Topic: DDW(digestive disease week)2011 Chicago Report
Thanks this foundation for providing me the opportunity for attending this conference. I have learned a lot and next time I will have a better strategy to spend my time between speaker sessions and the poster sessions. I did not have enough time for the poster sessions because I think I can read them later.(I have marked down 20+ of the posters that I want to check out,but I have only time for 2 of them.)
The following is one of the few I have come across that is of interest and relate to CC.(It received DDW poster of distinction award)
Do not worry about the title,I will try my best to explain it in layman's terms.
Title; Prognostic impact of Thymidylate Synthase(TS) Expression in Adjuvant Gemcitabine plus S-1 chemotherapy after surgical resection for Bile Duct cancer.
Authors:Hironori Kobayashi MD and 9 other Md from the dept. of Surgery,Div. of Clinical Medicine Science,Graduate school of Biomedical sciences,Hiroshima University.
Objective:The aim of this study was to investigate whether the TS,DPD, or OPRT expression can predict survival of advanced CC patients treated with gemcitabine(GEM)+S-1(a novel oral 5FU combination including tegafur,which similar to Capecitabine-also a prodrug of 5FU,DPD inhibitor and OPRT inhibitor.
Study Samples included 106 CC patients (stage II,III,IV)who had R0,R1 resection between 1989-2010 at Hiroshima hospital.(single location,not multi-center study)
Conclusion: Low intratumoral TS expression was associated with INCREASE overall survival in CC patients who received adjuvant GEM+S-1 chemotherapy after surgical resection.
TS therefore is a relevant PREDICTIVE MARKER of benefit from adjuvant GEM+S-1 chemotherapy in resected CC patients.
Following is my thinking about this study:
TS,DPD and OPRT are emzymes that related to the metabolism of the drug 5Fu and thus the effectiveness of the 5FU prodrugs like capecitabine and the like.
The study indicated if TS marker is high(that is 30% or higher in expression)the 5 year survival rate is 25% as compare to low TS expression is 81% when CC patients are on the GEM+S-1 chemo treatment.(If that is true, and if my TS marker is high,I will suggest to my oncologist to change Gemcitabine and Xeloda and use a different chemo agent that is different in chemical structure to Gemzar and 5 FU. Again this is my personal point of view only and it can be wrong in terms of outcome. Remember this study is the forefront of reseach and not the final phase III clinical trial or approval of a drug or marker.)
The study also indicated that there is NO significant difference in overall survival between the high TS group treated with the GEM+S1 and NO adjuvant chemo treatment group.
Therefore the TS marker may be of value in choosing the appropriate chemo treatment before it starts. and it may be of value in future drug development as well.
DPD and OPRT expressions were also mentioned in the study but they did not make any conclusion about them as potential markers for CC patients.So I presume both of them( the DPD and OPRT inhibitors in the S-1 regimen is not of value as markers at this point .)
I will also try to find out where and how to get the TS marker test done if available. I appreciate if our Gavin can provide his valuable research skill on this thymidylate synthase marker(TS).Gavin is an important resource and asset for information on the internet for this foundation.
I hope this is of interest to you in the research of treating CC .