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Ikeda M, Sekimoto M, Fukunaga Y, Konishi K, Fujiwara Y, Mizushima T, Takemasa I, Yamamoto H, Doki Y, Mori M. A phase I study of oral UFT/leucovorin and irinotecan, plus radiation for locally recurrent rectal cancer. JOURNAL OF THE ANUS RECTUM AND COLON 2018; 1:50-55. [PMID: 31583301 PMCID: PMC6768668 DOI: 10.23922/jarc.2016-009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/02/2017] [Indexed: 11/30/2022]
Abstract
Objectives: The aim of this phase I study is to identify the maximum tolerated dose (MTD) and recommended dose (RD) of CPT-11 in combination with UFT/LV and radiation in patients with locally recurrent rectal cancer. Methods: Patients with histologically proven rectal cancer with local recurrence were eligible for this study. Escalating doses of CPT-11 (30-60 mg/m2) were administered on days 3, 10, 24, and 31. UFT (300 mg/m2) and LV (75 mg/body) were given on days 1-5, 8-12, 22-26, and 29-33. Radiotherapy doses consisted of 50 Gy in daily fractions of 2.0 Gy each, 5 times per week, for total 5 weeks. Results: We recruited 27 patients, and the MTD of CPT-11 was 60 mg/m2 due to the occurrence of dose-limiting toxicity of grade 3 diarrhea. Major grade 3 adverse events were neutropenia (5/27; 18.5%) and diarrhea (6/27; 22.2%). No grade 4 adverse event was observed throughout this treatment. Conclusions: The combined chemoradiotherapy with oral UFT/LV plus CPT-11 is feasible and promising. The recommended dose for further phase II trials is determined to be 50 mg/m2 of CPT-11.
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Affiliation(s)
- Masataka Ikeda
- Department of Surgery, Osaka National Hospital, Osaka, Japan
| | | | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Yushi Fujiwara
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tsunekazu Mizushima
- Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ichiro Takemasa
- Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hirofumi Yamamoto
- Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuichiro Doki
- Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masaki Mori
- Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, Nordlinger B, van de Velde CJ, Balmana J, Regula J, Nagtegaal ID, Beets-Tan RG, Arnold D, Ciardiello F, Hoff P, Kerr D, Köhne CH, Labianca R, Price T, Scheithauer W, Sobrero A, Tabernero J, Aderka D, Barroso S, Bodoky G, Douillard JY, El Ghazaly H, Gallardo J, Garin A, Glynne-Jones R, Jordan K, Meshcheryakov A, Papamichail D, Pfeiffer P, Souglakos I, Turhal S, Cervantes A. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making. Ann Oncol 2012; 23:2479-2516. [PMID: 23012255 DOI: 10.1093/annonc/mds236] [Citation(s) in RCA: 1056] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Colorectal cancer (CRC) is the most common tumour type in both sexes combined in Western countries. Although screening programmes including the implementation of faecal occult blood test and colonoscopy might be able to reduce mortality by removing precursor lesions and by making diagnosis at an earlier stage, the burden of disease and mortality is still high. Improvement of diagnostic and treatment options increased staging accuracy, functional outcome for early stages as well as survival. Although high quality surgery is still the mainstay of curative treatment, the management of CRC must be a multi-modal approach performed by an experienced multi-disciplinary expert team. Optimal choice of the individual treatment modality according to disease localization and extent, tumour biology and patient factors is able to maintain quality of life, enables long-term survival and even cure in selected patients by a combination of chemotherapy and surgery. Treatment decisions must be based on the available evidence, which has been the basis for this consensus conference-based guideline delivering a clear proposal for diagnostic and treatment measures in each stage of rectal and colon cancer and the individual clinical situations. This ESMO guideline is recommended to be used as the basis for treatment and management decisions.
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Affiliation(s)
- H J Schmoll
- Department of Oncology/Haematology, Martin Luther University Halle, Germany.
| | - E Van Cutsem
- Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium
| | - A Stein
- Hubertus Wald Tumor Center, University Comprehensive Cancer Center, Hamburg-Eppendorf, Germany
| | - V Valentini
- Department of Radiotherapy, Policlinico Universitario "A. Gemelli," Catholic University, Rome, Italy
| | - B Glimelius
- Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - K Haustermans
- Department of Radiation Oncology, University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium
| | - B Nordlinger
- Department of Surgery, Assistance-Publique-Hôpitaux de Paris, Hôpital Ambroise Paré,Boulogne; Université Versailles Saint Quentin en Yvelines, Versailles, France
| | - C J van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J Balmana
- Department of Medical Oncology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - J Regula
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - I D Nagtegaal
- Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen
| | - R G Beets-Tan
- Department of Radiology, University Hospital of Maastricht, Maastricht, The Netherlands
| | - D Arnold
- Hubertus Wald Tumor Center, University Comprehensive Cancer Center, Hamburg-Eppendorf, Germany
| | - F Ciardiello
- Division of Medical Oncology, Department of Experimental and Clinical Medicine and Surgery "F. Magrassi and A. Lanzara", Second University of Naples, Naples, Italy
| | - P Hoff
- Hospital Sírio Libanês, Sao Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - D Kerr
- Department of Clinical Pharmacology, University of Oxford, Oxford, UK
| | - C H Köhne
- Department for Oncology/Haematology, Klinikum Oldenburg, Oldenburg, Germany
| | - R Labianca
- Department of Haematology and Oncology, Ospedali Riuniti, Bergamo, Italy
| | - T Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville, Australia
| | - W Scheithauer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - A Sobrero
- Oncologia Medica, Ospedale S. Martino, Genova, Italy
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Aderka
- Division of Oncology, Sheba Medical Center, Tel-Hashomer, Israel
| | - S Barroso
- Serviço de Oncologia Médica, Hospital do Espirito Santo de Evora, Evora, Portugal
| | - G Bodoky
- Department of Clinical Oncology, St. László Teaching Hospital, Budapest, Hungary
| | - J Y Douillard
- Service d'oncologie médicale, institut de Cancérologie de l'Ouest-René Gauducheau, Saint-Herblain, France
| | - H El Ghazaly
- Department of Oncology, Ain Shams University, Cairo, Egypt
| | - J Gallardo
- Department of Oncology, Clínica Alemana, INTOP, Santiago, Chile
| | - A Garin
- N. N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | - R Glynne-Jones
- Department of Radiotherapy, Mount Vernon Hospital, Northwood, UK
| | - K Jordan
- Department of Oncology/Haematology, Martin Luther University Halle, Germany
| | - A Meshcheryakov
- N. N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | - D Papamichail
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - P Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - I Souglakos
- Department of Medical Oncology, School of Medicine, University of Crete, Heraklion, Greece
| | - S Turhal
- Department of Medical Oncology, Marmara University Hospital, Istanbul, Turkey
| | - A Cervantes
- Department of Hematology and Medical Oncology, INCLIVA Health Research Institute, University of Valencia, Valencia, Spain
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Schmoll H, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, Nordlinger B, van de Velde C, Balmana J, Regula J, Nagtegaal I, Beets-Tan R, Arnold D, Ciardiello F, Hoff P, Kerr D, Köhne C, Labianca R, Price T, Scheithauer W, Sobrero A, Tabernero J, Aderka D, Barroso S, Bodoky G, Douillard J, El Ghazaly H, Gallardo J, Garin A, Glynne-Jones R, Jordan K, Meshcheryakov A, Papamichail D, Pfeiffer P, Souglakos I, Turhal S, Cervantes A. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol 2012. [DOI: 78495111110.1093/annonc/mds236' target='_blank'>'"<>78495111110.1093/annonc/mds236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [78495111110.1093/annonc/mds236','', '10.1097/00001813-200211000-00004')">Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
78495111110.1093/annonc/mds236" />
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Pfeiffer P. High-dose radiotherapy and concurrent UFT plus l-leucovorin in locally advanced rectal cancer: a phase I trial. Acta Oncol 2009; 44:224-9. [PMID: 16076693 DOI: 10.1080/02841860510029671] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A phase I trial of preoperative high dose pelvic radiotherapy and oral UFT/l-leucovorin in patients with locally advanced and unresectable rectal cancer patients to evaluate toxicity and efficacy was performed. Eighteen patients (14 with primary unresectable tumours and four with locally recurrent tumours) were treated. All patients were evaluable for acute toxicity and efficacy. Patients received increasing doses of UFT (150 to 300 mg/m2/day UFT and a fixed dose of 22.5 mg/day l-leucovorin) with each fraction, five days a week for 30 days, concomitantly with pelvic radiotherapy (60 Gy in 30 fractions using concomitant boost technique). All patients received the planned dose of radiotherapy. No hematological toxicity was observed. Only one patient developed grade 3 toxicity (diarrhea). Fourteen patients (78%) had surgery (11 R0 and 3 R1) after median 40 days. Two patients (11%) had a complete pathological response. Ten patients are alive after median follow-up of 49 months. Toxicity, resection rate and survival are very encouraging and the study continues as a phase II trial.
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Affiliation(s)
- Per Pfeiffer
- Department of Oncology, Odense University Hospital, DK-5000, Odense C, Denmark.
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Casado E, Pfeiffer P, Feliu J, González-Barón M, Vestermark L, Jensen HA. UFT (tegafur-uracil) in rectal cancer. Ann Oncol 2008; 19:1371-1378. [PMID: 18381370 DOI: 10.1093/annonc/mdn067] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Major achievements in the treatment of localised rectal cancer include the development of total mesorectal excision and the perioperative administration of radiotherapy in combination with continuous infusion (CI) 5-fluorouracil (5-FU). This multimodal approach has resulted in extended survival and lower local relapse rates, with the potential for sphincter-preserving procedures. However, CI 5-FU is inconvenient for patients and is costly. Oral fluoropyrimidines like UFT (tegafur-uracil) offer a number of advantages over 5-FU. METHODS We undertook a review of published articles and abstracts relating to clinical studies of UFT in the treatment of locally advanced rectal cancer (LARC). Pre- and postoperative studies carried out in patients with newly diagnosed or recurrent disease were included. RESULTS The combination of UFT and radiotherapy was effective and well tolerated in the preoperative setting, while adjuvant UFT improved survival and reduced distant relapse compared with surgery alone. The efficacy of UFT appears comparable with that of 5-FU and capecitabine and its side-effect profile is favourable. CONCLUSION Clinical experience to date suggests that UFT is a valuable treatment option for the perioperative treatment of LARC. Further improvements in patient outcomes may result from the combination of UFT with targeted agents.
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Affiliation(s)
- E Casado
- Department of Medical Oncology, Hospital Infanta Sofía, Madrid, Spain.
| | - P Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - J Feliu
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - M González-Barón
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - L Vestermark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - H A Jensen
- Department of Oncology, Odense University Hospital, Odense, Denmark
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Yasui M, Ikeda M, Sekimoto M, Yamamoto H, Takemasa I, Ueda T, Shimizu J, Fukunaga M, Suzuki O, Inoue T, Monden M. Preliminary results of phase I trial of oral uracil/tegafur (UFT), leucovorin plus irinotecan and radiation therapy for patients with locally recurrent rectal cancer. World J Surg Oncol 2006; 4:83. [PMID: 17118210 PMCID: PMC1664567 DOI: 10.1186/1477-7819-4-83] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 11/22/2006] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Surgical attempts for locally recurrent rectal cancer often fail due to local re-recurrence and distant metastasis. Preoperative chemoradiation may enhance better local control and survival. The aim of this study was to assess the safety of oral uracil and tegafur (UFT) plus leucovorin (LV), and irinotecan combined with radiation and determine the maximum-tolerated dose (MTD) and dose limiting toxicity (DLT) of the triple drug regimen. PATIENTS AND METHODS Patients with locally recurrent rectal cancer received escalating doses of irinotecan on days 1, 8, 15, and 22 (starting at 30 mg/m2, with 10 mg increments between consecutive cohorts) and fixed doses of UFT (300 mg/m2) plus LV (75 mg/day) on days 3 to 7, 10 to 14, 17 to 21, and 24 to 28. Radiation was given 5 days per week totaling 40 to 50 Gy (2Gy/day). RESULTS Six patients were treated at the starting dose, and 2 received the full scheduled chemoradiotherapy. The other 4 patients had grade 3 diarrhea and diarrhea was the DLT. One patient had partial response and he had subsequently radical surgical resection. Median progression free survival for local recurrence was 320 days. CONCLUSION Irinotecan plus UFT/LV with concomitant radiotherapy in patients with locally recurrent rectal cancer was not feasible due to diarrhea in this setting. Modification of the treatment is needed.
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Affiliation(s)
- Masayoshi Yasui
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masataka Ikeda
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hirofumi Yamamoto
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ichiro Takemasa
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takafumi Ueda
- Department of Orthopeadics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Junzo Shimizu
- Department of Surgery, Sakai Municipal Hospital, Osaka, Japan
| | | | - Osamu Suzuki
- Department of Radiation Oncology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takehiro Inoue
- Department of Radiation Oncology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Morito Monden
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Gambacorta MA, Valentini V, Morganti AG, Mantini G, Miccichè F, Ratto C, Di Miceli D, Rotondi F, Alfieri S, Doglietto GB, Vargas JG, De Paoli A, Rossi C, Cellini N. Chemoradiation with raltitrexed (Tomudex) in preoperative treatment of stage II-III resectable rectal cancer: a phase II study. Int J Radiat Oncol Biol Phys 2004; 60:130-8. [PMID: 15337548 DOI: 10.1016/j.ijrobp.2004.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2003] [Revised: 01/27/2004] [Accepted: 02/03/2004] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the impact of preoperative chemoradiation with raltitrexed (Tomudex(1)) on tumor response, sphincter preservation, and toxicity in patients with locally advanced rectal cancer. METHODS AND MATERIALS Between 1998 and 2002, 54 consecutive patients with Stage T3 or T2N+ resectable rectal carcinoma were treated with preoperative chemoradiation, i.v. bolus of raltitrexed on Days 1, 19, and 38 and concurrent 50 Gy external beam radiotherapy. Surgery was performed 6-8 weeks after the end of chemoradiation. RESULTS No patients had Grade 4 acute toxicity. Grade 3 acute toxicity occurred in 16.6% of cases and was hematologic in 6 patients and GI in 2. The overall clinical response rate was 88.8%, with a complete response in 5.5%, partial response in 83.3%, and no change in 9.2%. No patient showed disease progression. All patients underwent surgery. Sphincter saving was obtained in 83.3% of patients. No perioperative mortality occurred, and the perioperative morbidity rate was 5.5%. Of 20 resected patients (37%) who were candidates for abdominoperineal resection at diagnosis (anorectal ring distance < or =30 mm), 13 (65%) underwent a sphincter-saving procedure. At pathologic examination, 13 (24%) of 54 patients had a complete pathologic response (pT0) and 10 (18.5%) had rare isolated residual cancer cells (pT, microscopic foci). Overall, 42.5% had major downstaging. The tumor regression grade (TRG), using Mandard's score system, was also applied and was TRG1 in 13 patients, TRG2 in 11, TRG3 in 20, and TRG4 in 10 patients; no patient had TRG5. CONCLUSION The use of raltitrexed in a neoadjuvant chemoradiation schedule promoted high pathologic tumor downstaging and use of a sphincter-saving procedure. The low toxicity profile supports the rationale to explore raltitrexed combined with other drugs with different biologic targets.
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Affiliation(s)
- Maria Antonietta Gambacorta
- Department of Radiation Therapy, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, Rome 00168, Italy
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Rich TA, Shepard RC, Mosley ST. Four Decades of Continuing Innovation With Fluorouracil: Current and Future Approaches to Fluorouracil Chemoradiation Therapy. J Clin Oncol 2004; 22:2214-32. [PMID: 15169811 DOI: 10.1200/jco.2004.08.009] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Purpose Chemoradiotherapy, the combination of external radiation therapy and concurrent chemotherapy, has been the basis for the oncologic management of many patients since its development in the 1960s. Fluorouracil (FU) chemoradiotherapy has demonstrated success in several organ sites with multiple dosing schedules that now guide the selection of oral analogs of FU to provide new chemoradiotherapy options. Methods This article reviews the metabolism and pharmacology of FU and the advantages of administration of FU by continuous infusion or bolus. The potential role and impact of the oral fluorouracil prodrugs UFT, S-1, BOF-A2, and capecitabine as replacements for intravenous administration are discussed. The results of recent chemoradiotherapy studies with FU from 2000 to 2003 are summarized in rectal, head and neck, esophageal, gastric, pancreatic, biliary, anal, and cervical cancers. Results Chemoradiotherapy with FU has the potential to widen the therapeutic window by minimizing normal tissue toxicity while maintaining effective tumor toxicity. Overall, FU chemoradiotherapy maximizes local control and, for some tumor sites (such as head and neck, pancreatic, biliary, cervical, esophageal, and gastric cancers), improves survival rates. Moreover, FU chemoradiotherapy results in improved organ preservation with excellent functional outcome in several anatomic sites including head and neck cancer, anal, and rectal cancer, with improved sphincter preservation. Conclusion FU chemoradiotherapy continues to play an important role in the management of many cancer sites. During the last four decades, optimal dosing schedules have produced a therapeutic gain. The introduction of oral prodrug analogs will likely further improve the results of FU therapy in several organ systems, such as the rectum, head and neck, and esophagus.
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Affiliation(s)
- Tyvin A Rich
- FACR, Department of Radiation Oncology, University of Virginia Health System, PO Box 800383, Charlottesville, VA 22908-0383, USA.
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