Metastatic Colorectal Cancer Critical Review
Cancer has become one of the major deadly diseases in the world presented in different forms. Colorectal cancer is one of the significant malignancies in the United States, with an estimated 145,000 people diagnosed with colorectal cancer. An estimated 51, 020 died of colorectal cancer in 2019. Treatment intervention of these conditions has been evolving with a major consideration of specific treatment that can improve the rate of recovery. There is no particular treatment for cancer, although early detection has been associated with a higher rate of improvement (Xie et al., 2020). The study identifies that in the past decade, Metastatic colorectal cancer treatment has significantly expanded with the integration of the novel chemotherapeutic agents, biologic inhibitors, and the epidermal growth factor receptors. The purpose of the study was to investigate the activity of combined vertical blockade of VEGF signaling with sorafenib and BEV as rescue therapy among patients having progressive disease on all standard therapy in metastatic colorectal cancer.
The introduction presents a clear emphasis on the problem and its current development. The researchers have identified that angiogenesis is a substantial tumor growth, invasion, and metastases. The vascular endothelial growth factor is considered a more pro-angiogenic factor that is a vital mediator of angiogenesis. VEGF-A has been over-expressed mainly in a variety of human cancers, including metastatic colorectal cancer. Therefore, it is crucial to focus on VEGF-A for biologic therapy in controlling metastatic colorectal cancer. The BEV inhibits the VEGF-A interaction with its existing receptors, which include the VEGFR-1 and 2, which in turn neutralize VEGF-A activity. However, the study identifies that the past researches have shown that single-agent treatment with BEV has been associated with little activity in metastatic colorectal cancer. This study aims at assessing a combination of BEV and sorafenib (Xie et al., 2020).
The incorporation of BEV into treatment has led to significant improvements in PFS and OS among patients in a palliative care setting. The occurrence of resistance to anti-VEGF therapy can be mediated through the use of overexpression of the VEGF receptors. The Sorafenib is outlined as a multi-kinase inhibitor that effectively targets several serine-threonine and tyrosine kinases that are involved in tumor progression and angiogenesis. Based on the evidence-based assessment, sorafenib has been efficient in the treatment of advanced renal cell carcinoma, thyroid cancer, and other primary cancer cells. This presents a proper context within which it is easier to focus on its use among metastatic colorectal cancer. Thus, sorafenib has the potential to complement the BEV activity through blocking of VEGF signaling and inhibiting other angiogenic pathways.
The introduction of the study has been effectively outlined where it is easy to determine the background of the study and the purpose. The study focuses on improving the efficacy of the existing treatment for metastatic cancer through the evaluation assessment of combined therapy. This information has been made clear, forming the basis of the study. The purpose of the research has been well outlined, which presents a more substantial system that defines change and integration of better approaches that help in ensuring that the critical points of the study are known for improved reliability and validity of the findings.
The study employed the use of case-control experimental research design. The study participants included patients diagnosed with stage IV colorectal cancer and aged 18 years or older. Other aspects that were being considered included measurable disease and progressive within six months after the standard therapy. These are included the use of BEV, fluoropyrimidine, oxaliplatin, among others as prescribed. Individuals with a life expectancy of more than six months were also considered. Only patients who were willing to provide blood samples were included in the study. In increasing the validity of the study, the authors excluded patients with known brain metastatic as well as uncontrolled hypertension, high blood pressure, as well as other patients with other uncontrolled medical conditions.
The emphasis on these concepts presents a greater focus on better measures that help in defining a significant change while creating a transparent system that helps improve the level of efficiency. The inclusion strategy that is adopted present a better structure that can be effectively outlined and help present a seamless system that helps promote an emphasis on better processes that help improve positive outcomes. The study also included therapy restrictions among the respondents. These restrictions included patients with no prior sorafenib therapy, no discontinuation of BEV, as well as no current anticoagulant (Xie et al., 2020).
The study was approved by the Mayo Clinic Institutional Review Board and the North Central Cancer Treatment Group. Ensuring that the study met all the underlying ethical guidelines improves the quality of results where it is possible to identify significant changes. These changes can help present a clear strategy in improving change as well as a commitment to different processes that help improve the validity of healthcare outcomes. The study included 83 participants, although only 79 met all the inclusion criteria and were based on in the analysis of the results (Hubbard et al., 2017).
The results of the study have been well organized and performed in a systematic manner where it is easier to understand different outcomes based on the research problem that was being evaluated. The findings from the study showed that the median age of the respondents was 62 years, with the youngest participant being 36 years and the oldest being 88 years. The assessment of the outcomes showed that from the 79 participants, 42 of them were progression-free at three months. At the initial tumor assessment, 22 patients were found to have progressed, and six went of treatment before having tumor assessments done (Berghoff & Preusser, 2018). The reasons for treatment discontinuation were PD, adverse events, patient refusal, death, and physician decision. The findings from the study showed that the use of a combination of BEV a sorafenib as a rescue intervention in heavily pretreated metastatic colorectal cancer patients is more efficient compared to a single response. It was found that the combination is tolerable and manageable, with evidence showing improving results.
The study presents a better understanding of different interventions that can be used on metastatic patients and help improve their health and wellbeing. The authors have outlined that the use of BEV alone has not had improved results among the patients who presented an improved focus on sorafenib, which has mainly been successful in treating patients with other types of cancer (Clarke et al., 2017). Therefore the use of a combination of BEV and sorafenib, as found in the study, is more efficient and accurate.
The methodology has been well outlined with a clear structure where the study findings have been adequately analyzed and presented. The use of experimental research design offers a clear emphasis on efficacy and the ability to understand whether the use of a combined intervention between sorafenib and BEV can help improve the wellbeing of patients with metastatic colorectal cancer. This is an evidence-based practice that helps improve on the existing interventions that can help in controlling adverse outcomes among colorectal cancer. However, based on the inclusion strategy, the study excluded many patients, especially those who were having uncontrolled medical conditions. The reduced sample that the research was working with makes it difficult to determine whether the results would be the same in a more extensive study (Buonerba et al., 2016).
The study included a sample size of 79. Even though it is possible to focus on this sample and make conclusions, it is crucial to identify the need to improve the findings of the study through the integration of a better approach that helps improve change. Including more sample participants would have been effective in making a conclusion regarding the use of a combined intervention of sorafenib and BEV. Obtaining significant results is highly influenced by the underlying level of significance and the sample size (Berghoff & Preusser, 2018). A higher level of relevance increases the degree of error hence reducing the accuracy of the results. A smaller sample size reduces the accuracy of the results since the use of the same intervention of a different population is likely to have a negative influence on the findings.
The research design has not been fully developed, which makes it difficult to make better decisions that can help in improving the change and adoption of better strategies that will enhance change. The trial and control groups have not been effectively identified in the study. It understands the different groups in the study help in ensuring that there is a clear emphasis on research outcomes based on the underlying concepts that promote change. The degree of difference when using the combined intervention has not been fully identified, which provides a different perspective that can be fully assessed and present a highly specific system that can improve the accuracy of the findings. Understanding the influence of each intervention would have helped in understanding the influence of the combined intervention.
References
Berghoff, A. S., & Preusser, M. (2018). Anti-angiogenic therapies in brain metastases. memo-Magazine of European Medical Oncology, 11(1), 14-17.
Buonerba, C., Di Lorenzo, G., & Sonpavde, G. (2016). Combination therapy for metastatic renal cell carcinoma. Annals of translational medicine, 4(5).
Clarke, J., Neil, E., Terziev, R., Gutin, P., Barani, I., Kaley, T., … & Ballangrud, A. (2017). Multicenter, phase 1, dose escalation study of hypofractionated stereotactic radiation therapy with bevacizumab for recurrent glioblastoma and anaplastic astrocytoma. International Journal of Radiation Oncology* Biology* Physics, 99(4), 797-804.
Hubbard, J. M., Mahoney, M. R., Loui, W. S., Roberts, L. R., Smyrk, T. C., Gatalica, Z., … & Alberts, S. R. (2017). Phase I/II randomized trial of sorafenib and bevacizumab as first-line therapy in patients with locally advanced or metastatic hepatocellular carcinoma: North central cancer treatment group trial N0745 (Alliance). Targeted oncology, 12(2), 201-209.
Xie, H., Lafky, J. M., Morlan, B. W., Stella, P. J., Dakhil, S. R., Gross, G. G., … & Grothey, A. (2020). Dual VEGF inhibition with sorafenib and bevacizumab as salvage therapy in metastatic colorectal cancer: results of the phase II North Central Cancer Treatment Group study N054C (Alliance). Therapeutic advances in medical oncology, 12, 1758835920910913.