Neoadjuvant Radiotherapy with Capecitabine Plus Bevacizumab for Locally Advanced Lower Rectal Cancer: Results of a Single-institute Phase II Study

Maeda, Kiyoshi; Shibutani, Masatsune; Otani, Hiroshi; Fukuoka, Tatsunari; Iseki, Yasuhito; Matsutani, Shinji; Nagahara, Hisashi; Inoue, Toru; Tachimori, Akiko; Nishii, Takafumi; Miki, Yukari; Hosono, Mitsuharu; Ohira, Masaichi

doi:10.21873/anticanres.12713

Cited by 9 publications

(5 citation statements)

References 20 publications

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“…Other randomized trials have also investigated the use of targeted therapies (eg, bevacizumab, ziv-aflibercept) within neoadjuvant therapy for localized rectal cancer with mixed conclusions. 148,[181][182][183][184][185] At this time the panel does not endorse the use of bevacizumab, cetuximab, panitumumab, irinotecan, or oxaliplatin with concurrent radiotherapy for rectal cancer.…”

Section: Addition Of Oxaliplatinmentioning

confidence: 99%

Rectal Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology

Benson

Venook

Al-Hawary

et al. 2022

Journal of the National Comprehensive Cancer Network

328

147

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This selection from the NCCN Guidelines for Rectal Cancer focuses on management of malignant polyps and resectable nonmetastatic rectal cancer because important updates have been made to these guidelines. These recent updates include redrawing the algorithms for stage II and III disease to reflect new data supporting the increasingly prominent role of total neoadjuvant therapy, expanded recommendations for short-course radiation therapy techniques, and new recommendations for a “watch-and-wait” nonoperative management technique for patients with cancer that shows a complete response to neoadjuvant therapy. The complete version of the NCCN Guidelines for Rectal Cancer, available online at NCCN.org, covers additional topics including risk assessment, pathology and staging, management of metastatic disease, posttreatment surveillance, treatment of recurrent disease, and survivorship.

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Section: Addition Of Oxaliplatinmentioning

confidence: 99%

Rectal Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology

Benson

Venook

Al-Hawary

et al. 2022

Journal of the National Comprehensive Cancer Network

328

147

View full text Add to dashboard Cite

show abstract

“…This regimen is considered one of the standard approaches for preoperative chemoradiotherapy in locally advanced rectal cancer. There is also insufficient evidence to suggest that the addition of oxaliplatin or molecular target agents can improve tumor response or patient survival [33,34]. The use of the same treatment regimen helps minimize the impact of different chemotherapy drugs on the response to preoperative treatment.…”

Section: Discussionmentioning

confidence: 99%

Artemis as Predictive Biomarker of Responsiveness to Preoperative Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer

Liu,

Huang,

Shan

et al. 2024

Current Oncology

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The aim of this study was to identify Artemis as a predictive biomarker for guiding preoperative chemoradiotherapy in locally advanced rectal cancer. The resection specimens were collected from 50 patients with rectal cancer who underwent preoperative chemoradiotherapy. Artemis expression in biopsy tissues was evaluated using immunohistochemical staining according to the percentage of positively stained cells combined with staining intensity. Among the 50 patients, 36 (72%) had a weakly positive Artemis protein expression, 10 (20%) had a moderately positive expression, and 4 (8%) showed a strongly positive expression. The criteria of magnetic resonance imaging tumor regression grade (mrTRG) and pathological rectal cancer regression grade (RCRG) were used to assess the tumor response to chemoradiotherapy. Correlation analysis shows that there is a significant negative correlation between high Artemis immunoscore and treatment response (r = −0.532, p < 0.001). The results imply that high Artemis expression was associated with poor treatment response. Our study suggested a potential role of Artemis as a predictive biomarker of the tumor response to preoperative chemoradiotherapy in patients with locally advanced rectal cancer.

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“…The detrimental effect on the mucosa, mostly with hypofractionated high dose regimens, seemed to be true notwithstanding the order and time between the radiotherapy and bevacizumab. However, there are also other publications revealing the safety of bevacizumab and radiotherapy combinations 42,43 . Aside from its antiangiogenic effect to improve tumor response, bevacizumab has been increasingly used to clinically control, stabilize, and hopefully revert the clinically symptomatic radiation-induced brain necrosis [44][45][46][47] .…”

Section: Discussionmentioning

confidence: 99%

Simulations on the efficacy of radiotherapy with different time schemes of antiangiogenic therapy

Tuzer

Yιlmaz

Ünlü

2021

Preprint

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The combination of radiotherapy and antiangiogenic agents has been suggested to be potent in tumor growth control compared to the application of antiangiogenic therapy or radiotherapy alone. Since radiotherapy is highly dependent on the oxygen level of the tumor area, antiangiogenic agents are utilized for the reoxygenation of tumor vasculature. We present a mathematical framework to investigate the efficacy of radiotherapy combined with antiangiogenic treatment. The framework consists of tumor cells, vasculature, and oxygenation levels evolving with time to mimic a tumor microenvironment. Non-linear partial differential equations (PDEs) are employed to simulate each component of the framework. Different treatment schemes are investigated to see the changes in tumor growth and oxygenation. To test combination schedules, radiation monotherapy, neoadjuvant, adjuvant, and concurrent cases are simulated. The efficiency of each therapy scheme on tumor growth control, the changes in tumor cell density, and oxygen levels shared by tumor cells are represented. The simulation results indicate that the application of radiotherapy after antiangiogenic treatment is more efficient in tumor growth control compared to other therapy schemes. The present study gives an insight into the possible interaction and timing of the combination of radiotherapy and antiangiogenic drug treatment.

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Neoadjuvant Radiotherapy with Capecitabine Plus Bevacizumab for Locally Advanced Lower Rectal Cancer: Results of a Single-institute Phase II Study

Abstract: Although acute toxicity during CRT with bevacizumab was minimal and postoperative complications do not seem to increase, the addition of bevacizumab apparently offers no clinically-significant benefit for patients with LARC.

Cited by 9 publications

References 20 publications

Rectal Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology

Rectal Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology

Artemis as Predictive Biomarker of Responsiveness to Preoperative Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer

Simulations on the efficacy of radiotherapy with different time schemes of antiangiogenic therapy

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