A randomized phase II study of capecitabine-based chemoradiation with or without bevacizumab in resectable locally advanced rectal cancer: clinical and biological features
Por:
Salazar R, Capdevila J, Laquente B, Manzano JL, Pericay C, Villacampa MM, López C, Losa F, Safont MJ, Gómez A, Alonso V, Escudero P, Gallego J, Sastre J, Grávalos C, Biondo S, Palacios A and Aranda E
Publicada:
26 feb 2015
Resumen:
Background: Perioperatory chemoradiotherapy (CRT) improves local control and survival in patients with locally advanced rectal cancer (LARC). The objective of the current study was to evaluate the addition of bevacizumab (BEV) to preoperative capecitabine (CAP)-based CRT in LARC, and to explore biomarkers for downstaging.
Methods: Patients (pts) were randomized to receive 5 weeks of radiotherapy 45 Gy/25 fractions with concurrent CAP 825 mg/m(2) twice daily 5 days per week and BEV 5 mg/kg once every 2 weeks (3 doses) (arm A), or the same schedule without BEV (arm B). The primary end point was pathologic complete response (ypCR: ypT(0)N(0)).
Results: Ninety pts were included in arm A (44) or arm B (46). Grade 3-4 treatment-related toxicity rates were 16% and 13%, respectively. All patients but one (arm A) proceeded to surgery. The ypCR rate was 16% in arm A and 11% in arm B (p = 0.54). Fifty-nine percent vs 39% of pts achieved T-downstaging (arm A vs arm B; p = 0.04). Serial samples for biomarker analyses were obtained for 50 out of 90 randomized pts (arm A/B: 22/28). Plasma angiopoietin-2 (Ang-2) levels decreased in arm A and increased in arm B (p < 0.05 at all time points). Decrease in Ang-2 levels from baseline to day 57 was significantly associated with tumor downstaging (p = 0.02).
Conclusions: The addition of BEV to CAP-based preoperative CRT has shown to be feasible in LARC. The association between decreasing Ang-2 levels and tumor downstaging should be further validated in customized studies.
Filiaciones:
Salazar R:
Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Capdevila J:
Medical Oncology, Hospital Universitari Vall D'Hebrón, Barcelona, Spain.
Manzano JL:
Medical Oncology, Hospital Universitari German Trias I Pujol, Barcelona, Spain.
Pericay C:
Medical Oncology, Complejo Sanitario Parc Taulí, Barcelona, Spain.
López C:
Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Losa F:
Medical Oncology, Hospital General de L'Hospitalet, Barcelona, Spain.
Safont MJ:
Medical Oncology, Hospital General Universitario de Valencia, Valencia, Spain.
Gómez A:
Medical Oncology, Reina Sofía Hospital, University of Córdoba, Maimonides Institute of Biomedical Research (IMIBIC)
Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain.
Alonso V:
Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Escudero P:
Medical Oncology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
:
Medical Oncology, Hospital General U. de Elche, Alicante, Spain.
Sastre J:
Medical Oncology, Hospital Clínico Universitario San Carlos, Madrid, Spain.
Grávalos C:
Medical Oncology, Hospital Doce de Octubre, Madrid, Spain.
Biondo S:
General and Digestive Surgery Hospital Universitario de Bellvitge, Barcelona, Spain.
Palacios A:
Radiation Oncology, Hospital Universitario Reina Sofía, Córdoba, Spain.
Aranda E:
Medical Oncology, Reina Sofía Hospital, University of Córdoba, Maimonides Institute of Biomedical Research (IMIBIC)
Green Published, gold
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