Treatment outcomes regarding the addition of targeted agents in the therapeutic portfolio for stage II-III rectal cancer undergoing neoadjuvant chemoradiation
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Jin-Tung Liang1, Tzu-Chun Chen1, John Huang1, Yung-Ming Jeng2 and Jason Chia-Hsien Cheng3
1Division of Colorectal Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
2Department of Pathology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
3Department of Radiation Oncology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
Jin-Tung Liang, email: firstname.lastname@example.org
Keywords: bevacizumab; cetuximab; CCRT; rectal cancer; total mesorectal excision
Abbreviations: CCRT: Concurrent chemoradiation therapy; FOLFOX: folinic acid + leucovorin + oxaliplatin; TME: Total mesorectal excision
Received: April 13, 2017 Accepted: August 29, 2017 Published: October 10, 2017
Background: To evaluate the impact of targeted agents in stage II-III rectal cancer undergoing neoadjuvant concurrent chemoradiation therapy (CCRT).
Method: A retrospective study was performed in 124 consecutive patients with clinically T3N0-2M0-staged rectal cancer incorporating targeted agents in CCRT.
Results: Pathologic complete response was detected in 34.2% (n=26) of bevacizumab+FOLFOX-treated patients (n=76), which was significantly higher (p=0.019, post-hoc statistical power =35.87%) than that (n=10, 20.8%) of the cetuximab+FOLFOX-treated patients (n=48). Patients receiving cetuximab+FOLFOX therapy tended to develop severe liver toxicity (91.7%, n=44 versus 17.1%, n=13, p<0.0001), as evaluated by morphologic grading of hepatic steatosis and sinusoidal dilatation in laparoscopy. In the 57 patients with morphologically severe liver toxicity, 36 (63.2%) retained a normal liver function; for the remaining 21 patients with an abnormal liver function, the abnormality was self-limited in 19 patients, whereas 2 cetuximab–treated patients progressed to hepatic failure and mortality. A subset analysis within bevacizumab+FOLFOX-treated patients with either wild-type (n=36) or mutant (n=40) K-ras status indicated K-ras status did not significantly influence the treatment outcomes.
Conclusions: The addition of bevacizumab instead of cetuximab to FOLFOX in the neoadjuvant settings for T3N0-2M0-staged rectal cancer could induce a promising rate of pathologic complete response and lesser hepatotoxicity.
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