Capecitabine and Oxaliplatin Before, During, and After Radiotherapy for High-Risk Rectal Cancer

Larsen, Finn Ole; Markussen, Alice; Jensen, Benny Vittrup; Fromm, Anne L.; Vistisen, Kirsten; Parner, Vibeke; Linnemann, Dorte; Hansen, Rasmus Hvass; Johannesen, Helle Hjorth; Schou, Jesper Sølver

doi:10.1016/j.clcc.2016.07.020

Cited by 11 publications

(10 citation statements)

References 23 publications

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“…Most of these trials found induction chemotherapy enhanced tumor shrinkage and PCR rate with treatable toxicities. Table 4 illustrates the rates of PCR and R0 resection in these recent clinical trials and compares their results with those of the present study [7, 12, 14, 15, 22-28]. Accordingly, our study shows comparable results in terms of PCR and R0 resection compared to previous reports.…”

Section: Discussionsupporting

confidence: 81%

“…Despite advances in neoadjuvant CRT and TME in patients with locally advanced rectal cancer, local recurrence and distant metastasis occur in about 25%–30% and 10%, respectively [7, 15]. In order to enhance tumor shrinkage and minimizing metastasis, induction chemotherapy preceding surgery has been considered with or without CRT in some studies.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and Feasibility of Adding Induction Chemotherapy to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Phase II Clinical Trial

Nasrolahi¹,

Mirzaei

Mohammadianpanah

et al. 2019

Ann Coloproctol

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PurposeCurrently, neoadjuvant chemoradiation (CRT) followed by total mesorectal resection is considered the standard of care for treating locally advanced rectal cancer. This study aimed to investigate the efficacy and feasibility of adding induction chemotherapy to neoadjuvant CRT in locally advanced rectal cancer.MethodsThis phase-II clinical trial included 54 patients with newly diagnosed, locally advanced (clinical T3–4 and/or N1–2, M0) rectal cancer. All patients were treated with 3 cycles of preoperative chemotherapy using the XELOX (capecitabine + oxaliplatin) regimen before and after a concurrent standard long course of CRT (45–50.4 Gy) followed by standard radical surgery. Pathologic complete response (PCR) rate and toxicity were the primary and secondary endpoints, respectively.ResultsThe study participants included 37 males and 17 females, with a median age of 59 years (range, 20–80 years). Twenty-nine patients (54%) had clinical stage-II disease, and 25 patients (46%) had clinical stage-III disease. Larger tumor size (P = 0.006) and distal rectal location (P = 0.009) showed lower PCR compared to smaller tumor size and upper rectal location. Pathologic examinations showed significant tumor regression (6.1 ± 2.7 cm vs. 1.9 ± 1.8 cm, P < 0.001) with 10 PCRs (18.5%) compared to before the intervention. The surgical margin was free of cancer in 52 patients (96.3%). Treatment-related toxicities were easily tolerated, and all patients completed their planned treatment without interruption. Grade III and IV toxicities were infrequent.ConclusionThe addition of induction chemotherapy to neoadjuvant CRT is an effective and well-tolerated treatment approach in patients with rectal cancer.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Efficacy and Feasibility of Adding Induction Chemotherapy to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Phase II Clinical Trial

Nasrolahi¹,

Mirzaei

Mohammadianpanah

et al. 2019

Ann Coloproctol

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“…14 With respect to eligibility, the only difference in the independent study cohort from Copenhagen, Denmark (NCT00964457), was that a margin of ≥1 mm of the mesorectal fascia excluded patients from participating in the study. 35 Other eligibility criteria, evaluation procedures and follow-up have been described in detail previously. 14,35 Anonymised biobank samples linked to de-identified selected patient data were transferred between institutions in accordance with the current regulations.…”

Section: Methodsmentioning

confidence: 99%

Systemic immune response induced by oxaliplatin-based neoadjuvant therapy favours survival without metastatic progression in high-risk rectal cancer

et al. 2018

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“…It may represent a subgroup of LARC with an improved biological behavior. Larsen et al (25) evaluated the prognostic value of CapeOX regimen before, during and after NCRT in LARC and reported a 5-year OS and PFS of 72 and 62%, respectively. Garcia-Aguilar et al (8) recently published a nonrandomized trial in which the addition of 2–6 cycles of FOLFOX was associated with an increased pCR rate (from 18–38%), however the study did not provide evidence of a benefit to long-term survival.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of consolidation chemotherapy during the resting period in patients with local advanced rectal cancer

et al. 2018

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It remains controversial as to whether a long interval between neoadjuvant chemoradiotherapy (NCRT) and surgery may provide clinical benefits for patients with local advanced rectal cancer (LARC). The addition of consolidation chemotherapy during the resting period was recently considered as a treatment option. The present study aimed to verify the efficacy and safety of consolidation chemotherapy during the resting period in patients with LARC. A total of 156 patients with local advanced stage T3-4N0-2 rectal cancer were enrolled between January 2010 and July 2016. Patients were divided into two groups, those who received consolidation chemotherapy prior to surgery (n=76) and the control group who did not (n=80). Multivariate logistic regression and the Kaplan-Meier method were used to explore the predictors of pathological complete response (pCR) and survival. The demographic and tumor characteristics were comparable between the two groups. The consolidation group yielded significantly higher pCR and near pCR rates compared with the control group (P=0.015). Patients in the consolidation group who also underwent standard adjuvant chemotherapy displayed improved 3-year disease-free survival (DFS) compared with the control group (P=0.036). Notably, the addition of consolidation chemotherapy between NCRT and surgery did not significantly increase the incidence of surgical complications and grade 3 or 4 toxicities when compared with the control group. Consolidation chemotherapy was associated with increased pCR/near pCR rates and improved 3-year DFS, and displayed a manageable safety profile. The present study provided primary evidence for the efficacy and safety of consolidation chemotherapy in LARC. Further prospective studies are warranted in the future to verify these results.

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Capecitabine and Oxaliplatin Before, During, and After Radiotherapy for High-Risk Rectal Cancer

Cited by 11 publications

References 23 publications

Efficacy and Feasibility of Adding Induction Chemotherapy to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Phase II Clinical Trial

Efficacy and Feasibility of Adding Induction Chemotherapy to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Phase II Clinical Trial

Systemic immune response induced by oxaliplatin-based neoadjuvant therapy favours survival without metastatic progression in high-risk rectal cancer

Efficacy and safety of consolidation chemotherapy during the resting period in patients with local advanced rectal cancer

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