levoleucovorin and Diabetes-Mellitus

Topics: Aged; Aged, 80 and over; Albumin-Bound Paclitaxel; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Comorbidity; Deoxycytidine; Diabetes Mellitus; Diet; Drug Resistance, Neoplasm; Early Detection of Cancer; Fluorouracil; Gemcitabine; Genetic Predisposition to Disease; Humans; Irinotecan; Leucovorin; Neoadjuvant Therapy; Neoplasm Metastasis; Oxaliplatin; Palliative Care; Pancreatectomy; Pancreatic Neoplasms; Poly(ADP-ribose) Polymerase Inhibitors; Prognosis; Radiosurgery; Risk Factors; Spain

The effect of treatment delay on survival in pancreatic ductal adenocarcinoma (PDAC) remains unclear.. This study aimed to assess the prognostic impact of time to diagnosis and chemotherapy in advanced PDAC and factors influencing the time intervals.. advanced PDAC patients receiving chemotherapy in five centers in the decade 2007-2016 were included. Key time points during care pathway from clinical presentation to beginning of chemotherapy were retrospectively collected. Multivariate Cox proportional hazard model was performed.. A total of 409 patients were included (mean age 66.1 ± 10.3 years; 250 metastatic (61%); 139 received FOLFIRINOX chemotherapy (34%). The median overall survival (OS) was 7.2 months. The median times from first symptoms and from first specialist visit to the beginning of chemotherapy were respectively 100 days and 47 days. None of time intervals was significantly associated with OS. Significant prognostic factors were FOLFIRINOX chemotherapy (HR 0.6 [0.5-0.8]; P < 0.001), metastasis (HR 1.6 [1.3-2.0]; P = 0.001), WHO PS ≥ 2 (HR 1.6 [1.2-2.1]; P < 0.001) and acute pancreatitis as first symptom (HR 2.9 [1.7-4.9]; P < 0.001). Jaundice shortened time to diagnosis (P < 0.001). Acute pancreatitis (P < 0.001) and diabetes (P = 0.01) increased time to treatment.. Wait times from clinical presentation to beginning of chemotherapy do not influence survival in advanced PDAC.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Diabetes Mellitus; Female; Fluorouracil; France; Humans; Irinotecan; Leucovorin; Male; Middle Aged; Multivariate Analysis; Oxaliplatin; Pancreatic Neoplasms; Pancreatitis; Prognosis; Proportional Hazards Models; Retrospective Studies; Time-to-Treatment

The current analysis aims to provide an evaluation of the impact of diabetes mellitus (DM) on the efficacy and safety of first-line FOLFOX chemotherapy for patients with metastatic colorectal cancer (mCRC).. This is a pooled analysis of the comparator arms of two clinical trials (NCT00272051; NCT00305188) which evaluated first-line FOLFOX chemotherapy for patients with mCRC. The overall survival and progression-free survival according to patient subsets (non-diabetic and diabetic patients) were assessed through Kaplan-Meier analysis and log-rank testing. Propensity score matching was additionally conducted to account for heterogeneity in baseline characteristics of different subsets of patients.. A total of 756 patients were enrolled in the current analysis; of which 64 patients have pre-existing DM while 692 patients were non-diabetic. Through Kaplan-Meier analysis, no evidence for overall or progression-free survival difference was found among the two patient subsets (P = 0.501; P = 0.960, respectively). Moreover, metformin treatment does not affect overall or progression-free survival among diabetic patients (P = 0.598; P = 0.748, respectively). Repetition of overall and progression-free survival assessment following propensity score matching does not reveal any differences. Comparing diabetic to non-diabetic patients, there were no differences between the two groups in terms of acute oxaliplatin-induced neurological symptoms including cold-induced dysthesia (P = 0.600), laryngeal dysthesia (P = 0.707), jaw pain (P = 0.743) or muscle pain (P = 0.506). Moreover, no difference was seen between the two groups in terms of the incidence of long-term oxaliplatin-induced paresthesia (P = 0.107), highest grade of paresthesia (P = 0.498) or rates of recovery from paresthesia (P = 0.268). Diabetic patients have, however, a shorter time to develop oxaliplatin-induced paresthesia (P = 0.024).. DM does not seem to affect overall or progression-free survival of mCRC patients treated with first-line FOLFOX chemotherapy. Moreover, DM does not influence the incidence or severity of oxaliplatin-induced paresthesia in those patients while it might lead to a shorter time to develop oxaliplatin-induced paresthesia compared to non-diabetic patients.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Clinical Trials, Phase III as Topic; Colorectal Neoplasms; Comorbidity; Diabetes Mellitus; Drug-Related Side Effects and Adverse Reactions; Female; Fluorouracil; Humans; Kaplan-Meier Estimate; Leucovorin; Male; Middle Aged; Neoplasm Metastasis; Organoplatinum Compounds; Propensity Score; Survival Rate; Treatment Outcome

This retrospective study reports impact of diabetes on incidence rate of dose limiting symptoms of neurological toxicity and chemotherapy induced peripheral neuropathy (CIPN). Post-surgical colorectal cancer (CRC) patients with metastatic disease, treated with four different schedules of FOLFOX were included in this study. Neurological adverse effects were assessed by CTC v2.0. The incidence rate of adverse neurological symptoms in CRC patients, clinically diagnosed with diabetes (n=6) were compared with non-diabetic CRC patients (n=32). The results show that the difference in the incidence rate of paresthesia is significant (p=0.043) between diabetic and non-diabetic patients. The difference in the incidence rates of hypoesthesia (p=0.445), peripheral neuropathy (p=0.889), dizziness (p=0.445), insomnia (p=0.690), taste disturbances (p=0.258), and headache (p=0.498) in diabetic and non-diabetic CRC patients was not significant. The findings indicate that risk of frequent, distal and transient paresthesia within the first few minutes of Oxaliplatin infusion is higher in diabetic CRC patients.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Colorectal Neoplasms; Diabetes Mellitus; Female; Fluorouracil; Humans; Incidence; Leucovorin; Male; Middle Aged; Organoplatinum Compounds; Pakistan; Peripheral Nervous System Diseases; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Young Adult

Pancreatic cancers of the tail have an especially poor prognosis due to their late detection. An earlier diagnosis depends on a better understanding of the clinical course of the disease; however, much of the current literature focuses on pancreatic head adenocarcinomas owing to their higher incidence. Thus, we add our case report to the current literature of pancreatic tail cancers in the hope of aiding earlier detection. We present an interesting case of a patient who initially presented with innocuous abdominal pain and a single episode of vomiting who was subsequently diagnosed with metastatic pancreatic tail cancer.. A 56-year-old Hispanic man with a past medical history of alcohol and cocaine abuse was initially evaluated in our clinic after presenting to the emergency department with sudden onset of abdominal pain and one episode of emesis. On further questioning, he stated that he had been experiencing dull, intermittent left back pain for the past 2-3 years. Laboratory tests were performed, which showed that the patient had new-onset diabetes, and imaging revealed a pancreatic tail mass with metastases to the liver. Biopsy confirmed the diagnosis of stage IV metastatic pancreatic tail adenocarcinoma. During follow-up 1 month later, the patient reported that he had been largely asymptomatic since his hospital admission; however, his left back pain had increased in severity. He was then started on a FOLFIRINOX chemotherapy regimen (5-fluorouracil/leucovorin, irinotecan, and oxaliplatin).. There are many pitfalls in the diagnosis of pancreatic cancer, especially pancreatic tail cancer due to its vague symptoms. Thus, pancreatic cancer of the tail often presents late with a very poor prognosis. Because there is currently no widespread screening for pancreatic cancer, it is often difficult for practitioners to identify pancreatic tail cancers. Current research suggests that there is a strong association between new-onset diabetes after the age of 50 and pancreatic cancer, and tumors detected at the onset of diabetes are favorable to resection. Pancreatic cancer has also been shown to be associated with certain risk factors, such as smoking, high body mass index, chronic pancreatitis, and a family history of pancreatic cancer. Thus, when patients with presentations similar to our patient's with new-onset diabetes after the age of 50, along with vague symptoms such as back or abdominal pain as well as the presence of risk factors, we suggest that it is beneficial for practitioners to maintain a high index of suspicion for pancreatic cancer.

Topics: Abdominal Pain; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Diabetes Mellitus; Diagnosis, Differential; Early Detection of Cancer; Fluorouracil; Humans; Irinotecan; Leucovorin; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Oxaliplatin; Pancreas; Pancreatic Neoplasms; Risk Factors

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cell Transformation, Neoplastic; Cyclophosphamide; Diabetes Mellitus; Doxorubicin; Humans; Hypertriglyceridemia; Insulin Resistance; Leucovorin; Lipodystrophy; Magnetic Resonance Imaging; Male; Methotrexate; Middle Aged; Mycosis Fungoides; Parotid Diseases; Parotid Gland; Prednisone; Skin Neoplasms; Vincristine