Long-course preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for clinical T4 and fixed clinical T3 rectal cancer: long-term results of the randomized Polish II study

BACKGROUND

This trial evaluated whether preoperative short-course radiotherapy and consolidation chemotherapy (CCT) were superior to chemoradiation in rectal cancers with clinical (c)T4 or fixed cT3. Previously, we reported early results showing no differences in the radical surgery rate (primary end point). In the short-course/CCT group, we observed lower acute toxicity of preoperative treatment and better overall survival (OS). We updated results to determine whether the benefit in OS was sustained and to evaluate late complications.

PATIENTS AND METHODS

Patients with cT4 or fixed cT3 rectal cancer were randomized either to preoperative 5 × 5 Gy and three cycles of FOLFOX4 or to chemoradiation (50.4 Gy with bolus 5-Fu, leucovorin and oxaliplatin).

RESULTS

Patients (N = 515) were eligible for analysis, 261 in the short-course/CCT group and 254 in the chemoradiation group. The median follow-up was 7.0 years. The difference in OS was insignificant [hazard ratio (HR) 0.90; 95% confidence interval (CI) 0.70-1.15; P = 0.38). However, the difference in early OS favouring short-course/CCT previously reported was observed again, being 9% at 3 years (95% CI 0.5% to 17%). This difference disappeared later; at 8 years OS was 49% in both groups. There was no difference in disease-free survival (HR 0.95; 95% CI 0.75-1.19; P = 0.65) at 8 years 43% versus 41% in the short-course/CCT group versus the chemoradiation group, respectively. The corresponding values for cumulative incidences of local failure and distant metastases did not differ and were HR = 1.08, 95% CI 0.70-1.23, P = 0.60, 35% versus 32% and HR = 1.10, 95% CI 0.68-1.23, P = 0.54, 36% versus 34%, respectively. The rate of late complications was similar (P = 0.66), grade 3+ being 11% versus 9% in the short-course/CCT group versus the chemoradiation group, respectively.

CONCLUSION

The superiority of preoperative short-course/CCT over chemoradiation was not demonstrated.

CLINICAL TRIAL NUMBER

The trial is registered as ClinicalTrials.gov number NCT00833131.

Tecemotide in unresectable stage III non-small-cell lung cancer in the phase III START study: updated overall survival and biomarker analyses

BACKGROUND

Tecemotide is a MUC1-antigen-specific cancer immunotherapy. The phase III START study did not meet its primary end point but reported notable survival benefit with tecemotide versus placebo in an exploratory analysis of the predefined patient subgroup treated with concurrent chemoradiotherapy. Here, we attempted to gain further insight into the effects of tecemotide in START.

PATIENTS AND METHODS

START recruited patients who did not progress following frontline chemoradiotherapy for unresectable stage III non-small-cell lung cancer. We present updated overall survival (OS) data and exploratory analyses of OS for baseline biomarkers: soluble MUC1 (sMUC1), antinuclear antibodies (ANA), neutrophil/lymphocyte ratio (NLR), lymphocyte count, and HLA type.

RESULTS

Updated OS data are consistent with the primary analysis: median 25.8 months (tecemotide) versus 22.4 months (placebo) (HR 0.89, 95% CI 0.77-1.03, P = 0.111), with ∼20 months additional median follow-up time compared with the primary analysis. Exploratory analysis of the predefined subgroup treated with concurrent chemoradiotherapy revealed clinically relevant prolonged OS with tecemotide versus placebo (29.4 versus 20.8 months; HR 0.81, 95% CI 0.68-0.98, P = 0.026). No improvement was seen with sequential chemoradiotherapy. High sMUC1 and ANA correlated with a possible survival benefit with tecemotide (interaction P = 0.0085 and 0.0022) and might have future value as biomarkers. Interactions between lymphocyte count, NLR, or prespecified HLA alleles and treatment effect were not observed.

CONCLUSION

Updated OS data support potential treatment benefit with tecemotide in patients treated with concurrent chemoradiotherapy. Exploratory biomarker analyses suggest that elevated sMUC1 or ANA levels correlate with tecemotide benefit.

CLINICALTRIALSGOV NUMBER

NCT00409188.

Anthracycline-containing regimen in early breast cancer: Analysis of toxicity

11104

Background: The anthracycline-containing regimens is considered to be more beneficial to patients (pts) with early breast cancer (EBC). However at this moment is not clear which kind of regimen should be used in adjuvant setting. Methods: In our center, from Jan 2004 to Sep 2006, 248 breast cancer pts, who were qualified to the adjuvant chemotherapy received FEC100 (104 pts), AC (126 pts). or sequentially AC- taxans (18). Pts with many poor prognostic factors (N+, T3, G3, HER2/neu 3+) received 6 cycles of FEC100 or AC-taxans. Pts with better prognosis (Intermediate Risk Group according St.Gallen’s guidelines for 2005) received usually 4 cycles of AC. Besides, in most cases, internet access to the adjuvantonline! program was used during making decision. ER-ve or PR-ve positive pts received sequentially hormonal treatment. The radiotherapy (if needed) was delivered at the end of the chemotherapy. Results: During the treatment, toxicity of the chemotherapy was evaluated by NCI CTC v. 3. There was no toxic deaths. Median follow-up period was 19 months (range: 6–36). The febrile neutropenia was observed in 4 pts in FEC100 and in 5 pts in AC group. There was also no significant differences in the grade 3 or 4 neutropenia, anemia, thrombocytopenia and alopecia. In 3 pts treated with FEC100 and 1 with AC, cardiotoxicity grade 2 or 3 was diagnosed. Grade 2 or 3 asthenia was frequent in FEC100 group (44% vs 21% vs11%). In all pts prophylaxis of nausea/vomiting was used. However pts treated with FEC100 needed more 5HT3. Vomiting grade 2 or 3 were observed significantly more often in pts who received FEC100 (58% vs 26% vs 23%). Only at 1 pts in each group the chemotherapy was interrupted due to toxicity (asthenia gr 3, vomiting gr 3 and weight loss gr 2). The relative dose intensities of FEC100 and AC were 87% and 96% of planned doses, respectively. Conclusions: The acute symptoms of toxicity were important for breast cancer pts who received the adjuvant chemotherapy. According the adjuvantonline! 6 cycles of FEC100 were more effective than 4 cycles of AC. Nevertheless tolerability of AC is better. Many pts prefer only the hormonal treatment, even if it is not the optimal option, in fear of nausea or vomiting. The ongoing clinical trials should further define the best choice of anthracycline-containing regimen in the adjuvant setting.

No significant financial relationships to disclose.