Rectal cancer: Poster Session Reviewmedia.aiom.it/userfiles/files/doc/AIOM-Servizi/... · Sara Lonardi SS Trattamento Multidisciplinare Tumori Colorettali - UOC Oncologia Medica 1

Rectal cancer:

Poster Session Review

AIOM PostASCO GI

Roma, 5-6 febbraio 2016

Sara Lonardi SS Trattamento Multidisciplinare Tumori Colorettali - UOC Oncologia Medica 1

Dipartimento di Oncologia Clinica e Sperimentale

Istituto Oncologico Veneto – IRCCS, Padova

Rectal Cancer Poster Session

Estimation of risk

Combined-modality treatment

Prognostic factors

Fields of improvement

Estimation of risk (#716)


Prognostic factors



Nomogram for prediction of response to neoadjuvant CRT

Methods: Data from 309 patients enrolled in FOWARC study.

Pre-treatment clinical parameters collected to build a nomogram for pCR

Zhang J et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 716)

Univariate/multivariate analysis of pretreatment parameters


Nomogram for prediction of response to neoadjuvant CRT




(#691, #657, #677, #737, #713)

Prognostic factors



Same overall survival

Better local control

Reduced toxicity

Sineshaw HM et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 691)

Stage II/III rectal adenocarcinoma within the National Cancer Data Base

undergoing surgery between 2004-2012 were analyzed (n=66197).

Treatment patterns in the US over the past decade

OS in st II-III rectal cancer by treatment

Sineshaw HM et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 691)

5-yr OS:

NACRT:

72.4%

surgery and adj CRT: 70.9%

surgery alone: 44.9%

definitive CRT: 48.8%

Effect of combined neoadjuvant chemoradiation on OS


undergoing surgery between 2006-2012 were analyzed (n=32978).

Sun Z et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 657)


undergoing surgery between 2006-2012 were analyzed.


62%, 69%, 71%, 74%,

5y-OS

Effect of combined neoadjuvant chemoradiation on OS

Treatment impact on outcomes vs surgery alone



CRT impact on outcomes vs chemo/Rt alone

Optimal timing for curative surgery after CRT

Retrospective study on LARC (cT3-4N0-2M0) receiving preoperative CRT followed by

TME from 2003 to 2014, at 8 institutions in Korea (n=1786).

Kwak YK et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 677)

Primary EP:

to evaluate the period of

highest downstaging and

ypCR rates to determine the

optimal timing for surgery

after CRT.

Downstaging rates peaked between 6 and 7 weeks and declined afterwards.

ypCR rates increased from 5 to 6 weeks and decreased after 9 to 10 weeks.

Optimal timing for curative surgery after CRT

Complete tumor regression: 9.1% vs.13.2%, p = 0.004

Sphincter preservation rates: 89.9% vs. 92.4%, p = 0.078

No statistically significant difference regarding OS and DFS

Kwak YK et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 677)

Pachón Olmos V et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 737)

Retrospective study on LARC (cT3-4N0-2M0) receiving preoperative CRT followed by

TME from 2003 to 2011, single Institution (n=171).

Surveillance and timing of surgical resection after CRT

Pachón Olmos V et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 737)

Timing of surgical resection after CRT and outcome

Lorimer PD et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 713)

NCDB Retrospective study on non-metastatic rectal cancer (2004-2011) who

underwent neoadjuvant therapy followed by surgical resection (n=7,859)

The incidence of pCR was associated with favorable tumor factors (size, grade, T

classification), demographics (insurance status) as well as treatment factors (time

between radiation and surgery and institutional volume).

pCR rates after neoadj tx: an analysis of the NCDB



(#691, #657, #677, #737, #713)

Prognostic factors (#575, #661, #693)



Sprenger et al,J Clin Oncol 34, 2016 (suppl 4S; abstr 575)

Host immune response prognostic role after CRT

mRNA and protein expression of the B- and T-cell chemokines CXCL13 and

CXCL9 in LARC undergoing preoperative CRT and surgery (n=77)

Intratumoral mRNA expression levels of the T-cell activator CXCL9 (p < 0.001) as

well as the B-cell chemokine CXCL13 (p < 0.01) were inversely correlated with the

development of distant metastasis.

Patients with high CXCL9 (p < 0.0001) or CXCL13 expression (p < 0.01) had a

significantly prolonged DFS.

Integration of strategies in rectal cancer

Kim H et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 661)

Pts treated with nCRT followed by curative radical surgery (n=141)

LPLN before nCRT: 16 pts.

Group 1: 7 pts showing disappearance of LPLN after nCRT

Group 2 9 pts showing persistance of LPLN after nCRT

Group 1: similar oncologic outcome with ypTNM stage II (P = 0.761 ).

Group 2: tendency of worse oncologic outcome than ypTNM stage III (P = 0.135)

P = 0.058

Outcome prediction by cTNM stage vs ypTNM stage

Pts treated with nCRT followed by curative radical surgery (n=141)

cTNM stage did not demonstrate any correlation with DFS

(cII % vs cIII %, P = 0.266).


Outcome prediction by cTNM stage vs ypTNM stage

3-year DFS by ypTNM:

- ypI, 87.9%;

- ypII, 67.8%;

- ypIII, 53.3%




(#691, #657, #677, #737, #713)

Prognostic factors (#575, #661, #693)

Fields of improvement (#502, #673)



Acute and late

toxicities Improved

survival

Clinical

benefit

Reduce distant

metastases

Optimize

local control

Risk/benefit balance improvement

Acute and late

toxicities

Clinical

benefit

Neoadjuvant /

Consolidation /

adjuvant CT

intensification of

concurrent CRT

Phase II trial of perioperative chemotherapy using

FOLFOX with panitumumab for LARC

Multicenter phase II trial on clinical stage III, kRAS wt rectal cancer

Primary outcome: response rate of the primary lesion measured by T2

weighted sagittal image of magnetic resonance imaging.

Ota M et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 502)

Ota M et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 502)

Between January 2012 and December 2014, 42 out of 43 patients completed

preoperative chemotherapy

There was no progressive disease in the 42 patients

All of the 43 participants underwent resection without mortality or severe

complications.

Phase II trial of perioperative chemotherapy using

FOLFOX with panitumumab for LARC

Induction treatment with FOLFOXIRI + bev CRT + bev:

The phase II TRUST trial

LARC at < 12 cm from the anal verge

N+ or cT4 or high risk cT3 (MRI criteria)

Primary endpoint is 2-year disease-free survival (DFS).

Vivaldi C et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 673)

Patients characteristics


Induction treatment toxicities


Induction treatment toxicities


Concomitant chemoradiation


Activity


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Rectal cancer: Poster Session Reviewmedia.aiom.it/userfiles/files/doc/AIOM-Servizi/... · Sara Lonardi SS Trattamento Multidisciplinare Tumori Colorettali - UOC Oncologia Medica 1