Notes From the ASCO ,June 2012(current info may be sensitive to some)
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Hi, every one,
NOTE #3 Role of PET in assessment of response on oncology-6/5/2012 ASCO
http://www.ncbi.nlm.nih.gov/pubmed/19097774
http://www.ncbi.nlm.nih.gov/pubmed/22084190
http://www.springerlink.com/content/922w65631232m585/
http://www.springerlink.com/content/l175667m6876759w/?MUD=MP
Summary: Role of PET in assessment of response on oncology.
1. Reduction in tissue uptake of FDG is associated with a pathologic response and improved survival.
2. No change or new FDG uptake is less likely pathologic response and worse survival.
3. Complete metabolic response(CMR) for PET is = complete resolution FDG uptake and no new lesions.
4. Partial metabolic response (PMR)for PET is = 30% reduction in FDG uptake (PERCIST), or 25% on (EORTC); no new lesions,no CT progression.
5. Stable metabolic response is = no new lesions, and not CMR or PMR.
6. Progressive metabolic disease for PET is = >30% increase FDG uptake (PERCIST ),not related to infection ; or new lesions or increase in tumor extent.(FDG/CT).
7. There are EORTC,RECIST,PERCIST,IHP, and LONDON, 5 various criteria for assessment using CT and PET for treatment response. there was low correlation among the 5 criteria used for treatment response. there was good correlation between EORTC,PERCIST and LONDON criteria and these were best correlated with clinical outcome; RECIST had the lowest performance.
God bless.Hi, Lainy,
I will get back to you, I cannot answer your question right out of my head,but i will find it out for you, Happy travelling to your big party.
God bless.Percy, weird question. my daughter heard tonight that a client of hers (real estate) has a friend in Singapore who was just diagnosed with CC. He is 69 and they are wanting to do a Whipple as it is in the bile ducts. BUT they are talking of doing Chemo first. I have never heard of doing chemo before a Whpple, have you? In fact they wouldn’t even give Teddy chemo after the Whipple. They may be joining the CC site, not sure, but Robin told them about us. I was wondering about the Chemo before a Whipple.
Hi,everyone,
NOTE#2 about stats of biliary cancer for 1,057 patients.
(item #6 may be of interest if if you have resection done.)
In a study named ” Biliary Tract Cancer: A large institutional experience” done by Mairead McNamara,Jennifer J.Knox etc. at Princess Margaret Hospital among others. This study involved 1,057 pts with diagnosis of biliary tract cancer were followed from diagnosis to death between 1987-September,2011.
Findings:
1.Among others,,definitive surgery was performed on 41% of the 1,057 patients.
2. ADJUVANT chemotherapy(ct) or concurrent with chemo-radiotherapy (ct/R) were given only in 19% and 8% respectively; However,35% (ct) and 2% (ct/R) were given for UNRESECTABLE or metastatic disease in first-line palliative treatment of ALL biliary tract cancer respectively which included gallbadder and ampulla of vater cancer.3.Gemcitabine alone (55%) and Chemo+radiation(30%)and 5Fu (9%) were given in the adjuvant setting ; while Gem-5FU/capecitabine (46%),
gemcitabine alone (22%) and GEM/platium (18%) were given to the unresectable or metastatic disease group respectively in order of utilization frequency.
4.Most of the cancer were diagnosed at the stage IV ; for example,
30% of the distal bile duct CA; 52% of the Klatskin CCA; 59% of the intrahepatic CCA were discovered at stage IV.5.Surgery were performed on 48% of the distal bile duct patients; 30% on Klatskin patients and 59% on intrahepatic CCA.
6.Median time to recurrence post surgery are as follows;
18.8 months for distal bile duct patients; 17.6 months for Klatskin and 14.2 months for the intrahepatic CCA.7.Of all thos 1,057 patients, 267 (25%) patients are still alive.
Conclusions:
This is a very large biliary cancer cohort study. The different locations of the cancer clearly have a different prognosis. However ,therapeutic advancement mandates finding additional drug option and appropriate adjuvant care.God bless.
Thanks, Percy. I think a lot of it is what many of you have been saying all along and it just proves what brilliance sits on our Board here. We need research, reaserch, research which mean raising $$$$$$$$$$! Hope you are doing well.
Hi, everyone,
Now and then I will post the information I learned here whenn I review my notes during those sessions. Here is one . BUT
IF YOU ARE NOT COMFORTABLE TO READ ABOUT IT ,THEN JUST SKIP IT.NOTE#1
I went thru the notes from the ASCO 2012 convention about CCA; One of the he author belief that ” first, there is no definitive evidence we have ever benefited patients with adjuvant therapy for biliary tract cancers; Second, it is possible that adjuvant therapy will have differential effects depending on site of primary(IH,hilar,GB,EH) and third, the role of radiation may vary depending on site of primary.” The author also indicated the challenges of treating biliary cancers because of ” the heterogeneous of the disease. It is a uncommon tumor
and CCA and HCC are lumped together in annual statistics( in the past).Multiple locations– intrahepatic,extrahepatic(bile ducts,Klatzkin,periampullary); gallbadder. and we can’t be sure that these locations are truly the same pathology; and there are mixed tumor types(cholangiocellular). He concluded that in systemic therapy for biliary cancers, chemotherapy is the standard treatment and the level1 evidence standard is gemcitabine and cisplatin. Other combined regimens have activity. The FUTURE of this disease should lie in targeted therapies and there are a lot of targets and these should be applied wisely,however ,these are rare tumors and subdividing them by biomarkers may prove difficult.”
God bless,
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