Brain metastases from cholangiocarcinoma: a first case series in Thailand

Background: Brain metastasis from cholangiocarcinoma (CCA) is a rare but fatal event. To the best of ourknowledge, only few cases have been reported. Herein, we report the incident rate and a first case series of brainmetastases from CCA. Methods: Between January 2006 and December 2010 5,164 patients were treated atSrinagarind hospital, Khon Kaen University; of those, 8 patients developed brain metastasis. Here we reviewedclinical data and survival times. Results: The incident rate of brain metastases from CCA was 0.15%. The medianage of the patients was 60 years. Tumor subtypes were intrahepatic in 6 and hilar in 2 patients. All suffered fromsymptoms related to brain metastasis. Three patients were treated with whole-brain radiation therapy (WBRT),one of whom also underwent surgery. The median survival after the diagnosis of brain metastasis was 9.5 weeks(1-28 weeks). The longest survival observed in a patient in RPA class I with two brain lesions and received WBRT.Conclusion: This is a first case series of brain metastases from CCA with the incident rate of 0.15%. It is rareand associated with short survival time.     

Prognostic factors in resectable cholangiocarcinoma patients: Carcinoembryonic antigen,lymph node,surgical margin and chemotherapy

AIM: To evaluate outcomes in resectable cholangiocarcinoma patients and to determine prognostic factors. METHODS: A retrospective study was conducted among newly-diagnosed cholangiocarcinoma patients from January 2009 to December 2011 who underwent curative resection in Srinakarind Hospital (a 1000-bed university hospital). Two hundred and sixty-three cholangiocarcinoma patients with good performance were enrolled. These patients had pathological reports with clear margins or microscopic margins. Prognostic factors which included clinical factors, serum liver function test as well as serum tumor makers at presentation, tumor data, and receiving adjuvant chemotherapy were determined by uni- and multivariate analysis. RESULTS: The median overall survival time was 17 mo (95%CI: 13.2-20.7); and 1-, 2-, and 3- year survival rates were 65.5%, 45.2% and 35.4%. Serum albumin levels, serum carcinoembryonic antigen (CEA) levels, staging classifications by American Joint Committee on cancer, pathological tumor staging, lymph node metastases, tumor grading, surgical margin status, and if adjuvant chemotherapy was administered, were shown to be significant prognostic factors of resectable cholangiocarcinoma by univariate analysis. Multivariate analysis, however, established that only abnormal serum CEA [hazard ratio (HR) 1.68; P = 0.027] and lymph node metastases (HR 2.27; P = 0.007) were significantly associated with a decrease in overall survival, while adjuvant chemotherapy (HR 0.71; P = 0.067) and surgical margin negative (HR 0.72; P = 0.094) tended to improve survival time. CONCLUSION: Serum CEA and lymph node metastases which were associated with advanced stage tumors become strong negative prognostic factors in cholangiocarcinoma.     

A phase II randomized double-blind placebo-controlled study of 6-gingerol as an anti-emetic in solid tumor patients receiving moderately to highly emetogenic chemotherapy

6-Gingerol is a natural compound extracted from ginger. Preclinical studies demonstrated that 6-gingerol has an anti-emetic activity by inhibiting neurokinin-1, serotonin, and dopamine receptors. Several clinical trials examined crude ginger powder for preventing chemotherapy-induced nausea and vomiting (CINV), but none of them was conducted with a standardized bioactive compound. Patients who received moderately to highly emetogenic adjuvant chemotherapy were randomized to receive 6-gingerol 10 mg or placebo orally twice daily for 12 weeks. Ondansetron, metoclopramide, and dexamethasone were given to all patients. The primary endpoint was complete response (CR) rate defined as no emesis or rescue treatment at any time. Eighty-eight patients were randomized to receive 6-gingerol (N = 42) or placebo (N = 46). Most patients received highly emetogenic chemotherapy (93%). Overall CR rate was significantly higher in 6-gingerol group as compared with that of the placebo (77 vs. 32%; P < 0.001). The difference in means of appetite score was significant (P = 0.001) and more noticeable over time. Mean FACT-G score indicating quality of life was significantly higher (86.21) in 6-gingerol group at 64 days as compared with that of placebo group (72.36) (P < 0.001). No toxicity related to 6-gingerol was observed. Patients treated with 6-gingerol reported significantly less grade 3 fatigue (2 vs. 20%; P = 0.020). 6-Gingerol significantly improved overall CR rate in CINV, appetite and quality of life in cancer patients receiving adjuvant chemotherapy. A phase III randomized study of 6-gingerol is warranted to confirm these results.     

Palbociclib and beyond for the treatment of HR + HER2- metastatic breast cancer: an Asian-Pacific perspective and practical management guide on the use of CDK4/6 inhibitors

Abstract

Breast cancer is the most frequent cancer amongst women worldwide including in Asia where the incidence rate is rapidly increasing. Even with treatment, around 30% of patients with early breast cancer progress to metastatic disease, with hormone receptor positive (HR+) and human epidermal growth factor receptor 2 negative (HER2-) breast cancer the most common phenotype. First-line endocrine therapy targeting the estrogen receptor signaling pathway provides a median progression-free survival or time to progression of 6–15?months in HR?+?HER2- metastatic breast cancer. Recently, cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors, combined with endocrine therapy, have achieved more than two years median progression-free survival in HR?+?HER2- metastatic breast cancer. However, the characteristics of the Asian breast cancer population differ from those of Western populations and need to be considered when selecting a suitable treatment. Breast cancer is diagnosed at a younger age in Asian populations and late stage at presentation is generally more common in low-/middle-income countries than high-income countries. Consequently, the proportion of premenopausal women with metastatic breast cancer is higher in Asian compared with Western populations. While CDK4/6 inhibitors have been approved in the USA (FDA) since 2015, experience with them in Asia is more limited. We review the experience with the CDK4/6 inhibitor palbociclib in Asian patients with HR?+?HER2- metastatic breast cancer and provide guidance on the use of palbociclib in these patients.     

Lifestyle-related risk factors for stomach cancer in northeast Thailand.

Background: Stomach cancer is not common in Thailand but the life styles of the Thai population are changingto become more Western so that information for planning control programme of stomach cancer is necessary.The highest incidence rates of this neoplasm are found in Eastern Asia, ranging from age-standardized rates of95.5/105 (men) and 40.1/105 (women) in Yamagata, Japan to 4.1/105 (men) and 2.1/105 (women) in Khon Kaen,Northeast of Thailand. In Thailand, the estimated age-standardized incidence rates in 1993, 1996 were 4.9/105,4.1/105 in men and 3.0/105 , 2.6/105 in women. Risk factors for stomach cancer in Thai population are unclear,but possibly include low intake of vegetables and fruits, alcohol drinking, tobacco smoking and high intake ofsalt. Objective: To investigate various aspects of dietary factors, smoking, and alcohol drinking in determiningrisk of stomach cancer in Thai population. Methods: A case-control study was conducted in Khon Kaen, Thailandduring 2002-2006, to study the role of these factors in stomach cancer. 101 stomach cancer cases and 202 matchedcontrols (case : control = 1:2) by sex, age (± 3 years) and region were recruited from Srinagarind Hospital andKhon Kaen Regional Hospital, in Khon Kaen Province. All of cases were histologically confirmed. Controls hada variety of diseases, the main ones being disease of the eye. Information on dietary habits, alcohol drinking andsmoking were collected by a structured questionnaire, blood samples were collected for further study. Results:The distribution of the general characteristics by case-control status, the distribution of age and sex were similarin cases and controls. In the final analysis, the factors that found to be higher risk but not statistically significantwere long-term filter cigarette smoking (OR=1.9, 95%CI: 0.85-4.50), long-term alcohol consumption (OR=1.2,95%CI: 0.51-2.60) and low intake of vegetables and fruits (OR=1.2, 95%CI: 0.74-1.96). A high intake of vegetableoil (OR=4.5, 95%CI: 1.00.-20.17) was found to be associated with increased risk, and similar tendencies werenoted for pork oil (OR=1.4, 95%CI: 0.63-3.01) and jeaw prik (mainly chilly with plara broth) (OR=1.2, 95%CI:0 .76- 2.01). Conclusion: Our study confirmed protective effects of a high intake of fruits and vegetables againststomach cancer development and showed a high intake of sauces to increase risk of stomach cancer as in othercountries in Asia.