Neoadjuvant Treatment With Regorafenib and Capecitabine Combined With Radiotherapy in Locally Advanced Rectal Cancer: A Multicenter Phase Ib Trial (RECAP)-SAKK 41/16.

Details

Serval ID
serval:BIB_A4FE1C2C8768
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Neoadjuvant Treatment With Regorafenib and Capecitabine Combined With Radiotherapy in Locally Advanced Rectal Cancer: A Multicenter Phase Ib Trial (RECAP)-SAKK 41/16.
Journal
Clinical colorectal cancer
Author(s)
Bastian S., Joerger M., Holer L., Bärtschi D., Guckenberger M., Jochum W., Koeberle D., Siebenhüner A.R., Wicki A., Berger M.D., Winterhalder R.C., Largiadèr C.R., Löffler M., Mosna-Firlejczyk K., Maranta A.F., Pestalozzi B.C., Csajka C., von Moos R.
Working group(s)
Swiss Group for Clinical Cancer Research (SAKK)
ISSN
1938-0674 (Electronic)
ISSN-L
1533-0028
Publication state
In Press
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
The multi tyrosine kinase inhibitor regorafenib is active in metastatic colorectal cancer. Improvement in clinical outcome by adding regorafenib to long-course chemoradiotherapy (LcCRT) was investigated in molecularly undefined LARC.
Patients with T3-4 and/or N+ but M0 rectal cancer were included. Neoadjuvant LcRCT consisted in capecitabine (C) 825mg/m <sup>2</sup> d1-d38 and 28 fractions of 1.8Gy (50.4Gy). Regorafenib was added d1-14 and d22-35 in 3 dose escalation (DE) cohorts (40mg/80mg/120mg). The recommended dose (RD) was used for the expansion (EXP) cohort. Primary endpoints were dose-limiting toxicity (DLT) for DE and pathological response (near-complete regression [npCR] or complete regression [pCR]) for EXP.
Overall, 25 patients were included. Two DLTs occurred at the regorafenib dose level of 120 mg, thereby establishing the RD at 80mg daily. Among the 19 patients who were treated at the RD, 8 (42.1%; 1-sided 80% confidence interval [CI] (lower bound): 30.7%; 95% CI, 20.3%-66.5%) reached the primary endpoint (5 [26.3%] had npCR and 3 [15.8%] pCR). One additional patient received no surgery due to clinical complete response. All patients had R0 resections and clear circumferential margins. Postoperative complications occurred in 6 patients (35.3%). The most common grade ≥ 3 treatment-related adverse event in the EXP cohort was diarrhea (2 patients).
Adding regorafenib 80 mg to LcCRT in LARC resulted in both primary endpoints being met and yielded an expected pathological response rate. Toxicity was manageable, and postoperative complications were as expected.
Keywords
Neoadjuvant chemoradiation, Pathological response, Phase I, Toxicity, Tyrosine kinase inhibitors (TKI)
Pubmed
Open Access
Yes
Create date
18/11/2024 14:55
Last modification date
29/11/2024 7:08
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