Does the addition of oxaliplatin to preoperative chemoradiation benefit cT4 or fixed cT3 rectal cancer treatment? A subgroup analysis from a prospective study

Wiśniowska, Katarzyna; Nasierowska‐Guttmejer, Anna; Polkowski, Wojciech; Michalski, Wojciech; Pietrzak, L.; Rutkowski, A.; Malinowska, Małgorzata; Kryński, J; Kosakowska, Ewa; Zwoliński, Jakub; Winiarek, M.; Olędzki, Janusz; Kuśnierz, Jerzy; Zajâc, Leszek; Bednarczyk, M.; Szczepkowski, Marek; Tarnowski, Wiesław; Paśnik, Krzysztof; Radziszewski, Jakub; Partycki, M.; Bęczkowska, K.; Styliński, Roman; Wierzbicki, Ryszard; Bury, Paweł; Jankiewicz, M.; Paprota, Krzysztof; Lewicka, Magdalena; Ciseł, Bogumiła; Skórzewska, Magdalena; Mielko, Jerzy; Danek, Anna; Nawrocki, G; Sopyło, Rafał; Kępka, Lucyna; Bujko, Krzysztof

doi:10.1016/j.ejso.2016.08.001

Cited by 14 publications

(13 citation statements)

References 16 publications

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“…All 14 RCTs reported the rate of pCR. The chemoradiation regimen in the study of Wiśniowska et al13 included short-term radiotherapy (5×5 Gy irradiation over 5 days) combined with consolidation chemotherapy and long-course chemoradiation (50.4 Gy in 28 fractions of 1.8 Gy given concomitantly with chemotherapy). Only the data regarding long-course chemoradiation were extracted for the present meta-analysis to minimize heterogeneity.…”

Section: Resultsmentioning

confidence: 99%

“…For the analysis of sensitivity, the RCTs of low quality were removed. Either the study in which true randomization was unclear was excluded,13 or two studies in which the 5FU schedule varied between two arms were excluded 21,22. For the rate of pCR, there was no evidence of inconsistency, and the results of the NMA did not significantly change after removing these articles.…”

Section: Resultsmentioning

confidence: 99%

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Neoadjuvant chemoradiation for locally advanced rectal cancer: a systematic review of the literature with network meta-analysis

Chen¹,

Chen²,

Xu³

et al. 2019

CMAR

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BackgroundNeoadjuvant chemoradiotherapy (CRT) prior to surgery is a standard therapy for locally advanced rectal cancer, but the optimum regime is not conclusive. This meta-analysis evaluated various CRT regimens with regard to the rate of pathologic complete response (pCR) and toxic effects of grade ≥3.MethodsThe databases PubMed, Cochrane Library, and Embase were searched for randomized controlled trials (RCTs) that compared neoadjuvant CRT regimes for treating patients with locally advanced rectal cancer, published before 28 December 2017. The primary end points were pCR and toxic effects. A network meta-analysis was applied.ResultsFourteen RCTs (with 5,599 participants) involving the following eight regimens were included: fluorouracil (5FU) alone, or 5FU with oxaliplatin (OXA), cisplatin, or irinotecan (CPT-11); capecitabine (CAP) alone, or CAP with OXA or CPT-11; and CPT-11 with combined tegafur, 5-chloro-2,4-dihydroxypyridine, and potassium oxonate. The rate of pCR associated with CAP + OXA was significantly higher compared with 5FU alone; there were no significant differences among the other regimens. The toxicity of 5FU + OXA or CAP + OXA was significantly worse than that of 5FU alone or CAP alone. CAP + OXA and CAP were ranked, respectively, the most and second most effective regimens in terms of pCR rate. 5FU alone and CAP alone likely had the lowest and second lowest toxicity, respectively.ConclusionAmong the currently available CRT regimens for locally advanced rectal cancer, this meta-analysis indicated that CAP + OXA provides the superior clinical results. Adding OXA to 5FU or CAP significantly increases toxicity.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Neoadjuvant chemoradiation for locally advanced rectal cancer: a systematic review of the literature with network meta-analysis

Chen¹,

Chen²,

Xu³

et al. 2019

CMAR

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“…Long-course radiation was used in most studies but the dose was a little lower in an individual early study (34.5 Gy) (25). In the aspect of surgical intervention, some articles did not mention it (11)(12)(13)(14)(15)(16)20,21,27,29,30,32). Moreover, the rest of the studies reported the interval to be 3-10 weeks.…”

Section: Discussionmentioning

confidence: 99%

Comparison of different chemoradiotherapy regimens for the preoperative treatment in patients with locally advanced rectal cancer: a network meta-analysis

Yu¹,

Wang²,

Xu³

et al. 2020

Transl Cancer Res TCR

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Background: The efficacy of different neoadjuvant chemoradiotherapy regimens on locally advanced rectal cancer (LARC) remains confusing. We evaluated them together via a network meta-analysis in terms of survival benefits to find the optimal treatment. Methods: We searched , EMBASE, Cochrane Central Register of Controlled Trials and the ClinicalTrials website according to the selection criteria for eligible publications before Oct 25, 2019. Pathological complete response rate (pCR), disease-free survival (DFS), and overall survival (OS) were analyzed based on Bayesian methods in the meta-analysis. Results: Twenty-five articles containing 7,142 participants and 12 preoperative regimens were analyzed. In terms of pCR, radiation therapy plus 5-fluorouracil (RT+5-Fu), RT plus capecitabine (RT+CAPE), RT plus 5-fluorouracil and oxaliplatin (RT+FOLFOX), RT plus capecitabine and oxaliplatin (RT+XELOX), and RT plus S-1 and irinotecan (RT+IS) were better than RT alone [odds ratio (OR) =2.66, 95% credible interval [

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“…In spite of this, researchers are still exploring, but most clinical studies have shown that the addition of Oxa not only does not help to improve the pCR rate of patients [23][24][25][26], but also significantly increases the incidence of therapeutic toxicity such as bone marrow suppression and diarrhea [23,25,26]. In contrast, a meta-analysis of three large samples from 2017 to 2019 showed that although regimens using Oxa can expose patients to greater therapeutic toxicity, it is, however, beneficial for the short/long-term effect of patients [27][28][29].…”

Section: Oxaliplatinmentioning

confidence: 99%

“…At present, there is a large amount of evidence determining the efficacy of bevacizumab in the systematic treatment of colorectal cancer patients, but its application in nCRT for LARC patients is still being explored. Existing research [60][61][62][63][64][65][66] shows that adding bevacizumab to the Fu-nCRT regimen can achieve a pCR rate of 16-36% for LARC patients, compared to the 12%-34% obtained by Oxa+Fu-nCRT regimen [14][15][16][17][18][19][23][24][25][26], and is numerically superior to the 11%-15% achieved by the independent Fu-nCRT regimen [9,10]. In the phase II study of Xiao et al [67], 25 patients with LARC were treated with sandwich-like neoadjuvant therapy, that is, bevacizumab combined with FOLFOX induction + Fu-nCRT + sequential FOLFOX.…”

Section: Bevacizumabmentioning

confidence: 99%

Adding Adjuvants to Fluoropyrimidine-based Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer: An Option Worthy of Serious Consideration

Wu¹,

Zhou²,

Wu³

et al. 2021

J. Cancer

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The application of fluoropyrimidine-based neoadjuvant chemoradiotherapy (Fu-nCRT) of locally advanced rectal cancer (LARC) has become a common therapeutic regimen. In order to improve the efficacy and enable more patients to benefit from this treatment, an accumulation of studies have been carried out on the auxiliary use of other drugs with Fu-nCRT. However, due to specific challenges and the potential opportunities that coexist in this field, a more reasonable approach to the mode of treatment remains to be explored. In this review, we have summarized the results of the studies on the combination of Fu-nCRT with cytotoxic drugs, anti-tumor angiogenesis, and anti-EGFR agents, as well as the status of the application of immune checkpoint inhibitors in the neoadjuvant therapy of LARC patients.

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Does the addition of oxaliplatin to preoperative chemoradiation benefit cT4 or fixed cT3 rectal cancer treatment? A subgroup analysis from a prospective study

Cited by 14 publications

References 16 publications

Neoadjuvant chemoradiation for locally advanced rectal cancer: a systematic review of the literature with network meta-analysis

Neoadjuvant chemoradiation for locally advanced rectal cancer: a systematic review of the literature with network meta-analysis

Comparison of different chemoradiotherapy regimens for the preoperative treatment in patients with locally advanced rectal cancer: a network meta-analysis

Adding Adjuvants to Fluoropyrimidine-based Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer: An Option Worthy of Serious Consideration

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