| 1. |
- Le, Nha, et al.
(author)
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Real-world clinical practice of intensified chemotherapies for metastatic pancreatic cancer : results from a Pan-European questionnaire study
- 2016
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In: Digestion. - : S. Karger AG. - 0012-2823 .- 1421-9867. ; 94:4, s. 222-229
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Journal article (peer-reviewed)abstract
- Introduction: Recently, FOLFIRINOX and gemcitabine + nab-paclitaxel have been introduced as a novel intensified chemotherapy regimen for patients with metastasized pancreatic cancer. This study aims to analyze the real-world clinical practice with FOLFIRINOX and gemcitabine + nab-paclitaxel across Europe.Methods: Invitations to participate in an anonymous web-based questionnaire were sent via e-mail to 5,420 doctors in 19 European countries through the network of national gastroenterological, oncological, surgical and pancreatic societies as well as the European Pancreatic Club. The questionnaire consisted of 20 questions, 14 regarding the use of intensified chemotherapy, 4 regarding demographics of the participants, and 1 to verify the active involvement in the management of metastatic pancreatic cancer.Results: Two hundred and thirteen responses were received and 153 entries were valid for analysis. Of those, 63.4% came from an academic institution, 51% were oncologists, and 52% treated more than 25 cases per year. A majority of responses (71%) were from Italy (40%), Germany (23%), and Spain (8%). As first-line therapy, 11% used gemcitabine +/- erlotinib, 42% used FOLFIRINOX, and 47% used gemcitabine + nab-paclitaxel. Of the intensified regimens, both were applied to equal parts, but the likelihood of protocol deviation was higher when using FOLFIRINOX (p < 0.01). FOLFIRINOX was considered more toxic than gemcitabine + nab-paclitaxel (neutropenia 88 vs. 68%; polyneuropathy 42 vs. 41%; rapid deterioration 42 vs. 31%). FOLFIRINOX was rated to achieve longer survival with an acceptable quality of life (52 vs. 44%). Moreover, 57% of participants thought that gemcitabine + nab-paclitaxel should be the backbone for further clinical trials in pancreatic cancer.Conclusion: Intensified chemotherapy is widely used in pancreatic cancer patients in Europe following its recent clinical approval. Interestingly, nab-paclitaxel and FOLFIRINOX were used at comparable frequency although the latter had to be de-escalated more often.
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| 2. |
- Schneider, A, et al.
(author)
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Prevalence and Incidence of Autoimmune Pancreatitis in the Population Living in the Southwest of Germany
- 2017
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In: Digestion. - : S. Karger AG. - 1421-9867 .- 0012-2823. ; 96:4, s. 187-198
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Journal article (peer-reviewed)abstract
- <b><i>Background/Aims:</i></b> The prevalence and incidence of autoimmune pancreatitis (AiP) in those living in western countries are largely unknown. We aimed to determine the prevalence of AiP among patients with pancreatitis presenting to our tertiary referral center in Mannheim, Germany; and to estimate the incidence of AiP in the Southwest of Germany. <b><i>Methods:</i></b> We performed a retrospective cross-sectional analysis and determined the prevalence of AiP in patients with acute pancreatitis (AP) or chronic pancreatitis (CP). Patients (<i>n</i> = 704; alcoholic pancreatitis <i>n</i> = 373, nonalcoholic pancreatitis <i>n</i> = 331) were stratified into the Retrospective-Pancreas-Cohort (RPC, period 1998-2008, <i>n</i> = 534) and the Pancreas-Clinic-Cohort (PCC, periods 2008-2010 and 2013-2014, <i>n</i> = 170, with detailed investigation for features of AiP). Diagnosis of AiP was established by International-Consensus-Diagnostic-Criteria and Unifying-Autoimmune-Pancreatitis-Criteria. <b><i>Results:</i></b> In the RPC, the prevalence of AiP was 5.9% (<i>n</i> = 13/221) among individuals with nonalcoholic pancreatitis (<i>n</i> = 1/61 with AP, 1.6%; <i>n</i> = 12/160 with CP, 7.5%). In the PCC, the prevalence of AiP was 9.1% (<i>n</i> = 10/110) among patients with nonalcoholic pancreatitis (<i>n</i> = 2/24 with AP, 8.3%; <i>n</i> = 8/86 with CP, 9.3%), and 1.7% (<i>n</i> = 1/60) among subjects with alcoholic pancreatitis. We estimated the incidence of AiP with 0.29 per 100,000 population each year. <b><i>Conclusion:</i></b> The prevalence rate of AiP may account for 9% of patients with nonalcoholic pancreatitis but is almost never observed in patients with alcoholic pancreatitis. The incidence of AiP in Germany appears lower than 1 per 100,000 population.
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| 3. |
- Schneider, A, et al.
(author)
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Risk of Cancer in Patients with Autoimmune Pancreatitis: A Single-Center Experience from Germany
- 2017
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In: Digestion. - : S. Karger AG. - 1421-9867 .- 0012-2823. ; 95:2, s. 172-180
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Journal article (peer-reviewed)abstract
- <b><i>Background/Aims:</i></b> Autoimmune pancreatitis (AIP) has been associated with an increased risk of malignant diseases. We aimed to describe the incidence of malignant diseases in patients with AIP compared to the general population and to characterize the clinical presentation of these patients. <b><i>Methods:</i></b> We retrospectively analyzed data from 28 patients with AIP presenting to the clinic (periods 1998 until 2010, 2012 until September 2015). We retrieved the expected cancer incidence of the general population from the German cancer registry. We determined the ratio of patients with malignant disease, characterized the clinical presentation of these patients, and calculated standardized incidence ratios (SIR). <b><i>Results:</i></b> We observed 6 malignant diseases in 5 patients with AIP (non-Hodgkin lymphoma, colon cancer, breast cancer and ovarian carcinoma, breast cancer, bladder cancer, <i>n</i> = 5/28, 17.9%) during an overall observation period of 223 person-years (2,675 months). The overall SIR of cancer in patients with AIP was 17.3 (95% CI 5.9-35.8), and the overall incidence rate of malignant diseases in these patients was significantly increased compared to the expected incidence in the German population (Fisher's exact test, <i>p</i> < 0.001). <b><i>Conclusion:</i></b> The incidence of malignant diseases in patients with AIP is significantly increased compared to the general population. Careful clinical monitoring is required in individuals with AIP to exclude the occurrence of malignancy.
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| 4. |
- Schober, Marvin, et al.
(author)
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New Advances in the Treatment of Metastatic Pancreatic Cancer
- 2015
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In: Digestion. - : S. Karger. - 0012-2823 .- 1421-9867. ; 92:3, s. 175-184
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Research review (peer-reviewed)abstract
- Background: Pancreatic ductal adenocarcinoma (PDAC) is characterised by an extremely poor overall survival (OS) compared to other solid tumours. As the incidence of the disease is rising and the treatment options are limited, PDAC is projected to be the 2nd leading cause of cancer-related deaths in the United States by 2030. A majority of patients are not eligible for curative resection at the time of diagnosis, and those that are resected will often relapse within the first few years after surgery. Summary: Until recently, the nucleoside analogue gemcitabine has been the standard of care for patients with non-resectable PDAC with only marginal effects on OS. In 2011, the gemcitabine-free FOLFIRINOX regimen (folinic acid, fluorouracil, irinotecan and oxaliplatin) showed a significant survival advantage for patients with metastatic PDAC in a phase III trial. In 2013, the Metastatic Pancreatic Adenocarcinoma Trial phase III trial with nano-formulated albumin-bound paclitaxel (nab-paclitaxel) in combination with gemcitabine also resulted in a significant survival extension compared to gemcitabine monotherapy. However, both intensified therapy regimens show a broad spectrum of side effects and patients need to be carefully selected for the most appropriate protocol. Key Message: In this study, recent advances in the chemotherapeutic options available to treat metastatic PDAC and their implications for today's treatment choices are reviewed.
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| 5. |
- Valeur, J, et al.
(author)
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Fecal Fermentation in Irritable Bowel Syndrome: Influence of Dietary Restriction of Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols
- 2016
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In: Digestion. - : S. Karger AG. - 1421-9867 .- 0012-2823. ; 94:1, s. 50-56
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Journal article (peer-reviewed)abstract
- <b><i>Background/Aims:</i></b> Dietary restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) may relieve symptoms in patients with irritable bowel syndrome (IBS). We investigated whether this diet alters microbial fermentation, a process that may be involved in IBS symptom generation. <b><i>Methods:</i></b> Patients with IBS were included consecutively to participate in a 4-week FODMAP restricted diet. IBS symptoms were evaluated by using the IBS severity scoring system (IBS-SSS). Short-chain fatty acids (SCFAs) were analyzed in fecal samples before and after the dietary intervention, both at baseline and after in vitro fermentation for 24 h. <b><i>Results:</i></b> Sixty-three patients completed the study. Following the dietary intervention, IBS-SSS scores improved significantly (p < 0.0001). Total SCFA levels were reduced in fecal samples analyzed both at baseline (p = 0.005) and after in vitro fermentation for 24 h (p = 0.013). Following diet, baseline levels of acetic (p = 0.003) and n-butyric acids (p = 0.009) decreased, whereas 24 h levels of i-butyric (p = 0.003) and i-valeric acids (p = 0.003) increased. Fecal SCFA levels and IBS symptom scores were not correlated. <b><i>Conclusion:</i></b> Dietary FODMAP restriction markedly modulated fecal fermentation in patients with IBS. Saccharolytic fermentation decreased, while proteolytic fermentation increased, apparently independent of symptoms.
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