*FOLFIRINOX definitely in control as first choice for first line
but this option is too toxic in the elderly so a modified version is adopted by some
.*new IMPACT STUDY, GEMZAR-ABRAXANE is being rapidly adopted as an alternative to FOLFIRINOX for this same and very reason (Toxicity of Folfirinox)
This combination was reportedly tried in selected clinics (including Eastern Europe) in a Phase III trial, was tried against Gemzar alone
and gave Progression free survival of 5.5 months Vs 3.7 months
Overall survival 8.5 months Vs 6.7 months (Von Hoff DD et al.)
Abraxane given at 125 mg/m2 and Gemzar at 1000mg/m2 Q3/4 in the combination arm
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3rd choice of course was GEMZAR-ERLOTINIB follwed by GEMZAR ALONE.
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NOTABLY NO TARGET THERAPY DISCUSSED WHICH NEEDS TO BE CORRECTED FAST!
A blog about research, awareness, prevention, treatment and survivorship of Breast Cancer and all cancers, including targeted scientific research and a grassroots approach to increase screening for cancer, especially in the low income and under-insured population of El Paso, Texas, with a view to expand this new health care model to many other 'minority' populations across the United States and beyond
Showing posts with label pancreatic cancer. Show all posts
Showing posts with label pancreatic cancer. Show all posts
Sunday, March 10, 2013
Tuesday, February 5, 2013
NEW DEVELOPMENTS
Home > Blogs > Online First/Online Only > ONLINE FIRST: Pancreatic Cancer: Gemcitabine Plus Nab-Paclit...
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Monday, February 4, 2013
CELLULAR LANGUAGE (II)
In Cellular Language I published recently that we tried to emphasize that big functions of the cell start up with an on-and-off switch. The Tic and The Tan like in MORSE language, the 1and 0 of the computer. While this is true, there are many other simple things at the molecular level that are just as simple, but full of physiologic and scientific implications.
1.ON and OFF switch:
--------------------------
Events that lead to cancer are sometimes an exaggeration of a signal. The K-RAS (there exist many RAS (es) as we discussed in differentiation) has a switch called the Sons of the Sevenless which can stay on, sending signals down the cell continuously. Activated RAS will light on 3 signal pathways:
-MAP kinase (through RAF)--->FOS, JUN (stress), MYC (the dangerous leading to Burkitt)-TF
-RAL/CDC42 (important in the movement of the membrane, Metastasis)
-PI3K (leading to affect on AKT/MTOR) FOXO downstream hiding the PUMA-remember)
Mutations at the RAS itself can also cause it to stay on, as opposed to knocking it out.
Remember, Mutations of RAS occur in 80% of Pancreatic cancers and 50% of colon cancer.
Therefore, a simple switch can kill you with one of the most devastating diseases.
2. Change of shape:
---------------------
To confuse and look smart, your scientist calls this post-translational conformation to emphasize that this change has occurred later because of the nteraction with another molecule (in general).
At the surface of the membrane, there are here and there some Molecules called INTEGRINS; these are of various types and increasing molecular diversity and are best known as Receptors. They are large complexes of molecules gathered in chunks called 'subunits'. They basically cross the thickness of the cellular membrane and, outside the cell, they sense what is going on. Integrins serve many great purposes including cell division, proliferation, migration, adhesion to each either, differentiation, sensing etc. You name it, they do it! Only division of DNA, this, they don't do. But the membrane has to be divided also to make 2 cells in cell divison. Even anti-coagulation happens here. The versatility of the integrins is linked to the variety of subunits it is composed with. Some are nature of cell specific and some are contact specific. By contact specific, I mean what molecule outside the cell it will attach to (ie fibronectin Vs GPIIb).
Suffice is to say that kinking of the Integrins causes exposure of some parts of the Integrin molecule not naturally exposed. If one looks at the skin of the joint at the back of the finger, one will see folded skin. if you forcefully bend your finger, the fold you were looking at will unfold and the bottom of the fold will come out. This is what happen to the integrin when it meets outside the cell another molecule such as TALIN.
That bending triggers the attachment of other molecules or ions (phosphorylation) to the now exposed skin, lighting up the Integrins for the cascade of events which will unfold, including the activation of SRC in Sarcoma.
The shape imposed by the bending is also Molecule specific. Despite the resemblance of SRC with the c-ABL (leukemia), their bending does not offer the same shape, and therefore, different parts of the molecule are exposed and 2 different diseases result.
CELL ADHESION- "join at the hip"
----------------------------------------
At many points the cells are joined to each other at the hips of the Talins. Say, at the hip of the Talin which linked to one Integrin, there is a PLUS SIGN at Cell A, and at the next TALIN attached to the Integrin of cell B, there is a NEGATIVE sign. These 2 integrins will be attached, and cell adhesion is achieved. Simple as that!
Wheels of cellular migration,
-----------------------------,
Cells can roll over other cells by progressively attaching Talin to Talins and breaking the talin-talins (integrin-integrin) behind, engulfing the integrins and using them again in the forthcoming attachment like a wheel touching the ground. The cell is that smart at the membrane.
More simple things to come...
Hiding the PUMA behind the FOXO to have a death TRAP (Apoptsosis) in case the FOXO is compromised!
Just simple, but effective tricks ...
1.ON and OFF switch:
--------------------------
Events that lead to cancer are sometimes an exaggeration of a signal. The K-RAS (there exist many RAS (es) as we discussed in differentiation) has a switch called the Sons of the Sevenless which can stay on, sending signals down the cell continuously. Activated RAS will light on 3 signal pathways:
-MAP kinase (through RAF)--->FOS, JUN (stress), MYC (the dangerous leading to Burkitt)-TF
-RAL/CDC42 (important in the movement of the membrane, Metastasis)
-PI3K (leading to affect on AKT/MTOR) FOXO downstream hiding the PUMA-remember)
Mutations at the RAS itself can also cause it to stay on, as opposed to knocking it out.
Remember, Mutations of RAS occur in 80% of Pancreatic cancers and 50% of colon cancer.
Therefore, a simple switch can kill you with one of the most devastating diseases.
2. Change of shape:
---------------------
To confuse and look smart, your scientist calls this post-translational conformation to emphasize that this change has occurred later because of the nteraction with another molecule (in general).
At the surface of the membrane, there are here and there some Molecules called INTEGRINS; these are of various types and increasing molecular diversity and are best known as Receptors. They are large complexes of molecules gathered in chunks called 'subunits'. They basically cross the thickness of the cellular membrane and, outside the cell, they sense what is going on. Integrins serve many great purposes including cell division, proliferation, migration, adhesion to each either, differentiation, sensing etc. You name it, they do it! Only division of DNA, this, they don't do. But the membrane has to be divided also to make 2 cells in cell divison. Even anti-coagulation happens here. The versatility of the integrins is linked to the variety of subunits it is composed with. Some are nature of cell specific and some are contact specific. By contact specific, I mean what molecule outside the cell it will attach to (ie fibronectin Vs GPIIb).
Suffice is to say that kinking of the Integrins causes exposure of some parts of the Integrin molecule not naturally exposed. If one looks at the skin of the joint at the back of the finger, one will see folded skin. if you forcefully bend your finger, the fold you were looking at will unfold and the bottom of the fold will come out. This is what happen to the integrin when it meets outside the cell another molecule such as TALIN.
That bending triggers the attachment of other molecules or ions (phosphorylation) to the now exposed skin, lighting up the Integrins for the cascade of events which will unfold, including the activation of SRC in Sarcoma.
The shape imposed by the bending is also Molecule specific. Despite the resemblance of SRC with the c-ABL (leukemia), their bending does not offer the same shape, and therefore, different parts of the molecule are exposed and 2 different diseases result.
CELL ADHESION- "join at the hip"
----------------------------------------
At many points the cells are joined to each other at the hips of the Talins. Say, at the hip of the Talin which linked to one Integrin, there is a PLUS SIGN at Cell A, and at the next TALIN attached to the Integrin of cell B, there is a NEGATIVE sign. These 2 integrins will be attached, and cell adhesion is achieved. Simple as that!
Wheels of cellular migration,
-----------------------------,
Cells can roll over other cells by progressively attaching Talin to Talins and breaking the talin-talins (integrin-integrin) behind, engulfing the integrins and using them again in the forthcoming attachment like a wheel touching the ground. The cell is that smart at the membrane.
More simple things to come...
Hiding the PUMA behind the FOXO to have a death TRAP (Apoptsosis) in case the FOXO is compromised!
Just simple, but effective tricks ...
Labels:
AKT,
cellular language,
colon cancer,
crbcm,
fibronectin,
FOS,
FOXO,
GPIIb,
integrins,
JUN,
K-Ras,
MAP kinase,
morse,
mtor,
MYC,
pancreatic cancer,
PUMA
Monday, January 28, 2013
ASCO GI: Phase III Bevacizumab Results of the AVEX and TRIBE Trials
ASCO GI: Phase III Bevacizumab Results of the AVEX and TRIBE Trials
Plus: Avastin gets new indication from FDA for second-line treatment
By Anna Azvolinsky, PhD1 |
January 28, 2013
1Freelance Science Writer and Cancer Network Contributor. Follow Her on Twitter
The same week that bevacizumab (Avastin) received a new indication
for the treatment of metastatic colorectal cancer, results from two
phase III trials involving the drug were presented at the American
Society of Clinical Oncology 2013 Gastrointestinal Cancers Symposium
(ASCO GI) held January 24–26 in San Francisco.
Among 35 Italian centers, 508 patients
were randomized one to one to either arm, which both included up to 12
cycles of 5 mg/kg bevacizumab followed by bevacizumab plus fluorouracil
as a maintenance therapy.
The study met its primary endpoint—a median progression-free survival of 11.9 months was seen in the FOLFOXIRI arm compared with 9.5 months in the FOLFIRI arm (hazard ratio [HR] = 0.72; P = .001). Response rates were also higher for the FOLFOXIRI combination—64% compared with 53% in the FOLFIRI group (P = .015). Toxicities were as expected and comparable in the two groups.
According to the study researchers, this is the first randomized, prospective trial that has analyzed the benefit of bevacizumab specifically in elderly patients. The results show the combination may be a better treatment that improves elderly patient outcomes. The results validate the use of bevacizumab with capecitabine, a fluoropyrimidine, in elderly patients.
“[These results] confirm a benefit with increased response and tumor control,” said David Cunningham, MD, head of the gastrointestinal unit at the Royal Marsden Hospital in the United Kingdom, and the presenter of the study.
The open-label trial administered bevacizumab to one half of the patients at a 7.5 mg/kg dose every 3 weeks. A total of 280 patients (median age of 76) in 10 countries were part of the trial, which showed the combination prolonged progression-free survival compared with chemotherapy alone. Progression-free survival was 9.1 months for patients taking the combination compared with 5.1 months in the chemotherapy alone arm (HR = 0.53; P < .001).
Overall survival was also improved, but the difference between the two arms was not statistically significant—median overall survival was 20.7 months in the combination arm compared with 16.8 months for the capecitabine arm (HR = 0.79; P = .182). Grade 3 and higher adverse events were more frequent in the combination arm, but researchers said the regimen was generally well tolerated. Grade 3 or higher toxicities were seen in 59% of patients taking bevacizumab plus capecitabine compared with 44.1% of patients taking capecitabine alone.
“This trial result emphasizes that with appropriate selection, patients with advanced colorectal cancer, regardless of age, may benefit from chemotherapy and that the combination of capecitabine and bevacizumab represents a good option that has a favorable balance between efficacy against side effects,” said Cunningham.
Patients receiving the combination lived longer compared with those who switched to chemotherapy alone as a second-line treatment. Results showed a 19% risk of death reduction for patients on the combination therapy compared with standard chemotherapy alone (HR = 0.81; P = .0057) in the phase III ML18147 trial. The median overall survival was 11.2 months compared with 9.8 months. The results are published in the Lancet Oncology.
Bevacizumab is already approved in combination with chemotherapy as a first-line therapy for metastatic colorectal cancer patients and also as a second-line treatment in combination with FOLFOX4 (5-fluorouracil, leucovorin, and oxaliplatin).
TRIBE Trial Results at ASCO GI 2013
Results of the phase III TRIBE trial—comparing bevacizumab plus FOLFOXIRI with bevacizumab plus FOLFIRI—for metastatic colorectal cancer patients who have not been previously treated with chemotherapy were presented at ASCO GI (abstract #336). First-line FOLFOXIRI combined with bevacizumab showed better efficacy compared with the combination with FOLFIRI. A phase II trial had initially showed promise of this combination.The study met its primary endpoint—a median progression-free survival of 11.9 months was seen in the FOLFOXIRI arm compared with 9.5 months in the FOLFIRI arm (hazard ratio [HR] = 0.72; P = .001). Response rates were also higher for the FOLFOXIRI combination—64% compared with 53% in the FOLFIRI group (P = .015). Toxicities were as expected and comparable in the two groups.
AVEX Trial Results at ASCO GI 2013
Another bevacizumab phase III trial reported at the meeting was the AVEX trial of elderly metastatic colorectal cancer patients. The AVEX trial compared bevacizumab in combination with capecitabine or capecitabine alone in previously untreated patients 70 years or older (abstract #337).According to the study researchers, this is the first randomized, prospective trial that has analyzed the benefit of bevacizumab specifically in elderly patients. The results show the combination may be a better treatment that improves elderly patient outcomes. The results validate the use of bevacizumab with capecitabine, a fluoropyrimidine, in elderly patients.
“[These results] confirm a benefit with increased response and tumor control,” said David Cunningham, MD, head of the gastrointestinal unit at the Royal Marsden Hospital in the United Kingdom, and the presenter of the study.
The open-label trial administered bevacizumab to one half of the patients at a 7.5 mg/kg dose every 3 weeks. A total of 280 patients (median age of 76) in 10 countries were part of the trial, which showed the combination prolonged progression-free survival compared with chemotherapy alone. Progression-free survival was 9.1 months for patients taking the combination compared with 5.1 months in the chemotherapy alone arm (HR = 0.53; P < .001).
Overall survival was also improved, but the difference between the two arms was not statistically significant—median overall survival was 20.7 months in the combination arm compared with 16.8 months for the capecitabine arm (HR = 0.79; P = .182). Grade 3 and higher adverse events were more frequent in the combination arm, but researchers said the regimen was generally well tolerated. Grade 3 or higher toxicities were seen in 59% of patients taking bevacizumab plus capecitabine compared with 44.1% of patients taking capecitabine alone.
“This trial result emphasizes that with appropriate selection, patients with advanced colorectal cancer, regardless of age, may benefit from chemotherapy and that the combination of capecitabine and bevacizumab represents a good option that has a favorable balance between efficacy against side effects,” said Cunningham.
Avastin Gets New FDA Indication for Second-Line Treatment
The US Food and Drug Administration (FDA) approved the use of bevacizumab (Avastin) as part of a new combination treatment for the second-line treatment of metastatic colorectal cancer. The drug is now approved in combination with a fluoropyrimidine-based irinotecan or oxaliplatin chemotherapy for metastatic colorectal cancer patients whose cancer has progressed after first-line treatment with a regimen that contains bevacizumab (ie, second-line treatment of bevacizumab/oxaliplatin for patients who received prior therapy of bevacizumab/irinotecan and vice versa).Patients receiving the combination lived longer compared with those who switched to chemotherapy alone as a second-line treatment. Results showed a 19% risk of death reduction for patients on the combination therapy compared with standard chemotherapy alone (HR = 0.81; P = .0057) in the phase III ML18147 trial. The median overall survival was 11.2 months compared with 9.8 months. The results are published in the Lancet Oncology.
Bevacizumab is already approved in combination with chemotherapy as a first-line therapy for metastatic colorectal cancer patients and also as a second-line treatment in combination with FOLFOX4 (5-fluorouracil, leucovorin, and oxaliplatin).
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