The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 499
Slide Session
K-BP-15 Pancreatobiliary
The Effi cacy of Capecitabine Plus Oxaliplatin
Combination Chemotherapy for Advanced Pancreatic Cancer after Failed with Gemcitabine Based Therapy
Kwang Hyun Chung1, Ji Kon Ryu1, Dong Kee Jang1, Ban Seok Lee1, Sang Hyub Lee1, Yong-Tae Kim1
Seoul National University College of Medicine, Korea1
Background: Salvage chemotherapeutic regimen after progressing on gemcitabine based chemotherapy for patients with advanced pancreatic cancer was not estab- lished. The purpose of this study was to evaluate the effi cacy of capecitabine plus ox- aliplatin (XELOX) combination chemotherapy as a salvage treatment for patients with advanced pancreatic cancer progressed after a gemcitabine based chemotherapy.
Methods: Between August 2011 and May 2014, all of the patients who had received XELOX combination chemotherapy after progressed on gemcitabine based chemo- therapy for unresectable or recurred pancreatic ductal adenocarcinoma were recruited retrospectively. Response evaluation was performed every 9 weeks (after 3 cycles) and tumor response rate, progression free survival and overall survival were assessed.
Results: A total of 62 patients, who received at least 1 cycle of XELOX (capecitabine 1000 mg/m2 twice daily for 14 days and oxaliplatin 130 mg/m2 on Day 1, 3-week cycle) combination chemotherapy were included in the study. Of the 46 evaluable pa- tients, 7 (15.2%) patients had a partial response and 19 (41.3%) patients demonstrated stable disease. Median progression-free survival was 103 days (95% confi dence inter- val [95% CI], 54 – 152 days) and median overall survival was 196 days (95% CI, 118 - 274 days). Patients who maintained stable longer at frontline therapy (more than 200 days) were showed signifi cantly longer progression free survival and overall survival.
Most common grade 3-4 adverse event was vomiting (8.1%) followed by anorexia (6.5%). There was 1 treatment related mortality which caused by severe neutropenia and typhlitis.
Conclusions: XELOX combination chemotherapy showed acceptable response rate and survival rate for patients with advanced pancreatic cancer as a salvage treatment after progression on gemcitabine based chemotherapy.
K-BP-16 Pancreatobiliary
Does Reduced Dose of Folfi rinox Guarantee Tumor Response in Unresectable Pancreatic Cancer? : Suggestion for Minimal Relative Dose Intensity
Jong-chan Lee1, Kyu-hyun Paik1, Hyoung Woo Kim1, Yoon Suk Lee1, Jaihwan Kim1, Jin- Hyeok Hwang1
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea1
Background: Since PRODIGE4-ACCORD11 trial opened the era of FOLFIRINOX (5-fl uo- rouracil, oxaliplatin, and irinotecan) in pancreatic cancer, there have been published several reports about modifi ed FOLFIRINOX as a concept of dose reduction. However, it is still unclear how much reduction would be promising as a minimal threshold of effective dose.
Methods: The aim of this study is to investigate minimal relative dose intensity (RDI,%) of FOLFIRINOX to expect tumor response in unresectable pancreatic cancer.
A total of 63 patients treated with FOLFIRINOX from 2012 to 2014 were retrospec- tively reviewed. Assuming four cycles of standard FOLFIRINOX dose as a 100% dose, actually delivered cumulative dose was converted to RDI during the first 8 weeks.
Patients were divided into three groups depending on RDI; group A, RDI=80%; group B, 70=RDI<80%; group C, 50=RDI<70%. Response rate and toxicity were evaluated among three groups.
Results: Among 44 patients who received FOLFIRINOX as a 1st-line chemotherapy, the number of group A, B and C was 13 (30%), 19 (43%) and 12 (27%), respectively.
There was no difference among three groups in mean age, performance status and stage. The response rates in fi rst 8 weeks were 46%, 42% and 0% in group A, B, C, respectively - statistically not different between group A and B, whereas signifi cantly different between group B and C. Grade 3 or more toxicities were not statistically dif- ferent among three groups.
Conclusions: Dose reduction of FOLFIRINOX might be effective to control unresectable pancreatic cancer. However, less than 70% of RDI of FOLFIRINOX showed signifi cantly low response rate, whereas there was no change in terms of severe side effects. We suggest the 70% of RDI as a minimal relative dose intensity to expect tumor response in unresectable pancreatic cancer.
K-BP-17 Pancreatobiliary
Risk Factors Associated with Gallbladder Polyp in Health Promotion Examinee
Sung Bum Kim1, Kook Hyun Kim1, Ho Chan Lee1, Se Hoon Sohn1, Jae Hyun Park1, Yo Han Jeong1, Kyeong Ok Kim1, Si Hyung Lee1, Byung Ik Jang1, Tae Nyeun Kim1 Yeungnam University Mecical Center, Korea1
Background: Gallbladder (GB) polyps are frequently encountered in nowadays. Previ- ous studies have reported male sex, chronic hepatitis B infection, low HDL-cholesterol level and obesity as the risk factors associated with GB polyp. The aim of this study was to identify the risk factors of GB polyp in healthy subjects.
Methods: Patients who underwent examination through health promotion in Yeung- nam university hospital from Jan 2010 to Dec 2013 were included. All patients under- went abdominal ultrasonography and diagnosis of GB polyp was made by abdominal ultrasonography. Their medical records were reviewed and analyzed retrospectively.
Results: A total of 23,899 subjects were included in this study and 1,973 subjects were diagnosed with GB polyp. Mean age of GB polyp group was signifi cantly higher than non-GB polyp group (51.1 ± 10.4 vs 49.9 ± 11.4, p-value=0.001). Male was more predominant in GB polyp group (71.1% vs 54.8%, p<0.001). On univariate analysis, older age, male sex, HDL-cholesterol level, presence of fatty liver, GB stone and higher body mass index were signifi cantly associated with presence of GB polyp. On multi- variate analysis, male sex (odds ratio=1.909, p<0.001), low HDL-cholesterol level (odds ratio=0.996, p=0.019) and GB stone (odds ratio=2.046, p<0.001) were identifi ed as the risk factors associated with GB polyp.
Conclusions: In our study, risk factors for GB polyp were male sex, low HDL-cholester- ol level and GB stone.
K-BP-18 Pancreatobiliary
Gallstone Dissolution Effi cacy According to Stone Density on CT Scan
Jong Jin Hyun1, Jae Min Lee2, Seung Young Kim1, Sang Jun Suh1, Sung Woo Jung1, Young Kul Jung1, Ja Seol Koo1, Hyung Joon Yim1, Hong Sik Lee2, Sang Woo Lee1, Chang Duck Kim2
Korea University Ansan Hospital, Korea1, Korea University Anam Hospital, Korea2
Background: Currently available medications to dissolve gallbladder stones are ur- sodeoxycholic acid(UDCA) or a combination of chenodeoxycholic acid(CDCA) and UDCA. In the previous studies, dissolution effi cacy had been compared after excluding patients with stones evident on plain abdominal X-ray but CT scan was not routinely performed to evaluate the presence of calcifi cation. This study was conducted to com- pare the dissolution effi cacy of UDCA alone or a combination of CDCA and UCDA(C- NU) according to stone density on CT scan.
Methods: Among a total of 393 gallbladder stone patients who presented to the outpatient department of Korea University Ansan Hospital from December 2010 to March 2014, 124 patients underwent dissolution therapy with either CNU(n=61) or UDCA(n=63). Of these patients, 53 were excluded because of follow-up loss (n=37) or symptom development necessitating cholecystectomy(n=6). In the end, 71 patients (CNU group = 42, UDCA group = 29) were included for analysis. Dissolution was con- sidered effective if the largest stone size diameter showed decrease of >50% or com- pletely dissolved. Stone density on CT scan was divided into four groups: hypodense, isodense, hyperdense, and calcifi ed.
Results: The baseline age (49.40±14.85 years vs. 53.59±19.90 years), treatment duration (183.07±16.02 days vs. 180.48±16.10 days), and pre-treatment stone size (8.74±4.25mm vs. 9.20±4.50mm) were not different between the CNU group and UDCA group. Effective dissolution was observed in 26.2% (11/42) and 48.3% (14/29) of patients after CNU and UDCA treatment, respectively (p=0.055). When only those with stones that were hypodense or isodense on CT scan were analyzed, the effective dissolution rate rose to 57.1% (8/14) and 75% (9/12) with CNU and UDCA treatment, respectively (p=0.429).
Conclusions: Patients with gallbladder stones that were hypodense or isodense showed much better dissolution effi cacy. Therefore, CT scan should be performed prior to medication therapy if stone dissolution is intended.
