rectum and anus cancer highlights -...
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Carlo Aschele
La Spezia
Rectum and anus cancer
Highlights
AIOM post ASCO GI review, Roma 5-6 Febbraio 2016
• PREOP CRT POTENTIATION
• MAINTENANCE / CONSOLIDATION CHEMO
• INCIDENCE OF RT-INDUCED SECOND PELVIC
TUMORS
• RT schedule
• Role of chemo
• Optimal imaging / staging
TOPICS
Slide 4
Presented By Claus Roedel at TBD
Disease Free Survival (ITT analysis) : 5 year follow-up
Presented By Eric Francois at TBD
Overall Survival (ITT analysis) : 5 year follow-up
Presented By Eric Francois at TBD
Causes of death
Presented By Eric Francois at TBD
Cumulative local recurrence (5 year follow-up)
Presented By Eric Francois at TBD
Prognostic factors for DFS<br />(multivariate Cox proportional-hazards model)
Presented By Eric Francois at TBD
Conclusions
Presented By Eric Francois at TBD
PHASE III trials : neoadjuvant RCT with oxaliplatin
Presented By Eric Francois at TBD
Slide 14
Presented By Claus Roedel at TBD
• Negative also for 2ries endpoints (1ry ep=pCR)
… but effect on DFS seen and similar to other studies
• Apparent difference in deaths unrelated to rectal K
… could this balance the increased acute toxicity?
• Pay attention to LR
• pN stage strongly prognostic
ACCORD 12 (& co)
THM
WEEKLY OXA + FP-based CRT
PRO
4-5% DFS
early mts
Less late mortality
CONTRA
No impact on pCR
Increased acute toxicity
WEEKLY OXA + FP-based CRT
US rejected
FRANCE rejected
GERMANY RETAINED
ITALY ………
Slide 16
Presented By Claus Roedel at TBD
Inclusion criteria
Presented By Krzysztof Bujko at TBD
Slide 4
Presented By Krzysztof Bujko at TBD
5% ineligible!!!
Acute toxicity
Presented By Krzysztof Bujko at TBD
???
Postoperative complications
Presented By Krzysztof Bujko at TBD
Late toxicity
Presented By Krzysztof Bujko at TBD
Pathology
Presented By Krzysztof Bujko at TBD
Primary endpoint – R0 resections
Presented By Krzysztof Bujko at TBD
Cumulative incidence of local failure
Presented By Krzysztof Bujko at TBD
Cumulative incidence of distant metastases
Presented By Krzysztof Bujko at TBD
Disease-free survival
Presented By Krzysztof Bujko at TBD
Overall survival
Presented By Krzysztof Bujko at TBD
• Confirms the interest for consolidation chemo
• Major study limitations:
• heterogenous pop (loc adv + recurr)
• unusual endpoint
• staging
• unconventional control arm (with OXA)
• unusual OXA regimen (monotherapy)
• Roughly similar outcome and toxicity
• Implications for other studies of consolidation chemo?
POLISH II
Slide 19
Presented By Claus Roedel at TBD
Will this become an OXA vs non-OXA study?
The Incidence of Secondary Pelvic Tumors after Previous Radiation for Rectal Cancer<br />
Presented By Anouk Rombouts at TBD
Results
Presented By Anouk Rombouts at TBD
Standardized incidence ratios (SIR)
Presented By Anouk Rombouts at TBD
Cumulative incidence risk of second pelvic tumors
Presented By Anouk Rombouts at TBD
Cumulative incidence risk of second tumors - Prostate
Presented By Anouk Rombouts at TBD
Cumulative incidence risk of second tumors - Rectosigmoid
Presented By Anouk Rombouts at TBD
Cumulative incidence risk of second tumors - other locations
Presented By Anouk Rombouts at TBD
Results
Presented By Anouk Rombouts at TBD
Conclusion
Presented By Anouk Rombouts at TBD
Slide 23
Presented By Claus Roedel at TBD
Slide 24
Presented By Claus Roedel at TBD
THM
Modest DFS > with OXA (stat sig in 1 of 3 studies
so far reported)
No evident benefit for SCRT with maintenance
FOLFOX compared to OXA-based pre-op CRT
(major study limitations)
Protective effect of RT against 2nd pelvic tumors
(prov: will the same apply to oxa?)
GRAZIE
TME RT
FP FP
EORTC
CNR
PROCTOR/SCRIPT
Chronicle
CAO-ARO-AIO 04
PETACC
ADORE
CT vs obs
FP +/- OXA
2014
CNR EORTC Chronicle Proctor/Script
Random preop preop postop postop
Compliance 55% 43% 48% 73%
Accrual
duration 9-y 10-y 4-y 13-y
completed yes yes 113/780 437/840
Included in analysis 245/634 473/1011 75/113 403/437
ONLY yp stage II and III included
Slide 1
Presented By Claus Roedel at TBD
Slide 2
Presented By Claus Roedel at TBD
Slide 13
Presented By Claus Roedel at TBD
Slide 19
Presented By Claus Roedel at TBD
Will this become an OXA vs non-OXA study?
Slide 20
Presented By Claus Roedel at TBD
Slide 23
Presented By Claus Roedel at TBD
Slide 24
Presented By Claus Roedel at TBD
CRT TME CT
CRT/RT TME CT
(CRT) TME CT
Chemotherapy for Rectal Cancer: When Is It Needed? <br />
Presented By Bengt Glimelius at TBD
Conclusions <br />(adding chemotherapy to radiation preoperatively)
Presented By Bengt Glimelius at TBD
Slide 16
Presented By Bengt Glimelius at TBD
Adjuvant chemotherapy in rectal cancer
Presented By Bengt Glimelius at TBD
Adjuvant chemotherapy in rectal cancer<br />- pragmatic conclusions
Presented By Bengt Glimelius at TBD
TME RT
FP FP
EORTC
CNR
PROCTOR/SCRIPT
Chronicle
CAO-ARO-AIO 04
PETACC
ADORE
CT vs obs
FP +/- OXA
2014
CNR EORTC Chronicle Proctor/Script
Random preop preop postop postop
Compliance 55% 43% 48% 73%
Accrual
duration 9-y 10-y 4-y 13-y
completed yes yes 113/780 437/840
Included in analysis 245/634 473/1011 75/113 403/437
ONLY yp stage II and III included
Endoscopic Ultrasonography vs MRI for Staging and Response Evaluation
Presented By Gina Brown at TBD
Randomised trial evidence unimportance of nodal status
Presented By Gina Brown at TBD
mrEMVI is associated with pelvic sidewall tumour deposits
Presented By Gina Brown at TBD
MRI as a gold standard – why we need to go beyond TNM
Presented By Gina Brown at TBD
MDT choices and making best use of high resolution MRI
Presented By Gina Brown at TBD
Reporting Minimum Standards
Presented By Gina Brown at TBD
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