Annals of Surgical Oncology

, Volume 22, Issue 8, pp 2578–2584 | Cite as

Improved Survival with Anti-VEGF Therapy in the Treatment of Unresectable Appendiceal Epithelial Neoplasms

  • J. H. Choe
  • M. J. Overman
  • K. F. Fournier
  • R. E. Royal
  • A. Ohinata
  • S. Rafeeq
  • K. Beaty
  • J. K. Phillips
  • R. A. Wolff
  • P. F. Mansfield
  • C. Eng
Gastrointestinal Oncology

Abstract

Background

Currently, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are accepted treatments for surgically resectable appendiceal epithelial neoplasms. However, for nonsurgical candidates, systemic treatment may be considered. The purpose of this analysis was to determine the benefit of biologic therapy (anti-vascular endothelial growth factor and anti-epidermal growth factor receptor) in addition to systemic chemotherapy in this select patient population.

Methods

The MD Anderson Cancer Center tumor registry was retrospectively reviewed for systemic treatment-naive appendiceal epithelial neoplasm patients registered between January 2000 to July 2007 for prior cytoreductive surgery and hyperthermic intraperitoneal chemotherapy status, histologic grade, signet ring pathology, systemic chemotherapy, biologic therapy, tumor markers (carcinoembryonic antigen, carbohydrate antigen [CA] 125, and/or CA19-9), progression-free survival (PFS), overall survival (OS), and disease control rate. Kaplan–Meier method, log-rank, and Cox proportional hazard regression models were used for statistical analysis.

Results

A total of 353 patients were identified; 130 patients met the inclusion criteria. Fifty-nine patients received biologic therapy. The use of the anti–vascular endothelial growth factor (VEGF) agent bevacizumab improved both OS (42 months vs. 76 months, hazard ratio 0.49 [95 % confidence interval 0.25–0.94] P = 0.03) and PFS (4 months vs. 9 months, hazard ratio 0.69 [95 % confidence interval 0.47–0.995], P = 0.047) for all histologic subtypes. Moderately differentiated tumors had an improved PFS relative to well-differentiated tumors, 9 months versus 3 months (P = 0.05).

Conclusions

Bevacizumab in combination with chemotherapy appears to play a role in surgically unresectable appendiceal epithelial neoplasm patients, with an improvement in PFS and OS. Anti-VEGF agents should be strongly considered in the management of patients with higher-grade appendiceal epithelial neoplasms who are suboptimal candidates for surgical resection.

Keywords

Vascular Endothelial Growth Factor Overall Survival Bevacizumab Systemic Chemotherapy Median Overall Survival 

Notes

Acknowledgment

This work was supported by the Ric Summers Appendiceal Cancer Research Fund.

Disclosure

The authors declare no conflict of interest.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • J. H. Choe
    • 1
  • M. J. Overman
    • 2
  • K. F. Fournier
    • 3
  • R. E. Royal
    • 3
  • A. Ohinata
    • 2
  • S. Rafeeq
    • 3
  • K. Beaty
    • 3
  • J. K. Phillips
    • 2
  • R. A. Wolff
    • 2
  • P. F. Mansfield
    • 3
  • C. Eng
    • 2
  1. 1.Department of Internal MedicineBaylor College of MedicineHoustonUSA
  2. 2.Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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