P-0272 - Neoadjuvant Chemotherapy capecitabine and oxaliplatin (XELOX) combined with bevacizumab for high-risk localized rectal cancer

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Anti-Cancer Agents & Biologic Therapy
Rectal Cancer
Presenter Takeshi Kato
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors K. Murata1, Y. Fujie2, I. Takemasa3, M. Ikeda4, H. Yamamoto3, M. Sekimoto4, R. Nezu5, Y. Doki3, J. Hasegawa6, M. Mori3, T. Mizushima3, H. Kim3, J. Nishimura3, K. Ikenaga3, H. Takemoto7, S. Noura8, M. Ohue8
  • 1Suita City Hospital, Suita-City/JP
  • 2Osaka Saiseikai Senri Hospital, Suita/JP
  • 3Osaka University Graduate School of Medicine, Suita/JP
  • 4National Hospital Organization, Osaka National Hospital, Osaka/JP
  • 5Nishinomiya Municipal Central Hospital, Nishinomiya/JP
  • 6Osaka Rosai Hospital, Sakai/JP
  • 7Kinki Central Hospital of the Mutual Aid Association of Public School Teachers, Itami/JP
  • 8Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka/JP

Abstract

Introduction

Neoadjuvant Chemoradiotherapy followed by total mesorectal excision (TME) is the standard treatment for locally advanced rectal cancer. Although this approach decreases the risk of local recurrence, pelvic radiation is associated with long-term morbidity and delays systemic treatment. We conducted this study to evaluate the feasibility of neoadjuvant capecitabine and oxaliplatin (XELOX) plus bevacizumab as a treatment for high-risk localized rectal cancer.

Methods

Patients with T4 or lymph node-positive rectal cancer were treated with three cycles of XELOX plus bevacizumab, and one additional cycle of XELOX. This was followed by TME performed 3–8 weeks after the last chemotherapy session.

Results

Twenty-five patients were recruited between December 2009 and November 2011. In seven of the patients (28.0%), grade 3-4 adverse events occurred. After preoperative chemotherapy, the frequency of tumor (T) downstaging was 69.6%, and that of lymph node (N) downstaging was 78.9%. Seven patients discontinued the treatment after 2-3 cycles of XELOX plus bevacizumab. The frequency of subsequent surgery was 92%, and all patients underwent R0 resections. Postoperative complications occurred in six patients (26.1%). One patient achieved a pathological complete response (pCR) for the primary tumor and lymph nodes, whereas an additional four patients achieved near-pCR. After a median follow-up of 31 months, five patients displayed metastatic progression, including one who suffered local recurrence.

Conclusion

XELOX plus bevacizumab followed by TME is feasible for high-risk localized rectal cancer, as it achieves good tumor regression and causes manageable toxicity.