Gan to kagaku ryoho. Cancer & chemotherapy
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Gan To Kagaku Ryoho · Oct 2014
[Tolerability and efficacy of regorafenib in patients with unresectable metastatic colorectal cancer].
Regorafenib is an orally administered multikinase inhibitor that was approved for the treatment of unresectable metastatic colorectal cancer in Japan last year, following an international phase 3 trial(CORRECT)that provided evidence of a survival benefit. However, some concerns remain about high odd ratios of specific adverse events. ⋯ The efficacy of regorafenib was confirmed in late-stage cases that were refractory to standard chemotherapies. Most adverse events were manageable, although treatment was discontinued permanently in some cases because of hand-foot skin reactions, fatigue, and liver injury. The duration of treatment was short, but disease control, OS, and PFS were similar to those found in the CORRECT trial.
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Some trials have demonstrated the benefits of maintenance chemotherapy for advanced colorectal cancer. In chemotherapeutic strategies for advanced colorectal cancer, chemotherapy-related toxicity prevention and quality of life(QOL)maintenance are more important than the introduction of a strong regimen, especially when additional surgery is not possible. In Japan, the combination of a folinic acid/5-fluorouracil/oxaliplatin(FOLFOX)regimen and bevacizumab is a popular first-line chemotherapy regimen. ⋯ Additionally, the ML18147 trial demonstrated that bevacizumab beyond progression(BBP)prolonged overall survival(OS)and progression free survival(PFS)in patients with advanced colorectal cancer. Although those trials demonstrated the effectiveness of continuous or maintenance bevacizumab administration, no trials have compared the effectiveness of cytotoxic drugs with bevacizumab as maintenance therapies. Moreover, controversy exists regarding the selection of drugs as a maintenance therapy and the identification of patients who would benefit from maintenance therapy.
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Carcinomas of unknown primary are cancers that are pathologically diagnosed as carcinomas based on the findings of metastatic lesion biopsy but in which the primary site remains unknown even after thorough and detailed examinations. In the clinical setting, pathological diagnosis and diagnostic imaging are very important for cases of carcinoma of unknown primary. ⋯ In clinical practice, it is very important not to miss cases of favorable prognosis group, which is 20% of unknown cancer. Recently, microarray studies have been performed for cases of carcinoma of unknown primary.