151. Preoperative radiation therapy with concurrent capecitabine, bevacizumab, and erlotinib for rectal cancer: a phase 1 trial.
- Author
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Das P, Eng C, Rodriguez-Bigas MA, Chang GJ, Skibber JM, You YN, Maru DM, Munsell MF, Clemons MV, Kopetz SE, Garrett CR, Shureiqi I, Delclos ME, Krishnan S, and Crane CH
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma pathology, Adult, Angiogenesis Inhibitors administration & dosage, Antibodies, Monoclonal, Humanized administration & dosage, Antineoplastic Combined Chemotherapy Protocols adverse effects, Bevacizumab, Capecitabine, Chemoradiotherapy adverse effects, Deoxycytidine administration & dosage, Deoxycytidine analogs & derivatives, Disease-Free Survival, Drug Administration Schedule, Early Termination of Clinical Trials economics, Erlotinib Hydrochloride, Female, Fluorouracil administration & dosage, Fluorouracil analogs & derivatives, Humans, Male, Maximum Tolerated Dose, Middle Aged, Preoperative Care, Quinazolines administration & dosage, Radiotherapy Dosage, Rectal Neoplasms mortality, Rectal Neoplasms pathology, Adenocarcinoma therapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Chemoradiotherapy methods, Rectal Neoplasms therapy
- Abstract
Purpose: The goal of this phase 1 trial was to determine the maximum tolerated dose (MTD) of concurrent capecitabine, bevacizumab, and erlotinib with preoperative radiation therapy for rectal cancer., Methods and Materials: Patients with clinical stage II to III rectal adenocarcinoma, within 12 cm from the anal verge, were treated in 4 escalating dose levels, using the continual reassessment method. Patients received preoperative radiation therapy with concurrent bevacizumab (5 mg/kg intravenously every 2 weeks), erlotinib, and capecitabine. Capecitabine dose was increased from 650 mg/m(2) to 825 mg/m(2) orally twice daily on the days of radiation therapy; erlotinib dose was increased from 50 mg orally daily in weeks 1 to 3, to 50 mg daily in weeks 1 to 6, to 100 mg daily in weeks 1 to 6. Patients underwent surgery at least 9 weeks after the last dose of bevacizumab., Results: A total of 19 patients were enrolled, and 18 patients were considered evaluable. No patient had grade 4 acute toxicity, and 1 patient had grade 3 acute toxicity (hypertension). The MTD was not reached. All 18 evaluable patients underwent surgery, with low anterior resection in 7 (39%), proctectomy with coloanal anastomosis in 4 patients (22%), posterior pelvic exenteration in 1 (6%), and abdominoperineal resection in 6 (33%). Of the 18 patients, 8 (44%) had pathologic complete response, and 1 had complete response of the primary tumor with positive nodes. Three patients (17%) had grade 3 postoperative complications (ileus, small bowel obstruction, and infection). With a median follow-up of 34 months, 1 patient developed distant metastasis, and no patient had local recurrence or died. The 3-year disease-free survival was 94%., Conclusions: The combination of preoperative radiation therapy with concurrent capecitabine, bevacizumab, and erlotinib was well tolerated. The pathologic complete response rate appears promising and may warrant further investigation., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
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