Six months compared with 12 months of capecitabine as adjuvant chemotherapy for stage III (Dukes' C) colon cancer: Rationale for the open-label randomized phase III study, JFMC37-0801

517

Background: The standard duration of adjuvant chemotherapy (CT) in patient with stage III colorectal cancer is 6 months. On the other hand, no clinical trial which investigate an optimal duration of oral chemotherapeutic agents has yet been implemented for adjuvant treatments. According to the ACCENT database (Sargent, et al. J Clin Oncol 27: 872- 877, 2009), 83% of recurrences in stage II and III pts have occurred within the first 3 years after surgery and peak was observed around one year after surgery. Also, single-agent FU-based adjuvant CT reduced the hazard rate of OS, DFS, and TTR, although the peak of events around one year was still remained especially for stage III pts. We analyzed the data of recurrent risk of curatively resected colon cancer pts provided by JFMC7-1-7-2-15, X-ACT. Surgery alone group and 6 months CT (5FU/LV or capecitabine [Cape]) showed highest peak between 12 months to 18 months after surgery, but 12 months oral 5-FUs group did not show recurrence peak between 12 months to 18 months after surgery. Therefore, to clarify the benefit of 12 month administration of Cape, we planned a phase III randomized trial for a comparison of 6 months treatment and 12 months treatment.

Methods: JFMC37 is a multicenter, randomized phase III trial. Patients with fully resected stage III colon or recto sigmoid cancer were eligible. Patients were randomized 1:1 to receive Cape of 6 months (arm A) or Cape of 12 months (arm B). Primary endpoint is disease-free survival. The statistical design is based on superiority hypothesis; 5-yrs DFS is 60% in arm A, 67% in arm B; unilateral α=0.05, 1-β=0.8; and planed accrual is 1200 pts.

Results: Between September 2008 to December 2009, 1,304 pts were randomized. Patients characteristics are (armA/armB); number 653/651, gender M352-F301/M343-F308, median age 65 years/65 years, ECOG PS=0-1 620-33/632-19, involvement of lymph nodes=N0-N1-N2 503-130-20/499-128-24. There were no differences in baseline characteristics between arm A and arm B.

Conclusions: This trial is expected to show if 1 year adjutant chemotherapy with capecitabine can reduce the peak of recurrence in 1 year and provide long-term OS benefit.

[Table: see text]

Pigeons' discrimination of paintings by Monet and Picasso

Pigeons successfully learned to discriminate color slides of paintings by Monet and Picasso. Following this training, they discriminated novel paintings by Monet and Picasso that had never been presented during the discrimination training. Furthermore, they showed generalization from Monet's to Cezanne's and Renoir's paintings or from Picasso's to Braque's and Matisse's paintings. These results suggest that pigeons' behavior can be controlled by complex visual stimuli in ways that suggest categorization. Upside-down images of Monet's paintings disrupted the discrimination, whereas inverted images of Picasso's did not. This result may indicate that the pigeons' behavior was controlled by objects depicted in impressionists' paintings but was not controlled by objects in cubists' paintings.

[Bronchogenic cyst with a high computed tomography number]

A 55-year-old man was diagnosed as having colon cancer. During the preoperative survey for metastasis, chest computed tomography (CT) revealed a well-defined tumor (33 mm) with a high CT value in the left hilum. We performed thoracoscopic resection for diagnosis and treatment. The contents of the lesion were yellowish, viscid, and creamy. Pathological examination revealed that the tumor was a bronchogenic cyst. This case is reported with a review of the literature.

Multicenter phase II study of FOLFOX for metastatic colorectal cancer (mCRC) in Japan; SWIFT-1 and 2 study

BACKGROUND/AIMS

This study assessed the efficacy and toxicity of the FOLFOX4 (SWIFT1) and mFOLFOX6 (SWIFT2) regimens in Japanese patients with metastatic colorectal cancer (mCRC).

METHODOLOGY

Patients with mCRC were required to have ECOG performance status of 0 to 1, and to have adequate organ function. Two multicenter Phase II studies (SWIFT1/SWIFT2) were conducted in chemotherapy naive patients with mCRC.

RESULTS

112 patients were enrolled in these studies (SWIFT1: 54 patients / SWIFT2: 58 patients). The disease sites for each study were the colon in 27 patients and 28 patients, and the rectum in 27 patients and 30 patients, respectively. All patients received a median of 8 courses. After a median follow-up period of 35 months, 54 patients and 58 patients were evaluable in the respective studies, and the overall response rate was 50.0% (CR:31 PR:53). The response rate according to the sites of metastasis were as follows: liver, 54.1% (46/85); lung, 17.4% (4/23); and lymph node, 23.3% (7/30). Grade 3/4 neutropenia occurred in 14 patients (12.5%), while Grade 3/4 non-hematological toxicities were observed in 16 patients (31.0%) and Grade 3 neurotoxicity was observed in 6patients (5.4%) and 5 patients (4.5%), respectively.

CONCLUSIONS

FOLFOX4 (SWIFT1) and mFOLFOX6 (SWIFT2) regimens complying with the international standard dosage and schedule can also be administered safely and effectively in Japan.

Use of genotype subset selections of multi-UGT1As polymorphisms to predict severe neutropenia and tumor responses of metastatic CRC patients received FOLFIRI regimen

e15038

Introduction: The pharmacogenetics of irinotecan indicate that a common polymorphism in the uridine diphosphate glucuronosyltransferase 1As (UGT1As) gene predict severe toxicity. However the tumor response to irinotecan is variable and unpredictable. Methods: Two multi-center phase II studies of FOLFIRI (FLIGHT-1 and FLIGHT-2 study) were conducted for patients with metastatic colorectal cancer (CRC) in Japan. FLIGHT-1 study was first-line chemotherapy, and FLIGHT-2 study was FOLFOX-refractory second-line chemotherapy. 103 patients have been enrolled in these studies (53 patients in FLIGHT-1 and 50 patients in FLIGHT-2) from 20 institutions by April 2007 from November 2005. Seventy one patients were analyzed UGT1As polymorphisms, UGT1A1*28 (TA6>TA7), UGT1A1*6 (G>A), UGT1A1*60 (T>C), UGT1A7 (N129K; T>G), UGT1A7 (-57 T>G), UGT1A9*22 (T10>T9). Results: Out of 71 patients, 34 had G3/4 neutropenia or leukopenia, and 23 had tumor responses (CR +PR). G3/4 neutropenia was more frequent in patients with *6, N129K(G), -57(G), *22 allele than patients without these allele (p<0.05). Other polymorphism was not the predictive factor for toxicity and tumor response, independently. On the other hand, genotype subset selection of multi-UGT1As polymorphisms was useful to predict severe toxicities and tumor responses. Only 7 patients of 22 patients with TA6/TA6 and T10/T10, or TA6/TA7 and -57(T/T), or *6(G/G) and *60(T/T) had grade3/4 toxicity. Similarly, high risk group of toxicity or high and low tumor responses groups was also predicted by genotype subset selections. Conclusions: Genotype subset selections of multi-UGT1As polymorphisms were the excellent predictor for severe toxicities and tumor responses of metastatic CRC patients received FOLFIRI regimen.

No significant financial relationships to disclose.

A multicenter, phase III study of carboplatin/paclitaxel versus oral uracil-tegafur as the adjuvant chemotherapy in resected non-small cell lung cancer (NSCLC): Planned interim analyses

7560

Background: Recent studies have demonstrated that adjuvant chemotherapy provides a survival benefit in patients with resected NSCLC. In Japan, uracil-tegafur has been recognized as a standard adjuvant strategy for resected NSCLC, however, carboplatin based adjuvant chemotherapy has not been fully evaluated for the treatment of NSCLC patients in an adjuvant setting. The present phase III study assessed the efficacy and safety of carboplatin/paclitaxel and oral uracil-tegafur as the first study to compare intravenous and oral drugs in resected stage IB-IIIA NSCLC. Methods: The patients with pathological stage IB-IIIA NSCLC who underwent complete resection were randomized 1:1 to carboplatin (AUC 5) /paclitaxel (175 mg/m2) every 3 week for 4 cycles (A arm) or uracil-tegafur (250 mg/m2) daily for 2 years (B arm). The primary endpoint was overall survival (OS) and secondary endpoints were disease-free survival and toxicity. The accrual of 200 patients per arm is required to demonstrate an improvement of OS (15% increase) in the A arm compared to B arm. Randomization was stratified by histology and tumor stage. An interim analysis was planned to perform on the first 200 patients recruited and data of survival and toxicity were examined in the first 100 patients. Results: Between November 2004 and November 2008, 200 patients from 31 Japanese centers were randomized and the first 100 patients were included for interim analysis. Median age was 69 (range; 50–80) years. Ninety-eight patients had PS of 0–1 and 2 patients had PS of 2. Sixty-seven patients were male and 23 patients were female. Sixty patients had adenocarcinoma, 30 had squamous cell carcinoma, and 10 had other histologies. Disease stage was IB in 53, IIA in 14, IIB in 19, and IIIA in 14 patients. Toxicities observed during adjuvant chemotherapy were well tolerable. There was no toxic death. The median survival time of A and B arms combined was 4.1 year. Monitoring Committees approved to continue the present study. Conclusions: The present phase III trial with carboplatin/paclitaxel or uracil-tegafur is feasible with manageable toxicity. The study is on course to achieve its primary endpoint.

[Table: see text]