>\blacktriangledown</math>
- Hyperthermic intraperitoneal chemotherapy[3]
- Delivered in the operating room after cytoreductive surgery.
- in selected cases is accompanied by early postoperative intraperitoneal chemotherapy (EPIC) as well as Concomitant intravenous chemotherapy (CIVC).
| Common HIPEC current regimens |
|---|
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- Infuse the fluid at 43-45°Ci n order to maintain the intraperitoneal fluid temperature at 41-43°C.
- To avoid renal toxicity maintain urine output higher than 100 cc (desirable 150 cc) every 15 min during HIPEC.
References
- ↑ Moertel CG, Weiland LH, Nagorney DM, Dockerty MB (1987). "Carcinoid tumor of the appendix: treatment and prognosis". N. Engl. J. Med. 317 (27): 1699–701. doi:10.1056/NEJM198712313172704. PMID 3696178.
- ↑ Treatment Option Overview for GI Carcinoid Tumors . NATIONAL CANCER INSTITUTE . http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_97_toc Accessed on September 22, 2015
- ↑ 3.0 3.1 González-Moreno S, González-Bayón LA, Ortega-Pérez G (2010) Hyperthermic intraperitoneal chemotherapy: Rationale and technique. World J Gastrointest Oncol 2 (2):68-75. DOI:10.4251/wjgo.v2.i2.68 PMID: 21160924
- ↑ Cheeseman SL, Joel SP, Chester JD, Wilson G, Dent JT, Richards FJ et al. (2002) A 'modified de Gramont' regimen of fluorouracil, alone and with oxaliplatin, for advanced colorectal cancer. Br J Cancer 87 (4):393-9. DOI:10.1038/sj.bjc.6600467 PMID: 12177775
- ↑ Hochster HS, Hart LL, Ramanathan RK, Childs BH, Hainsworth JD, Cohn AL et al. (2008) Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer: results of the TREE Study. J Clin Oncol 26 (21):3523-9. DOI:10.1200/JCO.2007.15.4138 PMID: 18640933
- ↑ Tournigand C, André T, Achille E, Lledo G, Flesh M, Mery-Mignard D et al. (2004) FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 22 (2):229-37. DOI:10.1200/JCO.2004.05.113 PMID: 14657227