Phase II Trial of Neoadjuvant Bevacizumab, Capecitabine, and Radiotherapy for Locally Advanced Rectal Cancer

Journal Article · Mon Mar 01 04:00:00 EST 2010 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.02.037· OSTI ID:21372107

Eng, Cathy ^[1]; Feig, Barry W ^[2]; Das, Prajnan ^[3]; Skibber, John M; Chang, George J ^[4]; Wolff, Robert A ^[1]; Krishnan, Sunil ^[5]; Hamilton, Stanley ^[6]; Janjan, Nora A ^[5]; Maru, Dipen M ^[6]; Ellis, Lee M; Rodriguez-Bigas, Miguel A ^[2]

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1. Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
2. Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
3. Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
4. Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
5. Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
6. Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

Purpose: We designed this Phase II trial to assess the efficacy and safety of the addition of bevacizumab to concurrent neoadjuvant capecitabine-based chemoradiation in locally advanced rectal cancer. Methods: Between April 2004 and December 2007, 25 patients with clinically staged T3N1 (n = 20) or T3N0 (n = 5) rectal cancer received neoadjuvant therapy with radiotherapy (50.4 Gy in 28 fractions over 5.5 weeks), bevacizumab every 2 weeks (3 doses of 5 mg/kg), and capecitabine (900 mg/m{sup 2} orally twice daily only on days of radiation), followed by surgical resection a median of 7.3 weeks later. Results: Procedures included abdominoperineal resection (APR; 6 patients), proctectomy with coloanal anastamosis (8 patients), low anterior resection (10 patients), and local excision (1 patient). Eight (32%) of 25 patients had a pathologic complete response, and 6 (24%) of 25 had <10% viable tumor cells in the specimen. No patient had Grade 3 hand-foot syndrome, gastrointestinal toxicity, or significant hematologic toxicity. Three wound complications required surgical intervention (one coloanal anastamostic dehiscence requiring completion APR and two perineal wound dehiscences after initial APR). Five minor complications occurred that resolved without operative intervention. With a median follow-up of 22.7 months (range, 4.5-32.4 months), all patients were alive; one patient has had a recurrence in the pelvis (2-year actuarial rate, 6.2%) and 3 had distant recurrences. Conclusions: The addition of bevacizumab to neoadjuvant chemoradiation resulted in encouraging pathologic complete response without an increase in acute toxicity. The impact of bevacizumab on perineal wound and anastamotic healing due to concurrent bevacizumab requires further study.

• OSTI ID: 21372107
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 76; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ANTINEOPLASTIC DRUGS
BIOLOGICAL RECOVERY
BODY
DIGESTIVE SYSTEM
DISEASES
DRUGS
GASTROINTESTINAL TRACT
HEALING
INJURIES
INTESTINES
LARGE INTESTINE
MEDICINE
NEOPLASMS
NUCLEAR MEDICINE
ORGANS
RADIOLOGY
RADIOTHERAPY
RECTUM
SURGERY
THERAPY
TOXICITY
WOUNDS