Gastrointestinal Malignancies

Erbitux for gastric cancer – pro

Epidermal growth factor receptor (EGFR) is over-expressed in a significant proportion of esophageal and gastric carcinomas and there has been significant interest in targeting it. Unfortunately, it has not yet shown much progress. A phase II study by Chan et al showed minimal clinical activity of cetuximab.  A recent phase III trial, EXPAND (Erbitux in Combination With Xeloda and Cisplatin in Advanced Esophagogastric Cancer), involved 904 patients

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Interferon for VIPoma – pro

The VIPoma syndrome is rare and difficult to treat and for this reason, ti is not well studied. It is usually caused by a neuroendocrine tumor located in the pancreas or other organs and present primarily with diarrhea. Treatment relies on resection and octreotide but occasionally interferon or steroids can be used as adjuncts (Best Practice, Eppocrates). On the other hand, other reviews do not mention interferon or mention it in combiantion with

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Tykerb gastric cancer – pro

Gastric cancer is known to have amplification of the ErbB2 (HER2) gene and Herceptin is supported for use in gastric cancer. Recently, there has been an interest in using Tyker(lapatinib) which is a drug that utalizes the same mechanism of action as Herceptin. One such trial is: LOGiC - Lapatinib Optimization Study in ErbB2 (HER2) Positive Gastric Cancer: A Phase III Global, Blinded Study Designed to Evaluate Clinical Endpoints and Safety of Chemotherapy

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Taxotere/Avastin for esophageal cancer – pro

Bevacizumab, a recombinant humanized mAb, binds to all isoforms of human VEGF with high affinity and prevents the binding of VEGF to its receptor. For esophageal cancer, bevacizumab is in the early stages of clinical development. Most trials have been limited to GE adenocarcinomas, given the life-threatening hemoptysis described in bevacizumab-treated patients with squamous cell carcinoma of the lung. A multi-center phase II study of irinotecan,

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TACE – pro

Chemoembolization (CE) involves the periodic injection of chemotherapy mixed with embolic material into selected branches of the hepatic arteries feeding liver tumors. CE has been successfully used as a palliative treatment of symptoms associated with functioning neuroendocrine tumors involving the liver. The most common such tumor is the carcinoid tumor whose hormone production is associated with the carcinoid syndrome, characterized by debilitating

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Cisplatin/irinotecan for Gastric Cancer – pro

Both irinotecan and cisplatin are considered standard agents for stomach cancer and NCCN recommends cisplatin or irinotecan based regimens. Cisplatin has been a popular drug for this disease for 2 decades. Recent data have emerged on the use of irinotecan in advanced gastric cancer, both as a single agent and in various combination regimens. Active irinotecan-based combinations include cisplatin–irinotecan, 5-FU–LV–irinotecan, and irinotecan–oxaliplatin.

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HAI for hepatic mets – pro

Hepatic intra-arterial chemotherapy with floxuridine for liver metastases has produced higher overall response rates but no consistent improvement in survival when compared to systemic chemotherapy.Controversy regarding the efficacy of regional chemotherapy has led to initiation of a large multicenter phase III trial (CLB-9481) of hepatic arterial infusion versus systemic chemotherapy. The use of the combination of intra-arterial chemotherapy with

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Chemo for metastatic esophageal cancer – pro

Lay Summary: Metastatic esophageal cancer is often treated with chemotherapy. Drugs with the most supporting evidence for effectiveness are: cisplatin, 5-fluorouracil (5-FU), paclitaxel and antracyclins. How to best combine them with each other and novel agents is being studied. More than 50% of patients with esophageal cancer have metastatic disease at presentation. The use of chemotherapy for this patient group is increasing with the intention

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Chemo for HCC – pro

The only proven potentially curative therapy for HCC remainssurgical, either hepatic resection or liver transplantation,and patients with single small HCC ( 5 cm) or up to three lesions3 cm should be referred for assessment for these treatment modalities. A variety of local therapies are avialble short of surgical resection. In regard to chemotherapy, palliative systemic therapy with doxorubicin (Adriamycin) has been considered a standard of therapy

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Xelox + Avastin for metastatic CRC – pro

Avastin has been shown to be more effective with Folfox than Folfox alone. Preliminary results from a large, randomized clinical trial for patients with advanced colorectal cancer who had previously received treatment show that those who received bevacizumab (Avastin™) in combination with an oxaliplatin (Eloxatin™) regimen known as FOLFOX4 lived longer than patients who received FOLFOX4 alone. The Data Monitoring Committee overseeing the trial

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