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Li A, Huang T, Zheng R, Chi P, Li Z, Wang X, Xu B. Preoperative chemoradiotherapy with capecitabine and triweekly oxaliplatin versus capecitabine monotherapy for locally advanced rectal cancer: a propensity-score matched study. BMC Cancer 2022; 22:789. [PMID: 35850711 PMCID: PMC9295262 DOI: 10.1186/s12885-022-09855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Distant metastasis has been the main failure pattern for locoregionally advanced rectal cancer (LARC) patients, and intensified neoadjuvant chemotherapy has become a popular research topic. The present study aimed to compare the survival outcomes, acute toxicities and surgical complications in LARC patients who received preoperative chemoradiotherapy with triweekly oxaliplatin and capecitabine (triweekly XELOX) or capecitabine. Methods: Between 2007 and 2017, patients with clinically staged II-III rectal cancer who were treated with preoperative chemoradiotherapy using either triweekly XELOX (oxaliplatin 130 mg/m2 plus capecitabine 825 mg/m2) or capecitabine were included. Variables potentially influencing chemotherapy treatment selection were used to generate propensity scores (PS). The association between chemotherapy regimens and survival endpoints, including distant metastasis-free survival (DMFS), overall survival (OS) and disease-free survival (DFS), were evaluated and adjusted with PS. The acute toxicities and surgical complications were also compared. Results A total of 810 patients were included in the analysis; 277 (34.2%) patients received triweekly XELOX, and 533 (65.8%) received capecitabine. The pathological complete response (pCR) rates were 20.2 and 19.9% (P = 0.912) for the groups treated with triweekly XELOX and capecitabine, respectively. The 5-year DMFS, OS and DFS with triweekly XELOX versus capecitabine were 75.6% vs. 77.6% (P = 0.555), 79.2% vs. 83.3% (P = 0.101), and 69.9% vs. 73.7% (P = 0.283), respectively. Triweekly XELOX was not associated with an increased risk of severe toxicity during chemoradiotherapy, but it increased the risk of postoperative complications compared to capecitabine. After PS adjustment, the differences between the two groups remained insignificant in pCR rate, survival outcomes, and acute toxicities, and the difference in surgical complications disappeared. Conclusions Triweekly XELOX or capecitabine concurrent with neoadjuvant radiotherapy leads to similar long-term survival outcomes, acute toxicities and surgical complications in LARC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09855-z.
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Affiliation(s)
- Anchuan Li
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, 350001, China.,Department of Radiation Oncology, College of Clinical Medicine, Fujian Medical University, Fuzhou, 350001, China.,Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors, Fujian Medical University, Fuzhou, 350001, China.,Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, 350001, China
| | - Tingxuan Huang
- Department of Gastroenterology, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, 350001, China.,Fujian Medical University Cancer Center, Fujian Medical University, Fuzhou, 350001, China
| | - Rong Zheng
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, 350001, China.,Department of Radiation Oncology, College of Clinical Medicine, Fujian Medical University, Fuzhou, 350001, China.,Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors, Fujian Medical University, Fuzhou, 350001, China.,Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, 350001, China
| | - Pan Chi
- Department of Gastrointestinal Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Zhihua Li
- Department of Radiation Oncology, The Second Hospital of Zhangzhou, Zhangzhou, 363100, China
| | - Xiaozhong Wang
- Department of Gastroenterology, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, 350001, China. .,Fujian Medical University Cancer Center, Fujian Medical University, Fuzhou, 350001, China.
| | - Benhua Xu
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, 350001, China. .,Department of Radiation Oncology, College of Clinical Medicine, Fujian Medical University, Fuzhou, 350001, China. .,Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors, Fujian Medical University, Fuzhou, 350001, China. .,Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, 350001, China. .,Department of Medical Imagine Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, 350001, China.
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Des Guetz G, Landre T, Bollet MA, Mathonnet M, Quéro L. Is There a Benefit of Oxaliplatin in Combination with Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer? An Updated Meta-Analysis. Cancers (Basel) 2021; 13:6035. [PMID: 34885147 PMCID: PMC8657124 DOI: 10.3390/cancers13236035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/15/2021] [Accepted: 11/26/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Neoadjuvant fluoropyrimidine (5FU or capecitabine)-based chemoradiotherapy (CRT) has been considered the standard of care for locally advanced rectal cancer (LARC). Whether addition of oxaliplatin (OXP) will further improve clinical outcomes is still unclear. METHODS To identify clinical trials combining oxaliplatin in preoperative CRT or perioperative chemotherapy for LARC published until March 2021, we searched PubMed and the Cochrane Library. We also searched for relevant ASCO conference abstracts. The primary endpoint was disease-free survival (DFS). Data were extracted from every study to perform a meta-analysis using Review Manager (version 5.3). RESULTS A total of seven randomized clinical trials (ACCORD-12, CARO-AIO-04, FOWARC, JIAO, NSABP, PETACC-6, and STAR-01) with 5782 stage II or III rectal cancer patients were analyzed, including 2727 patients with OXP + 5FU regimen and 3055 patients with 5FU alone. Compared with the 5FU alone group, the OXP + 5FU regimen improved DFS (HR = 0.90, 95% CI: 0.81-0.99, p = 0.03) and pathologic complete response (pCR) (OR = 1.21, 95% CI: 1.07-1.37, p = 0.002). Patients treated with the OXP + 5FU regimen had significantly less metastatic progression (OR = 0.79; 95% CI, 0.67 to 0.94; p = 0.007). Considering adverse events (AEs), there was more grade 3-4 diarrhea with OXP + 5FU (OR = 2.41, 95% CI: 1.74-3.32, p < 0.00001). However, there were no significant differences grade 3-4 hematologic AEs (OR = 1.16, 95% CI: 0.87-1.57, p = 0.31). CONCLUSIONS Our meta-analysis with long-term results from the randomized studies showed a benefit of the addition of OXP + 5FU regiment in terms of DFS, metastatic progression, and pCR rate that did not translate to improved OS.
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Affiliation(s)
- Gaëtan Des Guetz
- Medical Oncology Department, Delafontaine Hospital, 93200 St Denis, France
- Department of Surgery, Faculty of Medicine, University of Limoges, 87032 Limoges, France;
| | - Thierry Landre
- Unité de Coordination en Onco-Gériatrie, Hôpitaux Universitaires Paris Seine-St-Denis, AP-HP, 93270 Sevran, France;
| | - Marc A. Bollet
- Centre de Radiothérapie Hartmann, 92300 Levallois-Perret, France;
| | - Muriel Mathonnet
- Department of Surgery, Faculty of Medicine, University of Limoges, 87032 Limoges, France;
- Department of Surgery, University Hospital of Limoges, 87032 Limoges, France
| | - Laurent Quéro
- INSERM U1160, Université de Paris, 75010 Paris, France;
- Radiation Oncology Department, Saint-Louis University Hospital, AP-HP, 75010 Paris, France
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李 萍, 袁 平, 阙 月, 刘 筱, 王 国. [Synergistic effect of polysaccharide from Trichoderma pseudokoningii and oxaliplatin on colorectal cancer cells in vitro]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:504-513. [PMID: 33963708 PMCID: PMC8110445 DOI: 10.12122/j.issn.1673-4254.2021.04.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore the synergistic inhibitory effect of polysaccharide from Trichoderma pseudokoningii (EPS) and oxaliplatin (Oxa) on colorectal cancer (CRC) HCT116 cells. OBJECTIVE HCT116 cells were treated with 8 μg/mL Oxa and 100 μg/mL EPS alone or in combination, and the changes in cell viability was assessed with CCK-8 assay. CompuSyn software was used for fitting the Fa-CI curve to evaluate the combined effect of the two agents. Flow cytometry was performed to analyze cell apoptosis and cell cycle changes, and wound healing assay and Transwell assay were used to examine the migration ability of the treated cells. Oxa- and EPS-related genes and CRC-related genes were intersected for protein-protein interaction (PPI) analysis and GO and KEGG enrichment analyses. OBJECTIVE Treatment with Oxa alone or in combination with EPS significantly inhibited the viability of HCT116 cells in a dose- and time-dependent manner, and the two agents exhibited a significant synergistic effect (CI < 1). The combined treatment with Oxa and EPS resulted in a significantly higher total cell apoptosis rate and a higher percentage of cells in S phase than Oxa alone and the control treatment (P < 0.05). EPS and Oxa alone both inhibited the migration of HCT116 cells, and their combination produced a stronger inhibitory effect. GO enrichment analysis of the key genes related with Oxa, EPS and CRC suggested that these genes were involved mainly in such biological processes as exogenous apoptosis signaling, cell response to chemical stress, and reactive oxygen metabolism; KEGG analysis showed that these genes were involved in the pathways of drug resistance, apoptosis and angiogenesis. OBJECTIVE EPS and Oxa can synergistically inhibit the proliferation of HCT116 cells possibly through the PI3K-Akt, MAPK, VEGF, and p53 signaling pathways.
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Affiliation(s)
- 萍 李
- 皖南医学院药物研发中心//药学院,安徽 芜湖 241002School of Pharmacy, Wannan Medical College, Wuhu 241002, China
- 安徽省多糖药物工程技术研究中心//活性生物大分子研究安徽省重点实验室,安徽 芜湖 241002Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Wuhu 241002, China
| | - 平川 袁
- 皖南医学院药物研发中心//药学院,安徽 芜湖 241002School of Pharmacy, Wannan Medical College, Wuhu 241002, China
- 安徽省多糖药物工程技术研究中心//活性生物大分子研究安徽省重点实验室,安徽 芜湖 241002Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Wuhu 241002, China
| | - 月月 阙
- 皖南医学院药物研发中心//药学院,安徽 芜湖 241002School of Pharmacy, Wannan Medical College, Wuhu 241002, China
| | - 筱琴 刘
- 重庆化工职业学院//制药领域关键共性工艺重庆市高等职业技术院校应用技术推广中心,重庆 401220Chongqing Chemical Industry Vocational College, Chongqing Municipal Vocational and Technical College Application Technology Promotion Center for Key Common Technology in Pharmaceuticals, Chongqing 401220, China
| | - 国栋 王
- 皖南医学院药物研发中心//药学院,安徽 芜湖 241002School of Pharmacy, Wannan Medical College, Wuhu 241002, China
- 安徽省多糖药物工程技术研究中心//活性生物大分子研究安徽省重点实验室,安徽 芜湖 241002Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Wuhu 241002, China
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