Lees ook literatuurlijst niet-toxische aanvullende behandelingen en middelen van arts-bioloog drs. Engelbert Valstar specifiek bij darmkanker

11 augustus 2018: Zie ook dit artikel: 

https://kanker-actueel.nl/plaats-van-de-primaire-tumor-bij-uitgezaaide-darmkanker-geeft-grote-verschillen-in-overall-overleving-bij-patienten-met-ras-wild-type-die-eerstelijns-behandeling-met-panitumumab-krijgen.html

11 april 2014: Bron: Arch Med Sci. 2014 Feb 24;10(1):1-9. Epub 2014 Feb 23

PIK3CA mutaties in z'n geheel, maar vooral een afwijking in PIK3CA exon 20 kan voorspellen dat een anti-EGFR MoAb gebaseerde chemotherapie bij patiënten met uitgezaaide darmkanker met het KRAS wild type weinig tot geen effectieve behandeling zal zijn. Opnieuw een reden te meer om het pathologisch rapport uit te breiden tot een volledig biomoleculair onderzoek, zodat een patiënt ook echt een behandeling binnen personalised medicine krijgt.

Conclusie uit de studie: Anti-epidermal growth factor receptor monoclonal antibody-based therapy for metastatic colorectal cancer: a meta-analysis of the effect of PIK3CA mutations in KRAS wild-type patients. waarvan het volledige studierapport gratis is in te zien luidt:

CONCLUSIONS:

PIK3CA mutations as a whole might be useful prognostic factors for assessing clinical outcomes of anti-EGFR MoAb-based chemotherapies in KRAS wild-type mCRC patients. In particular, PIK3CA exon 20 mutations were significantly associated with lack of response.

grafiek 2 studie met PIK3CA mutaties bij darmkanker

Hier het abstract plus referentielijst van de studie: Anti-epidermal growth factor receptor monoclonal antibody-based therapy for metastatic colorectal cancer: a meta-analysis of the effect of PIK3CA mutations in KRAS wild-type patients

Overall, our meta-analysis showed that PIK3CA mutations as a whole might be useful prognostic factors for assessing clinical outcomes and further confirmed that PIK3CA mutation on exon 20 decreases the response rate of anti-EGFR MoAb-based chemotherapies in wild-type KRAS mCRC patients. But we could not exclude the potential confounding by the interaction effect of other mutations which frequently associated with PIK3CA exon 20 mutations. We also strongly recommend that exon 9 and 20 mutations be studied separately.

Arch Med Sci. Feb 24, 2014; 10(1): 1–9.
Published online Feb 23, 2014. doi:  10.5114/aoms.2014.40728
PMCID: PMC3953972

Anti-epidermal growth factor receptor monoclonal antibody-based therapy for metastatic colorectal cancer: a meta-analysis of the effect of PIK3CA mutations in KRAS wild-type patients

Lulu Huang,1 Zhenfang Liu,2 Donghong Deng,2 Aihua Tan,3 Ming Liao,1 Zengnan Mo,1 and Xiaobo Yang1,4

Abstract

Introduction

We conducted a meta-analysis to dissect the association between PIK3CA mutations (exon 9 and exon 20) and resistance to anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (MoAbs) in KRAS wild-type metastatic colorectal cancer (mCRC) patients.

Material and methods

In 11 previously published studies, 864 cancer patients were treated with cetuximab or panitumumab-based therapy. Primary outcomes included objective response (complete response + partial response vs. stable disease + progressive disease), progression-free survival (PFS), and overall survival (OS). We calculated the odds ratio (OR) or hazard ratio (HR) with 95% confidence intervals (CIs) to estimate the risk or hazard. We found consistent and clinically substantial risk or hazard for objective response, PFS, and OS in the cetuximab or panitumumab-treated mCRC patients.

Results

PIK3CA mutations as a whole were associated with reduced response and poor PFS and OS in KRAS wild-type mCRC patients (objective response: OR = 0.42 and 95% CI 0.23–0.75; PFS: HR = 1.54 and 95% CI 1.13–2.09; and OS: HR = 1.4 and 95% CI 1.02–1.91). PIK3CA exon 9 mutations had no effect, whereas exon 20 mutations were associated with a worse outcome compared with wild types, with an OR of 0.21 (95% CI 0.05–0.93).

Conclusions

PIK3CA mutations as a whole might be useful prognostic factors for assessing clinical outcomes of anti-EGFR MoAb-based chemotherapies in KRAS wild-type mCRC patients. In particular, PIK3CA exon 20 mutations were significantly associated with lack of response.

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KRAS wild type, cetuximab, erbitux, panitumumab, uitgezaaide darmkanker, EGFR remmers, PIK3CA exon 20, PIK3CA


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