Elderly patients with advanced colorectal cancer derive similar benefit without excessive toxicity after first-line chemotherapy with oxaliplatin-based combinations: comparative outcomes from the 03-TTD-01 phase III study

PURPOSE

Healthy elderly patients with metastatic colorectal cancer may benefit from chemotherapy as much as the younger population. This analysis compares the outcomes of first-line oxaliplatin plus fluoropyrimidines in elderly versus young patients.

PATIENTS AND METHODS

348 patients were randomized to capecitabine 1000 mg/(m2 12 h), days 1-14 plus oxaliplatin 130 mg/m2 day 1, every 3 weeks or weekly infusional 5-FU 2250 mg/m2 over 48 h plus bimonthly oxaliplatin 85 mg/m2. We evaluated response rate, time to progression, overall survival and toxicity according to age.

RESULTS

ORR for elderly and young patients were 34.9% and 44.7%, respectively (p=0.081). Median TTP did not differ between the two groups: 8.3 months for patients > or =70 years and 9.6 months for those <70 years (p=0.114). Median OS was 16.8 months and 20.5 months for the > or =70 and <70 years groups, respectively (p=0.74). With XELOX, mild paresthesia and an increase in transaminase levels were more frequent for young patients, whereas grade 3/4 diarrhea was higher in those > or =70 years (25% vs. 8%, p=0.005). For FUOX, only paresthesia was significantly lower in patients > or =70 years (53% vs. 71%, p=0.032).

CONCLUSION

Elderly patients with MCRC benefit from first-line oxaliplatin-fluoropyrimidine combinations as much as younger patients, without increased toxicity.

[Capecitabine combined with cisplatin as first-line therapy in Chinese patients with advanced gastric carcinoma-a phase II clinical study]

OBJECTIVE

To evaluate the effectiveness and safety of the combination chemotherapy of capecitabine (X) with fractionated administration of cisplatin (C) in Chinese patients with advanced gastric cancer (AGC).

METHODS

141 patients with AGC were enrolled between July 2002 and August 2004. All patients had measurable tumor according to the criteria of RECIST, Karnofsky performance status > or = 60, adequate bone marrow, renal and hepatic functions. Prior radiotherapy or adjuvant chemotherapy was not permitted. Patients received oral administration of capecitabine at a dose of 1000 mg/m(2) twice a day on D1-D14, and intravenous infusion of fractionated cisplatin at a dose of 20 mg/m(2)/day on D1-D5. The regimen was repeated every 3 weeks, totally for 6 cycles.

RESULTS

Of the 141 evaluable patients, there were 104 men and 37 women, with a median age of 54 years (range, 23 - 80 years). Metastases before chemotherapy were detected in lymph nodes (46.8%), liver (40.4%), lung (5.7%) and other area (10.6%). The median treatment duration was 6 cycles (range, 3 - 6 cycles). The objective response rate (RR) was 36.2% (51/141). The median follow-up period was 17.5 months. The median time to progress (TTP) was 9.0 months, and the median overall survival (OS) was 12.0 months. The most common treatment-related adverse events (grade 3/4) were: hand-foot syndrome (HFS) (2.1%), leucopenia (0.7%), abnormal alanine transaminase elevation (2.8%). There was no treatment-related death.

CONCLUSION

Capecitabine combined with fractionated cisplatin is highly effective and well tolerated as a first-line treatment for advanced gastric cancer, with comparable results to 5-Fu plus cisplatin combination therapy.

[Docetaxel and capecitabine combination chemotherapy for patients with anthracycline-resistant metastatic breast cancer]

OBJECTIVE

To evaluate the efficacy and safety of docetaxel and capecitabine combination chemotherapy (DC regimen) for patients with anthracycline-resistant metastatic breast cancer.

METHODS

Thirty-two patients with anthracycline-resistant metastatic breast cancer were treated with a docetaxel and capecitabine combination regimen. All patients received oral administration of capecitabine at a dose of 1250 mg/m(2) twice daily, within 30 min after meal on D1 to D14, and intravenous infusion of docetaxel at a dose of 75 mg/m(2) on D1. The regimen was repeated every 3 weeks.

RESULTS

A total of 126 cycles of DC regimen were administered in the 32 cases, with a median of 4 cycles. The overall response rate was 46.9%. Among the 32 patients, there were complete response in 1, partial response in 14, stable disease in 11 and progressive disease in 6 cases. The median time to progression (TTP) was 5.6 months. The one-year survival rate was 56.3%. The effective cases in different metastatic organs were: 8 cases in the lung, 6 cases in the liver, 3 cases in the soft tissue and 3 cases in the lymph nodes. The common adverse reactions were myelosuppression, hand-foot syndrome, nausea and vomiting. Neutropenia was observed in 84.4% of the patients. Two patients developed degree IV myelosuppression.

CONCLUSION

The combination chemotherapy regimen of docetaxel plus capecitabine is well-tolerated and effective for anthracycline-resistant metastatic breast cancer.

First-line therapeutic strategies in metastatic colorectal cancer

The treatment of metastatic colorectal cancer (mCRC) has changed dramatically from the 1980s, when only fluorouracil (5-FU) was available for treatment and the median survival was at best 12 months, to a time when mCRC is considered more of a chronic disease in which the median survival is now reported in excess of 2 years. This review traces the evolution of treatment in this setting, including studies of single-agent vs combination treatment with 5-FU/leucovorin, irinotecan, oxaliplatin, and capecitabine, comparisons of simultaneous and sequential regimens, and the role of targeted agents such as bevacizumab, cetuximab, and panitumumab.

Gemcitabine-induced pulmonary toxicity during adjuvant therapy in a patient with pancreatic cancer

CONTEXT

Gemcitabine is a pyrimidine antimetabolite with activity in a number of cancers. Gemcitabine is the accepted standard for the adjuvant and metastatic treatment of pancreatic cancer, however, it also has indications in breast, ovarian, and non-small cell lung cancers. The most common side effect is myelosuppression. Dyspnea is reported in 23% and bronchospasm occurs in less than 2% of subjects. Acute respiratory distress syndrome is rare with single agent use or in combination.

CASE REPORT

A 68-year-old man being treated for stage IIA pancreatic cancer after pancreaticoduodenectomy developed hypoxemic respiratory distress after the second dose of gemcitabine 1,000 mg/m(2). The radiographic findings on computed tomography scans evolved from ground glass opacities to findings suggestive of cryptogenic organizing pneumonia over the course of two weeks. He was treated with antibiotics, steroids, nebulizers and oxygen. A follow-up computed tomography scan of chest four weeks after presentation showed complete resolution of pneumonitis.

CONCLUSIONS

We report the first case of gemcitabine-induced pneumonitis encountered during the adjuvant treatment of pancreatic cancer. Physicians seeing such patients should be aware of this rare but real pulmonary toxicity. A delay in diagnosis and treatment can lead to potentially fatal outcomes.

Interaction between capecitabine and gemcitabine with warfarin in a patient with pancreatic cancer

Gemcitabine is the only chemotherapeutic agent approved by the U.S. Food and Drug Administration (FDA) for the treatment of advanced pancreatic cancer. 5-fluorouracil or its oral pro-drug, capecitabine is the second most commonly used agent in this malignancy. Capecitabine or 5-fluorouracil is the second most common agent used either in second-line or as a radiosensitizer. Thromboembolism requiring anticoagulation is a common paraneoplastic complication in these patients. We report a patient with pancreatic cancer, challenged with maintaining the international normalized ratio (INR) with gemcitabine-capecitabine combination, and later with gemcitabine monotherapy with concomitant warfarin, as well as, a brief review of the literature. Patients with pancreatic cancer who receive warfarin and gemcitabine should be monitored for any potential drug interactions. Frequent prothrombin time and INR evaluations are suggested for anticoagulated patients receiving gemcitabine, especially when combined with capecitabine.

[A phase I study of combination therapy with capecitabine and paclitaxel for patients with inoperable breast cancer or recurrent breast cancer]

A dose-escalation study was conducted for patients with inoperable or recurrent breast cancer in order to determine the recommended dose (RD) of capecitabine combined with a fixed dose of weekly paclitaxel. Capecitabine was administered twice daily from day 1 through day 14 combined with paclitaxel given on days 1 and 8, every 21 days. Dose-limiting toxicities(DLT)were evaluated during the first two cycles. Three patients were recruited at one of two dose levels (capecitabine 1,255 mg/m2 or 1,657 mg/m2, paclitaxel 80 mg/m2). In this study, no DLT was seen in each level, and the RD of capecitabine was determined to be 1,657 mg/m2.

Role of neoadjuvant treatment in cT3N0M0 rectal cancer

BACKGROUND

The aim of the study was to evaluate the pathological response (pTNM), local relapse and overall survival (OS) in clinical T3N0M0 (cT3N0M0) rectal cancer after a neoadjuvant chemoradiotherapy (CHT-RT) with 5-fluorouracil (5-FU) continuous infusion (c.i.) (+/- oxaliplatin) or bolus or capecitabine (an oral fluorpyrimidine). A secondary endpoint was to identify the local relapse rate and OS in those patients also receiving an adjuvant chemotherapy.

PATIENTS AND METHODS

From January 2000 to January 2006, 48 consecutive cT3N0M0 rectal cancer cases neoadjuvantly treated were retrospectively examined. Variables considered were age, gender, modality of 5-FU administration and tumour site.

RESULTS

Median age was 64 years (range, 22-84 years) and the male:female ratio was 28:20. All the patients received the full course of CHT-RT. Twenty-eight patients received c.i. 5-FU neoadjuvant chemotherapy, 17 received bolus 5-FU administration and 3 patients received capecitabine-based therapy. The mean number of chemotherapy weeks was 4.9 (range, 2-6). A total of 85.4% of patients were operated on without relevant postoperative complications but another 4 are awaiting surgery. Twenty-one patients had a lower (< or = 5 cm from the anal verge) and 27 had a middle rectal lesion (from 6 to 10 cm). In those patients with the lower site of lesion, a sphincter-saving (SS) procedure was achieved in 88.9%. Downstaging was reported in 66.7%. Ninety percent of cases are still free from progression after a median follow-up of 22.1 months; 7.5% are dead.

CONCLUSION

The down-staging, the good level of SS and the disease-free survival (DFS) obtained here suggests that a neoadjuvant therapy may also be useful for stage II rectal cancer at diagnosis. The use of a postoperative chemotherapy should probably be outlined better.

Chemotherapy in elderly patients with colorectal cancer

Significant advancements in chemotherapy for metastatic colorectal cancer (mCRC) have been achieved over the past decade, and the median overall survival duration is now close to 24 months with appropriate treatment. The most widely recommended chemotherapy regimens are based on the use of irinotecan or oxaliplatin in combination with 5-fluorouracil and leucovorin; some data suggest further benefit with the addition of the targeted agents bevacizumab or cetuximab. Colorectal cancer primarily affects the elderly; however, much of the defining clinical research in this field has excluded subjects of advanced age or with a poor performance status, making it difficult for clinicians to interpret current treatment paradigms for their older patients. Most clinical trials that have included elderly patients document similar survival rates and toxicity profiles to those seen in younger patients. Moreover, survey data suggest that >70% of elderly patients with cancer are willing to undergo strong, palliative chemotherapy. While these findings suggest that age itself should not determine candidacy for chemotherapy, it is important to note the great heterogeneity of the elderly population with regard to overall health, independence, and performance status. The use of a comprehensive geriatric assessment is recommended to evaluate chemotherapy appropriateness. The management of frail elderly patients and those with a short life expectancy should be focused on palliation, while fit elderly patients can receive aggressive therapy in a similar fashion to younger patients.

FDA drug approval summary: lapatinib in combination with capecitabine for previously treated metastatic breast cancer that overexpresses HER-2

On March 13, 2007, the U.S. Food and Drug Administration approved lapatinib (Tykerb tablets; GlaxoSmithKline, Philadelphia), an oral, small molecule, dual tyrosine kinase inhibitor of ErbB-2 and ErbB-1, for use in combination with capecitabine for the treatment of patients with human epidermal growth factor receptor (HER)-2-overexpressing metastatic breast cancer who had received prior therapy including an anthracycline, a taxane, and trastuzumab. One multicenter, open-label, randomized trial was submitted. Eligible patients had stage IIIb or IV breast cancer, ErbB-2 overexpression (immunohistochemistry 3+ or 2+ with fluorescence in situ hybridization confirmation), measurable disease, a 0 or 1 Eastern Cooperative Oncology Group performance status score, a cardiac ejection fraction within the institutional normal range, and adequate laboratory function. Patients received either lapatinib (1,250 mg once daily on days 1-21) plus capecitabine (1,000 mg/m(2) every 12 hours on days 1-14) every 21 days or capecitabine alone (1,250 mg/m(2) every 12 hours on days 1-14) every 21 days. The primary endpoint was time to progression (TTP) determined by a blinded independent review panel. After TTP results of a prespecified interim analysis were made available, study enrollment was discontinued (399 patients enrolled). The median TTP was 27.1 versus 18.6 weeks (hazard ratio, 0.57; p = .00013) favoring the lapatinib plus capecitabine arm. Response rates were 23.7% (lapatinib plus capecitabine) versus 13.9% (capecitabine alone). Survival data were not mature. Although the toxicities observed in the lapatinib and capecitabine combination arm were generally similar to those in the capecitabine alone arm, a higher incidence of diarrhea and rash was noted with the combination. Grade 3 or 4 adverse reactions that occurred with a frequency of >5% in patients on the combination arm were diarrhea (13%) and palmar-plantar erythrodysesthesia (12%). There was a 2% incidence of reversible decreased left ventricular function in the combination arm.

[Combination of docetaxel and capecitabine for the treatment of anthracycline-resistant advanced breast carcinoma]

OBJECTIVE

To evaluate the efficacy and toxicity of docetaxel and capecitabine combination in the treatment of anthracycline-resistant advanced breast carcinoma.

METHODS

Forty-three patients with anthracycline-resistant advanced breast carcinoma were treated with docetaxel combined with capecitabine between January 2002 and November 2004. Docetaxel was administered intravenously at a dose of 75 mg/m(2) on D1, and oral intake of capecitabine at a dose of 1600 mg/d on D1 to D14, every 21 days as a cycle. The median number of cycles was 4 (range, 4 approximately 6 cycles).

RESULTS

All the 43 patients had a mean follow-up of 15 months. The overall response rate was 62.8%, with a complete response rate of 20.9% and partial response rate of 44.2%. The median survival time was 15 months with a median time to progression of 7.5 months. The one-year and 2-year survival rates were 62.8% and 41.9%, respectively. The quality of life was improved in all patients. The major toxicity and adverse effects were gastrointestinal reaction and hematological toxicity.

CONCLUSION

The combination of docetaxel and capecitabine for the treatment of anthracycline-resistant advanced breast carcinoma is effective, safe and tolerable.

Preoperative chemoradiation for locally advanced rectal cancer with capecitabine 2,000 mg/m2/day

OBJECTIVE

Evaluate the efficacy and the tolerability of preoperative chemoradiation with high dose Capecitabine.

MATERIAL AND METHOD

Fifteen patients with locally advanced resectable rectal cancer were treated with Capecitabine 2,000 mg/m2/day, orally 7 days/week concurrent with whole pelvic irradiation 45 Gy in 25 fractions/5 weeks. Patients underwent surgery in the following 4-6 weeks.

RESULTS

After complete treatment, 11 patients (73%) underwent surgery. Ten patients (66%) had sphincter preservative surgery; three of them had primary tumors located in the lower rectum. Five patients had grade 2 and one patient had grade 3 diarrhea. No grade 4 toxicity was reported.

CONCLUSION

Preoperative Capecitabine 2,000 mg/m2/day concurrent with whole pelvic irradiation were effective and well tolerated The potential dose limiting toxicity effect was the diarrhea.

Capecitabine and mitomycin-C in the therapy of pretreated patients with metastatic colorectal cancer: single center retrospective study with 36 patients

PURPOSE

To evaluate the therapeutic effectiveness and safety of treatment with capecitabine and mitomycin-C (MMC) in patients with metastatic colorectal cancer previously treated with at least one chemotherapy regimen for recurrent or metastatic disease.

PATIENTS AND METHODS

A total of 36 patients (male/female 21/15, median age 62.5 years) with metastatic colorectal cancer were treated with capecitabine and MMC as their second, third or fourth line chemotherapy regimen. Chemotherapy consisted of intravenous MMC 6 mg/m(2) on day 1 plus oral capecitabine 1000 mg/m(2) twice daily on days 1-15 followed by 7-day rest. Treatment courses were repeated every 3 weeks unless there was evidence of progressive disease or unacceptable toxicity.

RESULTS

All 36 patients were evaluable for toxicity and response. A total of 175 cycles were administered (median 4.86, range 3-6). Two (5.6%) patients achieved complete response, 3 (8.3%) partial response, 14 (38.9%) had stable disease and 16 (44.4%) patients progressed. Median time to tumor progression (TTP) was 4.5 months and median overall survival (OS) 13 months. No toxic deaths occurred. Toxicity was mild and easily manageable.

CONCLUSION

This retrospective study demonstrated that the combination of capecitabine and MMC is an effective and well-tolerated regimen for patients previously treated for metastatic or recurrent colorectal cancer.

Complete remission of unresectable colon cancer after preoperative chemotherapy selected by adenosine triphosphate-based chemotherapy response assay

The adenosine triphosphate-based chemotherapy response assay (ATP-CRA) is a chemosensitivity test that offers the potential of selecting cancer treatments based on the responsiveness of individual tumors. We report a case of 47-yr-old male, presented with sigmoid colon cancer with multiple liver and peritoneal metastases, in which there was a complete response for the primary colon cancer after administration of preoperative chemotherapy selected by ATP-CRA. Oxaliplatin was the most sensitive drug based on the ATP-CRA where the specimen obtained by ultrasound- guided percutaneous liver biopsy was used. After twelve cycles of oxaliplatincapecitabine chemotherapy, abdominopelvic computed tomography revealed marked shrinkage of the liver metastases and positron emission tomography showed no uptake of 18F-fluoro-deoxy-glucose (FDG) either in the liver or peritoneum except localized uptake in the sigmoid colon. The patient underwent an anterior resection and radiofrequency ablation of the liver metastases, which resulted in a macroscopic curative resection of the cancer cells. Histological examination revealed no residual cancer cells in the resected specimen of the sigmoid colon. This result suggested that preoperative chemotherapy chosen by ATP-CRA may be useful for treating advanced colon cancer with unresectable liver and peritoneal metastases.

Capecitabine induced vasospastic angina

Cardiotoxicity is a recognised side effect of intravenous 5-fluorouracils. In the two case reports described we demonstrate similar cardiotoxic side effects seen with the use of capecitabine. With the increasing use of oral adjuvant chemotherapeutic agents, capecitabine should be used with caution in those patients with existing coronary artery disease.

Efficacy of S-1 in heavily pretreated patients with metastatic breast cancer: cross-resistance to capecitabine

BACKGROUND

It is not clear what the optimal treatment of chemotherapy is for patients with heavily treated metastatic breast cancer (MBC). We have retrospectively examined the efficacy and safety of S-1 in patients with MBC who had been previously treated with anthracycline, taxane, and capecitabine.

METHODS

Patients with MBC who had been administered S-1, an oral modulated compound containing a fluoropyrimidine derivative, between November 2001 and June 2003 at the Cancer Institute Hospital were retrospectively reviewed. S-1 at a standard dose of 50 mg/body was administered twice daily for four weeks, followed by a two-week rest period. This was repeated every six weeks until disease progression or unacceptable toxicity.

RESULTS

Thirty-five patients were assessed. The patients were heavily pretreated with anthracycline (100%), taxane (paclitaxel or docetaxel) (100%), capecitabine (100%), vinorelbine (71%), and mitomycin (69%). Median follow-up time of patients was 9.6 months (range, 1.2-26.6). ORR was 3% (95% confidence interval: 0-9%), and CBR was 20% (95% confidence interval: 6-33%). Time to treatment failure was 2.8 months. Overall survival was 21.4 months. Grade 1 or 2 adverse events were observed in 17% and 13%, respectively. Grade 3 events occurred as anorexia (9%), nausea (9%), vomiting (9%), diarrhea (14%), fatigue (3%), and elevation of AST/ALT (3%). No grade 3 was seen as hand-foot syndrome. Neither grade 3 nor 4 was observed in bone marrow suppression.

CONCLUSIONS

S-1 was fairly well tolerated, but demonstrated very limited activity in capecitabine-pretreated patients who had already been exposed to anthracycline and taxane. It was suggested that S-1 clinically exhibited cross-resistance to capecitabine.

Complete remission in a colon cancer patient with a large, irresectable liver metastasis after XELOX/cetuximab/bevacizumab treatment

BACKGROUND

Stage IV colorectal cancer is usually an incurable disease. However, patients with resectable metastases have 5-year disease-free survival rates of up to 30%. Even with primarily irresectable disease, cure can be achieved in patients who become operable after neoadjuvant treatment. To improve the prognosis of these patients, highly effective neoadjuvant regimens need to be developed.

CASE REPORT

Here, we report the case of a 62-year-old male patient who had been diagnosed with International Union against Cancer (UICC) stage III colon cancer 7 years previously and now presented with a large, irresectable liver metastasis and enlarged perihepatic lymph nodes. After neoadjuvant treatment with cetuximab, bevacizumab and XELOX, the patient showed a complete remission and underwent surgery. Histopathologically, the resected tissue and lymph nodes were free of residual tumor.

CONCLUSION

To our knowledge, this is the first report of a complete pathological response in a patient with irresectable colorectal cancer after intensive chemotherapy/anti-EGFR/ VEGF antibody therapy. This combination regimen may help to improve the survival rates for patients with irresectable disease.

[A recurrent case of lipid-secreting carcinoma of the breast successfully treated with capecitabine]

We herein report a recurrent case of lipid-secreting carcinoma of the breast which was successfully treated with capecitabine. A 50-year-old female underwent a pectoralis-preserving mastectomy for left breast cancer in December 2002. The clinical staging of the disease was T2N1M0 (stage II B) and ER (-), PgR(-), HER2 (1+). Microscopic examinations revealed solid alveolar proliferation in the majority of the tumor cells, which had an abundant foamy cytoplasm. A variable amount of neutral lipid was also identified in the cytoplasm of the tumor cells by Sudan III staining. After the operation, the patient received two courses of systemic chemotherapy using docetaxel (60 mg/m(2)). In March 2004, she was diagnosed to have a recurrence in the thoracic wall. She received radiotherapy (total 50 Gy radiation), but it proved to be ineffective. In June 2004, treatment using capecitabine (2,400 mg/day) was therefore attempted. Two courses of the treatment resulted in a complete response of the tumor. The above patient has since continued to show a complete response with capecitabine for over 3.5 years.

Bevacizumab added to the irinotecan and capecitabine combination for advanced colorectal cancer: a well-tolerated, active and convenient regimen

OBJECTIVES

The literature data regarding bevacizumab (BEV) administered together with capecitabine (CAP) and irinotecan (IRI) in patients with advanced colorectal cancer (CRC) are limited. The safety and efficacy of the addition of BEV to the IRI and CAP (XELIRI) regimen were retrospectively analyzed and reported.

PATIENTS AND METHODS

Adult patients 18 years or older with advanced CRC, Eastern Cooperative Oncology Group performance status (ECOG PS) < or =2, exposed to < or =1 chemotherapy (CT) regimen not including IRI or CAP, received BEV 7.5 mg/kg and IRI 220 mg/m2 both on day 1; CAP 1.8 g/m2/d, dl-14. The treatment was repeated every 21 days up to a total of 8 cycles. Responding or stabilized patients were treated with BEV 7.5 mg/m2, administered as maintenance every 21 days until disease progression.

RESULTS

Thirty-four patients were treated, the majority (29, 85.3%) in first-line: eighteen (53%) male, 16 (47%) female, and aged 37-83 years (median 69.5). The treatment was moderately tolerated with mainly gastrointestinal complications: hematological, cardiovascular and other toxicities were also recorded, but they were manageable. No treatment-related death was noted. The overall response rate (RR) was 47.1%, while 41.2% of the patients achieved stable disease. Median progression-free survival and overall survival were 8 and 14 months, respectively, with 16% progression-free and 62% alive at 12 months.

CONCLUSION

BEV-XELIRI is effective and well tolerated, leading to disease control in a vast majority of patients with advanced CRC.

Hypofractionated accelerated radiotherapy, cytoprotection and capecitabine in the treatment of rectal cancer: a feasibility study

BACKGROUND

This is a report on the feasibility and efficacy of hypofractionated accelerated radiotherapy combined with amifostine cytoprotection (hypoARC) and capecitabine in the treatment of rectal adenocarcinoma.

PATIENTS AND METHODS

Twenty-seven patients (pts) received pre- (14 pts) or postoperative (13 pts) conformal radiotherapy with 10 consecutive fractions of 3.4 Gy in 12 days, supported with subcutaneously administered high-dose amifostine (up to 1000 mg) and capecitabine (daily dose of 600 mg/m2 twice a day, 5 days per week for 4 weeks). Ten additional patients with inoperable tumors received a higher dose (15 fractions of 3.4 Gy) as a radical intervention and 5 received a lower dose for palliation.

RESULTS

Chemotherapy-related toxicity was minimal and radiation grade 2 diarrhoea and proctitis was noted in 3/42 and 4/42 cases, respectively. No peri- or postoperative complications were noted in patients receiving pre-operative radiochemotherapy. Significant tumor regression was confirmed in post- RT CT-imaging and major histological responses were noted in 85% of cases treated before surgery. Late toxicity (median follow-up 26 months) was negligible. The 2-year local relapse-free survival was 85-90% in patients treated with pre- or postoperative radiotherapy and 35% in patients with inoperable tumors.

CONCLUSION

Capecitabine-based hypoARC is feasible with only minimal early and late toxicity and encouraging efficacy.

A modern regimen of pre-operative concurrent chemo-radiation therapy in locally advanced rectal cancer

PURPOSE

To evaluate the efficacy and toxicity of preoperative concurrent capecitabine and radiotherapy in the treatment of resectable locally advanced rectal cancer (LARC).

MATERIALS AND METHODS

We conducted a phase II trial to assess pathological complete response, tumor downstaging, toxicity and survival of capecitabine (825 mg/m(2) orally, twice daily) with radiotherapy (50.4 Gy/28 fractions) in 31 patients with LARC (cT3/T4 or N+) staged by endoscopic ultrasound (EUS).

RESULTS

Median age was 53 years; with M:F ratio of 1:1.58; 77.4% had Eastern Cooperative Oncology Group performance status of 1. EUS showed that 67.7% of tumors were T3, 19.4% were T4, and 58% were node positive. Of 30 patients who had surgery, 6.5% achieved pathological complete remission (pCR). Tumor and nodal downstaging were achieved in 53.9% and 50% of patients, respectively. Grade 3/4 toxicities were mainly diarrhea (35.5%) and proctitis (32.3%). Sphincter preservation was achieved in 4/21 (15%) of patients initially planned for abdominoperineal resection. The median follow-up was 46 months (Range: 1.47-63.9), and the 3-year disease-free and overall survival were 59.8% and 76.6%, respectively.

CONCLUSION

Capecitabine given concurrently with radiation therapy is generally well tolerated, and proved to be an effective radiosensitizer in the neoadjuvant treatment of locally advanced rectal cancer, yielding results comparable to those reported with 5-FU.

Micro-RNAs miR125b and miR137 are frequently upregulated in response to capecitabine chemoradiotherapy of rectal cancer

There is increasing evidence that some microRNAs change their levels in reaction to xenobiotic challenge. The aim of this study was to test the possible involvement of micro-RNAs in response to standard anticancer treatment. Tumor biopsies from 35 patients with rectal cancer before therapy and parallel tumor biopsies from 31 patients two weeks after starting preoperative capecitabine chemoradiotherapy were taken. The expression levels of single miRNA species were measured using TaqMan Micro-RNA assays after reverse transcription from isolated total RNAs. Many micro-RNAs (miR10a, miR21, miR145, miR212, miR339, miR361) responded to chemoradiotherapy in individual tumor samples, but there was profound intertumoral variability. However, other two micro-RNAs miR125b, miR137 showed a significant increase in median expression levels after starting therapy in most samples. Moreover, our results for the first time show that higher induced levels of miR125b and miR137 are associated with worse response to the therapy.