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A phase I/II study of oxaliplatin when added to 5-fluorouracil and leucovorin and pelvic radiation in locally advanced rectal cancer: a Colorectal Clinical Oncology Group (CCOG) study.

Sebag-Montefiore D, Glynne-Jones R, Falk S, Meadows HM, Maughan T - Br. J. Cancer (2005)

Bottom Line: In all, 28 out of 32 patients completed all treatments as planned; three had radiotherapy interrupted and three a chemotherapy dose reduction.Four patients did not proceed to surgery due to the presence of metastatic disease (two), unfitness (one) or patient refusal (one).The tumour downstaging and complete resection rates are encouragingly high for this very locally advanced group.

View Article: PubMed Central - PubMed

Affiliation: Cookridge Hospital, Hospital Lane, Cookridge, West Yorkshire LS16 6QB, UK. David.Sebag-Montefiore@leedsth.nhs.uk

ABSTRACT
The purpose of this study was to evaluate the maximum tolerated dose (MTD) and recommended dose of oxaliplatin given synchronously with 5-fluorouracil (5FU), leucovorin (LV) and preoperative pelvic radiation for primary unresectable, locally advanced, rectal cancer. Preoperative pelvic radiotherapy using a three- or four-field technique and megavoltage photons comprised 45 Gy given in 25 fractions, 1.8 Gy per fraction, and delivered with escalating doses of oxaliplatin in combination with low-dose LV and 5FU. Chemotherapy was given synchronously with radiotherapy in weeks 1 and 5. Escalating doses of oxaliplatin (85, 130 and 150 mg m(-2)) were given on days 2 and 30, followed by low-dose LV (20 mg m(-2)) and 5FU (350 mg m(-2)), both given on days 1-5 and 29-33. Surgery was performed 6-10 weeks later. The MTD was determined as the dose causing more than a third of patients to have a dose-limiting toxicity (DLT). Once the MTD was reached, a further 14 patients were treated at the dose level below the MTD. In all, 32 patients received oxaliplatin at the three dose levels, median age 60 years (range 31-79), 24 males and eight females. The MTD was reached at 150 mg m(-2) when four out of six patients experienced DLT. Dose-limiting grade 3 or 4 diarrhoea was reported in two out of six patients at 85 mg m(-2), 5 out of 20 at 130 mg m(-2) and four out of 6 at 150 mg m(-2). Grade 3 neuropathy was reported at 130 mg m(-2) (1 out of 20) and at 150 mg m(-2) (two out of six), and serious haematological toxicity was minimal; one grade 3 anaemia at 150 mg m(-2). In all, 28 out of 32 patients completed all treatments as planned; three had radiotherapy interrupted and three a chemotherapy dose reduction. Four patients did not proceed to surgery due to the presence of metastatic disease (two), unfitness (one) or patient refusal (one). Also, 28 patients underwent surgical resection. Histopathology demonstrated histopathological complete response (pCR) 2 out of 27 (7%), Tmic 3 out of 27 (11%), pCR+Tmic 5 out of 27 (19%), pT0-2 6 out of 27 (22%) and histologically confirmed clear circumferential resection margins in 22 out of 27 (81%). Dose-limiting toxicity with oxaliplatin is 150 mg m(-2) given days 2 and 30 when added to the described 5FU LV and 45 Gy radiation preoperatively. The acceptable toxicity and compliance at 130 mg m(-2) recommend testing this dose in future phase II studies. The tumour downstaging and complete resection rates are encouragingly high for this very locally advanced group.

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Patient outcome. *Five unassessable patients not included; one died, two did not start treatment, two refused week 5 chemo; **one specimen lost.
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fig2: Patient outcome. *Five unassessable patients not included; one died, two did not start treatment, two refused week 5 chemo; **one specimen lost.

Mentions: Of the 32 evaluable patients, four did not proceed to surgery due to the presence of metastatic disease (two), patient refusal (one) and unfitness for surgery (one) (Figure 2). All patients had a preliminary clinical assessment by their surgeon at entry, and were categorised on the basis of height of the cancer from the anal verge as requiring an abdominoperineal resection (APR) or anterior resection (AR). Of the 28 surgical procedures, 15 had an APR, two of which had initially been assessed as requiring an AR, the remaining 13 had APR as expected (one with cystectomy). Ten patients had an AR, six of which had been anticipated and four that had been expected to require an APR. One patient had a Hartman's procedure after an initial assessment of an APR. Two additional patients required exenterative surgery (one initially assessed to require this procedure and one initially assessed as requiring AR). There were no unexpected post operative complications or deaths.


A phase I/II study of oxaliplatin when added to 5-fluorouracil and leucovorin and pelvic radiation in locally advanced rectal cancer: a Colorectal Clinical Oncology Group (CCOG) study.

Sebag-Montefiore D, Glynne-Jones R, Falk S, Meadows HM, Maughan T - Br. J. Cancer (2005)

Patient outcome. *Five unassessable patients not included; one died, two did not start treatment, two refused week 5 chemo; **one specimen lost.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2361684&req=5

fig2: Patient outcome. *Five unassessable patients not included; one died, two did not start treatment, two refused week 5 chemo; **one specimen lost.
Mentions: Of the 32 evaluable patients, four did not proceed to surgery due to the presence of metastatic disease (two), patient refusal (one) and unfitness for surgery (one) (Figure 2). All patients had a preliminary clinical assessment by their surgeon at entry, and were categorised on the basis of height of the cancer from the anal verge as requiring an abdominoperineal resection (APR) or anterior resection (AR). Of the 28 surgical procedures, 15 had an APR, two of which had initially been assessed as requiring an AR, the remaining 13 had APR as expected (one with cystectomy). Ten patients had an AR, six of which had been anticipated and four that had been expected to require an APR. One patient had a Hartman's procedure after an initial assessment of an APR. Two additional patients required exenterative surgery (one initially assessed to require this procedure and one initially assessed as requiring AR). There were no unexpected post operative complications or deaths.

Bottom Line: In all, 28 out of 32 patients completed all treatments as planned; three had radiotherapy interrupted and three a chemotherapy dose reduction.Four patients did not proceed to surgery due to the presence of metastatic disease (two), unfitness (one) or patient refusal (one).The tumour downstaging and complete resection rates are encouragingly high for this very locally advanced group.

View Article: PubMed Central - PubMed

Affiliation: Cookridge Hospital, Hospital Lane, Cookridge, West Yorkshire LS16 6QB, UK. David.Sebag-Montefiore@leedsth.nhs.uk

ABSTRACT
The purpose of this study was to evaluate the maximum tolerated dose (MTD) and recommended dose of oxaliplatin given synchronously with 5-fluorouracil (5FU), leucovorin (LV) and preoperative pelvic radiation for primary unresectable, locally advanced, rectal cancer. Preoperative pelvic radiotherapy using a three- or four-field technique and megavoltage photons comprised 45 Gy given in 25 fractions, 1.8 Gy per fraction, and delivered with escalating doses of oxaliplatin in combination with low-dose LV and 5FU. Chemotherapy was given synchronously with radiotherapy in weeks 1 and 5. Escalating doses of oxaliplatin (85, 130 and 150 mg m(-2)) were given on days 2 and 30, followed by low-dose LV (20 mg m(-2)) and 5FU (350 mg m(-2)), both given on days 1-5 and 29-33. Surgery was performed 6-10 weeks later. The MTD was determined as the dose causing more than a third of patients to have a dose-limiting toxicity (DLT). Once the MTD was reached, a further 14 patients were treated at the dose level below the MTD. In all, 32 patients received oxaliplatin at the three dose levels, median age 60 years (range 31-79), 24 males and eight females. The MTD was reached at 150 mg m(-2) when four out of six patients experienced DLT. Dose-limiting grade 3 or 4 diarrhoea was reported in two out of six patients at 85 mg m(-2), 5 out of 20 at 130 mg m(-2) and four out of 6 at 150 mg m(-2). Grade 3 neuropathy was reported at 130 mg m(-2) (1 out of 20) and at 150 mg m(-2) (two out of six), and serious haematological toxicity was minimal; one grade 3 anaemia at 150 mg m(-2). In all, 28 out of 32 patients completed all treatments as planned; three had radiotherapy interrupted and three a chemotherapy dose reduction. Four patients did not proceed to surgery due to the presence of metastatic disease (two), unfitness (one) or patient refusal (one). Also, 28 patients underwent surgical resection. Histopathology demonstrated histopathological complete response (pCR) 2 out of 27 (7%), Tmic 3 out of 27 (11%), pCR+Tmic 5 out of 27 (19%), pT0-2 6 out of 27 (22%) and histologically confirmed clear circumferential resection margins in 22 out of 27 (81%). Dose-limiting toxicity with oxaliplatin is 150 mg m(-2) given days 2 and 30 when added to the described 5FU LV and 45 Gy radiation preoperatively. The acceptable toxicity and compliance at 130 mg m(-2) recommend testing this dose in future phase II studies. The tumour downstaging and complete resection rates are encouragingly high for this very locally advanced group.

Show MeSH
Related in: MedlinePlus