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Hanna CR, O’Cathail SM, Graham JS, Saunders M, Samuel L, Harrison M, Devlin L, Edwards J, Gaya DR, Kelly CA, Lewsley LA, Maka N, Morrison P, Dinnett L, Dillon S, Gourlay J, Platt JJ, Thomson F, Adams RA, Roxburgh CSD. Durvalumab (MEDI 4736) in combination with extended neoadjuvant regimens in rectal cancer: a study protocol of a randomised phase II trial (PRIME-RT). Radiat Oncol 2021; 16:163. [PMID: 34446053 PMCID: PMC8393812 DOI: 10.1186/s13014-021-01888-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Advances in multi-modality treatment of locally advanced rectal cancer (LARC) have resulted in low local recurrence rates, but around 30% of patients will still die from distant metastatic disease. In parallel, there is increasing recognition that with radiotherapy and systemic treatment, some patients achieve a complete response and may avoid surgical resection, including in many cases, the need for a permanent stoma. Extended neoadjuvant regimes have emerged to address these concerns. The inclusion of immunotherapy in the neoadjuvant setting has the potential to further enhance this strategy by priming the local immune microenvironment and engaging the systemic immune response. METHODS PRIME-RT is a multi-centre, open label, phase II, randomised trial for patients with newly diagnosed LARC. Eligible patients will be randomised to receive either: short course radiotherapy (25 Gray in 5 fractions over one week) with concomitant durvalumab (1500 mg administered intravenously every 4 weeks), followed by FOLFOX (85 mg/m2 oxaliplatin, 350 mg folinic acid and 400 mg/m2 bolus 5-fluorouracil (5-FU) given on day 1 followed by 2400 mg/m2 5-FU infusion over 46-48 h, all administered intravenously every 2 weeks), and durvalumab, or long course chemoradiotherapy (50 Gray to primary tumour in 25 fractions over 5 weeks with concomitant oral capecitabine 825 mg/m2 twice per day on days of radiotherapy) with durvalumab followed by FOLFOX and durvalumab. The primary endpoint is complete response rate in each arm. Secondary endpoints include treatment compliance, toxicity, safety, overall recurrence, proportion of patients with a permanent stoma, and survival. The study is translationally rich with collection of bio-specimens prior to, during, and following treatment in order to understand the molecular and immunological factors underpinning treatment response. The trial opened and the first patient was recruited in January 2021. The main trial will recruit up to 42 patients with LARC and commence after completion of a safety run-in that will recruit at least six patients with LARC or metastatic disease. DISCUSSION PRIME-RT will explore if adding immunotherapy to neoadjuvant radiotherapy and chemotherapy for patients with LARC can prime the tumour microenvironment to improve complete response rates and stoma free survival. Sequential biopsies are a key component within the trial design that will provide new knowledge on how the tumour microenvironment changes at different time-points in response to multi-modality treatment. This expectation is that the trial will provide information to test this treatment within a large phase clinical trial. Trial registration Clinicaltrials.gov NCT04621370 (Registered 9th Nov 2020) EudraCT number 2019-001471-36 (Registered 6th Nov 2020).
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Affiliation(s)
- Catherine R. Hanna
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Sean M. O’Cathail
- Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Janet S. Graham
- Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Mark Saunders
- The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX UK
| | | | - Mark Harrison
- Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, HA6 2RN UK
| | - Lynsey Devlin
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Joanne Edwards
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, G61 1QH UK
| | - Daniel R. Gaya
- Gastroenterology Unit, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, 4th Floor Walton Building, Castle Street, Glasgow, G4 0SF UK
| | - Caroline A. Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Liz-Anne Lewsley
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Noori Maka
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF UK
| | - Paula Morrison
- Snr Pharmacist Clinical Trials Oncology R&I, Research & Innovation, Dykebar Hospital, NHS Greater Glasgow & Clyde, Ward 11, Grahamston Road, Paisley, PA2 7DE UK
| | - Louise Dinnett
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Susan Dillon
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Jacqueline Gourlay
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Jonathan J. Platt
- Department of Radiology, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF UK
| | - Fiona Thomson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH UK
| | - Richard A. Adams
- Centre for Trials Research Cardiff University Heath Park, Cardiff University and Velindre NHS Trust, Cardiff, UK
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Campbell S. D. Roxburgh
- Institute of Cancer Sciences, Glasgow Royal Infirmary, University of Glasgow, Room 2.57, Level 2, New Lister Building, Glasgow, G31 2ER UK
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Senchukova MA, Makarova EV, Kalinin EA, Tkachev VV, Zubareva EY. Modern concepts on the role of hypoxia in the development of tumor radioresistance. SIBERIAN JOURNAL OF ONCOLOGY 2020. [DOI: 10.21294/1814-4861-2020-19-6-141-147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The purpose of the study was to systematize and summarize modern ideas about the role of hypoxia in the development of tumor radioresistance.Material and Methods. PubMed, eLibrary and Springer databases were used to identify reviews published from 1953 to 2020, of which 57 were selected to write our review.Results. Radiation therapy is one of the most important components in cancer treatment. The major drawback of radiation therapy is the development radiation resistance in cancerous cells and secondary malignancies. The mechanisms of cancer radioresistance are very complicated and affected by many factors, of which hypoxia is the most important. Hypoxia is able to activate the mechanisms of angiogenesis, epithelial-mesenchymal transformation and contribute to the formation of the pool of cancer stem cell, which are characterized by chemo- and radioresistance. In turn, the severity of hypoxia largely dependent on tumor blood flow. Moreover, not only the quantitative but also the qualitative characteristics of blood vessels can affect the development of tissue hypoxia in the tumor.Conclusion. A comprehensive assessment of the severity of hypoxia, as well as characteristics of angiogenesis and EMT can contribute to a better understanding of the mechanisms of development of cancer radioresistance.
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Affiliation(s)
- M. A. Senchukova
- Orenburg State Medical University;
Orenburg Regional Oncology Clinic
| | - E. V. Makarova
- Orenburg State Medical University;
Orenburg Regional Oncology Clinic
| | | | | | - E. Y. Zubareva
- Orenburg State Medical University;
Orenburg Regional Oncology Clinic
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