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Wang YQ, Shen LJ, Wan JF, Zhang H, Wang Y, Wu X, Wang JW, Wang RJ, Sun YQ, Tong T, Huang D, Wang L, Sheng WQ, Zhang X, Cai GX, Xu Y, Cai SJ, Zhang Z, Xia F. [Short-course radiotherapy combined with CAPOX and PD-1 inhibitor for the total neoadjuvant therapy of locally advanced rectal cancer: the preliminary single-center findings of a prospective, multicentre, randomized phase II trial (TORCH)]. Zhonghua Wei Chang Wai Ke Za Zhi 2023; 26:448-458. [PMID: 37217353 DOI: 10.3760/cma.j.cn441530-20230107-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Objective: Total neoadjuvant therapy has been used to improve tumor responses and prevent distant metastases in patients with locally advanced rectal cancer (LARC). Patients with complete clinical responses (cCR) then have the option of choosing a watch and wait (W&W) strategy and organ preservation. It has recently been shown that hypofractionated radiotherapy has better synergistic effects with PD-1/PD-L1 inhibitors than does conventionally fractionated radiotherapy, increasing the sensitivity of microsatellite stable (MSS) colorectal cancer to immunotherapy. Thus, in this trial we aimed to determine whether total neoadjuvant therapy comprising short-course radiotherapy (SCRT) combined with a PD-1 inhibitor improves the degree of tumor regression in patients with LARC. Methods: TORCH is a prospective, multicenter, randomized, phase II trial (TORCH Registration No. NCT04518280). Patients with LARC (T3-4/N+M0, distance from anus ≤10 cm) are eligible and are randomly assigned to consolidation or induction arms. Those in the consolidation arm receive SCRT (25Gy/5 Fx), followed by six cycles of toripalimab plus capecitabine and oxaliplatin (ToriCAPOX). Those in the induction arm receive two cycles of ToriCAPOX, then undergo SCRT, followed by four cycles of ToriCAPOX. Patients in both groups undergo total mesorectal excision (TME) or can choose a W&W strategy if cCR has been achieved. The primary endpoint is the complete response rate (CR, pathological complete response [pCR] plus continuous cCR for more than 1 year). The secondary endpoints include rates of Grade 3-4 acute adverse effects (AEs) etc. Results: Up to 30 September 2022, 62 patients attending our center were enrolled (Consolidation arm: 34, Induction arm:28). Their median age was 53 (27-69) years. Fifty-nine of them had MSS/pMMR type cancer (95.2%), and only three MSI-H/dMMR. Additionally, 55 patients (88.7%) had Stage III disease. The following important characteristics were distributed as follows: lower location (≤5 cm from anus, 48/62, 77.4%), deeper invasion by primary lesion (cT4 7/62, 11.3%; mesorectal fascia involved 17/62, 27.4%), and high risk of distant metastasis (cN2 26/62, 41.9%; EMVI+ 11/62, 17.7%). All 62 patients completed the SCRT and at least five cycles of ToriCAPOX, 52/62 (83.9%) completing six cycles of ToriCAPOX. Finally, 29 patients achieved cCR (46.8%, 29/62), 18 of whom decided to adopt a W&W strategy. TME was performed on 32 patients. Pathological examination showed 18 had achieved pCR, four TRG 1, and 10 TRG 2-3. The three patients with MSI-H disease all achieved cCR. One of these patients was found to have pCR after surgery whereas the other two adopted a W&W strategy. Thus, the pCR and CR rates were 56.2% (18/32) and 58.1% (36/62), respectively. The TRG 0-1 rate was 68.8% (22/32). The most common non-hematologic AEs were poor appetite (49/60, 81.7%), numbness (49/60, 81.7%), nausea (47/60, 78.3%) and asthenia (43/60, 71.7%); two patients did not complete this survey. The most common hematologic AEs were thrombocytopenia (48/62, 77.4%), anemia (47/62, 75.8%), leukopenia/neutropenia (44/62, 71.0%) and high transaminase (39/62, 62.9%). The main Grade III-IV AE was thrombocytopenia (22/62, 35.5%), with three patients (3/62, 4.8%) having Grade IV thrombocytopenia. No Grade V AEs were noted. Conclusions: SCRT-based total neoadjuvant therapy combined with toripalimab can achieve a surprisingly good CR rate in patients with LARC and thus has the potential to offer new treatment options for organ preservation in patients with MSS and lower-location rectal cancer. Meanwhile, the preliminary findings of a single center show good tolerability, the main Grade III-IV AE being thrombocytopenia. The significant efficacy and long-term prognostic benefit need to be determined by further follow-up.
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Affiliation(s)
- Y Q Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Shanghai Key Laboratory of Radiation Oncology, Shanghai 200032, China Shanghai Clinical Research Center for Radiation Oncology, Shanghai 200032, China
| | - L J Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Shanghai Key Laboratory of Radiation Oncology, Shanghai 200032, China Shanghai Clinical Research Center for Radiation Oncology, Shanghai 200032, China
| | - J F Wan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Shanghai Key Laboratory of Radiation Oncology, Shanghai 200032, China Shanghai Clinical Research Center for Radiation Oncology, Shanghai 200032, China
| | - H Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Shanghai Key Laboratory of Radiation Oncology, Shanghai 200032, China Shanghai Clinical Research Center for Radiation Oncology, Shanghai 200032, China
| | - Y Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Shanghai Key Laboratory of Radiation Oncology, Shanghai 200032, China Shanghai Clinical Research Center for Radiation Oncology, Shanghai 200032, China
| | - X Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Shanghai Key Laboratory of Radiation Oncology, Shanghai 200032, China Shanghai Clinical Research Center for Radiation Oncology, Shanghai 200032, China
| | - J W Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Shanghai Key Laboratory of Radiation Oncology, Shanghai 200032, China Shanghai Clinical Research Center for Radiation Oncology, Shanghai 200032, China
| | - R J Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Y Q Sun
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - T Tong
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - D Huang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - L Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - W Q Sheng
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - X Zhang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - G X Cai
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Y Xu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - S J Cai
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Z Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Shanghai Key Laboratory of Radiation Oncology, Shanghai 200032, China Shanghai Clinical Research Center for Radiation Oncology, Shanghai 200032, China
| | - F Xia
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Shanghai Key Laboratory of Radiation Oncology, Shanghai 200032, China Shanghai Clinical Research Center for Radiation Oncology, Shanghai 200032, China
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Shen J, Mo M, Dai WX, Zhou CM, Wang ZZ, Cai GX, Zhai LF, Xu Y, Zheng Y. [Association between obesity and risk for colorectal advanced adenoma]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 41:1643-1648. [PMID: 33297620 DOI: 10.3760/cma.j.cn112338-20200410-00553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives: To understand the association between obesity and the risk for colorectal advanced adenoma. Methods: Community residents aged 45 to 74 who had participated in the Shanghai community-based colorectal cancer (CRC) screening project in 2008 were included in our study. Anthropometries information including body weight, height and risk factors for colorectal advanced adenoma were collected. Results on colonoscopic diagnosis and personal health records were used for supplementary outcome information retrieval. Multivariate Cox proportional hazard regression models were used to evaluate the hazard ratio (HR) and 95%CI of obesity on the risk for colorectal advanced adenoma. Results: 20 811 residents were followed up for 122 739.36 person-years, with a median follow-up time of 5.87 years. A total of 657 cases of advanced adenomas were identified. After adjusting for potential confounding risk factors such as age, sex, family history of CRC, level of education, marriage, cigarette smoking, alcohol drinking, foods intake including fat, fried or pickled, vegetables and fruits etc., the HR was 1.25 (95%CI: 1.04-1.51) for obese people when compared with the normal weight persons. Further stratified analysis by age, gender and family history of CRC, results showed that obese people had a much higher risk of colorectal advanced adenoma than those with normal weight (male: HR=1.57, 95%CI: 1.20-2.04; more than 60- year-old: HR=1.63, 95%CI: 1.23-2.16). Conclusion: Data from this large scale population-based study revealed that obesity might be an independent risk factor for colorectal advanced adenoma and the risk increases along with the increase of BMI in China.
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Affiliation(s)
- J Shen
- Department of Cancer Prevention, Fudan University Affiliated Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - M Mo
- Department of Cancer Prevention, Fudan University Affiliated Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - W X Dai
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - C M Zhou
- Department of Cancer Prevention, Fudan University Affiliated Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Z Z Wang
- Department of Cancer Prevention, Fudan University Affiliated Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - G X Cai
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Colorectal Surgery, Fudan University Affiliated Cancer Center, Shanghai 200032, China
| | - L F Zhai
- Shanghai Qibao Community Health Service Center, Minhang District, Shanghai 201101, China
| | - Y Xu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Colorectal Surgery, Fudan University Affiliated Cancer Center, Shanghai 200032, China
| | - Y Zheng
- Department of Cancer Prevention, Fudan University Affiliated Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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