Appendix cancer medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Appendix cancer}} | {{Appendix cancer}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{Soroush}} | ||
==Overview== | ==Overview== | ||
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*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2]. | *Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2]. | ||
Systemic chemotherapy for metastatic appendiceal adenocarcinoma has not been studied appropriately. | *Systemic chemotherapy for metastatic appendiceal adenocarcinoma has not been studied appropriately. | ||
Many experts refer to current colorectal cancer chemotherapy approaches for adenocarcinoa of appendix | *Many experts refer to current colorectal cancer chemotherapy approaches for adenocarcinoa of appendix | ||
*'''Current colon cancer chemotherapy agents''' | :*'''Current colon cancer chemotherapy agents''' | ||
:*5-fluorouracil (5-FU) : Traditional active agent | ::*5-fluorouracil (5-FU) : Traditional active agent | ||
:*Irinotecan | ::*Irinotecan | ||
:*Oxaliplatin | ::*Oxaliplatin | ||
:*Vascular endothelial growth factor receptor inhibitors (bevacizumab) | :*Vascular endothelial growth factor receptor inhibitors (bevacizumab) | ||
:*Epidermal growth factor receptor inhibitors (cetuximab and panitumumab), | ::*Epidermal growth factor receptor inhibitors (cetuximab and panitumumab), | ||
:*Aflibercept | ::*Aflibercept | ||
:*Regorafenib: inhibitor of angiogenic tyrosine kinases (including the VEGF receptors 1,2, and 3), | ::*Regorafenib: inhibitor of angiogenic tyrosine kinases (including the VEGF receptors 1,2, and 3), | ||
:*Capecitabine or 5-FU with or without a platinum drug | ::*Capecitabine or 5-FU with or without a platinum drug | ||
*'''FOLFOX6 has been widely recommended in patients with appendix adenocarcinoma.''' | *'''FOLFOX6 has been widely recommended in patients with appendix adenocarcinoma.''' | ||
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:*Oxaliplatin, 5-FU and leucovorin or Capecitabine are active agents of the FOLFOX regime. Please see below for the details of FOlFOX6 <math>\blacktriangledown</math> | :*Oxaliplatin, 5-FU and leucovorin or Capecitabine are active agents of the FOLFOX regime. Please see below for the details of FOlFOX6 <math>\blacktriangledown</math> | ||
==='''Modified FOLFOX6'''<ref name="pmid12177775">Cheeseman SL, Joel SP, Chester JD, Wilson G, Dent JT, Richards FJ et al. (2002) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12177775 A 'modified de Gramont' regimen of fluorouracil, alone and with oxaliplatin, for advanced colorectal cancer.] ''Br J Cancer'' 87 (4):393-9. [http://dx.doi.org/10.1038/sj.bjc.6600467 DOI:10.1038/sj.bjc.6600467] PMID: [https://pubmed.gov/12177775 12177775]</ref><ref name="pmid18640933">Hochster HS, Hart LL, Ramanathan RK, Childs BH, Hainsworth JD, Cohn AL et al. (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18640933 Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer: results of the TREE Study.] ''J Clin Oncol'' 26 (21):3523-9. [http://dx.doi.org/10.1200/JCO.2007.15.4138 DOI:10.1200/JCO.2007.15.4138] PMID: [https://pubmed.gov/18640933 18640933]</ref> : Cycle length 14 days=== | ==='''Modified FOLFOX6'''<ref name="pmid12177775">Cheeseman SL, Joel SP, Chester JD, Wilson G, Dent JT, Richards FJ et al. (2002) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12177775 A 'modified de Gramont' regimen of fluorouracil, alone and with oxaliplatin, for advanced colorectal cancer.] ''Br J Cancer'' 87 (4):393-9. [http://dx.doi.org/10.1038/sj.bjc.6600467 DOI:10.1038/sj.bjc.6600467] PMID: [https://pubmed.gov/12177775 12177775]</ref><ref name="pmid18640933">Hochster HS, Hart LL, Ramanathan RK, Childs BH, Hainsworth JD, Cohn AL et al. (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18640933 Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer: results of the TREE Study.] ''J Clin Oncol'' 26 (21):3523-9. [http://dx.doi.org/10.1200/JCO.2007.15.4138 DOI:10.1200/JCO.2007.15.4138] PMID: [https://pubmed.gov/18640933 18640933]</ref> : Cycle length 14 days=== | ||
* | *'''Oxaliplatin''' 85 mg/m <sup>2</sup> IV | ||
:*Dilute with 250 mL 5 percent dextrose in water (D5W) | |||
:*Administer over 2 hrs | |||
:*''Avoid extravasation: May cause significant tissue damage'' | |||
*'''Leucovorin''' 400 mg/m <sup>2</sup> IV (d,l-racemic mixture) / 200 mg/m <sup>2</sup> IV (l-leucovorin) | |||
:*Dilute with 250 mL D5W | |||
:*Administer over 2 hrs concurrent with oxaliplatin. | |||
* | *'''Fluorouracil (FU)''' 400 mg/m <sup>2</sup> IV bolus | ||
:*Slow IV push over 5 mins (administer immediately after leucovorin) | |||
* | :*'''Fluorouracil (FU)''' 2400 mg/m <sup>2</sup> IV | ||
:*Administer immediately after FU IV bolus | |||
:*Dilute with 500 to 1000 mL D5W | |||
:*Administer over 46 hours | |||
*'''Doses should be recalculated if there is a 10 percent or more change in body weight.''' | |||
* '''Prior to each treatment<math>\blacktriangledown</math>''' | |||
:* Assess changes in neurologic function | |||
:* Assess electrolytes and liver and renal function | |||
:* CBC with differential and platelet count | |||
'''Common complications and approaches to complications''' | |||
* '''Diarrhea:''' | |||
:* Grade 2 or worse diarrhea <math>\blacktriangledown</math> | |||
:** Withhold treatment | |||
:** Restart at a lower dose of FU after complete resolution | |||
:* '''Severe diarrhea, mucositis, and myelosuppression after FU''' <math>\blacktriangledown</math> | |||
:** Evaluate for dihydropyrimidine dehydrogenase deficiency | |||
*'''Neurologic toxicity''' | |||
:*In order to decrease chance of developing Oxaliplatin induced neuropathy recommend patients to avoid exposure to cold up to 48 hours after each infusion. | |||
:*Transient grade 3 paresthesias/dysesthesias / grade 2 symptoms lasting longer than 1 week<math>\blacktriangledown</math> | |||
:**Decrease oxaliplatin dose by 25 percent. | |||
:*Grade 4 or persistent grade 3 paresthesia/dysesthesia<math>\blacktriangledown</math> | |||
:**Discontinue oxaliplatin | |||
*'''Myelotoxicity''' | |||
* | :*Total white blood cell count <3000 cells/mm <sup>3</sup> , absolute neutrophil count <1500 cells/mm <sup>3</sup> , or platelets <100,000 /mm <sup>3</sup> on the day of treatment<math>\blacktriangledown</math> | ||
:**Delay treatment cycle by one week | |||
** | :*''If treatment is delayed for '''two weeks''' or delayed '''for one week on two separate occasions,''' eliminate FU bolus'' | ||
** | :*If occurred again<math>\blacktriangledown</math> | ||
*** | :**Reduce infusional FU by 20 percent and | ||
:**Reduce oxaliplatin dose from 65 mg/m <sup>2</sup> . | |||
==References== | ==References== |
Revision as of 23:27, 29 January 2019
Appendix cancer Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]
Overview
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Medical Therapy
- Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
- Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
- Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
- Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
- Systemic chemotherapy for metastatic appendiceal adenocarcinoma has not been studied appropriately.
- Many experts refer to current colorectal cancer chemotherapy approaches for adenocarcinoa of appendix
- Current colon cancer chemotherapy agents
- 5-fluorouracil (5-FU) : Traditional active agent
- Irinotecan
- Oxaliplatin
- Vascular endothelial growth factor receptor inhibitors (bevacizumab)
- Epidermal growth factor receptor inhibitors (cetuximab and panitumumab),
- Aflibercept
- Regorafenib: inhibitor of angiogenic tyrosine kinases (including the VEGF receptors 1,2, and 3),
- Capecitabine or 5-FU with or without a platinum drug
- FOLFOX6 has been widely recommended in patients with appendix adenocarcinoma.
- Oxaliplatin, 5-FU and leucovorin or Capecitabine are active agents of the FOLFOX regime. Please see below for the details of FOlFOX6 <math>\blacktriangledown</math>
Modified FOLFOX6[1][2] : Cycle length 14 days
*Oxaliplatin 85 mg/m 2 IV :*Dilute with 250 mL 5 percent dextrose in water (D5W) :*Administer over 2 hrs :*Avoid extravasation: May cause significant tissue damage *Leucovorin 400 mg/m 2 IV (d,l-racemic mixture) / 200 mg/m 2 IV (l-leucovorin) :*Dilute with 250 mL D5W :*Administer over 2 hrs concurrent with oxaliplatin. *Fluorouracil (FU) 400 mg/m 2 IV bolus :*Slow IV push over 5 mins (administer immediately after leucovorin) :*Fluorouracil (FU) 2400 mg/m 2 IV :*Administer immediately after FU IV bolus :*Dilute with 500 to 1000 mL D5W :*Administer over 46 hours *Doses should be recalculated if there is a 10 percent or more change in body weight.
- Prior to each treatment<math>\blacktriangledown</math>
- Assess changes in neurologic function
- Assess electrolytes and liver and renal function
- CBC with differential and platelet count
Common complications and approaches to complications
- Diarrhea:
- Grade 2 or worse diarrhea <math>\blacktriangledown</math>
- Withhold treatment
- Restart at a lower dose of FU after complete resolution
- Severe diarrhea, mucositis, and myelosuppression after FU <math>\blacktriangledown</math>
- Evaluate for dihydropyrimidine dehydrogenase deficiency
- Grade 2 or worse diarrhea <math>\blacktriangledown</math>
- Neurologic toxicity
- In order to decrease chance of developing Oxaliplatin induced neuropathy recommend patients to avoid exposure to cold up to 48 hours after each infusion.
- Transient grade 3 paresthesias/dysesthesias / grade 2 symptoms lasting longer than 1 week<math>\blacktriangledown</math>
- Decrease oxaliplatin dose by 25 percent.
- Grade 4 or persistent grade 3 paresthesia/dysesthesia<math>\blacktriangledown</math>
- Discontinue oxaliplatin
- Myelotoxicity
- Total white blood cell count <3000 cells/mm 3 , absolute neutrophil count <1500 cells/mm 3 , or platelets <100,000 /mm 3 on the day of treatment<math>\blacktriangledown</math>
- Delay treatment cycle by one week
- If treatment is delayed for two weeks or delayed for one week on two separate occasions, eliminate FU bolus
- If occurred again<math>\blacktriangledown</math>
- Reduce infusional FU by 20 percent and
- Reduce oxaliplatin dose from 65 mg/m 2 .
- Total white blood cell count <3000 cells/mm 3 , absolute neutrophil count <1500 cells/mm 3 , or platelets <100,000 /mm 3 on the day of treatment<math>\blacktriangledown</math>
References
- ↑ Cheeseman SL, Joel SP, Chester JD, Wilson G, Dent JT, Richards FJ et al. (2002) A 'modified de Gramont' regimen of fluorouracil, alone and with oxaliplatin, for advanced colorectal cancer. Br J Cancer 87 (4):393-9. DOI:10.1038/sj.bjc.6600467 PMID: 12177775
- ↑ Hochster HS, Hart LL, Ramanathan RK, Childs BH, Hainsworth JD, Cohn AL et al. (2008) Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer: results of the TREE Study. J Clin Oncol 26 (21):3523-9. DOI:10.1200/JCO.2007.15.4138 PMID: 18640933