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Fernandez-Martos C, Pericay C, Maurel J, Virgili A, Capdevila J, Gallego J, Vera R, Rodriguez-Salas N, Losa F, Valladares M, Vivancos A, Ayuso J, Maas M, Martínez F, Melian M, García de Albéniz X. Phase II trial of neoadjuvant mFOLFOX 6 with panitumumab (P) in T3 rectal cancer with clear mesorectal fascia (MRF) and KRAS, NRAS, BRAF, PI3KCA wild type (4WT). GEMCAD 1601 PIER trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3512 Background: Patients with advanced colorectal cancer with 4WT tumors achieve increased response rates with chemotherapy and anti-EGFR therapy as compared with chemotherapy alone. In clinically staged (c) T3 rectal cancer neoadjuvant oxaliplatin/fluoropyrimidine combination has shown to induce encouraging pathological complete response (pCR). We hypothesize that combining FOLFOX and P could improve outcomes in 4WT tumors. Methods: PIER was an investigator-initiated phase II, single-arm, multicentre clinical trial to evaluate the safety and efficacy of neoadjuvant mFOLFOX6 with P in pts < 75-y, with 4WT rectal cancer of the middle third staged as T3 by centrally-reviewed magnetic resonance imaging (MRI) and clear MRF, who were candidate for a R0 resection with sphincter preservation surgery. Pts received 6 cycles and underwent re-staging with MRI and sigmoidoscopy. Pts without progression underwent total mesorectal excision 4 weeks after the last cycle. Patients with progression were treated with pre-op chemoradiotherapy. The primary endpoint was pCR. The study followed a 2-Stage Simon’s MiniMax design (P0 of 16%, P1 of 35%, alpha and beta of 0.1). The target sample size was 35 patients and if 9 or more achieved a pCR, the results would be compatible with efficacy. We present primary and early secondary endpoints. Results: Between 9/2017 and 6/2020, 90 patients were screened (56 excluded; 42 were excluded due to mutations, 12 were excluded due to discrepancies with central review of radiology) of whom 34 were enrolled. In the ITT population a pCR was observed in 11 pts (32.3%; [95% CI 17.39-50.53]) and a near-complete pathological response (Mandard 1+2) was observed 17 pts (52.9%). Clinical complete or near complete response was achieved in 50% and there were no progressions. R0 resection rate and pathological circumferential resection margin neg- were 100%. Full compliance with induction was 88%. Neoadjuvant G3/4 toxicity occurred in 54% and was consistent with FOLFOX/P safety profile. G3/4 postoperative related toxicity was 19% with one reoperation. Conclusions: The study met the threshold for efficacy. mFOLFOX6 with P as neoadjuvant therapy can be effective and safe without unexpected toxicities in mrT3, clear MRF and 4WT rectal cancer and resulted in a higher rate of pCR compared with our previous series (GEMCAD 0801; The Oncologist 2014) in a similar molecular-unselected population. This study was funded by Amgen S.A. Clinical trial information: NCT03000374.
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Affiliation(s)
| | | | | | | | | | | | - Ruth Vera
- Hospital de Navarra, Pamplona, Spain
| | | | - Ferran Losa
- Hospital Sant Joan Despí-Moisés Broggi, Barcelona, Spain
| | | | - Ana Vivancos
- Cancer Genomics, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Juan Ayuso
- University Hospital Clínic de Barcelona, Barcelona, Spain
| | - Monique Maas
- Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Marcos Melian
- Fundación Instituto Valenciano de Oncología (FIVO), Valencia, Spain
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Aguilar G, Albiol S, Alcaide J, Alonso M, Alonso V, Andreu M, Aparicio J, de la Vega FA, Arrivi A, Ayuso JR, Bohn U, Bouzas R, Cano JM, Castañón C, Castells A, Cerdà P, Cerezo L, Conill C, Cuatrecasas M, Pozo MND, Delgado JI, Enriquez-Navascues JM, Escudero P, Espín E, l RE, Falcó E, Farré J, Feliu J, Fernández-Martos C, Ferrer AI, Gallego R, Galvez E, de Albéniz XG, Olmo DG, García-Carbonero R, Dorronsoro MG, Martín CG, Moreno SG, Hernández A, Iraola A, Jímenez E, Jiménez MC, Jurado I, Leno R, León A, Martín E, Martín M, Maurel J, Méndez JC, Méndez R, Palma P, Pardo F, Pereira F, Pérez-Altozano J, Pérez E, Rodríguez J, Ruiz-Casado AI, Sabater L, Sarría L, Segura A, Sevilla I, Tobeña M, Torres E, Viudez A, Zanui M, Zorrilla M. Guidelines for diagnosis, staging and treatment of metastatic colorectal cancer by Grupo Español Multidisciplinar en Cancer Digestivo (GEMCAD). Colorectal Cancer 2015. [DOI: 10.2217/crc.15.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Advances in the care of patients with metastatic colorectal cancer arise from well-designed clinical trials. In the present document we address specific challenges in the design of clinical trials for metastatic colorectal cancer regarding staging and standard of care according to prognosis, as well as some relevant methodological issues.
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Affiliation(s)
| | - Santiago Albiol
- Department of Medical Oncology, Hospital del Espíritu Santo, Barcelona, Spain
| | - Julia Alcaide
- Department of Medical Oncology, Hospital Costa del Sol, Marbella, Spain
| | - Martina Alonso
- Department of Medical Oncology, Hospital San Pedro, de Logroño, Spain
| | - Vicente Alonso
- Department of Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Jorge Aparicio
- Department of Medical Oncology, Hospital La Fe, Valencia, Spain
| | | | - Antonio Arrivi
- Department of Medical Oncology, Clinica Rotger, Palma de Mallorca, Spain
| | - Juan Ramón Ayuso
- Department of Radiology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Uriel Bohn
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Rosa Bouzas
- Department of Radiology, Hospital Universitario de Vigo, Vigo, Spain
| | - Juana Maria Cano
- Department of Medical Oncology, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - Carmen Castañón
- Department of Medical Oncology, Complejo Asistencial de León, León, Spain
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Paula Cerdà
- Department of Medical Oncology, Instituto Oncológico Teknon, Barcelona, Spain
| | - Laura Cerezo
- Department of Radiation Oncology, Hospital Universitario La Princesa, Madrid, Spain
| | - Carles Conill
- Department of Radiation Oncology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | | | - Jose Ignacio Delgado
- Department of Medical Oncology, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | | | - Pilar Escudero
- Department of Medical Oncology, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Eloy Espín
- Department of Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rafael Estevan l
- Department of Surgery, Instituto Valenciano de Oncología, Valencia, Spain
| | - Esther Falcó
- Department of Medical Oncology, Hospital Son Llatzer, Palma de Mallorca, Spain
| | - José Farré
- Department of Surgery, Hospital Quirón, Torrevieja, Spain
| | - Jaime Feliu
- Department of Medical Oncology, Hospital La Paz, Madrid, Spain
| | | | - Ana Isabel Ferrer
- Department of Medical Oncology, Hospital Obispo Polanco, Teruel, Spain
| | - Rosa Gallego
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Elisa Galvez
- Department of Medical Oncology, Hospital General Universitario de Elda, Alicante, Spain
| | | | | | | | | | - Carlos Gómez Martín
- Department of Medical Oncology, Hospital Universitario 12 de octubre, Madrid, Spain
| | | | - Ana Hernández
- Department of Radiation Oncology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Amparo Iraola
- Department of Medical Oncology, Hospital Verge dels Lliris, Alcoi, Spain
| | - Esther Jímenez
- Department of Radiation Oncology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | - Ismael Jurado
- Department of Pathology, Hospital Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Rubén Leno
- Department of Medical Oncology, Hospital Virgen del Puerto, Plasencia, Spain
| | - Ana León
- Department of Medical Oncology, Fundación Jiménez Díaz, Madrid, Spain
| | - Elena Martín
- Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - Marta Martín
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Madrid, Spain
| | - Joan Maurel
- Department of Medical Oncology, Hospital Clinic Barcelona, C. Villarroel 170, 08030 Barcelona, Spain
| | | | - Ramiro Méndez
- Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Pablo Palma
- Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Fernando Pardo
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Fernando Pereira
- Department of Surgery, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | | | - Elisabet Pérez
- Department of Medical Oncology, Hospital Costa del Sol, Marbella, Spain
| | - Javier Rodríguez
- Department of Medical Oncology, Hospital Costa del Sol, Marbella & Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Luis Sabater
- Department of Surgery, Hospital General Universitario de Valencia, Valencia, Spain
| | - Luis Sarría
- Department of Radiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Angel Segura
- Department of Medical Oncology, Hospital La Fe, Valencia, Spain
| | - Isabel Sevilla
- Department of Medical Oncology, Hospital Clínico de Málaga, Málaga, Spain
| | - Maria Tobeña
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Madrid, Spain
| | - Esperanza Torres
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Antonio Viudez
- Department of Medical Oncology, Complejo Universitario de Navarra, Pamplona, Spain
| | - Montserrat Zanui
- Department of Medical Oncology, Hospital de Mataró, Barcelona, Spain
| | - Miriam Zorrilla
- Department of Medical Oncology, Hospital San Pedro, de Logroño, Spain
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