The consensus molecular subtypes (CMS) classification is one of the most robust colorectal cancer (CRC) classifications based on comprehensive gene expression profiles. This study aimed to clarify whether the CMS is a predictive factor for therapeutic effects of standard chemotherapies for metastatic CRC (mCRC). We retrospectively enrolled 193 patients with mCRCs, and using comprehensive gene expression data, classified them into 4 subtypes: CMS1–CMS4. The associations between the subtypes and treatment outcomes were analyzed. Regarding first-line chemotherapy, irinotecan (IRI)-based chemotherapy was significantly superior to oxaliplatin (OX)-based chemotherapy for progression-free survival (PFS; hazard ratio [HR] = 0.31, 95% confidence interval [CI] 0.13–0.64) and overall survival (OS; HR = 0.45, 95% CI 0.19–0.99) in CMS4. Regarding the anti-epidermal growth factor receptor (anti-EGFR) therapy, CMS1 showed particularly worse PFS (HR = 2.50, 95% CI 1.31–4.39) and OS (HR = 4.23, 95% CI 1.83–9.04), and CMS2 showed particularly good PFS (HR = 0.67, 95% CI 0.44–1.01) and OS (HR = 0.49, 95% CI 0.27–0.87) compared with the other subtypes. The biological characteristics of CMS may influence the efficacy of chemotherapy. CMS might be a new predictive factor for the efficacy of chemotherapy against mCRCs.

BackgroundSome elderly cancer patients, even with good Eastern Cooperative Oncology Group performance status (ECOG-PS), have poor survival outcomes and cannot tolerate standard therapy. Few studies have detailed the associations between the G8 screening tool, ECOG-PS, and overall survival (OS) in such patients.MethodsCancer patients, aged 70 years or older, were assessed for G8 and classified into three groups according to their G8 score: <11 as the low score group, 11–14 as the intermediate score group, and >14 as the high score group. We retrospectively analyzed the association between G8 score and OS in all patients and for each ECOG-PS-categorized group.ResultsOut of 264 enrolled patients, most patients (87%) with solid tumor were categorized as TNM stage IV. ECOG-PS was 0 or 1 in 215 patients and ≥2 in 48; there was missing data for one patient. Among all patients, the low score group with a median OS of 7.7 months survived significantly less than both the high score group with a median OS of 25.6 months [Hazard ratio (HR) 3.48; 95% confidence interval (CI), 1.96–6.63; p < 0.0001] and the intermediate score group with a median of 15.6 months (HR 1.83; 95% CI, 1.28–2.65; p < 0.001). In the multivariate analysis, TNM stage and G8 score were independent prognostic factors for OS. When patients with an ECOG-PS of 0 or 1 were analyzed, patients with a lower G8 score showed significantly shorter OS than patients with a higher score when any two groups were compared.ConclusionThis novel classification of the G8 score contributes to prompt identification of patients with poor prognosis and improved the prognostic value of ECOG-PS. Using G8 with ECOG-PS may be helpful in deciding treatment for elderly patients with advanced cancer.

The nm23-H1 gene is known as a potential metastasis suppressor gene in various types of carcinomas. However, the role of nm23-H1 in colorectal carcinoma still remains controversial and the cellular mechanisms by which its protein may modulate the metastatic phenotype are not yet known. We transfected nm23-H1 cDNA into the human colon cancer cell line, HT-29, to test the effects and cellular biological mechanism of nm23 protein in colon cancer. We found that nm23-H1 strongly inhibited the liver metastasis of HT-29 cells in nude mice and inhibited the epidermal growth factor (EGF)-induced cell migration in vitro. The nm23 gene was first identified as a gene whose expression was reduced in highly metastatic rodent tumors relative to poorly metastatic tumor cells. 1 The transfection of nm23 cDNA into various cancer cell lines resulted in the suppression of metastatic potential of motility, invasion or colonization. [2][3][4][5][6][7] This implies that nm23 is a potential metastasis suppressor gene and could function on the invasion and migration steps of the metastatic pathway. The nm23 protein has a kinase activity and is recognized as a nucleoside diphosphate (NDP) kinase. Eight human nm23 genes have been characterized so far. The initial 4 human genes of this family, nm23- H1,) and nm23-H4, encode proteins products that process NDP kinase activity and are named NDP kinase A-D, respectively. Of the 8 human nm23 genes, the H1 gene is most closely correlated with the metastatic phenotype in human breast, colorectal and ovarian carcinoma. 8 -12 However, the role of nm23-H1 in colorectal carcinoma is still controversial. Conflicting observations have been reported. Allelic deletion or mutation of the nm23-H1 gene appears to be associated with distant metastasis in some studies; 13-16 on the other hand, there are several studies that denied the correlation between the progression of colorectal carcinogenesis or distant metastasis and nm23-H1 expression. [17][18][19] The cellular mechanisms by which the nm23-H1 protein may directly or indirectly modulate the metastatic phenotype are not yet known; however, several studies reported that nm23-H1 inhibited the cell motility toward polypeptide growth factors such as platelet derived growth factor (PDGF) and insulin-like growth factor (IGF). 20,21 Among those growth factor receptors, the epidermal growth factor receptor (EGFR) is one of the receptors most commonly associated with human tumors and has been shown to correlate with the progression of many types of tumors, 22,23 and it is associated with the aspects of tumor growth (i.e., proliferation, apoptosis and cell survival). However, it has been reported that EGF stimulated the migration of both normal and tumor cells. 24 -27 Furthermore, it has been reported that mitogen-activated protein kinase (MAPK) (ERK1 and ERK2) influenced the cellular motility mechanism by phosphorylating and thereby enhanced myosin light chain kinase (MLCK) activity leading to the phosphorylation of myosin light chains (MLC). 28 In our study...

The combinations of oral fluoropyrimidines and cisplatin such as capecitabine and cisplatin (XP) or S-1 and cisplatin (SP) are regarded as a standard therapy against unresectable, recurrent, or advanced gastric cancer (AGC). Especially, SP is the most common regimen against AGC in Japan. For patients with human epidermal growth factor receptor type 2 (HER2)-positive AGC, trastuzumab, a monoclonal antibody targeting HER2 antibody, is additionally used in combination. Although trastuzumab in combination with XP (trastuzumab-XP) have been widely accepted, the efficacy of trastuzumab in combination with SP (trastuzumab-SP) lacks sufficient verification. The aim of the present study is to validate the comparability of trastuzumab-SP to trastuzumab-XP. Patients with HER2-positive AGC were assigned to the trastuzumab-XP or trastuzumab-SP group. We then retrospectively compared the efficacy and safety between both groups. As a first-line chemotherapy, trastuzumab in combination with XP or SP was administered to 58 patients: 28 with trastuzumab-XP and 30 with trastuzumab-SP. In the trastuzumab-XP group, response rate (RR), disease control rate (DCR), median progression-free survival (mPFS), and median overall survival (mOS) were 39.3%, 89.3%, 7.9 months, and 20.0 months, respectively. In the trastuzumab-SP group, RR, DCR, mPFS and mOS were 50.0%, 86.7%, 6.9 months, and 16.7 months, respectively. No significant difference in efficacy was observed between both groups. Severe hand-foot syndrome was observed more frequently in the trastuzumab-XP group than in the trastuzumab-SP group (14.3% vs. 0%, p = 0.05). Trastuzumab in combination with SP is a potential first-line therapeutic option for patients with HER2-positive AGC.