PreOP XRT: Oral fluoropyrimidines in randomized trials n NSABP R 04 open 1600 Cape vs. FU infusional (+/- Oxaliplatin 2x2 factorial) German Group open ca. 180 Cape vs. FU infusional (pre- and postOP) Spanish Group ECCO 2005 149 UFT/FA vs. FU/FA no difference in pCR, local failure, toxicity
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PreOP XRT: Oral fluoropyrimidines in randomized trials n NSABP R 04 open 1600 Cape vs. FU infusional (+/- Oxaliplatin 2x2 factorial) German Group open.
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PreOP XRT: Oral fluoropyrimidines in randomized trials
n
NSABP R 04 open
1600Cape vs. FU infusional (+/- Oxaliplatin 2x2 factorial)
German Group open
ca. 180Cape vs. FU infusional (pre- and postOP)
Spanish Group ECCO 2005
149UFT/FA vs. FU/FAno difference in pCR, local failure, toxicity
No Bolus-FU anymore in Coloncancer
5FU inf / FAAndré et al., J Clin Oncol
2003
CapecitabinTwelves et al., NEJM 2005
Präoperative Radiochemotherapie des Rektumkarzinoms
Rödel, Arnold et al., Int J Radiation Oncology Biol Physics 2008
Phase I/II Trial: Preoperative Radiotherapywith CAPOX and Cetuximab
No increase of toxicity,
No increase of
perioperative complication rate
Tumor regression grading (Dworak and Keilholz 1997)
Cet-Capox-RT Capox-RT*
(n=46) (n=103)
Complete Regression 9% 19%
Good Regression (50 - 99%) 38% 55%
Moderate Regression (25 - 50%)
Poor Regression (< 25) 53% 26%
No Regression *Rödel, Liersch, Arnold et al., J Clin Oncol 2007
Rödel, Arnold et al., Int J Radiation Oncology Biol Physics 2007
Phase II trials with intensified preoperative Radiochemotherapy N pts. pCR (%)
1 FU / Cape 9 – 21
2FU / Cape Oxali 16 – 33
FU / Cape Irino 18 – 32
3
1Cape Cetuximab 40 5
2Cape Oxali Cetuximab 49 9
3Cape Irino Cetuximab 20 25
4Cape Irino Cetuximab 10 20
Arnold et al., Eur J Cancer 2005 (Suppl.); 1Machiels, Ann Oncol 2007; 2Arnold, ASCO 2007, 3Hofheinz et al., Int J Radiat Oncol Biol Phys 2006; 4Bertolini ASCO 2007
Bevacizumab RT in rectal cancer
N chemotherapy
Willett et al., ASCO 2007
22 5FU CI 50.4 Gy No increase in toxicitypCR: 22%
Czito et al., ASCO 2007
11 XELOX 50.4 Gy Lowered dose of Capecitabine due to diarrhea
Privitera et al., ASCO 2007
11 XELOX (6) XELIRI (5)
45.0 Gy. 3 pts.: hypertension, no further toxicity
Colon cancer stage III:Oxaliplatin combinations > FU/FA
André T et al., NEJM, 2004; Wolmark N et al., ASCO 2005