Cancer Treatment Today

Appendiceal cancer is usually treated with colon cancer chemotherapy as the apppendix is a part of colon, most often Folfox or Xelox with or without Avastin. There are very few studies of this rare cancer subtype. From 1973 to 1998, 2117 primary malignant tumors of the appendix were reported to the SEER program. The prognosis depends on histology. Some experts recommend heated intraperitoneal chemotehrapy after extensive surgical debulking, which was not possbile, as stated, in this case, but others disagree.While there are ongoing trials of the hyperthermic approach, I have not been able to find trials of systemic chemotherapy in this rare disease.

A 2010 review by Schapiro et al presented 186 patients diagnosed with appendiceal neoplasm, 54 (29%) were not surgical candidates and received>or =2 cycles of systemic chemotherapy. Thirty (55.6%) patients had a disease control rate noted as a complete response, partial response, or stable disease. After a median follow-up of 24 months, the median progression-free survival (PFS) and overall survival were determined to be 7.6 months (95% confidence interval [CI], 4-11) and 56 months (95% CI, 36-not applicable), respectively. The authors concluded that systemic chemotherapy has a role in appendiceal neoplasm patients who are suboptimal candidates for cytoreductive surgery , and that prospective randomized trials including systemic chemotherapy are needed to provide further insight into this malignancy, for which no standard exists.

A report from M. D. Anderson included 54 patients with a mucinous adenocarcinoma, signet ring cell adenocarcinoma, or PMP, each originating from the appendix, who received at least two courses of chemotherapy. Several different regimens were used, although the majority (84 percent) received capecitabine or 5-FU with or without a platinum drug. Clinical benefit was achieved in 30 patients (55 percent), with a median progression-free survival duration of 7.6 months. There were two complete responses, 11 partial responses (objective response rate 24 percent), and 17 cases of prolonged stable disease (32 percent). The median overall survival was 55 months, reflective of the predominance of well-differentiated tumors in this cohort. The only published phase II trial in advanced unresectable PMP suggested activity for capecitabine combined with mitomycin C

Watson, Paul Advanced Colorectal Cancer: Consensus Group Recommends Heated Chemotherapy after Surgery, but Other Experts Disagree, Citing Need for Phase III Data. Oncology Times. 29(2):24,27-29, January 25, 2007.

nccn.org, colorectal cancer, 2015

Shapiro JF, Chase JL, Wolff RA, et al. Modern systemic chemotherapy in surgically unresectable neoplasms of appendiceal origin: a single-institution experience. Cancer 2010; 116:316.

Lieu CH, Lambert LA, Wolff RA, et al. Systemic chemotherapy and surgical cytoreduction for poorly differentiated and signet ring cell adenocarcinomas of the appendix. Ann Oncol 2012; 23:652.

Farquharson AL, Pranesh N, Witham G, et al. A phase II study evaluating the use of concurrent mitomycin C and capecitabine in patients with advanced unresectable pseudomyxoma peritonei. Br J Cancer 2008; 99:591.

Shapiro JF, Chase JL, Wolff RA, et al. Modern systemic chemotherapy in surgically unresectable neoplasms of appendiceal origin: a single-institution experience. Cancer 2010; 116:316.