DOI: 10.1097/DCR.0b013e3182781fbe
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Issn Print: 0012-3706
Publication Date: 2013/02/01
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Excerpt
Resectability and outcomes with anti-EGFR agents in patients with KRAS wild-type colorectal liver-limited metastasis: a meta-analysis
Petrelli F, Barni S. Int J Colorectal Dis. 2012;27:997–1004.
PURPOSE: This study evaluated the effects of anti-EGFR agents in patients with unresectable KRAS wild-type, liver-only metastases from colorectal carcinoma (CRC).
METHODS: This meta-analysis from Treviglio, Italy included 4 randomized controlled trials (RCT) comparing 1st line chemotherapy ± anti-EGFR agents (cetuximab or panitumumab) for patients with unresectable liver-limited metastatic CRC. The study endpoints were progression free /overall survival and conversion to resectability.
RESULTS: A total of 4 RCTs included 484 patients with KRAS wild-type CRC. Compared to chemotherapy alone, the addition of anti-EGFR agents significantly increased: overall response rate (RR 1.67, p = 0.0001), R0 resection rate (from 11% to 18%) (RR 1.59, p = 0.04), and progression free survival (HR 0.68, p = 0.002) but not overall survival (p = 0.42).
CONCLUSION: The addition of anti-EGFR agents to conventional chemotherapy increased the R0 resection rate by 60% and reduced the risk of progression by 32% for patients with unresectable liver-limited metastases from CRC.
Abstractor’s Comments: This study summarized information which was already known regarding the treatment of metastatic CRC. It also serves to emphasize that conversion chemotherapy may allow patients with initially unresectable liver-limited metastases from CRC to become candidates for curative resection. One limitation of this analysis is that the RCTs used different primary chemotherapeutic regimens (FOLFIRI vs FOLFOX).–Ian M. Paquette, M.D.
Split-dose picosulfate, magnesium oxide, and citric acid solution markedly enhances colon cleansing before colonoscopy: a randomized, controlled trial
Flemming JA, Vanner SJ, Hookey LC. Gastrointest Endosc. 2012;75:537–544.
PURPOSE: Studies of bowel preparation agents for colonoscopy have suggested that split-dose regimens may further enhance efficacy. This study examined whether a split-dose of picosulfate, magnesium oxide, and citric acid solution increased bowel cleansing efficacy while maintaining tolerability and safety.
METHODS: Patients who underwent colonoscopy (mean age 56 years, 53.8% women) at the Hotel Dieux Hospital (Kingston, Ontario) between October 2008 and March 2010 were invited into the study. Patients in the traditional arm (n = 109) consumed 1 sachet of solution at 5:00 P.M. and 11:00 P.M. the night before colonoscopy. Patients in the split-dose arm (n = 113) consumed 1 sachet at 7:00 P.M. the night before and another sachet 4 hours before their colonoscopy. Patients were also asked to drink only clear liquids the day before the colonoscopy. In addition, 2 5-mg tablets of bisacodyl were ingested for 2 consecutive nights before starting the preparation (day 2 and day 3 precolonoscopy). The Ottawa Bowel Preparation Scale (OBPS) was used to score the preparation. OBPS scores are calculated by assigning a number (0–4) for the quality of preparation in the right, middle and rectosigmoid colon each, plus a score (0–2) for the overall fluid present. The higher the score (maximum = 14), the poorer the visibility.
RESULTS: Overall, the OBPS scores in the split-dose group were significantly improved vs the traditional dose group (4.05 vs 5.51, p < 0.001). This was mostly attributed to improvements in right-sided colon cleansing (1.22 in split-dose vs 2.14 in traditional arm, p < 0.001), and this was seen for both morning and afternoon colonoscopies. Both regimens were well tolerated by patients, and no safety issues were identified.
CONCLUSION: The split-dose regimen of picosulfate, magnesium oxide, and citric acid solution provided superior colon cleansing for colonoscopy vs the traditional night-before-colonoscopy dosing regimen.
Abstractor’s Comments: The preparation described in this study, Pico-Salax (PSLx) is a compound which has been commercially available in Canada since 2004 and has been used for >20 years in Europe and Australia. PSLx is currently under review by the US FDA.
