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Open Access Research

Phase II trial of preoperative radiochemotherapy with concurrent bevacizumab, capecitabine and oxaliplatin in patients with locally advanced rectal cancer

Kathrin Dellas12*, Thomas Höhler3, Thomas Reese4, Florian Würschmidt5, Erik Engel6, Claus Rödel7, Wolfgang Wagner8, Michael Richter9, Dirk Arnold10 and Jürgen Dunst2

Author Affiliations

1 Department of Radiooncology, University of Kiel, Kiel, Germany

2 Department of Radiooncology, University of Luebeck, Luebeck, Germany

3 Prosper Hospital Recklinghausen, Recklinghausen, Germany

4 Martin Luther University Halle-Wittenberg, Department of Radiotherapy, Halle, Saale, Germany

5 Private Practice of Radiooncology, Radiologische Allianz, Hamburg, Germany

6 Private Practice of Hematology and Medical Oncology, Hamburg, Germany

7 University of Frankfurt, Department of Radiooncology, Frankfurt, Germany

8 Department of Radiooncology, Osnabrueck, Germany

9 Coordination Center for Clinical Trials, Halle, Saale, Germany

10 Clinic for Medical Oncology, Tumor Biology Center Freiburg, Freiburg, Germany

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Radiation Oncology 2013, 8:90  doi:10.1186/1748-717X-8-90

Published: 15 April 2013

Abstract

Background

Preoperative radiochemotherapy (RCT) with 5-FU or capecitabine is the standard of care for patients with locally advanced rectal cancer (LARC). Preoperative RCT achieves pathological complete response rates (pCR) of 10-15%. We conducted a single arm phase II study to investigate the feasibility and efficacy of addition of bevacizumab and oxaliplatin to preoperative standard RCT with capecitabine.

Methods

Eligible patients had LARC (cT3-4; N0/1/2, M0/1) and were treated with preoperative RCT prior to planned surgery. Patients received conventionally fractionated radiotherapy (50.4 Gy in 1.8 Gy fractions) and simultaneous chemotherapy with capecitabine 825 mg/m2 bid (d1-14, d22-35) and oxaliplatin 50 mg/m2 (d1, d8, d22, d29). Bevacizumab 5 mg/kg was added on days 1, 15, and 29. The primary study objective was the pCR rate.

Results

70 patients with LARC (cT3-4; N0/1, M0/1), ECOG < 2, were enrolled at 6 sites from 07/2008 through 02/2010 (median age 61 years [range 39–89], 68% male). At initial diagnosis, 84% of patients had clinical stage T3, 62% of patients had nodal involvement and 83% of patients were M0. Mean tumor distance from anal verge was 5.92 cm (± 3.68). 58 patients received the complete RCT (full dose RT and full dose of all chemotherapy). During preoperative treatment, grade 3 or 4 toxicities were experienced by 6 and 2 patients, respectively: grade 4 diarrhea and nausea in one patient (1.4%), respectively, grade 3 diarrhea in 2 patients (3%), grade 3 obstipation, anal abscess, anaphylactic reaction, leucopenia and neutropenia in one patient (1.4%), respectively. In total, 30 patients (46%) developed postoperative complications of any grade including one gastrointestinal perforation in one patient (2%), wound-healing problems in 7 patients (11%) and bleedings in 2 patients (3%). pCR was observed in 12/69 (17.4%) patients. Pathological downstaging (ypT < cT and ypN ≤ cN) was achieved in 31 of 69 patients (44.9%). All of the 66 operated patients had a R0 resection. 47 patients (68.1%) underwent sphincter preserving surgery.

Conclusions

The addition of bevacizumab and oxaliplatin to RCT with capecitabine was well tolerated and did not increase perioperative morbidity or mortality. However, the pCR rate was not improved in comparison to other trials that used capecitabine or capecitabine/oxaliplatin in preoperative radiochemotherapy.

Keywords:
Bevacizumab; Rectal cancer; Preoperative radiochemotherapy; Capecitabine; Oxaliplatin