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Comparison of efficacy of pharmacological therapies for gastric endoscopic submucosal dissection-induced ulcers: a systematic review and network meta-analysis.
Gao, H, Li, L, Zhang, C, Tu, J, Geng, X, Wang, J, Zhou, X, Jing, J, Pan, W
Expert review of gastroenterology & hepatology. 2020;(3):207-220
Abstract
Objectives: This study aimed to compare the efficacy of various anti-ulcer medications in preventing delayed bleeding and promoting ulcer healing after ESD.Methods: Asystematic search was conducted for articles up to August2019. The treatments of iatrogenic ulcer were analyzed by Bayesian network meta-analysis.Results: The analysis included 28 studies. Six treatments were compared. For the prevention of delayed bleeding, potassium-competitive acid blocker (P-CAB) alone was superior to proton-pump inhibitor (PPI) alone [RR = 1.02, 95%CI (1.00, 1.05)]. Treatments based on P-CAB tended to be better than the non-P-CAB groups [RR = 1.05, 95%CI (1.03, 1.07)]. Concerning the ulcer healing rate at 4 weeks, the combined treatment of PPI and mucoprotective agent (MP) was superior to PPI alone [RR = 1.81, 95%CI (1.19, 2.76)] and P-CAB alone [RR = 2.75, 95%CI (1.02, 7.44)]. At 8 weeks, PPI+MP and P-CAB+MP tend to be superior to than the other four groups. The healing effect of MP-based therapies was better than that of non-MP groups at 4 weeks [RR = 1.63, 95%CI (1.32, 2.01)] and 8 weeks [RR = 1.06, 95%CI (1.02, 1.11)].Conclusion: P-CAB may prevent delayed bleeding, but not significantly. MP agents have the potential to heal post-ESD ulcers.
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AGA Technical Review on Gastric Intestinal Metaplasia-Epidemiology and Risk Factors.
Altayar, O, Davitkov, P, Shah, SC, Gawron, AJ, Morgan, DR, Turner, K, Mustafa, RA
Gastroenterology. 2020;(3):732-744.e16
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FOLFIRINOX for the Treatment of Advanced Gastroesophageal Cancers: A Phase 2 Nonrandomized Clinical Trial.
Park, H, Jin, RU, Wang-Gillam, A, Suresh, R, Rigden, C, Amin, M, Tan, BR, Pedersen, KS, Lim, KH, Trikalinos, NA, et al
JAMA oncology. 2020;(8):1231-1240
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Abstract
IMPORTANCE Standard first-line regimens for patients with metastatic gastroesophageal adenocarcinomas have an approximate 40% objective response rate (ORR). The combination of leucovorin, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) has been efficacious as first-line therapy for other gastrointestinal cancers, such as pancreatic and colon cancers. OBJECTIVE To evaluate the clinical activity and safety of FOLFIRINOX as first-line treatment for patients with advanced gastroesophageal adenocarcinoma. DESIGN, SETTING, AND PARTICIPANTS This is an open-label, single-arm phase 2 study of first-line FOLFIRINOX in patients with advanced gastroesophageal adenocarcinoma. Estimated sample size included 41 patients with ERBB2-negative disease with 90% power to detect an ORR of 60% or greater with α of .10. No enrollment goal was planned for ERBB2-positive patients, but they were allowed to receive trastuzumab in combination with FOLFIRINOX. INTERVENTIONS Starting doses were fluorouracil, 400 mg/m2 bolus, followed by 2400 mg/m2 over 46 hours; leucovorin, 400 mg/m2; irinotecan, 180 mg/m2; and oxaliplatin, 85 mg/m2. Trastuzumab was administered as a 6 mg/kg loading dose, followed by 4 mg/kg every 14 days in patients with ERBB2-positive disease. MAIN OUTCOMES AND MEASURES The primary end point was ORR by the Response Evaluation Criteria in Solid Tumors, version 1.1. Secondary end points included safety profile, progression-free survival (PFS), overall survival (OS), and duration of response. RESULTS From November 2013 to May 2018, 67 patients were enrolled (median [range] age, 59.0 [34-78] years; including 56 [84%] men), and 26 of 67 (39%) had ERBB2-positive disease. Median follow-up was 17.4 months. The ORR was 61%(95% CI, 44.5%-75.8%) (25 of 41) in the ERBB2-negative group and 85% (95% CI, 65.1%-95.6%) (22 of 26) in the ERBB2-positive group, including 1 patient with complete response. For ERBB2-negative patients, median PFS was 8.4 months and median OS was 15.5 months; for ERBB2-positive patients, median PFS was 13.8 months and median OS was 19.6 months. Fifty-six patients (84%) had dose modifications or treatment delays. The most common toxic effects were neutropenia (91%, n = 61), diarrhea (63%, n = 42), peripheral sensory neuropathy (61%, n = 41), and nausea (48%, n = 32), with no unexpected toxic effects. CONCLUSIONS AND RELEVANCE The FOLFIRINOX regimen with or without trastuzumab was associated with improved ORR and PFS in patients with advanced gastroesophageal adenocarcinoma in the first-line setting. This regimen may be a reasonable therapeutic option for patients with preserved performance status. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01928290.
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Are depression and anxiety disorders associated with adductor pollicis muscle thickness, sleep duration, and protein intake in cancer patients?
de Sousa, DE, de Carli, MN, Fernandes, RC, Trindade, DB, Laviano, A, Pichard, C, Pimentel, GD
Experimental gerontology. 2020;:110803
Abstract
INTRODUCTION Psychological disturbances may be associated with compromised body composition and food intake. However, this has not been elucidated totally. Thus, this study aimed to evaluate the prevalence of anxiety and depression, and whether there is an association between these disorders and adductor pollicis muscle thickness (APMT), protein intake and sleep duration, in gastrointestinal cancer patients. METHODS A cross-sectional study evaluated 117 patients of both genders diagnosed with gastrointestinal cancer. Protein intake was assessed by the USDA food database; sleep duration by self-administered questionnaire; and APMT using the skinfold. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety (HADS-A) and depression (HADS-D). RESULTS A total of 117 (65% male) patients were assessed, of which 40 (34%) had anxiety and 39 (33%) depression. There was a negative correlation between APMT and anxiety (r = -0.20, p = .020) and depression (r = -0.19, p = .03), and between anxiety and sleep duration (r = -0.30, p = .001). Although there was an inverse association between anxiety and APMT (OR: 0.88, 95%CI: 0.79-0.99, p = .032) and sleep duration (OR: 0.71, 95%CI: 0.58-0.87, p = .001), when adjusted for gender and age, the association remained only between anxiety and sleep duration (OR: 0.71, 95%CI: 0.58-0.87, p = .001). CONCLUSION One-third of gastrointestinal cancer patients were classified as expressing anxiety and depression. Additionally, only sleep duration is associated with anxiety.
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Postoperative nutritional outcomes and quality of life-related complications of proximal versus total gastrectomy for upper-third early gastric cancer: a meta-analysis.
Lee, I, Oh, Y, Park, SH, Kwon, Y, Park, S
Scientific reports. 2020;(1):21460
Abstract
Although proximal gastrectomy (PG) provides superior nutritional outcomes over total gastrectomy (TG) in upper-third early gastric cancer (EGC), surgeons are reluctant to perform PG due to the high rate of postoperative reflux. This meta-analysis aimed to comprehensively compare operative outcomes, nutritional outcomes, and quality of life-related complications between TG and PG performed with esophagogastrostomy (EG), jejunal interposition, or double-tract reconstruction (DTR) to reduce reflux after PG. After searching PubMed, Embase, Medline, and Web of Science databases, 25 studies comparing PG with TG in upper-third EGC published up to October 2020 were identified. PG with DTR was similar to TG regarding operative outcomes. Patients who underwent PG with DTR had less weight reduction (weighted mean difference [WMD] 4.29; 95% confidence interval [0.51-8.07]), reduced hemoglobin loss (WMD 5.74; [2.56-8.93]), and reduced vitamin B12 supplementation requirement (odds ratio [OR] 0.06; [0.00-0.89]) compared to patients who underwent TG. PG with EG caused more reflux (OR 5.18; [2.03-13.24]) and anastomotic stenosis (OR 3.94; [2.40-6.46]) than TG. However, PG with DTR was similar to TG regarding quality of life-related complications including reflux, anastomotic stenosis, and leakage. Hence, PG with DTR can be recommended for patients with upper-third EGC considering its superior postoperative nutritional outcomes.
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The role of curcumin/curcuminoids during gastric cancer chemotherapy: A systematic review of non-clinical study.
Najafi, M, Mortezaee, K, Rahimifard, M, Farhood, B, Haghi-Aminjan, H
Life sciences. 2020;:118051
Abstract
AIMS: Chemotherapy is an effective therapeutic modality which is commonly used for battling various cancers. However, several side effects induced by chemotherapeutic drugs would limit their clinical use. The present systematic review aims to evaluate the role of curcumin/curcuminoids co-administration during gastric cancer chemotherapy. METHODS This systematic review was done according to PRISMA guidelines and a full systematic search in the electronic databases up to May 2020 using search terms in the titles and abstracts for the identification of relevant literature. 279 articles were found in electronic databases and 175 articles screened by title and abstract. Finally, 13 articles were included in this systematic review according to our inclusion and exclusion criteria. KEY FINDINGS The findings indicated that gastric cancer chemotherapy induces cytotoxicity effects in various ways including a decrease of cell viability, colony formation, metastasis, tumor growth, and weight, as well as elevation of apoptosis pathway, oxidative stress pathway compared to the control group. Co-administration of curcumin/curcuminoids with chemotherapy synergistically increased the effects of anti-cancer chemotherapy compared to the group solo treated with chemotherapeutic agents. Also, in chemoresistance gastric cancer cells, co-administration of curcumin reduced chemoresistance mainly through the reduction of NF-κB activation and elevation of apoptosis. SIGNIFICANCE According to the findings, the use of curcumin/curcuminoids during gastric cancer chemotherapy has chemosensitizing effects, and also it can reduce chemoresistance in gastric cancer.
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Comparison of the short-term outcomes between totally laparoscopic total gastrectomy and laparoscopic-assisted total gastrectomy for gastric cancer: a meta-analysis.
Liao, G, Wang, Z, Zhang, W, Qian, K, Mariella Mac, S, Li, H, Huang, Z
Medicine. 2020;(7):e19225
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Abstract
BACKGROUND Totally laparoscopic total gastrectomy (TLTG) and laparoscopic-assisted total gastrectomy (LATG) are two common surgical approaches for upper and middle gastric cancer. Which surgical approach offers more advantages is still controversial due to a lack of evidence from randomized controlled trials (RCTs). This meta-analysis was conducted to compare the short-term outcomes between the two surgical approaches. METHODS A systematic literature search was performed to evaluate short-term outcomes between TLTG and LATG, including overall postoperative complications, anastomosis-related complications, time for anastomosis, operation time, intraoperative blood loss, harvested lymph nodes, proximal margin, distal margin, time to first flatus, time to first diet, and postoperative hospital stay. Short-term outcomes were pooled and compared by meta-analysis using RevMan 5.3. Mean differences (MDs) or risk ratios (RRs) were calculated with 95% confidence intervals (CIs). P < .05 was considered statistically significant. RESULTS A total of 9 cohort studies fulfilled the selection criteria. The total sample included 1671 cases. The meta-analysis showed no significant difference between the two surgical approaches in overall postoperative complications (RR = 1.02, 95% CI = 0.82 to 1.26, P = .87),anastomosis-related complications (RR = 0.64, 95%CI = 0.39 to 1.03, P = .06),time for anastomosis (MD = -5.13, 95% CI = -10.54 to 0.27, P = .06),operation time (MD = -10.68, 95% CI = -23.62 to 2.26, P = .11), intraoperative blood loss (MD = -25.58, 95% CI = -61.71 to 10.54, P = .17), harvested lymph nodes (MD = 1.61, 95% CI = -2.09 to 5.31, P = .39), proximal margin (MD = -0.37, 95% CI = -0.78 to 0.05, P = .09), distal margin (MD = 0.79, 95% CI = -0.57 to 2.14, P = .25), time to first flatus (MD = 0.01, 95% CI = -0.13 to 0.15, P = .87), time to first diet (MD = -0.22, 95% CI = -0.45 to 0.02, P = .07), and postoperative hospital stay (MD = -0.51, 95% CI = -1.10 to 0.07, P = .09). CONCLUSIONS TLTG is a safe and feasible surgical approach for upper and middle gastric cancer, with short-term outcomes that are similar to LATG. Nevertheless, high-quality, large-sample and multicenter RCTs are still required to further verify our conclusions.
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Endocrinological Toxicity Secondary to Treatment of Gastroenteropancreatic Neuroendocrine Neoplasms (GEP-NENs).
Alexandraki, KI, Daskalakis, K, Tsoli, M, Grossman, AB, Kaltsas, GA
Trends in endocrinology and metabolism: TEM. 2020;(3):239-255
Abstract
Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are increasingly recognized, characterized by prolonged survival even with metastatic disease. Their medical treatment is complex involving various specialties, necessitating awareness of treatment-related adverse effects (AEs). As GEP-NENs express somatostatin receptors (SSTRs), long-acting somatostatin analogs (SSAs) that are used for secretory syndrome and tumor control may lead to altered glucose metabolism. Everolimus and sunitinib are molecular targeted agents that affect glucose and lipid metabolism and may induce hypothyroidism or hypocalcemia, respectively. Chemotherapeutic drugs can affect the reproductive system and water homeostasis, whereas immunotherapeutic agents can cause hypophysitis and thyroiditis or other immune-mediated disorders. Treatment with radiopeptides may temporarily lead to radiation-induced hormone disturbances. As drugs targeting GEP-NENs are increasingly introduced, recognition and management of endocrine-related AEs may improve compliance and the quality of life of these patients.
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A systematic review of the effect of preoperative nutrition support on nutritional status and treatment outcomes in upper gastrointestinal cancer resection.
Deftereos, I, Kiss, N, Isenring, E, Carter, VM, Yeung, JM
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2020;(8):1423-1434
Abstract
BACKGROUND Malnutrition is highly prevalent in patients with Upper Gastrointestinal (UGI) cancer and is associated with poor outcomes. However, there are no evidence-based guidelines for nutrition support specific to UGI cancer surgery. METHODS Databases including MEDLINE, PUBMED, CINAHL, Web of Science, Cochrane Central and Clinicaltrials.gov were systematically searched. Abstracts of studies investigating the effect of preoperative nutrition support on nutritional status, functional status, body composition, quality of life and treatment outcomes in adult patients undergoing oesophageal, gastric or pancreatic cancer resection were identified. Screening of studies, quality assessment using the Downs and Black checklist, data extraction, and appraisal of evidence using GRADE were performed by two reviewers. Due to heterogeneity of the studies, results were synthesised narratively. The protocol was registered in PROSPERO (CRD42018111930). RESULTS Nine studies with a total of 442 oesophageal and 418 gastric patients were included. Individualised dietary counselling, and enteral feeding in neoadjuvant therapy for oesophageal cancer demonstrated positive effects for weight maintenance and surgical complications, however the GRADE evidence quality was very low. Preoperative nutrition support in gastric cancer decreased the incidence of surgical site infections, length of stay and hospital costs, but GRADE assessment was unable to be completed due to only one study reporting on each outcome measure. CONCLUSIONS This review demonstrates the lack of strong evidence to determine the most optimal methods of nutrition support prior to UGI cancer resection. Current surgical oncology guidelines should be utilised until further research from high quality trials enable the development of specific clinical practice guidelines.
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Index-based dietary patterns in relation to gastric cancer risk: a systematic review and meta-analysis.
Du, S, Li, Y, Su, Z, Shi, X, Johnson, NL, Li, P, Zhang, Y, Zhang, Q, Wen, L, Li, K, et al
The British journal of nutrition. 2020;(9):964-974
Abstract
Dietary indices are widely used in diet quality measurement, and the index-based dietary patterns are related to gastric cancer risk. To evaluate the relationship between different kinds of index-based dietary patterns and gastric cancer risk, we systematically searched four English-language databases and four Chinese-language databases. The quality of studies was assessed by the Newcastle–Ottawa Scale. Meta-analyses were performed to estimate the association between gastric cancer incidence and different types of index-based dietary patterns. The OR and hazard ratios (HR) of gastric cancer incidence were calculated by regression models in case–control studies and prospective cohort studies, respectively. The studies were pooled in the random effects model to calculate the summarised risk estimate of the highest quantile interval of dietary indices, taking the lowest as the referent. The dietary indices included different versions of Mediterranean diet score (MDS) and dietary inflammatory index (DII), healthy eating index, Chinese Food Pagoda score and food index score. The meta-analysis was carried out for studies on MDS and DII. The combined OR of gastric cancer for the highest MDS v. the referent was 0·42 (95 % CI 0·2, 0·86), and the combined HR was 0·89 (95 % CI 0·68, 1·17). The combined OR for DII was 2·11 (95 % CI 1·41, 3·15). Higher Mediterranean dietary pattern consumption might reduce gastric cancer risk, while higher inflammatory diet pattern consumption might increase gastric cancer risk.