Rectal cancer: Poster Session Review

Transcription

1 AIOM PostASCO GI Roma, 5-6 febbraio 2016 Rectal cancer: Poster Session Review Sara Lonardi SS Trattamento Multidisciplinare Tumori Colorettali - UOC Oncologia Medica 1 Dipartimento di Oncologia Clinica e Sperimentale Istituto Oncologico Veneto IRCCS, Padova

2 Rectal Cancer Poster Session Estimation of risk Combined-modality treatment Prognostic factors Fields of improvement

3 Rectal Cancer Poster Session Estimation of risk (#716) Combined-modality treatment Prognostic factors Fields of improvement

4 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)

5 Univariate/multivariate analysis of pretreatment parameters Zhang J et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 716)

6 Nomogram for prediction of response to neoadjuvant CRT Zhang J et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 716)

7 Rectal Cancer Poster Session Estimation of risk (#716) Combined-modality treatment (#691, #657, #677, #737, #713) Prognostic factors Fields of improvement

8 Same overall survival Better local control Reduced toxicity

9 Treatment patterns in the US over the past decade Stage II/III rectal adenocarcinoma within the National Cancer Data Base undergoing surgery between were analyzed (n=66197). Sineshaw HM et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 691)

10 OS in st II-III rectal cancer by treatment 5-yr OS: NACRT: 72.4% surgery and adj CRT: 70.9% surgery alone: 44.9% definitive CRT: 48.8% Sineshaw HM et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 691)

11 Effect of combined neoadjuvant chemoradiation on OS Stage II/III rectal adenocarcinoma within the National Cancer Data Base undergoing surgery between were analyzed (n=32978). Sun Z et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 657)

12 Effect of combined neoadjuvant chemoradiation on OS Stage II/III rectal adenocarcinoma within the National Cancer Data Base undergoing surgery between were analyzed. 62%, 69%, 71%, 74%, 5y-OS Sun Z et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 657)

13 Treatment impact on outcomes vs surgery alone Sun Z et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 657)

14 CRT impact on outcomes vs chemo/rt alone Sun Z et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 657)

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

16 Optimal timing for curative surgery after CRT Complete tumor regression: 9.1% vs.13.2%, p = Sphincter preservation rates: 89.9% vs. 92.4%, p = No statistically significant difference regarding OS and DFS Kwak YK et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 677)

17 Surveillance and timing of surgical resection after CRT Retrospective study on LARC (ct3-4n0-2m0) receiving preoperative CRT followed by TME from 2003 to 2011, single Institution (n=171). Pachón Olmos V et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 737)

18 Timing of surgical resection after CRT and outcome Pachón Olmos V et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 737)

19 pcr rates after neoadj tx: an analysis of the NCDB NCDB Retrospective study on non-metastatic rectal cancer ( ) 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). Lorimer PD et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 713)

20 Rectal Cancer Poster Session Estimation of risk (#716) Combined-modality treatment (#691, #657, #677, #737, #713) Prognostic factors (#575, #661, #693) Fields of improvement

21 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 < ) or CXCL13 expression (p < 0.01) had a significantly prolonged DFS. Sprenger et al,j Clin Oncol 34, 2016 (suppl 4S; abstr 575)

22 Integration of strategies in rectal cancer 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 = ). Group 2: tendency of worse oncologic outcome than yptnm stage III (P = 0.135) P = Kim H et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 661)

23 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). Kim H et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 693)

24 Outcome prediction by ctnm stage vs yptnm stage 3-year DFS by yptnm: - ypi, 87.9%; - ypii, 67.8%; - ypiii, 53.3% Kim H et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 693)

25 Rectal Cancer Poster Session Estimation of risk (#716) Combined-modality treatment (#691, #657, #677, #737, #713) Prognostic factors (#575, #661, #693) Fields of improvement (#502, #673)

26 Fields of improvement Optimize local control Acute and late toxicities Reduce distant metastases Improved survival Clinical benefit

27 Risk/benefit balance improvement intensification of concurrent CRT Acute and late toxicities Neoadjuvant / Consolidation / adjuvant CT Clinical benefit

28 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)

29 Phase II trial of perioperative chemotherapy using FOLFOX with panitumumab for LARC 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. Ota M et al, J Clin Oncol 34, 2016 (suppl 4S; abstr 502)

30 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)

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

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

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

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

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

36