Trifluridine/tipiracil shows survival benefits in patients with metastatic gastric/gastroesophageal junction cancer

A recent study found that trifluridine/tipiracil shows survival and functioning benefits in patients with metastatic gastric/gastroesophageal junction cancer in later lines of therapy. This study was published in the Journal of cancer research and clinical oncology.

The TAGS trial was a phase 3, randomized study that included 507 patients with metastatic gastric/gastroesophageal junction cancer and ≥ 2 prior chemotherapies. The participants were categorized into the following overlapping subgroups: ramucirumab ± other agents (n = 169), no ramucirumab (n = 338), paclitaxel but no ramucirumab (n = 136), ramucirumab + paclitaxel in combination or sequentially (n = 154). Other subgroups included neither paclitaxel nor ramucirumab (n = 202), irinotecan (n = 281), and no irinotecan (n = 226). Overall and progression-free survival (PFS), safety, and time to Eastern Cooperative Oncology Group performance status (ECOG PS) ≥ 2 were assessed.

Median overall survival across subgroups was found to be 4.6-6.1 versus 3.0-3.8 months while the median PFS was 1.9-2.3 versus 1.7-1.8 months. Similarly, the median time to ECOG PS ≥ 2 was 4.0-4.7 versus 1.9-2.5 months. Median overall and progression-free survival was longer in trifluridine/tipiracil-randomized patients who did not receive ramucirumab, paclitaxel and ramucirumab, or irinotecan. The safety profile for the interventional drug remained consistent across subgroups.

Thus, it can be concluded that trifluridine/tipiracil may show overall and progression-free survival as well as functioning benefits in patients with metastatic gastric/gastroesophageal junction cancer in later lines.

Greater hemostasis and lower rebleeding rates with TC-325 hemostatic powder; treatment for Gastrointestinal Tumor

A recent study found that TC-325 hemostasis powder achieved greater immediate hemostasis rates and lower 30-day rebleeding rates when compared to contemporary standard endoscopic treatment (SET). This study’s results were published in the journal, Gastroenterology.

This study was a multicenter, randomized controlled trial that was patient-and outcome assessor-blinded. Patients who presented with active bleeding from an upper or lower GI lesion were randomly allocated to receive either TC-325 alone or standard endoscopic treatment (SET). A total of 106 patients made it in the study population (55 in TC-325, 51 in SET), with 1 exclusion in TC- 325 and 5 in SET. Primary outcome of the study was 30-day rebleeding while the secondary objectives were immediate hemostasis and other clinically relevant endpoints.

It was observed that the 30-day rebleeding was significantly lower in the TC-325. The immediate hemostasis rates were 100% and 68.6% in the TC-325 group and SET group, respectively. The other secondary outcomes were not different between the two groups. From these results, it may be concluded that when compared to the contemporary SET, TC-325 hemostatic powder results in greater immediate hemostasis rates followed by lower 30-day rebleeding rates.

Comparison of radiofrequency ablation with hybrid argon plasma coagulation for eradicating Barrett's esophagus

A recent study suggests that hybrid argon plasma coagulation (H-APC) has slightly better outcomes than radiofrequency ablation (RFA) for eradicating Barrett’s esophagus following endoscopic resection. This study was published in the journal, Surgical Endoscopy.

This prospective, randomized trial included 101 patients who were randomly assigned to either H-APC (n=54) or RFA (n=47). For the H-APC technique, 60W was applied while RFA consisted of a 90° focal catheter and a simplified protocol of 12 J/cm2 × 3 or with a Halo 360° balloon and 10 J/cm2/cleaning/10 J/cm2. Eradication rates as well as adverse events were reported. Follow-up examinations were done after 3, 6, 12 and 24 months. The median follow-up period for the short-term was 6.0 months while it was 21 months for long term. Overall, 211 ablations were performed.

It was observed that eradication rates after long-term follow-up were 74.2% and 82.9% in the RFA and H-APC groups. The mean score of post-interventional pain was significantly higher at 4.56/10 and duration of 7.54 days while it was 2.07/10 over 3.59 days in the H-APC group. Stenosis that required intervention was reported in 3.7% of patients in the H-APC arm and 14.9% of those in the RFA arm.

From the above results, it can be concluded that although both ablation techniques give good results with respect to the eradication rates, H-APC group showed slightly better outcome. Even the severity and duration of pain were significantly greater for the RFA group than the H-APC group.

Efficacy and safety of thalidomide for the treatment of recurrent bleeding due to small-intestinal angiodysplasia

A recent study suggests that thalidomide is safe and efficacious for use in treating recurrent bleeding due to small-intestinal angiodysplasia (SIA). This study’s results were published in The New England Journal of Medicine.

This multicenter, randomized, double-blind, placebo-controlled trial included 150 patients with at least four episodes of recurrent bleeding during the previous year due to SIA. They were randomized to receive either 100 mg (n=51) or 50 mg (n=49) of oral thalidomide or placebo (n=50) for four months. The patients were followed up for at least one year after the treatment period. The primary endpoint of the study was effective response, marked by reduction of at least 50% of bleeding episodes after thalidomide treatment.

At the end of the treatment period, it was seen that 68.6%, 51.0%, and 16.0% of the patients in the 100-mg thalidomide group, 50-mg thalidomide group, and placebo group, respectively showed effective response. From the above results, it can be concluded that treatment with thalidomide may result in a reduction in bleeding in patients with recurrent bleeding due to SIA.