O-MAX Chemotherapy: High Activity in Metastatic Esophagogastric Adenocarcinoma and Possible Relation to Subclinical Hemolysis

Abstract

Objectives: Our objectives were to confirm the activity of O-MAX chemotherapy in adenocarcinoma of the stomach and esophagus, particularly the high rate of complete remission (CR) and the relation of subclinical hemolysis to CR. Patients and Methods: Twenty-five patients with metastatic esophagogastric adenocarcinoma were treated with O-MAX. Two developed cancer-related hemolytic-uremic syndrome (C-HUS); both achieved CR. Subsequent patients were monitored for serum haptoglobin for subclinical hemolysis. Results: Median survival was 16.5 months. The objective response rate was 90%, with 38% CR. Three patients achieving CR relapsed in the central nervous system and died (2 without systemic disease). Four patients have remained alive, off therapy, the longest for 20 years. Two patients developed clinical C-HUS and 5 of 8 monitored patients developed subclinical hemolysis based on abnormal serum haptoglobin. Four of the patients with subclinical hemolysis achieved CR. Of the 7 patients developing clinical C-HUS or subclinical hemolysis, 6 (86%) achieved CR. Conclusions: O-MAX appears highly active in esophagogastric adenocarcinoma. A few long-term survivors of metastatic disease are being seen. CR and long-term survival appear to correlate with the development of hemolysis. Although highly promising, these results should be considered only as hypothesis-generating and require confirmation in a prospective trial.

ARHGEF12 regulates erythropoiesis and is involved in erythroid regeneration after chemotherapy in acute lymphoblastic leukemia patients

“…Chemotherapy-induced anemia can be caused by cytotoxic inhibition of normal hematopoiesis similar to chemotherapy-induced neutropenia and thrombocytopenia. Chemotherapy agent-related autoimmune hemolysis 31,32 and chemotherapy-induced eryptosis can also cause anemia. 33 Our current GWAS studies have found that chemotherapy-induced anemia is associated with SNP in CHPT1, 6 BSG, 11,12 ANAX7, 14 EPB42, 15,16 and ABCC417 that may be related to increased erythrocyte…”

Peritoneal metastases from malignant degeneration of ectopic gastric epithelium in Meckel’s diverticulum: A case report

“…The most aggressive gastric cancer treatment regimen that the patient can tolerate is selected. In our patient in this case report the O-MAX regimen was selected [10]. If the response to the systemic chemotherapy is complete or near complete, a gastrectomy to resect the primary disease site and cytoreduction to remove residual sites of peritoneal metastases may be recommended.…”

“…2). In the first 25 consecutive patients (all metastatic) treated with O-MAX for adenocarcinoma of the stomach or esophagus, the objective response rate was 90% with 38% complete remissions [10]. Preliminary evidence suggested subclinical hemolysis in complete responders, implying the presence of antitumor antibodies as identified by Camtrell et al [18].…”