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Zheng Z, Wang X, Lu X, Huang Y, Chi P. Prognostic significance of carcinoembryonic antigen combined with carbohydrate antigen 19-9 following neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. Colorectal Dis 2021; 23:2320-2330. [PMID: 33900006 DOI: 10.1111/codi.15694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/06/2021] [Accepted: 04/18/2021] [Indexed: 12/14/2022]
Abstract
AIM The clinical significance of carcinoembryonic antigen (CEA) combined with carbohydrate antigen 19-9 (CA19-9) in patients with rectal cancer is not well established. The aim of this study was to determine the prognostic value of these combined tumour markers in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT). METHOD A total of 687 consecutive patients with LARC who underwent nCRT and radical surgery were analysed. Tumour characteristics, recurrence-free survival (RFS) and overall survival (OS) were compared according to the number of elevated tumour markers measured before and after nCRT. In addition, the prognostic significance of perioperative changes in the combined tumour markers was further evaluated. RESULT The RFS and OS rates decreased in a stepwise manner in association with the number of elevated pre- and post-nCRT tumour markers (all p < 0.05). Multivariate analysis showed that only the number of elevated post-nCRT tumour markers was an independent prognostic factor (both p < 0.05). For 311 patients with elevated pre-nCRT tumour markers, normalization of the tumour markers after nCRT was an independent prognostic protective factor (both p < 0.05), and patients with both markers elevated post-nCRT had a 2.5- and 3.7-fold increased risk of recurrence and death, respectively (p < 0.05). Furthermore, normalization of post-nCRT tumour markers after surgery was also closely related to an improved prognosis. CONCLUSION This combination of post-nCRT tumour markers can accurately predict the long-term survival of patients with LARC treated with nCRT and curative resection, and normalization of the combined tumour markers after either nCRT or surgery was associated with better survival.
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Affiliation(s)
- Zhifang Zheng
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaojie Wang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xingrong Lu
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ying Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Pan Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
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2
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A Signature That May Be Predictive of Early Versus Late Recurrence After Radiation Treatment for Breast Cancer That May Inform the Biology of Early, Aggressive Recurrences. Int J Radiat Oncol Biol Phys 2020; 108:686-696. [DOI: 10.1016/j.ijrobp.2020.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/30/2020] [Accepted: 05/11/2020] [Indexed: 01/20/2023]
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3
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Huang CW, Chen YT, Tsai HL, Yeh YS, Su WC, Ma CJ, Tsai TN, Wang JY. EGFR expression in patients with stage III colorectal cancer after adjuvant chemotherapy and on cancer cell function. Oncotarget 2017; 8:114663-114676. [PMID: 29383110 PMCID: PMC5777722 DOI: 10.18632/oncotarget.23072] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/14/2017] [Indexed: 12/31/2022] Open
Abstract
The epidermal growth factor receptor (EGFR)/RAS/RAF/MEK/MAPK pathway plays a crucial role in the carcinogenesis, invasion and metastasis of colorectal cancer (CRC). However, its role in the prognosis and prediction of relapse in patients with stage III CRC after adjuvant chemotherapy remains controversial. In the present study, the clinicopathological features of 173 patients with stage III CRC who underwent radical resection and adjuvant chemotherapy with the fluoropyrimidine/folinic acid, and oxaliplatin (FOLFOX) regimen, and their prognostic values of EGFR expression were retrospectively analyzed. By conducting an in vitro CRC cell line study through the knockdown of EGFR expression, we analyzed cell proliferation, colony formation and migration. Positive EGFR expression and an abnormal postoperative serum carcinoembryonic antigen (CEA) level were found to be significant independent negative predictive factors for postoperative relapse. Furthermore, positive EGFR expression was a significant independent negative prognostic factor for disease-free survival (DFS) and overall survival (OS). Additionally, an in vitro cell line study showed that the knockdown of EGFR expression significantly reduced CRC cell proliferation, colony formation and migration. The results of in vitro and in vivo experiments demonstrated that EGFR expression had a prognostic value for OS and DFS, as well as predictive roles for postoperative relapse, in patients with stage III CRC. By analyzing both EGFR expression and the postoperative CEA, the patients with stage III CRC who were at a high risk of postoperative relapse, or mortality following adjuvant chemotherapy could be identified. In short, CRC cells with EGFR expression would exhibit a highly malignant behavior.
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Affiliation(s)
- Ching-Wen Huang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ting Chen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pathology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Lin Tsai
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Sung Yeh
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Chih Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Jen Ma
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsen-Ni Tsai
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jaw-Yuan Wang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Biomarkers and Biotech Drugs, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Center for Environmental Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Center for Natural Products and Drug Development, Kaohsiung Medical University, Kaohsiung, Taiwan
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4
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Santos MD, Silva C, Rocha A, Nogueira C, Castro-Poças F, Araujo A, Matos E, Pereira C, Medeiros R, Lopes C. Predictive clinical model of tumor response after chemoradiation in rectal cancer. Oncotarget 2017; 8:58133-58151. [PMID: 28938543 PMCID: PMC5601639 DOI: 10.18632/oncotarget.19651] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/18/2017] [Indexed: 12/25/2022] Open
Abstract
Survival improvement in rectal cancer treated with neoadjuvant chemoradiotherapy (nCRT) is achieved only if pathological response occurs. Mandard tumor regression grade (TRG) proved to be a valid system to measure nCRT response. The ability to predict tumor response before treatment may significantly have impact the selection of patients for nCRT in rectal cancer. The aim is to identify potential predictive pretreatment factors for Mandard response and build a clinical predictive model design. 167 patients with locally advanced rectal cancer were treated with nCRT and curative surgery. Blood cell counts in peripheral blood were analyzed. Pretreatment biopsies expression of cyclin D1, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF) and protein 21 were assessed. A total of 61 single nucleotide polymorphisms were characterized using the Sequenom platform through multiplex amplification followed by mass-spectometric product separation. Surgical specimens were classified according to Mandard TRG. The patients were divided as: "good responders" (Mandard TRG1-2) and "poor responders" (Mandard TGR3-5). We examined predictive factors for Mandard response and performed statistical analysis. In univariate analysis, distance from anal verge, neutrophil lymphocyte ratio (NLR), cyclin D1, VEGF, EGFR, protein 21 and rs1810871 interleukin 10 (IL10) gene polymorphism are the pretreatment variables with predictive value for Mandard response. In multivariable analysis, NLR, cyclin D1, protein 21 and rs1800871 in IL10 gene maintain predictive value, allowing a clinical model design. CONCLUSION It seems possible to use pretreatment expression of blood and tissue biomarkers, and build a model of tumor response prediction to neoadjuvant chemoradiation in rectal cancer.
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Affiliation(s)
- Marisa D Santos
- Department of Surgery, Digestive Surgery Service, Hospital Center of Porto, Porto, Portugal.,Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal
| | - Cristina Silva
- Department of Surgery, Digestive Surgery Service, Hospital Center of Porto, Porto, Portugal.,Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal
| | - Anabela Rocha
- Department of Surgery, Digestive Surgery Service, Hospital Center of Porto, Porto, Portugal.,Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal
| | - Carlos Nogueira
- Department of Surgery, Digestive Surgery Service, Hospital Center of Porto, Porto, Portugal.,Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal
| | - Fernando Castro-Poças
- Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal.,Gastroenterology Service, Hospital Center of Porto, Porto, Portugal
| | - António Araujo
- Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal.,Service of Medical Oncology, Hospital Center of Porto, Porto, Portugal
| | - Eduarda Matos
- Department of Health Community, Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal
| | - Carina Pereira
- Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal.,Molecular Oncology and Viral Pathology Group, IPO Research Center, Portuguese Oncologic Institute, Porto, Portugal.,Research Department, Portuguese League Against Cancer, Porto, Portugal
| | - Rui Medeiros
- Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal.,Molecular Oncology and Viral Pathology Group, IPO Research Center, Portuguese Oncologic Institute, Porto, Portugal.,Research Department, Portuguese League Against Cancer, Porto, Portugal.,CEBIMED, Faculty of Health Sciences of Fernando Pessoa, University of Porto, Porto, Portugal
| | - Carlos Lopes
- Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal.,Department of Pathology, Pathological Anatomy Service, Hospital Center of Porto, Porto, Portugal.,Department of Pathology and Molecular Immunology, Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal
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5
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Sclafani F, Brown G, Cunningham D, Rao S, Tekkis P, Tait D, Morano F, Baratelli C, Kalaitzaki E, Rasheed S, Watkins D, Starling N, Wotherspoon A, Chau I. Systemic Chemotherapy as Salvage Treatment for Locally Advanced Rectal Cancer Patients Who Fail to Respond to Standard Neoadjuvant Chemoradiotherapy. Oncologist 2017; 22:728-736. [PMID: 28476941 DOI: 10.1634/theoncologist.2016-0396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/03/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The potential of chemotherapy as salvage treatment after failure of neoadjuvant chemoradiotherapy for locally advanced rectal cancer (LARC) has never been explored. We conducted a single-center, retrospective analysis to address this question. PATIENTS AND METHODS Patients with newly diagnosed LARC who were inoperable or candidates for extensive (i.e., beyond total mesorectal excision [TME]) surgery after long-course chemoradiotherapy and who received salvage chemotherapy were included. The primary objective was to estimate the proportion of patients who became suitable for TME after chemotherapy. RESULTS Forty-five patients were eligible (39 candidates for extensive surgery and 6 unresectable). Previous radiotherapy was given concurrently with chemotherapy in 43 cases (median dose: 54.0 Gy). Oxaliplatin- and irinotecan-based salvage chemotherapy was administered in 40 (88.9%) and 5 (11.1%) cases, respectively. Eight patients (17.8%) became suitable for TME after chemotherapy, 10 (22.2%) ultimately underwent TME with clear margins, and 2 (4.4%) were managed with a watch and wait approach. Additionally, 13 patients had extensive surgery with curative intent. Three-year progression-free survival and 5-year overall survival in the entire population were 30.0% (95% confidence interval [CI]: 15.0-46.0) and 44.0% (95% CI: 26.0-61.0), respectively. For the curatively resected and "watch and wait" patients, these figures were 52.0% (95% CI: 27.0-73.0) and 67.0% (95% CI: 40.0-84.0), respectively. CONCLUSION Systemic chemotherapy may be an effective salvage strategy for LARC patients who fail to respond to chemoradiotherapy and are inoperable or candidates for beyond TME surgery. According to our study, one out of five patients may become resectable or be spared from an extensive surgery after systemic chemotherapy. IMPLICATIONS FOR PRACTICE High-quality evidence to inform the optimal management of rectal cancer patients who are inoperable or candidates for beyond total mesorectal excision surgery following standard chemoradiotherapy is lacking. We show for the first time that systemic chemotherapy may be beneficial and result in one out of five poor prognosis patients becoming resectable or being spared from an extensive surgical approach. Although mores studies are needed to confirm these data, administering salvage systemic chemotherapy in this setting may have the potential to minimize morbidity associated with extensive surgical procedures and improve long-term oncological outcome.
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Affiliation(s)
- Francesco Sclafani
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Gina Brown
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - David Cunningham
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Sheela Rao
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Paris Tekkis
- Department of Surgery, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Diana Tait
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Federica Morano
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Chiara Baratelli
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Eleftheria Kalaitzaki
- Department of Clinical Research and Development, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Shahnawaz Rasheed
- Department of Surgery, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - David Watkins
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Naureen Starling
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Andrew Wotherspoon
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Ian Chau
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
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6
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Gupta S, Kushwaha VS, Verma S, Khan H, Bhatt MLB, Husain N, Negi MPS, Bhosale VV, Ghatak A. Understanding molecular markers in recurrent oral squamous cell carcinoma treated with chemoradiation. Heliyon 2016; 2:e00206. [PMID: 27981249 PMCID: PMC5148783 DOI: 10.1016/j.heliyon.2016.e00206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/04/2016] [Accepted: 11/24/2016] [Indexed: 01/02/2023] Open
Abstract
Introduction Oral cancer accounts for approximately 2.1% of all cancers worldwide. In India, oral squamous cell carcinoma (OSCC) is the most common cancer with half a million new cases diagnosed every year. More than 50% of patients eventually develop local recurrence or metastasis usually within the first 2-years following completion of treatment. It is beneficial to analyze the prognostic significance of Cyclin D1, p53 and EGFR which are critical mediators in the pathogenesis of OSCC. The objective of this study was to assess the association of expression of these markers with recurrence and pattern of recurrence in OSCC patients undergoing chemoradiation. Materials and Methods A Total 290 OSCC cases of locally advanced stage (III, IV) oral cancer with World Health Organization (W.H.O.) performance status of grade 0/1 in the year 2009–2012 were enrolled in the study. Treatment response was assessed according to W.H.O. criteria. Cyclin D1, EGFR and p53 expression in tumor tissue was estimated by immunohistochemical (IHC) method and quantified as percentage positive nuclei. Results During the 2-years follow up, 56 (19.3%) patients recurred, out of which, 47 (83.9%) were locoregional and 9 (16.1%) distant sites. On correlating, χ2 test showed significant (P < 0.05 or P < 0.01 or P < 0.001) association of marker expressions (Cyclin D1, EGFR and p53) with recurrence. The strong positive expressions of all three markers showed significant association with early time of recurrence. The multivariate logistic regression analysis showed significant (P < 0.05 or P < 0.01 or P < 0.001) association of recurrence with primary site, differentiation, Cyclin D1 and p53 expressions indicating these as an independent predictors of recurrence in OSCC. The Cyclin D1, EGFR and p53 expressions also showed significant (P < 0.001) poor survivals (OS, DFS and RFS) in patients with positive/strong positive expressions than negative expression suggesting their prognosis in OSCC. Conclusion Our results signifies that tumors over expressing Cyclin D1, EGFR and p53 are resistant to chemoradiation and are associated with increased risk of locoregional recurrence and metastasis in OSCC patients undergoing chemoradiation.
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Affiliation(s)
- Seema Gupta
- Department of Radiotherapy, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vandana Singh Kushwaha
- Department of Radiotherapy, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sandeep Verma
- Department of Radiotherapy, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Huma Khan
- Department of Radiotherapy, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - M L B Bhatt
- Department of Radiotherapy, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nuzhat Husain
- Department of Pathology, RMLIMS, Lucknow, Uttar Pradesh, India
| | - Mahendra Pal Singh Negi
- Clinical and Experimental Medicine Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Vivek Vidyadhar Bhosale
- Clinical and Experimental Medicine Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Ashim Ghatak
- Clinical and Experimental Medicine Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
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7
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Cuneo KC, Nyati MK, Ray D, Lawrence TS. EGFR targeted therapies and radiation: Optimizing efficacy by appropriate drug scheduling and patient selection. Pharmacol Ther 2015; 154:67-77. [PMID: 26205191 PMCID: PMC4570853 DOI: 10.1016/j.pharmthera.2015.07.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/01/2015] [Indexed: 12/13/2022]
Abstract
The epidermal growth factor receptor (EGFR) plays an important role in tumor progression and treatment resistance for many types of malignancies including head and neck, colorectal, and nonsmall cell lung cancer. Several EGFR targeted therapies are efficacious as single agents or in combination with chemotherapy. Given the toxicity associated with chemoradiation and poor outcomes seen in several types of cancers, combinations of EGFR targeted agents with or without chemotherapy have been tested in patients receiving radiation. To date, the only FDA approved use of an anti-EGFR therapy in combination with radiation therapy is for locally advanced head and neck cancer. Given the important role EGFR plays in lung and colorectal cancer and the benefit of EGFR inhibition combined with chemotherapy in these disease sites, it is perplexing why EGFR targeted therapies in combination with radiation or chemoradiation have not been more successful. In this review we summarize the clinical findings of EGFR targeted therapies combined with radiation and chemoradiation regimens. We then discuss the interaction between EGFR and radiation including radiation induced EGFR signaling, the effect of EGFR on DNA damage repair, and potential mechanisms of radiosensitization. Finally, we examine the potential pitfalls with scheduling EGFR targeted therapies with chemoradiation and the use of predictive biomarkers to improve patient selection.
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Affiliation(s)
- Kyle C Cuneo
- University of Michigan, Department of Radiation Oncology, Ann Arbor, MI, United States; Ann Arbor Veterans Affairs Hospital, Department of Radiation Oncology, Ann Arbor, MI, United States
| | - Mukesh K Nyati
- University of Michigan, Department of Radiation Oncology, Ann Arbor, MI, United States
| | - Dipankar Ray
- University of Michigan, Department of Radiation Oncology, Ann Arbor, MI, United States
| | - Theodore S Lawrence
- University of Michigan, Department of Radiation Oncology, Ann Arbor, MI, United States.
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8
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The prognostic significance of tumor epidermal growth factor receptor (EGFR) expression change after neoadjuvant chemoradiation in patients with rectal adenocarcinoma. Contemp Oncol (Pozn) 2015. [PMID: 26199571 PMCID: PMC4507892 DOI: 10.5114/wo.2015.50013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim of the study The aim of this retrospective study was to determine the prognostic impact of epidermal growth factor receptor (EGFR) expression changes during neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. Material and methods Fifty patients with locally advanced rectal cancer were evaluated. All the patients were administered the total dose of 44 Gy. Capecitabine has been concomitantly administered in the dose 825 mg/m2 in two daily oral administrations. Surgery was indicated 4–8 weeks from the chemoradiotherapy completion. Epidermal growth factor receptor expression in the pretreatment biopsies and in the resected specimens was assessed with immunohistochemistry. Results All of 50 patients received radiotherapy without interruption up to the total planned dose. In 30 patients sphincter-saving surgery was performed, 20 patients underwent amputation of the rectum. Downstaging was described in 30 patients. Four patients have had complete pathologic remission. Twenty-six patients have had partial remission, the disease was stable in 15 patients. Progression was reported in 5 patients. The median disease-free survival was 64.9 months, median overall survival was 76.4 months. Increased EGFR expression was found in 12 patients (26.1%). A statistically significantly shorter overall survival (p < 0.0001) and disease-free survival (p < 0.0001) was found in patients with increased expression of EGFR compared with patients where no increase in the expression of EGFR during neoadjuvant chemoradiotherapy was observed. Conclusions The overexpression of EGFR during neoadjuvant chemoradiotherapy for locally advanced rectal adenokarcinoma associated with significant shorter overall survival and disease free survival.
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9
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Jin T, Zhu Y, Luo JL, Zhou N, Li DC, Ju HX, Fan YT, Liu Y, Zhu YP, Feng HY, Liu LY. Prospective phase II trial of nimotuzumab in combination with radiotherapy and concurrent capecitabine in locally advanced rectal cancer. Int J Colorectal Dis 2015; 30:337-45. [PMID: 25564344 DOI: 10.1007/s00384-014-2097-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of the study was to evaluate the safety and efficacy of adding concurrent nimotuzumab to preoperative radiotherapy with concurrent capecitabine in locally advanced rectal cancer. METHODS AND MATERIALS Patients with rectal cancer (clinical stage T3/4 or N+) were scheduled to receive weekly nimotuzumab (400 mg; days -6, 1, 8, 15, 22, and 29). Capecitabine (825 mg/m(2)) was delivered orally twice daily for the duration of radiotherapy. Radiotherapy was administered at 50.4 Gy (45 + 5.4 Gy). The main endpoint was the pathologic complete response (pCR) rate. RESULTS Twenty-one patients with T3 or T4 disease were enrolled; 66.7 % were nodal-positive; the median distance from the anal verge was 5.5 cm. A pCR was achieved in four patients (19.0 %); 71.4 % patients obtained moderate or good tumor regression (Grade 2 and 3). Downstaging occurred in 15/21 (71.4 %) patients by T stage and 11/14 (78.6 %) by N stage. The actual dose intensities (median/mean, %) were nimotuzumab (100, 100) and capecitabine (100, 99.5). The most frequent Grade 1/2 toxicities were radiation dermatitis (57.1 %), nausea/vomiting (52.4 %), leukocytopenia (47.6 %), diarrhea (47.6 %), and proctitis (38.1 %). Grade 3 diarrhea was observed in 9.5 % of patients and Grade 3 leukocytopenia in 4.8 %. CONCLUSION These preliminary results indicate that nimotuzumab can be safely combined with radiotherapy plus concurrent capecitabine. The efficacy of this regimen (pCR = 19.0 %) was significantly higher than that observed in previous phase II trials of preoperative radiotherapy with concurrent capecitabine and cetuximab in rectal cancer. Further investigation of concurrent nimotuzumab with radiotherapy plus capecitabine is warranted.
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Affiliation(s)
- Ting Jin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 38 Guang Ji Road, Hangzhou, 310022, Zhejiang, People's Republic of China
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10
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Goos JACM, Hiemstra AC, Coupé VMH, Diosdado B, Kooijman W, Delis-Van Diemen PM, Karga C, Beliën JAM, Menke-van der Houven van Oordt CW, Geldof AA, Meijer GA, Hoekstra OS, Fijneman RJA. Epidermal growth factor receptor (EGFR) and prostaglandin-endoperoxide synthase 2 (PTGS2) are prognostic biomarkers for patients with resected colorectal cancer liver metastases. Br J Cancer 2014; 111:749-55. [PMID: 24983372 PMCID: PMC4134500 DOI: 10.1038/bjc.2014.354] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/22/2014] [Accepted: 05/29/2014] [Indexed: 12/24/2022] Open
Abstract
Background: Resection of colorectal cancer liver metastasis (CRCLM) with curative intent has long-term benefit in ∼40% of cases. Prognostic biomarkers are needed to improve clinical management and reduce futile surgeries. Expression of epidermal growth factor receptor (EGFR) and prostaglandin-endoperoxide synthase 2 (PTGS2; also known as cyclooxygenase-2) has been associated with carcinogenesis and survival. We investigated the prognostic value of EGFR and PTGS2 expression in patients with resected CRCLM. Methods: Formalin-fixed paraffin-embedded CRCLM tissue and corresponding primary tumour specimens from a multi-institutional cohort of patients who underwent liver resection between 1990 and 2010 were incorporated into tissue microarrays (TMAs). TMAs were stained for EGFR and PTGS2 by immunohistochemistry. The hazard rate ratio (HRR) for the association between expression in CRCLM and overall survival was calculated using a 500-fold cross-validation procedure. Results: EGFR and PTGS2 expression could be evaluated in 323 and 351 patients, respectively. EGFR expression in CRCLM was associated with poor prognosis (HRR 1.54; P<0.01) with a cross-validated HRR of 1.47 (P=0.03). PTGS2 expression was also associated with poor prognosis (HRR 1.60; P<0.01) with a cross-validated HRR of 1.63 (P<0.01). Expression of EGFR and PTGS2 remained prognostic after multivariate analysis with standard clinicopathological variables (cross-validated HRR 1.51; P=0.02 and cross-validated HRR 1.59; P=0.01, respectively). Stratification for the commonly applied systemic therapy regimens demonstrated prognostic value for EGFR and PTGS2 only in the subgroup of patients who were not treated with systemic therapy (HRR 1.78; P<0.01 and HRR 1.64; P=0.04, respectively), with worst prognosis when both EGFR and PTGS2 were highly expressed (HRR 3.08; P<0.01). Expression of PTGS2 in CRCLM was correlated to expression in patient-matched primary tumours (P=0.02, 69.2% concordance). Conclusions: EGFR and PTGS2 expressions are prognostic molecular biomarkers with added value to standard clinicopathological variables for patients with resectable CRCLM.
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Affiliation(s)
- J A C M Goos
- 1] Department of Pathology, VU University Medical Center, CCA 1.08, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands [2] Department of Radiology & Nuclear Medicine, VU University Medical Center, CCA 1.08, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - A C Hiemstra
- Department of Pathology, VU University Medical Center, CCA 1.08, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - V M H Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Center, CCA 1.08, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - B Diosdado
- Department of Pathology, VU University Medical Center, CCA 1.08, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - W Kooijman
- Department of Pathology, VU University Medical Center, CCA 1.08, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - P M Delis-Van Diemen
- Department of Pathology, VU University Medical Center, CCA 1.08, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - C Karga
- Department of Radiology & Nuclear Medicine, VU University Medical Center, CCA 1.08, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - J A M Beliën
- Department of Pathology, VU University Medical Center, CCA 1.08, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | | | - A A Geldof
- Department of Radiology & Nuclear Medicine, VU University Medical Center, CCA 1.08, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - G A Meijer
- Department of Pathology, VU University Medical Center, CCA 1.08, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - O S Hoekstra
- Department of Radiology & Nuclear Medicine, VU University Medical Center, CCA 1.08, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - R J A Fijneman
- Department of Pathology, VU University Medical Center, CCA 1.08, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
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11
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Oppenheim DE, Spreafico R, Etuk A, Malone D, Amofah E, Peña-Murillo C, Murray T, McLaughlin L, Choi BS, Allan S, Belousov A, Passioukov A, Gerdes C, Umaña P, Farzaneh F, Ross P. Glyco-engineered anti-EGFR mAb elicits ADCC by NK cells from colorectal cancer patients irrespective of chemotherapy. Br J Cancer 2014; 110:1221-7. [PMID: 24496456 PMCID: PMC3950873 DOI: 10.1038/bjc.2014.35] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/23/2013] [Accepted: 01/07/2014] [Indexed: 12/18/2022] Open
Abstract
Background: The epidermal growth factor receptor (EGFR) is overexpressed in colorectal cancer (CRC), and is correlated with poor prognosis, making it an attractive target for monoclonal antibody (mAb) therapy. A component of the therapeutic efficacy of IgG1 mAbs is their stimulation of antibody-dependent cellular cytotoxicity (ADCC) by natural killer (NK) cells bearing the CD16 receptor. As NK cells are functionally impaired in cancer patients and may be further compromised upon chemotherapy, it is crucial to assess whether immunotherapeutic strategies aimed at further enhancing ADCC are viable. Methods: CRC patients before, during and after chemotherapy were immunophenotyped by flow cytometry for major white blood cell populations. ADCC-independent NK cell functionality was assessed in cytotoxicity assays against K562 cells. ADCC-dependent killing of EGFR+ A431 cancer cells by NK cells was measured with a degranulation assay where ADCC was induced by GA201, an anti-EGFR mAb glyco-engineered to enhance ADCC. Results: Here, we confirm the observation that NK cells in cancer patients are dysfunctional. However, GA201 was able to induce robust NK cell-dependent cytotoxicity in CRC patient NK cells, effectively overcoming their impairment. Conclusions: These findings support the evaluation of the therapeutic potential of GA201 in combination with chemotherapy in CRC patients.
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Affiliation(s)
- D E Oppenheim
- 1] Comprehensive Biomedical Research Centre, King's College London, King's Health Partners, London, UK [2] Experimental Cancer Medicine Centre, King's College London, King's Health Partners, London, UK [3] Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - R Spreafico
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - A Etuk
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - D Malone
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - E Amofah
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - C Peña-Murillo
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - T Murray
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - L McLaughlin
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - B S Choi
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - S Allan
- Department of Medical Oncology, Guy's and St Thomas' Hospital, King's College London School of Medicine, King's Health Partners, 4th Floor Thomas Guy House, Guy's Hospital, St Thomas Street, London SE1 9RT, UK
| | - A Belousov
- Roche Diagnostics GmbH, Nonnenwald 2, Penzberg 82377, Germany
| | - A Passioukov
- Roche Glycart AG, Wagistrasse 18, Schlieren 8952, Switzerland
| | - C Gerdes
- Roche Glycart AG, Wagistrasse 18, Schlieren 8952, Switzerland
| | - P Umaña
- Roche Glycart AG, Wagistrasse 18, Schlieren 8952, Switzerland
| | - F Farzaneh
- 1] Comprehensive Biomedical Research Centre, King's College London, King's Health Partners, London, UK [2] Experimental Cancer Medicine Centre, King's College London, King's Health Partners, London, UK [3] Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - P Ross
- 1] Comprehensive Biomedical Research Centre, King's College London, King's Health Partners, London, UK [2] Experimental Cancer Medicine Centre, King's College London, King's Health Partners, London, UK [3] Department of Medical Oncology, Guy's and St Thomas' Hospital, King's College London School of Medicine, King's Health Partners, 4th Floor Thomas Guy House, Guy's Hospital, St Thomas Street, London SE1 9RT, UK
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12
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Ensinger C, Sterlacci W. Implications of EGFR PharmDx™ Kit for cetuximab eligibility. Expert Rev Mol Diagn 2014; 8:141-8. [DOI: 10.1586/14737159.8.2.141] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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The prognostic values of EGFR expression and KRAS mutation in patients with synchronous or metachronous metastatic colorectal cancer. BMC Cancer 2013; 13:599. [PMID: 24330663 PMCID: PMC3878756 DOI: 10.1186/1471-2407-13-599] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 12/03/2013] [Indexed: 12/20/2022] Open
Abstract
Background The epidermal growth factor receptor (EGFR)/RAS/RAF/MEK/MAPK pathway is an important pathway in the carcinogenesis, invasion and metastasis of colorectal cancers (CRCs). We conducted a retrospective study to determine the prognostic values of EGFR expression and KRAS mutation in patients with metastatic CRC (mCRC) based on synchronous or metachronous status. Methods From October 2002 to March 2012, 205 patients with mCRC were retrospectively analyzed; 98 were found to have metachronous mCRC while 107 were found to have synchronous mCRC. The EGFR expressions were determinate by IHC (immunohistochemistry) analysis and categorized 1+ (weak intensity), 2+ (moderate intensity), and 3+ (strong intensity). Genomic DNA was isolated from frozen primary CRC tissues and direct sequencing of KRAS was performed. The clinicopathological features of these mCRC patients were retrospectively investigated according to EGFR expression and KRAS mutation status. Moreover, we analyzed the prognostic values of EGFR expression and KRAS mutation among these patients. Results Of the 205 patients with mCRC, EGFR expression was analyzed in 167 patients, and positive EGFR expression was noted in 140 of those patients (83.8%). KRAS mutation was investigated in 205 patients and mutations were noted in 88 of those patients (42.9%). In patients with metachronous mCRC, positive EGFR expression was significantly correlated with well-and moderately-differentiated tumors (P = 0.028), poorer disease-free survival (DFS) (P < 0.001), and overall survival (OS) (P < 0.001). Furthermore, positive EGFR expression was a significant independent prognostic factor of DFS (P = 0.006, HR: 4.012, 95% CI: 1.130–8.445) and OS (P = 0.028, HR: 3.090, 95% CI: 1.477–10.900) in metachronous mCRC patients. KRAS mutation status was not significantly related to DFS and OS of patients with metachronous mCRC; likewise, KRAS mutation status was not significantly different in the progression-free survival (PFS) and OS of patients with synchronous mCRC (all P > 0.05). Conclusions The present study demonstrated that EGFR expression has prognostic value only for patients with metachronous mCRC. However, KRAS mutation did not have prognostic value in patients with metachronous or synchronous mCRC.
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Preoperative Chemoradiation Therapy With Capecitabine/Oxaliplatin and Cetuximab in Rectal Cancer: Long-Term Results of a Prospective Phase 1/2 Study. Int J Radiat Oncol Biol Phys 2013; 87:992-9. [DOI: 10.1016/j.ijrobp.2013.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 09/04/2013] [Accepted: 09/08/2013] [Indexed: 12/14/2022]
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15
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Glynne-Jones R, Hadaki M, Harrison M. The status of targeted agents in the setting of neoadjuvant radiation therapy in locally advanced rectal cancers. J Gastrointest Oncol 2013; 4:264-84. [PMID: 23997939 DOI: 10.3978/j.issn.2078-6891.2013.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 05/21/2013] [Indexed: 12/18/2022] Open
Abstract
Radiotherapy has a longstanding and well-defined role in the treatment of resectable rectal cancer to reduce the historically high risk of local recurrence. In more advanced borderline or unresectable cases, where the circumferential resection margin (CRM) is breached or threatened according to magnetic resonance imaging (MRI), despite optimized local multimodality treatment and the gains achieved by modern high quality total mesorectal excision (TME), at least half the patients fail to achieve sufficient downstaging with current schedules. Many do not achieve an R0 resection. In less locally advanced cases, even if local control is achieved, this confers only a small impact on distant metastases and a significant proportion of patients (30-40%) still subsequently develop metastatic disease. In fact, distant metastases have now become the predominant cause of failure in rectal cancer. Therefore, increasing the intensity and efficacy of chemotherapy and chemoradiotherapy by integrating additional cytotoxics and biologically targetted agents seems an appealing strategy to explore-with the aim of enhancing curative resection rates and improving distant control and survival. However, to date, we lack validated biomarkers for these biological agents apart from wild-type KRAS. For cetuximab, the appearance of an acneiform rash is associated with response, but low levels of magnesium appear more controversial. There are no molecular biomarkers for bevacizumab. Although some less invasive clinical markers have been proposed for bevacizumab, such as circulating endothelial cells (CECS), circulating levels of VEGF and the development of overt hypertension, these biomarkers have not been validated and are observed to emerge only after a trial of the agent. We also lack a simple method of ongoing monitoring of 'on target' effects of these biological agents, which could determine and pre-empt the development of resistance, prior to radiological and clinical assessessments or even molecular imaging. These shortcomings probably explain our current relative lack of success in the arena of combining these agents with chemoradiation.
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Vyslouzil K, Brychtova S, Zboril P, Skalicky P, Vomackova K, Bezdekova M, Brychta T. Unusual recurrent rectal carcinoma: a cancer field theory viewpoint. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 158:433-7. [PMID: 23128827 DOI: 10.5507/bp.2012.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Indexed: 12/15/2022] Open
Abstract
AIM The rate of rectal cancer locoregional recurrence following radical surgery varies from 4% to 33%. Though the causes are unclear, likely factors include microscopic tumor residues in the lymphatics, positive resection margins and exfoliation of tumor cells and their subsequent intraluminar spread during operation. Other significant factors include type and technique of surgical procedure. Recently, it has been demonstrated that local recurrence may also be associated with the biological behaviour of the tumor and/or with the composition of the cellular microenvironment which creates optimal conditions for the growth and spread of tumor cells. CASE REPORT The presented case here is interesting because the tumour recurred early following a curative surgical procedure with negative resection margins, without positive lymph nodes, without infiltration of the pelvic wall and without distant metastases. CONCLUSION In patients with a determined risk of genetically altered tumor field encompassing epithelial or stromal changes, a different treatment strategy, including gene therapy, anti-inflammatory or anti-angiogenic therapy should be chosen to minimize increased tumor risk.
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Affiliation(s)
- Kamil Vyslouzil
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
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[Prognostic significance of changes of tumor epidermal growth factor receptor expression after neoadjuvant chemoradiation in patients with rectal adenocarcinoma]. Strahlenther Onkol 2012; 188:833-8. [PMID: 22847519 DOI: 10.1007/s00066-012-0160-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/16/2012] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of the present study was to examine the effect of neoadjuvant chemoradiation on tumor epidermal growth factor receptor (EGFR) expression in patients with locally advanced rectal adenocarcinoma. PATIENTS AND METHODS A total of 53 patients with rectal adenocarcinoma (clinical stages II and III) were studied. Neoadjuvant treatment consisted of 50.4 Gy/28 fractions external radiation with concomitant continuous 5-fluorouracil. Surgical resection was performed 4-6 weeks after the chemoradiation. EGFR expression in the pretreatment biopsies and in the resected specimens was assessed with immunohistochemistry. RESULTS Patients with an increase of EGFR expression during chemoradiation had significantly shorter disease-free survival (DFS; p = 0.003) and overall survival (OS; p = 0.005) compared to patients with either no change or decrease in EGFR expression. The 5-year DFS in patients with increased EGFR expression was only 29% compared to 61% in patients without an increase of EGFR expression. Similarly, the 5-year OS of the patients with increased EGFR expression was 29% compared to 66% in patients without an increase of EGFR expression. All recurrences in patients who had an increase of EGFR expression occurred within the first 2 years after the treatment. The increase in EGFR expression was the only significant predictor of DFS (p = 0.007) and OS (p = 0.04) using multivariate Cox regression analysis. CONCLUSION An increase of EGFR expression during chemoradiation may be associated with significantly shorter DFS and OS. The increase of EGFR could identify a population of patients in whom the effect of the treatment with anti-EGFR therapy should be studied.
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18
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Czito BG, Willett CG. Potential Novel Drugs to Combine with Radiation in Rectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2012. [DOI: 10.1007/s11888-012-0120-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Vordermark D. Ten years of progress in radiation oncology. BMC Cancer 2011; 11:503. [PMID: 22128868 PMCID: PMC3259125 DOI: 10.1186/1471-2407-11-503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 11/30/2011] [Indexed: 12/03/2022] Open
Abstract
Over the last decade, BMC Cancer has continuously published important research from the field of radiation oncology. Major developments in this field include the introduction of new imaging modalities into radiotherapy planning, the availability of hardware and software for more precise delivery of radiation dose, the individualization of radiotherapy concepts, for example, based on microarray data, and the combination of radiotherapy with molecular targeting approaches to overcome the radioresistance of tumor cells.
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Affiliation(s)
- Dirk Vordermark
- Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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20
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Bibeau F, Rullier A, Jourdan MF, Frugier H, Palasse J, Leaha C, Gudin de Vallerin A, Rivière B, Bodin X, Perrault V, Cantos C, Lavaill R, Boissière-Michot F, Azria D, Colombo PE, Rouanet P, Rullier E, Panis Y, Guedj N. [Locally advanced rectal cancer management: which role for the pathologist in 2011?]. Ann Pathol 2011; 31:433-41. [PMID: 22172116 DOI: 10.1016/j.annpat.2011.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 10/15/2011] [Indexed: 01/16/2023]
Abstract
Locally advanced rectal cancers mainly correspond to lieberkünhien adenocarcinomas and are defined by T3-T4 lesions with or without regional metastatic lymph nodes. Such tumors benefit from neoadjuvant treatment combining chemotherapy and radiotherapy, followed by surgery with total mesorectum excision. Such a strategy can decrease the rate of local relapse and lead to an easier complementary surgery. The pathologist plays an important role in the management of locally advanced rectal cancer. Indeed, he is involved in the gross examination of the mesorectum excision quality and in the exhaustive sampling of the most informative areas. He also has to perform a precise histopathological analysis, including the determination of the circumferential margin or clearance and the evaluation of tumor regression. All these parameters are major prognostic factors which have to be clearly included in the pathology report. Moreover, the next challenge for the pathologist will be to determine and validate new prognostic and predictive markers, notably by using pre-therapeutic biopsies. The goal of this mini-review is to emphasize the pathologist's role in the different steps of the management of locally advanced rectal cancers and to underline its implication in the determination of potential biomarkers of aggressiveness and response.
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Affiliation(s)
- Frédéric Bibeau
- Service de pathologie, CRLC Val-d'Aurelle, Montpellier, France.
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Garajová I, Di Girolamo S, de Rosa F, Corbelli J, Agostini V, Biasco G, Brandi G. Neoadjuvant treatment in rectal cancer: actual status. CHEMOTHERAPY RESEARCH AND PRACTICE 2011; 2011:839742. [PMID: 22295206 PMCID: PMC3263610 DOI: 10.1155/2011/839742] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 06/20/2011] [Accepted: 06/28/2011] [Indexed: 02/07/2023]
Abstract
Neoadjuvant (preoperative) concomitant chemoradiotherapy (CRT) has become a standard treatment of locally advanced rectal adenocarcinomas. The clinical stages II (cT3-4, N0, M0) and III (cT1-4, N+, M0) according to International Union Against Cancer (IUCC) are concerned. It can reduce tumor volume and subsequently lead to an increase in complete resections (R0 resections), shows less toxicity, and improves local control rate. The aim of this review is to summarize actual approaches, main problems, and discrepancies in the treatment of locally advanced rectal adenocarcinomas.
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Affiliation(s)
- Ingrid Garajová
- Department of Hematology and Oncology Sciences “L. A. Seragnoli”, Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40138 Bologna, Italy
| | - Stefania Di Girolamo
- Department of Hematology and Oncology Sciences “L. A. Seragnoli”, Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40138 Bologna, Italy
| | - Francesco de Rosa
- Department of Hematology and Oncology Sciences “L. A. Seragnoli”, Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40138 Bologna, Italy
| | - Jody Corbelli
- Department of Hematology and Oncology Sciences “L. A. Seragnoli”, Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40138 Bologna, Italy
| | - Valentina Agostini
- Department of Hematology and Oncology Sciences “L. A. Seragnoli”, Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40138 Bologna, Italy
| | - Guido Biasco
- Department of Hematology and Oncology Sciences “L. A. Seragnoli”, Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40138 Bologna, Italy
| | - Giovanni Brandi
- Department of Hematology and Oncology Sciences “L. A. Seragnoli”, Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40138 Bologna, Italy
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Beyond 5-Fluorouracil: The Emerging Role of Newer Chemotherapeutics and Targeted Agents with Radiation Therapy. Semin Radiat Oncol 2011; 21:203-11. [DOI: 10.1016/j.semradonc.2011.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Belov L, Zhou J, Christopherson RI. Cell surface markers in colorectal cancer prognosis. Int J Mol Sci 2010; 12:78-113. [PMID: 21339979 PMCID: PMC3039945 DOI: 10.3390/ijms12010078] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 12/16/2010] [Accepted: 12/20/2010] [Indexed: 12/14/2022] Open
Abstract
The classification of colorectal cancers (CRC) is currently based largely on histologically determined tumour characteristics, such as differentiation status and tumour stage, i.e., depth of tumour invasion, involvement of regional lymph nodes and the occurrence of metastatic spread to other organs. These are the conventional prognostic factors for patient survival and often determine the requirement for adjuvant therapy after surgical resection of the primary tumour. However, patients with the same CRC stage can have very different disease-related outcomes. For some, surgical removal of early-stage tumours leads to full recovery, while for others, disease recurrence and metastasis may occur regardless of adjuvant therapy. It is therefore important to understand the molecular processes that lead to disease progression and metastasis and to find more reliable prognostic markers and novel targets for therapy. This review focuses on cell surface proteins that correlate with tumour progression, metastasis and patient outcome, and discusses some of the challenges in finding prognostic protein markers in CRC.
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Affiliation(s)
- Larissa Belov
- School of Molecular Bioscience, University of Sydney, Sydney, NSW 2006, Australia; E-Mails: (J.Z.); (R.I.C.)
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Weiss C, Arnold D, Dellas K, Liersch T, Hipp M, Fietkau R, Sauer R, Hinke A, Rödel C. Preoperative Radiotherapy of Advanced Rectal Cancer With Capecitabine and Oxaliplatin With or Without Cetuximab: A Pooled Analysis of Three Prospective Phase I-II Trials. Int J Radiat Oncol Biol Phys 2010; 78:472-8. [DOI: 10.1016/j.ijrobp.2009.07.1718] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 07/26/2009] [Accepted: 07/30/2009] [Indexed: 10/19/2022]
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Bengala C, Bettelli S, Bertolini F, Sartori G, Fontana A, Malavasi N, Depenni R, Zironi S, Del Giovane C, Luppi G, Conte PF. Prognostic role of EGFR gene copy number and KRAS mutation in patients with locally advanced rectal cancer treated with preoperative chemoradiotherapy. Br J Cancer 2010; 103:1019-24. [PMID: 20842128 PMCID: PMC2965865 DOI: 10.1038/sj.bjc.6605853] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/24/2010] [Accepted: 07/20/2010] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR), evaluated by immunohistochemistry, has been shown to have prognostic significance in patients with colorectal cancer. Gene copy number (GCN) of EGFR and KRAS status predict response and outcome in patients treated with anti-EGFR therapy, but their prognostic significance in colorectal cancer patients is still unclear. METHODS We have retrospectively reviewed the baseline EGFR GCN, KRAS status and clinical outcome of 146 locally advanced rectal cancer (LARC) patients treated with preoperative chemoradiotherapy. Pathological response evaluated by Dworak's tumour regression grade (TRG), disease-free survival (DFS) and overall survival (OS) were analysed. RESULTS Tumour regression grade 4 and TRG3-4 were achieved in 14.4 and 30.8% of the patients respectively. Twenty-nine (19.9%) and 33 patients (19.2%) had an EGFR/nuclei ratio >2.9 and CEP7 polisomy >50% respectively; 28 patients (19.2%) had a KRAS mutation. Neither EGFR GCN nor KRAS status was statistically correlated to TRG. 5-year DFS and OS were 63.3 and 71.5%, respectively, and no significant relation with EGFR GCN or KRAS status was found. CONCLUSION Our data show that EGFR GCN and KRAS status are not prognostic factors in LARC treated with preoperative chemoradiation.
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Affiliation(s)
- C Bengala
- Division of Medical Oncology, Department of Oncology, Hematology and Respiratory Disease, University Hospital, University of Modena and Reggio Emilia, Via del Pozzo, 71, Modena-41100, Italy.
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Wadlow RC, Ryan DP. The role of targeted agents in preoperative chemoradiation for rectal cancer. Cancer 2010; 116:3537-48. [DOI: 10.1002/cncr.25155] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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High epidermal growth factor receptor expression in metastatic colorectal cancer lymph nodes may be more prognostic of poor survival than in primary tumor. Am J Clin Oncol 2009; 32:245-52. [PMID: 19451802 DOI: 10.1097/coc.0b013e3181891326] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES High epidermal growth factor receptor (EGFR) expression in the primary tumor predicts poor survival in colorectal cancer. However, EGFR expression may be discordant in primary tumor versus nodal or distant metastasis. We evaluated prognostic values of high EGFR expression in nodal metastasis versus primary tumor tissue. METHODS Tissue microarrays from 94 surgically resected colorectal primary tumors were analyzed for EGFR expression using immunohistochemistry along with 49 paired positive metastatic nodes and 19 distant metastases. Proportional odds regression and log-rank tests described the association of tumor stage and survival with EGFR, dichotomized to low expression (0, 1) versus high expression (2, 3). RESULTS High EGFR expression rates in the primary tumor, metastatic lymph node and distant metastases were 18%, 24%, and 21%, respectively. The concordance rate was 71% for stage III/IV patients. High EGFR expression in primary tumor was associated with higher tumor stage (odds ratio 4.3, P = 0.005) and thus predicted poor survival (P = 0.046). High EGFR expression in the primary tumor was not associated with survival in patients with stage III or IV disease, whereas high EGFR expression in metastatic lymph nodes was associated with relatively poor survival (P = 0.005), for both stage III (P = 0.002) and stage IV patients (P = 0.014). Concordant high EGFR expression in primary tumor and lymph nodes conferred added risk of death (P = 0.003), conversely, concordant EGFR-negative primary tumor and lymph node was protective (P = 0.097). CONCLUSIONS EGFR expression may be discordant among primary, nodes, and metastases in colorectal cancer. High EGFR expressions in metastatic lymph nodes seem to be more accurate in predicting survival than in primary or metastatic tissues.
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Debucquoy A, Haustermans K, Daemen A, Aydin S, Libbrecht L, Gevaert O, De Moor B, Tejpar S, McBride WH, Penninckx F, Scalliet P, Stroh C, Vlassak S, Sempoux C, Machiels JP. Molecular Response to Cetuximab and Efficacy of Preoperative Cetuximab-Based Chemoradiation in Rectal Cancer. J Clin Oncol 2009; 27:2751-7. [DOI: 10.1200/jco.2008.18.5033] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To characterize the molecular pathways activated or inhibited by cetuximab when combined with chemoradiotherapy (CRT) in rectal cancer and to identify molecular profiles and biomarkers that might improve patient selection for such treatments. Patients and Methods Forty-one patients with rectal cancer (T3-4 and/or N+) received preoperative radiotherapy (1.8 Gy, 5 days/wk, 45 Gy) in combination with capecitabine and cetuximab (400 mg/m2 as initial dose 1 week before CRT followed by 250 mg/m2 /wk for 5 weeks). Biopsies and plasma samples were taken before treatment, after cetuximab but before CRT, and at the time of surgery. Proteomics and microarrays were used to monitor the molecular response to cetuximab and to identify profiles and biomarkers to predict treatment efficacy. Results Cetuximab on its own downregulated genes involved in proliferation and invasion and upregulated inflammatory gene expression, with 16 genes being significantly influenced in microarray analysis. The decrease in proliferation was confirmed by immunohistochemistry for Ki67 (P = .01) and was accompanied by an increase in transforming growth factor-α in plasma samples (P < .001). Disease-free survival (DFS) was better in patients if epidermal growth factor receptor expression was upregulated in the tumor after the initial cetuximab dose (P = .02) and when fibro-inflammatory changes were present in the surgical specimen (P = .03). Microarray and proteomic profiles were predictive of DFS. Conclusion Our study showed that a single dose of cetuximab has a significant impact on the expression of genes involved in tumor proliferation and inflammation. We identified potential biomarkers that might predict response to cetuximab-based CRT.
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Affiliation(s)
- Annelies Debucquoy
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
| | - Karin Haustermans
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
| | - Anneleen Daemen
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
| | - Selda Aydin
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
| | - Louis Libbrecht
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
| | - Olivier Gevaert
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
| | - Bart De Moor
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
| | - Sabine Tejpar
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
| | - William H. McBride
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
| | - Freddy Penninckx
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
| | - Pierre Scalliet
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
| | - Christopher Stroh
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
| | - Soetkin Vlassak
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
| | - Christine Sempoux
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
| | - Jean-Pascal Machiels
- Departments of Radiation Oncology and Pathology, Leuven Cancer Institute, University Hospitals Leuven; Department of Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven; Digestive Oncology Unit, Department of Internal Medicine, and Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven; Departments of Pathology, Radiation Oncology, and Medical Oncology, Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques
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Molecular targeted treatment and radiation therapy for rectal cancer. Strahlenther Onkol 2009; 185:371-8. [PMID: 19506820 DOI: 10.1007/s00066-009-1936-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 12/10/2008] [Indexed: 12/17/2022]
Abstract
BACKGROUND EGFR (epidermal growth factor receptor) and VEGF (vascular endothelial growth factor) inhibitors confer clinical benefit in metastatic colorectal cancer when combined with chemotherapy. An emerging strategy to improve outcomes in rectal cancer is to integrate biologically active, targeted agents as triple therapy into chemoradiation protocols. MATERIAL AND METHODS Cetuximab and bevacizumab have now been incorporated into phase I-II studies of preoperative chemoradiation therapy (CRT) for rectal cancer. The rationale of these combinations, early efficacy and toxicity data, and possible molecular predictors for tumor response are reviewed. Computerized bibliographic searches of Pubmed were supplemented with hand searches of reference lists and abstracts of ASCO and ASTRO meetings. RESULTS The combination of cetuximab and CRT can be safely applied without dose compromises of the respective treatment components. Disappointingly low rates of pathologic complete remission have been noted in several phase II studies. The K-ras mutation status and the gene copy number of EGFR may predict tumor response. The toxicity pattern (radiation-induced enteritis, perforations) and surgical complications (wound healing, fistula, bleeding) observed in at least some of the clinical studies with bevacizumab and CRT warrant further investigations. CONCLUSION Longer follow-up (and, finally, randomized trials) is needed to draw any firm conclusions with respect to local and distant failure rates, and toxicity associated with these novel treatment approaches.
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Bertolini F, Chiara S, Bengala C, Antognoni P, Dealis C, Zironi S, Malavasi N, Scolaro T, Depenni R, Jovic G, Sonaglio C, Rossi A, Luppi G, Conte PF. Neoadjuvant Treatment With Single-Agent Cetuximab Followed by 5-FU, Cetuximab, and Pelvic Radiotherapy: A Phase II Study in Locally Advanced Rectal Cancer. Int J Radiat Oncol Biol Phys 2009; 73:466-72. [DOI: 10.1016/j.ijrobp.2008.04.065] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 04/25/2008] [Accepted: 04/25/2008] [Indexed: 10/21/2022]
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Chemoradiotherapy and adjuvant chemotherapy for rectal cancer. Int J Clin Oncol 2008; 13:488-97. [PMID: 19093175 DOI: 10.1007/s10147-008-0849-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Indexed: 01/01/2023]
Abstract
Local recurrence is an important factor in determining the outcome of patients after surgery for rectal cancer, and various attempts have been made to reduce the local recurrence rate. Randomized controlled trials have shown that radiotherapy combined with total mesorectal excision can reduce the local recurrence rate in rectal cancer patients who undergo curative surgery. Chemoradiotherapy is more effective in achieving local control than radiotherapy alone, and preoperative chemoradiotherapy is superior to postoperative chemoradiotherapy in terms of adverse events. Recent advances have led to the identification of potential therapeutic targets such as epidermal growth factor receptor, vascular endothelial growth factor, and endothelial receptors. These new agents have been used in combination with conventional chemoradiotherapy, and higher pathological complete response rates have been reported for such combinations in comparison with conventional regimens. With regard to lateral node dissection, a recent study showed that postoperative chemoradiotherapy was more effective in reducing the local recurrence rate than lateral node dissection. As for adjuvant chemotherapy, one randomized controlled trial showed that patients who received uracil and tegafur as adjuvant therapy had significantly prolonged relapse-free survival times and overall survival times. As well, one metaanalysis has shown the efficacy of oral uracil-tegafur as adjuvant chemotherapy for rectal cancer.
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Bengala C, Bettelli S, Bertolini F, Salvi S, Chiara S, Sonaglio C, Losi L, Bigiani N, Sartori G, Dealis C, Malavasi N, D'Amico R, Luppi G, Gatteschi B, Maiorana A, Conte PF. Epidermal growth factor receptor gene copy number, K-ras mutation and pathological response to preoperative cetuximab, 5-FU and radiation therapy in locally advanced rectal cancer. Ann Oncol 2008; 20:469-74. [PMID: 19095777 DOI: 10.1093/annonc/mdn647] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Cetuximab improves activity of chemotherapy in metastatic colorectal cancer (mCRC). Gene copy number (GCN) of epidermal growth factor receptor (EGFR) has been suggested to be a predictive factor of response to cetuximab in patients (pts) with mCRC; on the contrary, K-ras mutation has been associated with cetuximab resistance. PATIENTS AND METHODS We have conducted a phase II study with cetuximab administered weekly for 3 weeks as single agent and then with 5-fluorouracil and radiation therapy as neo-adjuvant treatment for locally advanced rectal cancer (LARC). EGFR immunohistochemistry expression, EGFR GCN and K-ras mutation were evaluated on diagnostic tumor biopsy. Dworak's tumor regression grade (TRG) was evaluated on surgical specimens. RESULTS Forty pts have been treated; 39 pts are assessable. TRG 3 and 4 were achieved in nine (23.1%) and three pts (7.7%) respectively; TRG 3-4 rate was 55% and 5.3% in case of high and low GCN, respectively (P 0.0016). Pts with K-ras mutated tumors had lower rate of high TRG: 11% versus 36.7% (P 0.12). In pts with wild-type K-ras, TRG 3-4 rate was 58.8% versus 7.7% in case of high or low GCN, respectively (P 0.0012). CONCLUSIONS In pts with LARC, EGFR GCN is predictive of high TRG to cetuximab plus 5-FU radiotherapy. Moreover, our data suggest that a wild-type K-ras associated with a high EGFR GCN can predict sensitivity to cetuximab-based treatment.
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Affiliation(s)
- C Bengala
- Division of Medical Oncology, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy.
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Santoro M. Optimization of the therapeutic index through the integration among target therapy and radiotherapy. EJC Suppl 2008. [DOI: 10.1016/j.ejcsup.2008.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Combined Cetuximab, Capecitabine, Oxaliplatin, and Radiotherapy in Rectal Cancer: Dr. Jekyll or Mr. Hyde? In Regard to Rödel et al. (Int J Radiat Oncol Biol Phys 2008;70:1081–1086.). Int J Radiat Oncol Biol Phys 2008; 71:959-60; author reply 960. [DOI: 10.1016/j.ijrobp.2008.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 02/06/2008] [Indexed: 11/18/2022]
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Maingon P, Créhange G, Peignaux K, Truc G. Place potentielle des thérapies ciblées en association avec la radiothérapie dans les cancers digestifs. Cancer Radiother 2008; 12:25-30. [DOI: 10.1016/j.canrad.2007.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 11/20/2007] [Accepted: 11/23/2007] [Indexed: 10/22/2022]
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Rödel C, Arnold D, Hipp M, Liersch T, Dellas K, Iesalnieks I, Hermann RM, Lordick F, Hinke A, Hohenberger W, Sauer R. Phase I-II trial of cetuximab, capecitabine, oxaliplatin, and radiotherapy as preoperative treatment in rectal cancer. Int J Radiat Oncol Biol Phys 2007; 70:1081-6. [PMID: 17881150 DOI: 10.1016/j.ijrobp.2007.07.2356] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 07/13/2007] [Accepted: 07/13/2007] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate the safety and activity of preoperative radiotherapy (RT) with concurrent cetuximab, capecitabine, and oxaliplatin in rectal cancer patients. PATIENTS AND METHODS A total of 60 patients with rectal cancer (T3-T4 or N+, M1 allowed) entered the trial at five investigator sites; the data from 58 patients were assessable. Cetuximab was given as an initial dose of 400 mg/m2 7 days before the start of RT, and then at 250 mg/m2 once weekly during RT (50.4 Gy in 28 fractions). Capecitabine and oxaliplatin were administered according to an established schedule of oxaliplatin (50 mg/m2 on Days 1, 8, 22, and 29) and capecitabine (Days 1-14 and 22-35) at three dose levels: 1,000, 1,300, and 1,650 mg/m2/d during the Phase I part of the study. The main endpoint of the Phase II was the pathologic complete response rate. RESULTS Thirteen patients were included in the Phase I part of the study, and the maximal tolerated dose was not reached. Overall, 48 patients were treated at the recommended dose of capecitabine (1,650 mg/m2) and 45 patients (94%) underwent surgery. A pathologic complete response was observed in 4 patients (9%), and moderate (n=12), minimal (n=10), and no tumor regression (n=2) was noted in 24 (53%) of 45 patients. The mean radiation dose intensity, cetuximab, capecitabine, oxaliplatin was 98%, 95%, 94%, and 94%, respectively. The incidence of Grade 3-4 diarrhea was restricted to 19%. Postoperative complications of any grade occurred in 33% of patients. CONCLUSIONS The results of our study have shown that cetuximab can be combined safely with capecitabine and oxaliplatin plus RT. The low pathologic complete response rate achieved should stimulate additional preclinical investigations to establish the best sequence of triple combinations.
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Affiliation(s)
- Claus Rödel
- Department of Radiation Therapy, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
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Spindler KLG, Nielsen JN, Lindebjerg J, Jakobsen A. Germline polymorphisms may act as predictors of response to preoperative chemoradiation in locally advanced T3 rectal tumors. Dis Colon Rectum 2007; 50:1363-9. [PMID: 17661145 DOI: 10.1007/s10350-007-0264-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Patients with locally advanced T3 rectal tumors who present with complete pathologic response to preoperative chemoradiation have a low rate of local recurrence and an excellent prognosis. Predictive markers for complete pathologic response are needed with the perspective of improving individualized treatment of these patients. This study was designed to investigate the predictive value of a new combination of three gene polymorphisms: thymidylate synthase, epidermal growth factor receptor Sp1-216, and epidermal growth factor A61G. METHODS Pretreatment blood samples from 60 patients with locally advanced T3 rectal tumors were analyzed for thymidylate synthase, epidermal growth factor receptor Sp1-216, and epidermal growth factor A61G gene polymorphisms by polymerase chain reaction. Treatment consisted of preoperative radiotherapy (total dose 65 Gy) and concomitant chemotherapy (Uftoral) followed by total mesorectal excision eight weeks after treatment. Pathologic response was evaluated according to the tumor regression grade system. RESULTS Thirty percent (18/60) of patients presented with complete pathologic response. Patients with thymidylate synthase genotype 2/2 had a significantly higher rate of complete pathologic response with 53 percent (8/15) compared with 22 percent in the 2/3 or 3/3 group. When combining thymidylate synthase and epidermal growth factor A61G genotype analysis, a small subgroup with a complete pathologic response rate of 100 percent was identified. Only a minor proportion of the complete responders were identified by this combination. Adding the epidermal growth factor receptor Sp1-216 genotype analysis, a complete pathologic response rate of 64 percent in the combination group was found compared with 21 percent and an 87 percent risk of being a noncomplete responder in the noncombination group. CONCLUSIONS A promising new combination of predictive markers for complete pathologic response was presented and warrants further investigation in prospective clinical trials.
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Czito BG, Willett CG, Bendell JC. Combined-Modality Therapy for Rectal Cancer: Future Prospects. Clin Colorectal Cancer 2007; 6:625-33. [DOI: 10.3816/ccc.2007.n.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Zlobec I, Terracciano L, Jass JR, Lugli A. Value of staining intensity in the interpretation of immunohistochemistry for tumor markers in colorectal cancer. Virchows Arch 2007; 451:763-9. [PMID: 17674041 DOI: 10.1007/s00428-007-0466-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Revised: 06/27/2007] [Accepted: 06/27/2007] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to determine whether staining intensity in conjunction with the percentage of positive tumor cells should be used as an indicator of protein expression detected by immunohistochemistry. A tissue microarray of 1,197 colorectal cancers was immunostained for p53, Her2/neu, epidermal growth factor receptor (EGFR), adenomatosis polyposis coli (APC), and beta-catenin. Immunoreactivity was described by the percentage of positive tumor cells (percent positivity) and by the staining intensity (weak, moderate, strong). The interobserver reproducibility of both was evaluated by two pathologists. The association of T stage, N stage, tumor grade, vascular invasion, and survival with percent positivity, staining intensity, and the combination of both was assessed. In univariate analysis, protein expression assessed by percent positivity resulted in 11 significant associations between the proteins and clinico-pathological features. Eight of these 11 were also demonstrated using only the degree of staining intensity. However, more than half of the associations identified by percent positivity alone were lost when staining intensity was also analyzed in combination with the percentage of positive tumor cells. A scoring method based on percent positivity, rather than on staining intensity, for p53, Her2/neu, EGFR, APC, and beta-catenin is reproducible and appears to be sufficient for establishing associations of the selected tumor markers with most clinico-pathological features.
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Affiliation(s)
- Inti Zlobec
- Institute of Pathology, University Hospital of Basel, Schönbeinstrasse 40, Basel 4031, Switzerland.
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Willett CG, Duda DG, Czito BG, Bendell JC, Clark JW, Jain RK. Targeted therapy in rectal cancer. ONCOLOGY (WILLISTON PARK, N.Y.) 2007; 21:1055-65; discussion 1065, 1070, 1075 passim. [PMID: 17910311 PMCID: PMC2686129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) are often overexpressed in colorectal cancer and are associated with inferior outcomes. Based on successful randomized phase III trials, anti-EGFR and anti-VEGF therapeutics have entered clinical practice. Cetuximab (Erbitux), an EGFR-specific antibody, is currently approved in the United States in combination with irinotecan (Camptosar) for patients with metastatic colorectal cancer refractory to irinotecan or as a single agent for patients unable to tolerate irinotecan-based therapy. In retrospective analyses, patients with EGFR-expressing rectal cancer undergoing neoadjuvant radiation therapy had a significantly inferior disease-free survival and lower rates of achieving pathologic complete response. Based on the positive data in metastatic colorectal cancer and synergy with radiation therapy seen in preclinical models, there is a strong rationale to combine cetuximab with neoadjuvant radiation therapy and chemotherapy in rectal cancer. Bevacizumab (Avastin), a VEGF-specific antibody, was the first antiangiogenic agent to be approved in the United States for use in combination with standard chemotherapy in the first- and second-line of treatment in metastatic colorectal cancer. VEGF-targeted therapy may lead to indirect killing of cancer cells by damaging tumor blood vessels, and may increase the radiosensitivity of tumor-associated endothelial cells. VEGF blockade can also "normalize" tumor vasculature, thereby leading to greater tumor oxygenation and drug penetration. This review will address completed and ongoing trials that have established and continue to clarify the effects of these agents in rectal cancer.
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Affiliation(s)
- Christopher G Willett
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27705, USA.
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Bertolini F, Bengala C, Losi L, Pagano M, Iachetta F, Dealis C, Jovic G, Depenni R, Zironi S, Falchi AM, Luppi G, Conte PF. Prognostic and predictive value of baseline and posttreatment molecular marker expression in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. Int J Radiat Oncol Biol Phys 2007; 68:1455-61. [PMID: 17445998 DOI: 10.1016/j.ijrobp.2007.02.018] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 02/12/2007] [Accepted: 02/13/2007] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate expression of a panel of molecular markers, including p53, p21, MLH1, MSH2, MIB-1, thymidylate synthase, epidermal growth factor receptor (EGFR), and tissue vascular endothelial growth factor (VEGF), before and after treatment in patients treated with neoadjuvant chemoradiotherapy for locally advanced rectal cancer, to correlate the constitutive profile and dynamics of expression with pathologic response and outcome. METHODS AND MATERIALS Expression of biomarkers was evaluated by immunohistochemistry in tumor samples from 91 patients with clinical Stage II and III rectal cancer treated with preoperative pelvic radiotherapy (50 Gy) plus concurrent 5-fluorouracil by continuous intravenous infusion. RESULTS A pathologic complete remission was observed in 14 patients (15.4%). Patients with MLH1-positive tumors had a higher pathologic complete response rate (24.3% vs. 9.4%; p = 0.055). Low expression of constitutive p21, absence of EGFR expression after chemoradiotherapy, and high Dworak's tumor regression grade (TRG) were significantly associated with improved disease-free survival and overall survival. A high MIB-1 value after chemoradiotherapy was significantly associated with worse overall survival. Multivariate analysis confirmed the prognostic value of constitutive p21 expression as well as EGFR expression and MIB-1 value after chemoradiotherapy among patients not achieving TRG 3-4. CONCLUSIONS In our study, we observed the independent prognostic value of EGFR expression after chemoradiotherapy on disease-free survival. Moreover, our study suggests that a constitutive high p21 expression and a high MIB-1 value after neoadjuvant chemoradiotherapy treatment could predict worse outcome in locally advanced rectal cancer.
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Affiliation(s)
- Federica Bertolini
- Division of Medical Oncology, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy.
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Zlobec I, Vuong T, Hayashi S, Haegert D, Tornillo L, Terracciano L, Lugli A, Jass J. A simple and reproducible scoring system for EGFR in colorectal cancer: application to prognosis and prediction of response to preoperative brachytherapy. Br J Cancer 2007; 96:793-800. [PMID: 17311026 PMCID: PMC2360062 DOI: 10.1038/sj.bjc.6603619] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The aim of this study was to determine the predictive and prognostic value of epidermal growth factor receptor (EGFR) expression in rectal cancers treated with preoperative high-dose rate brachytherapy and in mismatch-repair (MMR)-proficient colorectal cancers (CRCs), respectively. We validate the use of receiver operating characteristic (ROC) curve analysis to select cutoff scores for EGFR overexpression for the end points studied. Immunohistochemistry (IHC) for EGFR was performed on 82 rectal tumour biopsies and 1197 MMR-proficient CRCs using a tissue microarray. Immunoreactivity was scored as the percentage of positive tumour cells by three pathologists and the inter-observer reliability was assessed. ROC curve-derived cutoffs were used to analyse the association of EGFR overexpression, tumour response and several clinicopathological features including survival. The scoring method was found to be reproducible in rectal cancer biopsies and CRCs. The selected cutoff scores from ROC curve analysis for each clinicopathological feature were highly consistent among pathologists. EGFR overexpression was associated with response to radiotherapy (P-value <0.001) and with worse survival time (P-value <0.001). In multivariate analysis, EGFR overexpression was independently associated with adverse prognosis (P-value <0.001). Epidermal growth factor receptor is a predictive marker of response to preoperative radiotherapy and an independent adverse prognostic factor CRC.
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Affiliation(s)
- I Zlobec
- Department of Pathology, McGill University, Montreal, Québec, Canada.
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Machiels JP, Sempoux C, Scalliet P, Coche JC, Humblet Y, Van Cutsem E, Kerger J, Canon JL, Peeters M, Aydin S, Laurent S, Kartheuser A, Coster B, Roels S, Daisne JF, Honhon B, Duck L, Kirkove C, Bonny MA, Haustermans K. Phase I/II study of preoperative cetuximab, capecitabine, and external beam radiotherapy in patients with rectal cancer. Ann Oncol 2007; 18:738-44. [PMID: 17208931 DOI: 10.1093/annonc/mdl460] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To assess the safety and preliminary efficacy of concurrent radiotherapy, capecitabine, and cetuximab in the preoperative treatment of patients with rectal cancer. PATIENTS AND METHODS Forty patients with rectal cancer (T3-T4, and/or N+, endorectal ultrasound) received preoperative radiotherapy (1.8 Gy, 5 days/week for 5 weeks, total dose 45 Gy, three-dimensional conformal technique) in combination with cetuximab [initial dose 400 mg/m(2) intravenous given 1 week before the beginning of radiation followed by 250 mg/m(2)/week for 5 weeks] and capecitabine for the duration of radiotherapy (650 mg/m(2) orally twice daily, first dose level; 825 mg/m(2) twice daily, second dose level). RESULTS Four and six patients were treated at the first and second dose level of capecitabine, respectively. No dose-limiting toxicity occurred. Thirty additional patients were treated with capecitabine at 825 mg/m(2) twice daily. The most frequent grade 1/2 side-effects were acneiform rash (87%), diarrhea (65%), and fatigue (57%). Grade 3 diarrhea was found in 15%. Three grade 4 toxic effects were recorded: one myocardial infarction, one pulmonary embolism, and one pulmonary infection with sepsis. Two patients (5%) had a pathological complete response. CONCLUSIONS Preoperative radiotherapy in combination with capecitabine and cetuximab is feasible with some patients achieving pathological downstaging.
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Affiliation(s)
- J-P Machiels
- Clinique des Pathologies Tumorales du Côlon et du Rectum, Centre du Cancer, Université catholique de Louvain, Cliniques universitaires Saint-Luc, 10 avenue Hippocrate, 1200 Brussels, Belgium.
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Bibeau F, Sennesse P, Boissiere F, Azria D. Epidermal growth factor receptor and rectal cancer: In regard to Kim et al. (Int J Radiat Oncol Biol Phys 2006;66:195–200). Int J Radiat Oncol Biol Phys 2007; 67:318. [PMID: 17189081 DOI: 10.1016/j.ijrobp.2006.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Accepted: 09/12/2006] [Indexed: 10/23/2022]
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Spindler KLG, Nielsen JN, Lindebjerg J, Brandslund I, Jakobsen A. Prediction of response to chemoradiation in rectal cancer by a gene polymorphism in the epidermal growth factor receptor promoter region. Int J Radiat Oncol Biol Phys 2006; 66:500-4. [PMID: 16757132 DOI: 10.1016/j.ijrobp.2006.03.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 03/24/2006] [Accepted: 03/28/2006] [Indexed: 11/15/2022]
Abstract
PURPOSE Epidermal growth factor receptor (EGFR) has been associated with radioresistance in solid tumors. Recently a polymorphism in the Sp1 recognition site of the EGFR promoter region was identified. The present study investigated the predictive value of this polymorphism for the outcome of chemoradiation in locally advanced rectal cancer. METHODS AND MATERIALS The study included 77 patients with locally advanced T3 rectal tumors. Treatment consisted of preoperative radiation therapy at a total tumor dose of 65 Gy and concomitant chemotherapy with Uftoral. Blood samples from 63 patients were evaluated for Sp1 -216 G/T polymorphism by polymerase chain reaction analysis. Forty-eight primary tumor biopsies were available for EGFR immunostaining. Patients underwent surgery 8 weeks after treatment. Pathologic response evaluation was performed according to the tumor regression grade (TRG) system. RESULTS Forty-nine percent had major response (TRG1-2) and 51% moderate response (TRG 3-4) to chemoradiation. The rates of major response were 34% (10/29) in GG homozygote patients compared with 65% (22/34) in patients with T containing variants (p=0.023). Fifty-eight percent of biopsies were positive for EGFR expression (28/48). The major response rates with regard to EGFR immunostaining were not significantly different. EGFR-positive tumors were found in 83% of the GG homozygote patients compared with 38% of patients with TT or GT variants (p=0.008). CONCLUSIONS There was a significant correlation between EGFR Sp1 -216 G/T polymorphism and treatment response to chemoradiation in locally advanced rectal cancer. Further investigations of a second set of patient and other treatment schedules are warranted.
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Affiliation(s)
- Karen-Lise Garm Spindler
- Department of Oncology, Danish Colorectal Cancer Group South, Vejle Hospital, University of Southern Denmark, Vejle, Denmark.
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