Role of Innate Immunity in Colorectal Cancer

Bora Keum Korean Society of Gastrointestinal Cancer 2018 Journal of digestive cancer reports Vol.6 No.1

Chemotherapy and surgical resection are the mainstay of cancer treatment. Particularly for chemotherapy, although it is effective method to care, sometimes cure various cancers, there are many different status of cancer not being controlled by chemotherapy such as recurrence and resistance to chemotherapy. In order to overcome those difficulties during cancer therapy, immunotherapy targeting immune cells and immune associated factors to enhance cancer immunity has been highlighted. Innate immunity plays important roles on initial stage of cancer immunity that are detecting, killing cancer cells and initiating adaptive immunity for cancer. So many basic and clinical studies to manage innate immunity for cancer therapy have been going on, and most of them were to stimulate innate immune cells including dendritic cell, macrophage, monocyte, and natural killer cell in various ways. They showed promising results but still there are many things to be resolved before clinical application. Herein, I review the role of innate immune cells and therapeutic trials for colorectal cancer.

Importance of Early Diagnosis and Screening, Lessons from Gastric Cancer and Colorectal Cancer

Seun Ja Park Korean Society of Gastrointestinal Cancer 2014 Journal of digestive cancer reports Vol.2 No.1

Screening and early diagnosis of cancer is important. Screening lead to detect disease earlier, and earlier treatment of disease cause to yield a better outcome than treatment at the onset of symptoms. Some studies suggest that gastric cancer screening may be associated with a reduced risk of mortality from gastric cancer, although there are no definitive data from large controlled trials. Regular colorectal cancer screening or testing is one of the most powerful weapons for preventing colorectal cancer, because some polyps, or growths can be found and removed before they have the chance to turn into cancer. Screening can also result in finding colorectal cancer early, when it is highly curable. In conclusion, to increase utilization of screening is important to decrease gastric and colorectal cancer morbidity and mortality.

Micronutrients as Supportive Care for Gastrointestinal Cancer Patients; Benefits and Concerns

Yoo-Sun Kim,Yuri Kim Korean Society of Gastrointestinal Cancer 2013 Journal of digestive cancer reports Vol.1 No.2

Cancer is the first leading cause of death in Korea and the second leading cause of death in the USA. There is extensive research into prevention of cancer and the support of oncology patients with diet or dietary supplements. In vitro and in vivo animal studies have indicated that antioxidants, including beta-carotene, alpha-tocopherol, and ascorbic acid, can yield anti-cancer effects in addition to providing protection against oxidative damage. Although many observational studies have shown that consuming fruits and vegetables can reduce the risk of some cancers, the results of several large-scale human intervention trials testing the benefits of a single or combined higher-dose of individual micronutrients have been inconsistent. Cancer can cause profound metabolic and physiological changes which may affect patients' nutrient requirements. Although the optimal route of nutrient delivery is through diet, cancer patients often suffer symptoms that disrupt their food intake, including anorexia, premature satiety, altered taste and smell, and changes in bowel mobility. In particular, micronutrient deficits can slow postoperative healing, contribute to depression symptoms, and decrease immune competence. Cancer patients are generally motivated to take dietary supplements to improve responses to treatment and quality of life. The Physician's Health Study II (PHS II) randomized controlled trial reported recently that daily multivitamin supplementation significantly, albeit modestly, reduced the risk of total cancer. Although evidence of multivitamin use benefits is limited in cancer patients, taking dietary supplements with constituents in the range of the recommended daily allowance according to the Dietary Reference Intake (DRI) recommendation is generally considered to be safe.

STAT3 and SHP-1: Toward Effective Management of Gastric Cancer

Moon Kyung Joo Korean Society of Gastrointestinal Cancer 2018 Journal of digestive cancer reports Vol.6 No.1

The importance of signal transducer and activator of transcription 3 (STAT3) signaling in gastric carcinogenesis was firmly evaluated in the previous studies. Fully activated STAT3 induces various target genes involving tumor invasion and epithelial-mesenchymal transition (EMT), and mediates interaction between cancer cells and microenvironmental immune cells. Thus, suppression of STAT3 activity is an important issue for inhibition of gastric carcinogenesis and invasion. Unfortunately, data from clinical studies of direct inhibitor targeting STAT3 have been disappointing. SH2-containing protein tyrosine phosphatase 1 (SHP-1) effectively dephosphorylates and inhibits STAT3 activity, which has not been extensively studied gastric cancer research field. However, by summarizing recent data, it is evident that protein and gene expression of SHP-1 are minimal in gastric cancer cells, and induction of SHP-1 effectively downregulates phosphorylated STAT3 and inhibits cellular invasion in gastric cancer cells. Several SHP-1 inducers have been investigated in the experimental studies, including proton pump inhibitor, arsenic trioxide, and other natural compounds. Taken together, we suggest that modulation of SHP-1/STAT3 signaling axis may present a new way for treatment of gastric cancer, and development of effective SHP-1 inducer may be an important task in the future search field of gastric cancer.

Oxaliplatin and Leucovorin Plus Fluorouracil Combination Chemotherapy as a First-line versus Salvage Treatment in HER2-negative Advanced Gastric Cancer Patients

Hee Seok Moon,Jae Ho Park,Ju Seok Kim,Sun Hyung Kang,Jae Kyu Seong,Hyun Yong Jeong Korean Society of Gastrointestinal Cancer 2018 Journal of digestive cancer reports Vol.6 No.1

Background: In Korea, stomach cancer is the second most common malignancy and the third leading cause of cancer-related deaths. the time of diagnosis is very important for treatment so early detection and surgery are currently considered the mainstay of treatment, when diagnosed advanced with tumor extension through the gastric wall and direct extension into other organs, with metastatic involvement. Recently, new drugs, drug combinations, and multimodal approaches have been used to treat this disease and In cancers over expressing or amplifying HER2, the combination of cisplatin-fluoropyrimidine-trastuzumab is considered to be the treatment of reference. but At present, the choice of treatment schedule for HER2-negative tumors is based on the medical institution's preferences and adverse effects profile. The aim of this study was to evaluate the effectiveness and safety of using FOLFOX regimen as a first-line therapy or a salvage therapy in the patients with HER2-negative advanced or metastatic gastric cancer. Methods: We retrospective reviewed the patient medical record from March 2012 to July 2017. This study evaluated 113 patients. Sixty-eight patients were treated with the FOLFOX regimen for the first time (first-line group) and 45 patients were treated with the FOLFOX regimen as a second (35 patients) or third (10 patients) chemotherapy (salvage group). Results: In the first-line group, the response rate was 54.9%. In the salvage therapy group, the response rate was 24.4% and The difference was statistically significant (p=0.205). The median TTP of the first-line group was 10.7 months (95% confidence interval [95% CI], 7.8-13.7 months) and that of salvage line group was 6.1 months (95% CI, 3.8-8.4 months). The median OS of the first-line group was 15.8 months (95% CI, 12.7-18.9 months) and that of the salvage therapy group was 10.2 months (95% CI, 8.2-11.9 months). drug toxicity was similar andtolerable between two groups. Conclusion: In patients with unresctable metastatic gastric cancer, after failing to respond to first-line therapy, most patients have no alternative other than second-line therapy because the disease is highly progressive. if the performance status of the patient is good enough to be eligible to treatments beyond best supportive care. FOLFOX regimen can be a considerable therapeutic option for salvage treatment.

Quality of Life Findings of Adjuvant FOLFOX4 vs. XELOX in Stage III Colon Cancer Patients

Moo In Park,Youn Jung Choi,Seun Ja Park,Won Moon,Sung Eun Kim,Jae Hyun Kim,Byung Kwon Ahn,Sung Uhn Baek,Seung Hyun Lee,Seung Hun Lee Korean Society of Gastrointestinal Cancer 2017 Journal of digestive cancer reports Vol.5 No.2

Background: To compare the quality of life (QoL), the convenience of chemotherapy and satisfaction between colon cancer patients treated with FOLFOX4 and XELOX. Methods: The study was conducted in 26 patients with stage III colon cancer. Patients were received FOLFOX4 (n=17) or XELOX (n=9). QoL, convenience, and satisfaction were assessed using the Quality of Life Questionnaire-C30 (QLQ-C30), Quality of Life Questionnaire-Chemotherapy Induced Peripheral neuropathy (QLQ-CIPN) and Functional Assessment of Chronic Illness Therapy Chemotherapy Convenience and Satisfaction Questionnaire (FACIT-CCSQ), respectively. Patients completed questionnaires at baseline, at cycle 4 (C4) and cycle 8 (C8) (FOLFOX4) or at cycle 3 (C3) and cycle 6 (C6) visits (XELOX) and at their final visit. Results: In the QLQ-C30, at the final visit, XELOX patients had better functional scores than FOLFOX4 patients (physical: 85.7 vs.60.4, p=0.03; role: 83.3 vs. 57.5, p=0.04) as well as better symptom scores (constipation: 9.5 vs. 40.4, p=0.01). In CIPN, at the C6/C8 visit, XELOX patients had lower motor scale scores than FOLFOX4 patients (3.8 vs. 21.6, p=0.02). Moreover, at the C6/C8 visit, XELOX was more convenient than FOLFOX4 in FACIT-CCSQ (79.7 vs. 55.5, p=0.04). Male patients were especially likely to consider XELOX to be more convenient (90.0 vs. 55.0, p=0.01) and satisfactory (55.4 vs. 26.2, p=0.03) and fewer concern (91.0 vs. 65.0, p=0.03) than FOLFOX4. XELOX patients spent fewer days on hospital visits at C3/C4, C6/C8 and final visit (2.8 vs. 4.2, p=0.01; 2.7 vs. 4.1, p=0.01; 3.0 vs. 4.5, p=0.01). Conclusion: XELOX may be a better adjuvant chemotherapy choice for patients with colon cancer than FOLFOX4 in terms of QoL, convenience, and satisfaction.

Stool-based MicroRNA for Early Diagnosis of Colorectal Cancer

Ji Hye Choi,Young-Seok Cho Korean Society of Gastrointestinal Cancer 2013 Journal of digestive cancer reports Vol.1 No.2

MicroRNA (miRNA) dysregulations are associated with various types of human cancers, and miRNAs can function as tumor suppressors and oncogenes. Emerging evidence has shown that miRNA pathway is also altered during colorectal tumorigenesis. The detection of cancer-related miRNAs in stool samples may become useful diagnostic marker for colorectal cancer, because miRNAs in stool samples has high stability, and maintains a high portion of its original level. Recent studies reported that stool-based miRNAs can offer more sensitivity and specificity than currently used stool-based screening methods for CRC. In addition, unlike fecal occult blood test, sampling on consecutive dates and special dietary restrictions are not required. In this review, the authors discuss stool-based miRNA for the early diagnosis of CRC and perspectives on future application.

Best Treatments in Borderline Resectable Advanced Pancreatic Cancer

Joon Seong Park Korean Society of Gastrointestinal Cancer 2016 Journal of digestive cancer reports Vol.4 No.2

Pancreatic cancer is the lethal disease and the prognosis of pancreatic cancer has remained largely unchanged over the past years. Borderline advanced pancreatic cancer is a biological different from resectable pancreatic cancer due to higher risk of early recurrence because of artery/vein abutment. Therefore this unique subset of pancreatic cancer has a controversial issue with regard to their treatment policy. Some institutes managed borderline advanced pancreatic cancer by up-front neoadhuvant chemotherapy because neoadjuvant chemotherapy provide the opportunity to treat early micro-metastasis with unfavorable tumor biology. But, some institutes try aggressive up-front surgical procedures to provide a chance of long-term survival in highly selected patients. Therefore this unique subset of pancreatic cancer has a controversial issue with regard to their treatment policy. This review address recent treatment trend for patients with borderline advanced pancreatic cancer.

Current Status of Robotic-assisted Surgery in Gastric Cancer

Eli Kakiashvili Korean Society of Gastrointestinal Cancer 2016 Journal of digestive cancer reports Vol.4 No.2

Minimally invasive surgery for gastric cancer has increased in popularity during the last two decades mainly in the Asia for patients with early-stage cancer. Nevertheless, the development of laparoscopic surgery for gastric cancers in the Western world has been slow because of the advanced stage at diagnosis for which LG is not yet considered an acceptable alternative to standard open surgery. RAG has been reported as a safe alternative to conventional surgery for treating of early gastric carcinoma. We assess the current status of robotic surgery in the treatment of gastric cancer focusing on the technical details, postoperative outcome, oncological considerations and future perspectives. In gastrectomy the biggest advantage of the robotic approach is the ease and reproducibility of lymphadenectomy. Reports also show that even the intra corporeal digestive restoration is facilitated by use of the robotic approach, particularly following TG. Additionally, the accuracy of robotic dissection is confirmed by decreased blood loss in comparison to conventional laparoscopy. The learning curve and technical reproducibility also appear to be shorter with robotic surgery and, consequently, robotics can help to standardize and diffuse minimally invasive surgery in the treatment of gastric cancer. While published reports have shown no significant differences in surgical morbidity, mortality, or oncological adequacy between robot-assisted and conventional gastrectomy. There are some advantages in terms of postoperative recovery of patients after robotic surgery. More studies are needed to assess the true indications and oncological effectiveness of robotic use in the treatment of gastric carcinoma.

Current and New Molecularly Targeted Agents for Metastatic Gastric Cancer

Sung Chul Park Korean Society of Gastrointestinal Cancer 2015 Journal of digestive cancer reports Vol.3 No.1

The discovery of HER2, a biomarker in advanced gastric cancer, and successful clinical trial using trastuzumab that targets this biomarker signaled a revolutionary turning point in treatment of metastatic gastric cancer. Many studies about targeted agents for gastric cancer have been attempted. Among them, ramicirumab, a monoclonal antibody that targets vascular endothelial growth factor receptor-2 (VEGFR-2), and apatinib, a tyrosine kinase inhibitor (TKI) that targets VEGFR2, have shown to improve the survival rates in advanced gastric cancer patients, for whom previous therapies had failed; hence, they are expected to be accepted as one of the standard therapies for advanced gastric cancer.