Joe-Bin Chen’s research while affiliated with Chung-Shan Medical University Hospital and other places

Malnutrition is a common problem in patients with metastatic colorectal cancer (mCRC) receiving targeted therapy plus chemotherapy, resulting in severe toxicity and decreased survival rates. This retrospective study employing propensity score matching (PSM) examined the efficacy and safety of a supplemental home parenteral nutrition (HPN) program for patients with RAS wild-type mCRC receiving cetuximab plus chemotherapy. This retrospective nationwide registry study included data from 14 medical centers/hospitals across Taiwan, and the data period ranged from November 2016 to December 2020. Patients with RAS wild-type mCRC receiving cetuximab plus chemotherapy as their first-line therapy were included and divided into HPN and non-HPN program groups. HPN was initiated based on patient-specific factors, such as baseline nutritional status, treatment-related toxicities, and comorbidities. Clinical outcomes were evaluated using response to therapy, duration of response (DoR), progression-free survival (PFS), and overall survival (OS). This study recruited 758 patients, of whom 110 and 648 were included in the HPN and non-HPN program groups, respectively. After 1:3 PSM, the data of 109 and 327 patients from the HPN and non-HPN program groups were analyzed, respectively. The HPN program group had a higher metastasectomy rate (33.9% vs. 20.2%, p = 0.005), and longer duration of treatment and DoR than the non-HPN program group (13.6 vs. 10.3 and 13.6 vs. 9.9 months, p = 0.001 and < 0.001, respectively). The HPN program group tended to have a longer median PFS (18.2 vs. 13.9 months, p = 0.102). Moreover, we noted a significant improvement in the median OS in the same group (53.4 vs. 34.6 months, p = 0.002). Supplemental HPN programs may be recommended for select patients with mCRC receiving targeted therapy plus chemotherapy to improve oncological outcomes.

Background En bloc right hemicolectomy plus pancreaticoduodenectomy (PD) is administered for locally advanced colon carcinoma that invades the duodenum and/or pancreatic head. This procedure may also be called colo-pancreaticoduodenectomy (cPD). Patients with such carcinomas may present with acute abdomen. Emergency PD often leads to high postoperative morbidity and mortality. Here, we aimed to evaluate the feasibility and outcomes of emergency cPD for patients with advanced colon carcinoma manifesting as acute abdomen. Methods We retrospectively reviewed 4898 patients with colorectal cancer who underwent curative colectomy during the period from 1994 to 2018. Among them, 30 had locally advanced right colon cancer and had received cPD. Among them, surgery was performed in 11 patients in emergency conditions (bowel obstruction: 6, perforation: 3, tumor bleeding: 2). Selection criteria for emergency cPD were the following: (1) age ≤ 60 years, (2) body mass index < 35 kg/m², (3) no poorly controlled comorbidities, and (4) perforation time ≤ 6 h. Three patients did not meet the above criteria and received non-emergency cPD after a life-saving diverting ileostomy, followed by cPD performed 3 months later. We analyzed these patients in terms of their clinicopathological characteristics, the early and long-term postoperative outcomes, and compared findings between emergency cPD group (e-group, n = 11) and non-emergency cPD group (non-e-group, n = 19). After cPD, staged pancreaticojejunostomy was performed in all e-group patients, and on 15 of 19 patients in the non-e-group. Results The non-e-group was older and had a higher incidence of associated comorbidities, while other clinicopathological characteristics were similar between the two groups. None of the patients in the two groups succumbed from cPD. The postoperative complication rate was 63.6% in the e-group and 42.1% in the non-e-group (p = 0.449). The 5-year overall survival rate were 15.9% in the e-group and 52.6% in the non-e-group (p = 0.192). Conclusions Emergency cPD is feasible in highly selected patients if performed by experienced surgeons. The early and long-term positive outcomes of emergency cPD are similar to those after non-emergency cPD in patients with acute abdominal conditions.

Background The only curative option for locally advanced colon carcinoma invading duodenum and/or pancreatic head is the en-bloc right hemicolectomy plus pancreaticoduodenectomy (PD), so called colo-pancreaticoduodenectom (cPD). Patients with this disease may present as an acute abdomen. Emergent PD often has high postoperative morbidity and mortality. Here we aimed to evaluate the feasibility and outcomes of emergent cPD for such patients of advanced colon carcinoma, manifesting as life-threatening acute abdominal conditions.Patients and Methods We retrospectively review of 4,793 patients who underwent curative colectomy for the treatment of colorectal cancer in the period from 1993 and 2017. Among these patients, 30 had locally advanced right colon cancer and underwent a cPD. The cPD of 11 patients were performed in acute abdomen conditions (bowel obstruction 6, perforation 3, tumor bleeding 2). Selection criteria for emergent cPD were: (1) age ≦60 years, (2) body mass index <35 kg/m ² , (3) no poorly-controlled comorbidities, and (4) perforation time ≤6 hours. Three patients who failed to meet these criteria received non-emergent cPD after a life-saving diverting ileostomy, and cPD was performed three months later. The patients clinicopathological characteristics, the early and long-term postoperative outcomes were compared between emergent cPD (e-group, n=11) and non-emergent cPD (non-e group, n=19). After cPD, staged pancreaticojejunostomy (PJ) was performed in all e-group, and on 15 of 19 non-e group patients.ResultsThe non-e group had significant higher patient age and higher incidence of associated comorbidities, while clinicopathological characteristics were otherwise similar. None of the patients in the two groups succumbed from cPD. Postoperative complication rate was 63.6% in the e-group, and 42.1% in the non-e group (p=0.449). The 5-year overall survival rate was 15.9% in the e-group, and 52.6% in the non-e-group (p=0.192).Conclusions In highly selected patients, emergent cPD is feasible by cooperation of experienced colorectal and pancreatic surgeons. The early and long-term outcomes of emergent and were similar to those after non-emergent cPD.

Background For locally advanced colon carcinoma that invades duodenum and/or pancreatic head is en-bloc right hemicolectomy plus pancreaticoduodenectomy (PD). This procedure may be also named as colo-pancreaticoduodenectomy (cPD). Patients with such carcinoma may abdomen. Emergent PD often leads to high postoperative morbidity and mortality. Here, we aimed to evaluate the feasibility and outcomes of emergent cPD, for patients with advanced colon carcinoma, manifest acute abdomen condition.Patients and Methods We retrospectively reviewed of 4,793 patients of colorectal cancer, receiving curative colectomy, during the period from 1993 and 2017. Among them, 30 had locally advanced right colon cancer and had received cPD. Among them, surgery of 11 patients was performed in emergent conditions (bowel obstruction 6, perforation 3, tumor bleeding 2). Selection criteria for emergent cPD were the following: (1) age £60 years, (2) body mass index <35 kg/m ² , (3) no poorly-controlled comorbidities, and (4) perforation time ≤6 hours. Three patients did not meet the above criteria received non-emergent cPD after a life-saving diverting ileostomy, followed by cPD, performed three months later. We analyzed these patients in terms of their clinicopathological characteristics, the early and long-term postoperative outcomes, and compared findings between emergent cPD group (e-group, n=11) and non-emergent cPD group (non-e group, n=19). After cPD, staged pancreaticojejunostomy was performed in all e-group, and on 15 of 19 patients in the non-e group. ResultsThe non-e group was older, and had a higher incidence of associated comorbidities, while other clinicopathological characteristics were, similar between the two groups. None of the patients in the two groups succumbed from cPD. Postoperative complication rate was 63.6% in the e-group, and 42.1% in the non-e group (p=0.449). The 5-year overall survival rate was 15.9% in the e-group, and 52.6% in the non-e-group (p=0.192).Conclusions Emergent cPD is feasible in highly selected patients if performed by experienced surgeons. The early and long-term positive outcomes of emergent cPD are similar to those after non-emergent cPD in patients with acute abdominal conditions.

Aim Uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) polymorphism plays a crucial role in the increased susceptibility of patients to irinotecan and its toxicity. This study is a multicenter, randomised clinical trial comparing the clinical outcomes and adverse events (AEs) in metastatic colorectal cancer (mCRC) patients treated with bevacizumab plus FOLFIRI with or without UGT1A1 genotyping and irinotecan dose escalation as the first-line therapy. Methods The control group received conventional biweekly FOLFIRI plus bevacizumab without UGT1A1 genotyping, whereas the study group received the same regimen with irinotecan dose escalation based on UGT1A1 genotyping. The primary end-point was progression-free survival (PFS), and secondary end-points were overall response rate (ORR), disease control rate (DCR), overall survival (OS), AEs and metastasectomy rate. Results Over a median follow-up of 26.0 months (IQR, 17.0–35.0 months), study group (n = 107) was superior to the control group (n = 106) in PFS, OS, ORR, DCR, and metastasectomy rate (all P < 0.05). Furthermore, there were no significant differences in AEs ≥ grade III between the two groups, even with the 1.36-fold increase in the relative dose intensity of irinotecan in the study group. Dose escalation of irinotecan, an independent factor of ORR (P < 0.001) and DCR (P = 0.006), improved PFS in mCRC patients with wild-type and mutant KRAS (P = 0.007 and P = 0.019, respectively). Conclusion The current study revealed that mCRC patients, regardless of KRAS gene status, with UGT1A1 genotyping can tolerate escalated doses of irinotecan and potentially achieve a more favourable clinical outcome without significantly increased toxicities. Clinical trial registration NCT02256800.

Aim: This phase II, open-label study evaluated the efficacy and safety of neoadjuvant therapy with bevacizumab plus XELOX (capecitabine and oxaliplatin) for untreated metastatic colorectal cancer with unresectable liver metastases and assessed conversion of unresectable to resectable metastases after neoadjuvant treatment. Methods: Patients received bevacizumab 5 mg/kg and oxaliplatin 85 mg/m(2) on day 1, and capecitabine 1000 mg/m(2) twice daily on days 1-5 followed by 2 days of rest in a 14-day cycle for 12 cycles; bevacizumab was excluded in cycles 6 and 7. Patients were later divided into resected and unresected groups, depending upon whether they underwent curative resection after chemotherapy. Efficacy and safety were evaluated. Results: Of 45 patients enrolled, 17.8% completed the study. The resection rate of liver metastases after neoadjuvant therapy was 42.2%. The median time to disease progression was 10.1 and 8.7 months in the resected and unresected groups, respectively (P = 0.1341). Response rate was significantly higher in the resected (47.4%) versus the unresected group (34.6%; P = 0.0010), and seven patients achieved complete response (resected group). Overall, 94.3% of adverse events were of mild or moderate severity, and grade ≥3 adverse events occurred in 4.3% and 7.3% of patients in the resected and unresected groups, respectively. The most common adverse events in both groups were palmar-plantar erythrodysesthesia syndrome, decreased appetite, thrombocytopenia, peripheral neuropathy, fatigue, diarrhea, vomiting, proteinuria and nausea. Conclusion: Neoadjuvant therapy with bevacizumab plus XELOX was well tolerated and effective in previously untreated metastatic colorectal cancer patients with initially unresectable liver metastases.

The treatment of metastatic melanoma is challenging. BRAF gene mutation is found in 40–60% of melanoma cases, the most common being the V600E mutation. Vemurafenib was approved by the Food and Drug Administration in 2011 as target therapy for the treatment with BRAF V600 mutation-positive metastatic melanoma. We report a case of metastatic amelanotic melanoma with unknown primary cancer as the initial presentation. The patient presented with neutrophilic septal panniculitis 1 week after vemurafenib treatment, which is a rare cutaneous toxicity of BRAF inhibitor. We also review the current literature on management of BRAF inhibitor-related adverse skin effects.

Castleman's disease (CD) is a rare, benign lymphoproliferative disorder that can involve single lymph node stations or can be systemic. Unicentric CD in patients with microcytic anemia is rarely described in the English literature. We describe the case of a 19-year-old Chinese woman with hyaline vascular type of unicentric CD presenting as severe non-iron deficiency microcytic anemia. We report the clinical course from the initial presentation to diagnosis and surgical cure, and discuss the most up-to-date information on CD. CD should be included in the differential diagnosis of microcytic anemia. Imaging tools and pathological studies should be considered in order to make a more accurate diagnosis and to avoid the use of ineffective treatments.

Pelvic irradiation has been a popular therapy modality for cervical cancer for many years, and its usage in rectal cancer and prostate cancer cases is on the rise. However, it is associated with significant side effects. In this study, we compared the different characteristics of surgical and nonsurgical patients who were treated for radiation enterocolitis, the treatment results, posttreatment quality of life (QOL), nutrition status, and predisposing factors for surgery. From 1985 to 2009, the records of a total of 89 patients with chronic radiation enterocolitis in our hospital were retrospectively reviewed for demographic data, operative data and long-term treatment results. Posttreatment QOL and nutrition status were also recorded. Univariate and multivariate analyses were performed to identify the independent predicting factors associated with surgical intervention. Characteristics of surgical and nonsurgical patients were compared. Radiotherapy before 1995, concomitant radiation uropathy and smoking were independent predictive factors for surgery. Surgical and nonsurgical cases had similar Kaplan-Meier curves. Although the recurrence rate of radiation enterocolitis was much higher for the surgical group (p = 0.031), both groups had similar QOL score (median: 8 vs.7; p = 0.709), serum albumin level (3.29 g/dL vs. 3.16 g/dL; p = 0.095), and body mass index (20.19 vs. 19.86; p = 0.603). We confirmed that as compared with recently developed innovative techniques, early primitive radiotherapy techniques were associated with more severe radiotherapy complications that required surgery. Smoking may enhance patients' vulnerability to severe radiation injury. Surgery for radiation-induced intestinal obstruction, intestinal fistula and perforation is warranted because QOL, serum albumin level and body mass index were similar between the surgical and nonsurgical groups.