The use of biologic therapy in the treatment of unresectable appendiceal neoplasms.

15546 Background: Peritoneal dissemination of appendiceal neoplasms (AN) is traditionally treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) with a reported median 10-yr overall survival (OS) of 50-60%. Treatment options are limited for those who are not optimal candidates for CRS. We have previously shown that systemic chemotherapy may help in selected patients (Shapiro et al; ASCO GI, 2007); however, the role for biologic agents has not been characterized in these poor prognosis patients. Increased vascular endothelial growth factor (VEGF) expression in tissue specimens has recently been associated with poor prognosis. The purpose of this study was to evaluate the role of biologic agents in patients who were not candidates for cytoreduction.,A retrospective observational cohort study was conducted of AN pts who received systemic chemotherapy with anti-VEGF (bevacizumab) or anti-epidermal growth factor receptor-targeted therapy (cetuximab, panitumumab, or gefitinib) between January 2000 and July 2007. The type of systemic chemotherapy and biologic therapy, response rate (RR), progression-free survival (PFS) and overall survival (OS) were determined. RR was a composite of either radiological or clinical response.,A total of 41 pts (M:F - 23:18) were evaluable for response; median age = 53 yrs (range: 41-78). Thirty-five pts had prior CRS and/or HIPEC. Response rates were 71.4% among those who received 1st line therapy (n=28), and 53.8% among those who received 2nd line therapy (n=13). The majority of 1st line pts received combination chemotherapy with 5-fluorouracil (86%) or platinum-based (75%) therapy. Thirty-two pts (78%) received bevacizumab as the biologic therapy of choice. There were no complete responders. After a median follow up of 26.1 mos, the median PFS was 9.8 mos after 1st line and 4.7 mos after 2nd line therapy. The median OS was 56 mos.,Treatment options for patients with appendiceal neoplasms who are not candidates for CRS/HIPEC are limited. The addition of biologic therapy to systemic chemotherapy may provide added benefit in response and survival. Initiation of a quality of life analysis is planned. No significant financial relationships to disclose.