Refining the Use of Adjuvant Oxaliplatin in Clinical Stage II or III Rectal Adenocarcinoma

The oncologist

article

Ofer Margalit¹  Dan Aderka¹  Bruce Giantonio³  Einat Shacham-Shmueli¹  Ben Boursi¹  Ronac Mamtani⁴  Scott Kopetz⁶  Yu-Xiao Yang⁴  Yaacov R. Lawrence¹  Samir Abu-Gazala⁹  Kim A. Reiss⁵  Talia Golan¹  Naama Halpern¹ 

[1] Department of Oncology, Sheba Medical Center;Tel-Aviv University;Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School;Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania;Abramson Cancer Center, University of Pennsylvania;University of Texas MD Anderson Cancer Center;Division of Gastroenterology, Department of Medicine, University of Pennsylvania;Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University;Division of Transplantation, Department of Surgery, Perelman School of Medicine, University of Pennsylvania

关键词: Rectal cancer;    Stage II;    Stage III;    Adjuvant;    Oxaliplatin;   

DOI  :  10.1634/theoncologist.2018-0333

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background Current guidelines include the use of adjuvant oxaliplatin in clinical stage II or III rectal adenocarcinoma. However, its efficacy is supported by a single phase II trial. We aimed to examine whether oxaliplatin confers survival benefit in this patient population. Methods Using the National Cancer Database (2006–2013) we identified 6,868 individuals with clinical stage II or III rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy, surgery, and adjuvant chemotherapy. We used multivariate Cox regression to evaluate survival differences according to treatment intensity and change from clinical to pathological stage. Results We demonstrated an association with improved overall survival with the use of doublet adjuvant chemotherapy in pathological stage III rectal adenocarcinoma (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.67–0.92). This association was confirmed in patients with clinical stage III and subsequent pathological stage III disease (HR, 0.69; 95% CI, 0.57–0.83) and was not observed in patients who progressed from clinical stage II to pathological stage III disease. Doublet adjuvant chemotherapy was not associated with improved overall survival in patients with pathological stage 0 or I disease, regardless of their clinical stage. Conclusion Adjuvant oxaliplatin following neoadjuvant chemoradiotherapy in rectal adenocarcinoma was confirmed in patients with clinical stage III and subsequent pathological stage III disease. Omission of oxaliplatin can be considered in pathological complete response or pathological stage I disease. Implications for Practice Current guidelines include the use of oxaliplatin as part of adjuvant chemotherapy (AC) in patients with clinical stage II or III rectal adenocarcinoma (RAC). However, its efficacy is supported only by a single phase II trial. This study found an association with improved overall survival with the use of doublet AC in patients diagnosed with clinical stage III and subsequent pathological stage III, and not in patients with pathological stage 0 or I, regardless of their clinical stage. Therefore, omission of oxaliplatin can be considered in patients with either pathological complete response or pathological stage I RAC, thereby avoiding oxaliplatin-induced neuropathy.

【 授权许可】

CC BY|CC BY-NC