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Curbside Consultation in GI Cancer for the Gastroenterologist
Are you looking for concise, practical answers to questions that are often left unanswered by traditional cancer references that are not designed for gastroenterologists? Are you seeking brief, evidence-based advice for complicated cases or patients with complications that need management? Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions provides quick and direct answers to the thorny questions commonly posed during a \"curbside consultation\" between colleagues.
Dr. Douglas G. Adler has designed this unique reference, which offers expert advice, preferences, and opinions on tough clinical questions commonly associated with GI cancer. The unique Q&A format provides quick access to current information related to GI cancer with the simplicity of a conversation between two colleagues. Numerous images, diagrams, and references are included to enhance the text and to illustrate the treatment of GI cancer patients.
Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions provides information basic enough for residents while also incorporating expert advice that even high-volume clinicians will appreciate. Gastroenterologists, fellows and residents in training, surgical attendings, and surgical residents will benefit from the user-friendly and casual format and the expert advice contained within.
Some of the questions that are answered:
An 81-year-old man is found to have unresectable esophageal cancer and malignant dysphagia. Should he have a stent? A nasogastric feeding tube? A PEG tube?
How is tumor-related bleeding from gastric cancers best approached?
Do patients with pancreatic cancer and jaundice need to have an ERCP preoperatively?
What is the role of ERCP and EUS in patients with suspected cholangiocarcinoma?
Why are rectal cancers so different from colon cancers with regards to medical and surgical management?
Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions illustrates how patients at different points in their treatment may go back and forth between specialists to receive coordination of care, and incorporates input from gastroenterologists, surgeons, radiologists, and oncologists. While providing up-to-date information, this book will help gastroenterologists to manage complex cancer-related issues and guide physicians through the maze of cancer-related treatments available.
Ideal for practicing gastroenterologists, gastroenterology fellows, surgeons, oncologists, residents, and medical students, Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions is sure to benefit anyone caring for patients with gastrointestinal cancers.
eBook
Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib (GRID): an international, multicentre, randomised, placebo-controlled, phase 3 trial
Until now, only imatinib and sunitinib have proven clinical benefit in patients with gastrointestinal stromal tumours (GIST), but almost all metastatic GIST eventually develop resistance to these agents, resulting in fatal disease progression. We aimed to assess efficacy and safety of regorafenib in patients with metastatic or unresectable GIST progressing after failure of at least imatinib and sunitinib.
We did this phase 3 trial at 57 hospitals in 17 countries. Patients with histologically confirmed, metastatic or unresectable GIST, with failure of at least previous imatinib and sunitinib were randomised in a 2:1 ratio (by computer-generated randomisation list and interactive voice response system; preallocated block design (block size 12); stratified by treatment line and geographical region) to receive either oral regorafenib 160 mg daily or placebo, plus best supportive care in both groups, for the first 3 weeks of each 4 week cycle. The study sponsor, participants, and investigators were masked to treatment assignment. The primary endpoint was progression-free survival (PFS). At disease progression, patients assigned placebo could crossover to open-label regorafenib. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01271712.
From Jan 4, to Aug 18, 2011, 240 patients were screened and 199 were randomised to receive regorafenib (n=133) or matching placebo (n=66). Data cutoff was Jan 26, 2012. Median PFS per independent blinded central review was 4·8 months (IQR 1·4–9·2) for regorafenib and 0·9 months (0·9–1·8) for placebo (hazard ratio [HR] 0·27, 95% CI 0·19–0·39; p<0·0001). After progression, 56 patients (85%) assigned placebo crossed over to regorafenib. Drug-related adverse events were reported in 130 (98%) patients assigned regorafenib and 45 (68%) patients assigned placebo. The most common regorafenib-related adverse events of grade 3 or higher were hypertension (31 of 132, 23%), hand-foot skin reaction (26 of 132, 20%), and diarrhoea (seven of 132, 5%).
The results of this study show that oral regorafenib can provide a significant improvement in progression-free survival compared with placebo in patients with metastatic GIST after progression on standard treatments. As far as we are aware, this is the first clinical trial to show benefit from a kinase inhibitor in this highly refractory population of patients.
Bayer HealthCare Pharmaceuticals.
Journal Article
Be good to your gut : the ultimate guide to gut health-- with 80 delicious recipes to feed your body and mind
\"What if the answer to being the healthiest and happiest you could be is down to your gut and the complex and diverse kingdom of bugs that live there? Be Good to Your Gut will be an insightful and beautifully curated book based that will help you to better understand digestion. Based on Eve Kalinik's modern, fresh and innovative approach to gut health, it will arm you with the knowledge of what truly reflects a healthy and happy gut, and teach you how to translate this onto the plate with colourful, vibrant and energetic foods. Combining solid science and practical advice with inspiring and delicious recipes, Be Good to Your Gut will highlight the importance of good gut health and the many reasons to be enthusiastic about healthy eating. It will teach readers how to use food to support digestion, without sacrificing taste and flavour.\"--Provided by publisher.
Book
Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study
Background
Autism spectrum disorders (ASD) are complex neurobiological disorders that impair social interactions and communication and lead to restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. The causes of these disorders remain poorly understood, but gut microbiota, the 10
13
bacteria in the human intestines, have been implicated because children with ASD often suffer gastrointestinal (GI) problems that correlate with ASD severity. Several previous studies have reported abnormal gut bacteria in children with ASD. The gut microbiome-ASD connection has been tested in a mouse model of ASD, where the microbiome was mechanistically linked to abnormal metabolites and behavior. Similarly, a study of children with ASD found that oral non-absorbable antibiotic treatment improved GI and ASD symptoms, albeit temporarily. Here, a small open-label clinical trial evaluated the impact of Microbiota Transfer Therapy (MTT) on gut microbiota composition and GI and ASD symptoms of 18 ASD-diagnosed children.
Results
MTT involved a 2-week antibiotic treatment, a bowel cleanse, and then an extended fecal microbiota transplant (FMT) using a high initial dose followed by daily and lower maintenance doses for 7–8 weeks. The Gastrointestinal Symptom Rating Scale revealed an approximately 80% reduction of GI symptoms at the end of treatment, including significant improvements in symptoms of constipation, diarrhea, indigestion, and abdominal pain. Improvements persisted 8 weeks after treatment. Similarly, clinical assessments showed that behavioral ASD symptoms improved significantly and remained improved 8 weeks after treatment ended. Bacterial and phagedeep sequencing analyses revealed successful partial engraftment of donor microbiota and beneficial changes in the gut environment. Specifically, overall bacterial diversity and the abundance of
Bifidobacterium
,
Prevotella
, and
Desulfovibrio
among other taxa increased following MTT, and these changes persisted after treatment stopped (followed for 8 weeks).
Conclusions
This exploratory, extended-duration treatment protocol thus appears to be a promising approach to alter the gut microbiome and virome and improve GI and behavioral symptoms of ASD. Improvements in GI symptoms, ASD symptoms, and the microbiome all persisted for at least 8 weeks after treatment ended, suggesting a long-term impact.
Trial registration
This trial was registered on the ClinicalTrials.gov, with the registration number
NCT02504554
Journal Article
Ripretinib versus sunitinib in gastrointestinal stromal tumor: ctDNA biomarker analysis of the phase 3 INTRIGUE trial
INTRIGUE was an open-label, phase 3 study in adult patients with advanced gastrointestinal stromal tumor who had disease progression on or intolerance to imatinib and who were randomized to once-daily ripretinib 150 mg or sunitinib 50 mg. In the primary analysis, progression-free survival (PFS) with ripretinib was not superior to sunitinib. In clinical and nonclinical studies, ripretinib and sunitinib have demonstrated differential activity based on the exon location of
KIT
mutations. Therefore, we hypothesized that mutational analysis using circulating tumor DNA (ctDNA) might provide further insight. In this exploratory analysis (
N
= 362), baseline peripheral whole blood was analyzed by a 74-gene ctDNA next-generation sequencing–based assay. ctDNA was detected in 280/362 (77%) samples with
KIT
mutations in 213/362 patients (59%). Imatinib-resistant mutations were found in the KIT ATP-binding pocket (exons 13/14) and activation loop (exons 17/18). Mutational subgroup assessment showed 2 mutually exclusive populations with differential treatment effects. Patients with only
KIT
exon 11 + 13/14 mutations (ripretinib,
n
= 21; sunitinib,
n
= 20) had better PFS with sunitinib versus ripretinib (median, 15.0 versus 4.0 months). Patients with only
KIT
exon 11 + 17/18 mutations (ripretinib,
n
= 27; sunitinib,
n
= 25) had better PFS with ripretinib versus sunitinib (median, 14.2 versus 1.5 months). The results of this exploratory analysis suggest ctDNA sequencing may improve the prediction of the efficacy of single-drug therapies and support further evaluation of ripretinib in patients with
KIT
exon 11 + 17/18 mutations. ClinicalTrials.gov identifier: NCT03673501.
Exploratory ctDNA analyses from the phase 3 INTRIGUE trial indicate that ripretinib may provide benefits in patients with advanced gastrointestinal stromal tumors with
KIT
exon 11 + 17/18 mutations
Journal Article
Guts : our digestive system
Provides a guide to the workings of the digestive system through a review of the organs, the digestive process, and detailed photos of the surface of the stomach.
Book
Inflammasomes in the gastrointestinal tract: infection, cancer and gut microbiota homeostasis
Inflammasome signalling is an emerging pillar of innate immunity and has a central role in the regulation of gastrointestinal health and disease. Activation of the inflammasome complex mediates both the release of the pro-inflammatory cytokines IL-1β and IL-18 and the execution of a form of inflammatory cell death known as pyroptosis. In most cases, these mediators of inflammation provide protection against bacterial, viral and protozoal infections. However, unchecked inflammasome activities perpetuate chronic inflammation, which underpins the molecular and pathophysiological basis of gastritis, IBD, upper and lower gastrointestinal cancer, nonalcoholic fatty liver disease and obesity. Studies have also highlighted an inflammasome signature in the maintenance of gut microbiota and gut–brain homeostasis. Harnessing the immunomodulatory properties of the inflammasome could transform clinical practice in the treatment of acute and chronic gastrointestinal and extragastrointestinal diseases. This Review presents an overview of inflammasome biology in gastrointestinal health and disease and describes the value of experimental and pharmacological intervention in the treatment of inflammasome-associated clinical manifestations.
Journal Article