The Acceptable Toxicity Level Of New Chemotherapeutic Regimen

For lesions > 3 cm TACE should be preferred because its effectiveness appears to be better in well-vascularized tumors with large feeding arteries and the possible advantage of DEBs-TACE over lipiodol-TACE should be investigated in future studies. Also the role of alternative treatments such as MWA and TARE needs to be investigated in a larger number of patients. But it must be clear that the use of any type of treatment as a Downstaging tool in patients with decompensated liver should be cautiously to avoid irreversible liver failure and severe complications precluding LT. ( Clavien PA et al.,2012).

Usually, radiation therapy is treated by neoadjuvant, adjuvant or definitive treatment with systemic therapy. Around 20% to 80 % of the patients with cancer received radiation therapy through the way of their treatment (de Gonzalez et al., 2011). In this treatment the radiation is usually given along with chemotherapy, which is recognized as chemoradiation or chemoradiotherapy. The Duke University conducts investigational study of neoadjuvant radiation therapy in 96 resectable patients. Everyday patients who received 50.4 Gy dose of radiotherapy are combined with 5-FU-based chemotherapy. After this patients were then surgically findout if there was no evidence of metastatic disease and less mortality. Overall survival (OS) and median survival was (28%:23 months) respectively (Spitz et al., 1997; White and Tyler, 2004). In 1980’s The Gastro-intestinal Tumor Study Group (GITSG) conducted randomized study in purpose of adjuvant chemoradiotherapy in resected pancreatic cancer. After R0 resection 49 patients were treated with chemorediotherapy for evaluation of adjuvant

This is a 43-year-old male who came in ER with complain of weight loss, about 50 pounds in last 4 months, intermittent vomiting, abdominal pain. Patient has been admitted to hospital as an inpatient as his CT scan showed severe bowel perforation and peritonitis. Patient underwent for exploratory laparotomy followed by sigmoidectomy with colostomy. His previous CT scan (02/2016) revealed multiple liver lesions, largest measuring left hepatic lobe 4 x 5.5 cm and the right hepatic lobe as well as multiple periportal and peripancreatic adenopathy in the stomach and pancreas measuring , and periportal node and prominent epigastric notes. He had a CT-guided biopsy of the liver on 03/02/2016 which revealed carcinoma consistent with Stage IV squamous cell carcinoma of stomach and esophagus with metastasized to the liver. The patient has been on chemotherapy, recently completed 3rd cycle on chemotherapy.

The epidermal growth factor receptor (EGFR) is the cell-surface receptor for extracellular protein ligands. EGFR family has four closely related receptor tyrosine kinases: EGFR (ErbB-1), HER2/c-neu, Her 3 and Her 4. Mutations affecting EGFR expression or activity could lead to cancer.

There are so many risks associated with the use of chemotherapy drugs to treat cancer. The major reason for this is that, chemotherapy drugs works on both normal cells and cancer cells. Therefore, while killing cancer cells, it kills normal cells as well. Additional risk can arise from overdose, extravasation (when an injected drug finds its way from the intended vessel to surrounding tissues) from cancer injections and serious damage to important organs of the body. Thankfully, drugs like Totect (Dexrazoxane Hydrochloride) have been developed to combat the effects of any risk that manifest in patients while undergoing chemotherapy.

The Phase II trial was randomized and placebo-controlled that enrolled 164 patients with previously untreated GI cancers. These patients received ramucirumab in combination with oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX) or a placebo plus FOLFOX. The main endpoint of the Phase II trials was to test progression free survival (PFS), but other end points also included overall response rate (ORR), safety, and overall survival. The results of these trials found that there was no improvement in PFS or median OS, but that there was a significant increase in disease control rate (management of metastasis), which allowed the drug to move to Phase III trials

Description: I had the chance to work on multiple manuscripts pertaining to colorectal cancer in African Americans and Caucasians. My contribution included compiling the results from each experiment and inputting them into the corresponding manuscript, creation of all necessary tables and figures, as well as proofreading all sections to correct any mistakes.

Chemoprevention is a form of a clinical population prevention, proposed at diminishing the probability of disease advancement, not across the population but in recognized high-risk individuals and not by behavioral or lifestyle modification, but by the use of pharmaceutical agents43. In other words, it is the use of specific drugs to keep cancer from forming, growing, or recurring. Prescribing chemotherapy to a patient is one of the most difficult conundrums for medical practitioners. While chemotherapy can be beneficial, it can only be successful in certain settings and once animal studies have truly been exhausted to validate the efficacy of the pharmaceutical agents.

One gene that is prominent in the regulation and development of cells is the Tumor Suppressor Gene. The function of the Tumor Suppressor Gene is to inhibit cell growth when it is deemed necessary in the body. When this gene is mutated is result in the overgrowth of cells because the body can not inform the proper cells to stop growing which can lead to cancer. Cells begin to take up space and oxygen without regard to the other cells around them. The gene “p53” is a common mutation of tumor suppressor genes and is said to be a cause and the development of cancers such as breast cancer. The problem with this mutation is that at the G1 checkpoint of interphase the mutated cell moves directly from G1 to S phase and produces two daughter cells with the mutated p53 gene. The Tumor Suppressor gene “apc” is also mutated in a majority of colorectal cancers. Researchers found that two protein inactivating mutations at apc result in sporadic tumors on the colerectum. Another gene that aids in cell reproduction is the Proto-Oncogene. The proto-oncogene stimulates cell growth. When this gene is mutated is results in the overgrowth of cells because the body is stimulating the cells to continue to divide and produce uncontrollably which can cause cancer because again cancer is defined as the uncontrollable division of cells. The oncogene version of the ras family has been proven to be present in a variety of cancers. The ras family has three major genes including H-ras, K-ras and N-ras. When ras genes are mutated they grow uncontrollably and evade death signals. The gene “k-ras” has played an early role in the development of pancreatic cancer. The last prominent gene that aid in cell cycle is DNA Repair Genes. DNA Repair Genes correct mistakes in DNA, mistakes which result in certain parts of the DNA producing the incorrect protein and function. When this gene is mutated the gene is

Cancer is often conceived as a single disease. The general idea of cancer deals with the proliferation of cell division amounting into tumors. The cause of cancer and how it’s treated is what scientists have spent decades trying to understand. In recent decades, scientists have been effective in characterizing the “hallmarks” of cancer and better understanding the disease through the use of molecular biology techniques. Additionally, scientists have been successful in understanding the influence that environmental factors and genetics play in the progression of cancer. Cancer is now understood to be caused by the mutation of genes leading to the activation/inactivation

Colorectal cancer (CRC) is the third most common cancer in the world, with nearly 1.4 million new cases diagnosed in 2012. Almost 55% of the cases occur in more developed regions. About 95% of those diagnosed are adenocarcinomas, malignant tumors that form from glandular structures of the epithelial tissues, and mortality is primarily due to hepatic metastasis. It is predicted that by 2035, there will be 2.4 million cases of colorectal cancer diagnosed annually worldwide. http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/colorectal-cancer-statistics

’s radiotherapy and Capecitabine treatment he presented a troubling set of symptoms. He was tired, lacked appetite, and felt an overall depression in his mood and health. His physicians expected his symptoms to originate from metastatic disease or tumor progression but no signs of either were found. A CT scan was ordered and revealed thickening of the second portion of the duodenum, which may have been the first sign of liver disease caused by PVT. By the beginning of 2014 there were still no tumor recurrence or metastatic disease in the chest, abdomen, or pelvis, but he exhibited worsening cachexia. The patient took a series of two liver function tests within two months. The first showed mild elevation of liver enzymes. The next month, repeat liver function tests revealed the worsening condition of his disease (Table 2) accompanied by declining

A total of 40 patients (64.5%) were restaged after modified-FOLFIRINOX treatment. The response of these patients was evaluated and is shown in Table 2. No CR was observed, while 13 (32.5%) patients with MPC showed PR. PD was the most common response in MPC (n = 16, 40%). A total of 54 patients (87.1%) presented with elevated CA19-9 levels before chemotherapy and the response was evaluated in 32 of them. A decrease in CA19-9 was observed in 25 patients (25/32, 78.1%) at the first response evaluation time point. The median survival time of the decreased group was 12 months, while that of the others was 7 months with a p-value of less than 0.01 (Figure 1a). A temporary increase in CA19-9 levels (more than 1.5 times baseline) was observed in 11

The conventional treatment for a stage IV colorectal cancer would be a palliative surgery to resect the primary tumour but this poses high risk of mortality and morbidity when distant metastases are present. In addition, since the patient has experienced significant weight loss and their condition is declining they are not stable enough for surgery (Van der Pool et al., 2012). Surgery is also best suited for tumours located in the left colon rather than the right colon, which is not the case for the discussed patient (Van der Pool et al., 2012). Not being eligible for palliative primary tumour resection is not a huge concern as the patient is not experiencing obstruction, perforation, or bleeding (Van der Pool et al., 2012). In fact, studies

David is a 49-year-old male diagnosed with stage IV malignant neoplasm of colon/rectum (C18.9), along with anemia. David was previously treated with Folfox, avastin, folfiri and a hemicolectomy but still experienced disease progression. David’s disease is aggressive and progressive. David’s testing identified a KRAS exon 2 mutations, TS is un-mutated, studies show that some colon cancer patients with this mutation do not have positive outcomes following treatment with anti-EGFR medications. Stivarga improves survival and delays cancer progression among patients with metastatic colorectal cancer that has worsened in spite of other treatments. Due to his advancing age and disease state, David is currently unable to tolerate IV chemotherapy.