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      Radioimmunotherapy Improves Survival of Rats with Microscopic Liver Metastases of Colorectal Origin

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          Abstract

          Background

          Half of the patients with colorectal cancer develop liver metastases during the course of their disease. The aim of the present study was to assess the efficacy of radioimmunotherapy (RIT) with a radiolabeled monoclonal antibody (mAb) to treat experimental colorectal liver metastases.

          Methods

          Male Wag/Rij rats underwent a minilaparotomy with intraportal injection of 1 × 10 6 CC531 tumor cells. The biodistribution of 111In-labeled MG1, 1 day after intravenous administration, was determined in vivo and compared with that of an isotype-matched control antibody (UPC-10). The maximal tolerated dose (MTD) of 177Lu-labeled MG1 was determined and the therapeutic efficacy of 177Lu-MG1 at MTD was compared with that of 177Lu-UPC-10 and saline only. RIT was administered either at the day of tumor inoculation or 14 days after tumor inoculation. Primary endpoint was survival.

          Results

          111In-MG1 preferentially accumulated in CC531 liver tumors (9.2 ± 3.7%ID/g), whereas 111In-UPC-10 did not (0.8 ± 0.1%ID/g). The MTD of 177Lu-MG1 was 400 MBq/kg body weight. Both the administration of 177Lu-MG1 and 177Lu-UPC-10 had no side-effects except a transient decrease in body weight. The survival curves of the group that received 177Lu-UPC-10 and the group that received saline only did not differ ( P = 0.407). Administration of 177Lu-MG1 RIT immediately after surgery improved survival significantly compared with administration of 177Lu-UPC-10 ( P = 0.009) whereas delayed treatment did not ( P = 0.940).

          Conclusion

          This study provides proof of principle that RIT can be an effective treatment modality for microscopic liver metastases, whereas RIT is not effective in larger tumors.

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          Most cited references21

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          Cancer statistics, 2007.

          Each year, the American Cancer Society (ACS) estimates the number of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. This report considers incidence data through 2003 and mortality data through 2004. Incidence and death rates are age-standardized to the 2000 US standard million population. A total of 1,444,920 new cancer cases and 559,650 deaths for cancers are projected to occur in the United States in 2007. Notable trends in cancer incidence and mortality rates include stabilization of the age-standardized, delay-adjusted incidence rates for all cancers combined in men from 1995 through 2003; a continuing increase in the incidence rate by 0.3% per year in women; and a 13.6% total decrease in age-standardized cancer death rates among men and women combined between 1991 and 2004. This report also examines cancer incidence, mortality, and survival by site, sex, race/ethnicity, geographic area, and calendar year, as well as the proportionate contribution of selected sites to the overall trends. While the absolute number of cancer deaths decreased for the second consecutive year in the United States (by more than 3,000 from 2003 to 2004) and much progress has been made in reducing mortality rates and improving survival, cancer still accounts for more deaths than heart disease in persons under age 85 years. Further progress can be accelerated by supporting new discoveries and by applying existing cancer control knowledge across all segments of the population.
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            Global cancer statistics in the year 2000.

            D Parkin (2001)
            Estimation of the burden of cancer in terms of incidence, mortality, and prevalence is a first step to appreciating appropriate control measures in a global context. The latest results of such an exercise, based on the most recent available international data, show that there were 10 million new cases, 6 million deaths, and 22 million people living with cancer in 2000. The most common cancers in terms of new cases were lung (1.2 million), breast (1.05 million), colorectal (945,000), stomach (876,000), and liver (564,000). The profile varies greatly in different populations, and the evidence suggests that this variation is mainly a consequence of different lifestyle and environmental factors, which should be amenable to preventive interventions. World population growth and ageing imply a progressive increase in the cancer burden--15 million new cases and 10 million new deaths are expected in 2020, even if current rates remain unchanged.
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              Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma.

              Twelve hundred ninety-six patients with resected colon cancer that either was locally invasive (Stage B2) or had regional nodal involvement (Stage C) were randomly assigned to observation or to treatment for one year with levamisole combined with fluorouracil. Patients with Stage C disease could also be randomly assigned to treatment with levamisole alone. The median follow-up time at this writing is 3 years (range, 2 to 5 1/2). Among the patients with Stage C disease, therapy with levamisole plus fluorouracil reduced the risk of cancer recurrence by 41 percent (P less than 0.0001). The overall death rate was reduced by 33 percent (P approximately 0.006). Treatment with levamisole alone had no detectable effect. The results in the patients with Stage B2 disease were equivocal and too preliminary to allow firm conclusions. Toxic effects of levamisole alone were infrequent, usually consisting of mild nausea with occasional dermatitis or leukopenia, and those of levamisole plus fluorouracil were essentially the same as those of fluorouracil alone--i.e., nausea, vomiting, stomatitis, diarrhea, dermatitis, and leukopenia. These reactions were usually not severe and did not greatly impede patients' compliance with their regimen. We conclude that adjuvant therapy with levamisole and fluorouracil should be standard treatment for Stage C colon carcinoma. Since most patients in our study were treated by community oncologists, this approach should be readily adaptable to conventional medical practice.
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                Author and article information

                Contributors
                +31-24-3619097 , +31-24-3540501 , g.dejong@chir.umcn.nl
                Journal
                Ann Surg Oncol
                Annals of Surgical Oncology
                Springer-Verlag (New York )
                1068-9265
                1534-4681
                9 May 2009
                July 2009
                : 16
                : 7
                : 2065-2073
                Affiliations
                [1 ]Department of Surgery, Division of Abdominal and Oncological Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
                [2 ]Department of Nuclear Medine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
                Article
                477
                10.1245/s10434-009-0477-6
                2695874
                19430843
                84d22cc0-9667-4caa-b073-d3c7f781e624
                © The Author(s) 2009
                History
                : 19 January 2009
                : 25 March 2009
                : 25 March 2009
                Categories
                Translational Research and Biomarkers
                Custom metadata
                © Society of Surgical Oncology 2009

                Oncology & Radiotherapy
                Oncology & Radiotherapy

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