Getting chemo first may help in rectal cancer

May 15, 2014 by David Orenstein
Only 60 percent of rectal cancer patients comply with chemotherapy after surgery. More patients complied and got the full benefit of chemotherapy when they received it first. For 13 patients in the study, the tumor (left) had disappeared when it was time for surgery. Credit: CONTRE Trial

(Medical Xpress)—A new phase II study to be presented at the annual meeting of the American Society for Clinical Oncology finds that if chemotherapy is offered before radiation and surgery, more patients will be able to tolerate it and receive a full regimen of treatment.

First things first. If are having trouble tolerating after chemoradiation and surgery, then try administering it beforehand. Reordering the regimen that way enabled all but six of 39 patients to undergo a full course of standard treatment for rectal cancer, according to research to be presented at the American Society for Clinical Oncology annual meeting in Chicago.

Studies have shown that only about 60 percent of rectal cancer patients comply with postoperative chemotherapy, said lead researcher Dr. Kimberly Perez, assistant professor of medicine in the Warren Alpert Medical School of Brown University and a cancer physician at Rhode Island Hospital. In the phase II trial, "Complete Neoadjuvant Therapy in Rectal Cancer" (CONTRE), more than 90 percent of the patients were able to complete a regimen of mFOLFOX6 when it was moved to the front of the line.

"The thought was, what can we do to make it more tolerable and get the benefit that we wanted," said Perez, who will speak at 4 p.m. CDT on Saturday, May 31, 2014 at ASCO.

"It's encouraging because we were able to get the numbers up of patients who were able to get all the chemotherapy indicated."

All but one patient in the study underwent surgery and 85 percent underwent the middle step of chemoradiation after completing chemotherapy. The vast majority therefore received all three courses of standard treatment, albeit in a new order.

Almost all of the patients came into the study with rectal bleeding, but that symptom abated for all of them during treatment, Perez said.

Regarding the cancer itself, a majority of patients, 32 of whom entered the trial at stage III and seven of whom were less advanced at stage II, responded at least to some degree to the induction chemotherapy and chemoradiation treatments. By the time they got to surgery, 13 had no tumor left ("pathologic complete response"), 10 got all they way back to stage I, seven were at stage II, and eight remained at stage III.

The study occurred too recently, however, to provide a measure of overall survival, Perez acknowledged. The last patient finished surgery in January 2014.

The rate of side effects such as neutropenia, an adverse impact on the immune system, was not unusual.

The results of the CONTRE trial are now feeding into the development of a new national trial spearheaded by NRG Oncology, Perez said. That protocol will involve chemo first, then chemoradiation with biological anti-cancer agents, and finally . Brown Univeristy Oncology Group and the Cancer Center of Rhode Island Hospital and associated satellites will be one of the study sites, Perez said.

Explore further: Chemo, radiation followed by surgery improves survival in lung cancer patients

Related Stories

Chemo, radiation followed by surgery improves survival in lung cancer patients

April 30, 2013
In one of the largest observational studies of its kind, researchers report that a combination of chemotherapy and radiation followed by surgery in patients with stage 3 non-small cell lung cancer improves survival.

Chemotherapy before or after surgery for high-risk bladder cancer improves survival, but is not routinely administered

April 14, 2014
Contrary to treatment guidelines for high-risk bladder cancer, chemotherapy before or after surgery is not commonly used in routine clinical practice. The findings are published early online in Cancer, a peer-reviewed journal ...

New presurgery treatment combination more effective for women with triple-negative breast cancer

December 13, 2013
Adding the chemotherapy drug carboplatin and/or the antibody therapy bevacizumab to standard presurgery chemotherapy increased the number of women with triple-negative breast cancer who had no residual cancer detected at ...

Unexpected results in cancer drug trial

April 8, 2014
Research from the University of Southampton has shown a drug, used in combination with chemotherapy to treat advanced colorectal cancer, is not effective in some settings, and indeed may result in more rapid cancer progression.

Experts issue treatment guidelines for aggressive form of breast cancer

May 5, 2014
(HealthDay)—Two sets of guidelines for treating patients with an aggressive form of breast cancer have been released by the American Society of Clinical Oncology (ASCO).

Surgery beats chemotherapy for tongue cancer, study finds

December 26, 2013
Patients with tongue cancer who started their treatment with a course of chemotherapy fared significantly worse than patients who received surgery first, according to a new study from researchers at the University of Michigan ...

Recommended for you

Stem cell therapy attacks cancer by targeting unique tissue stiffness

July 26, 2017
A stem cell-based method created by University of California, Irvine scientists can selectively target and kill cancerous tissue while preventing some of the toxic side effects of chemotherapy by treating the disease in a ...

Understanding cell segregation mechanisms that help prevent cancer spread

July 26, 2017
Scientists have uncovered how cells are kept in the right place as the body develops, which may shed light on what causes invasive cancer cells to migrate.

Study uncovers potential 'silver bullet' for preventing and treating colon cancer

July 26, 2017
In preclinical experiments, researchers at VCU Massey Cancer Center have uncovered a new way in which colon cancer develops, as well as a potential "silver bullet" for preventing and treating it. The findings may extend to ...

Compound shows promise in treating melanoma

July 26, 2017
While past attempts to treat melanoma failed to meet expectations, an international team of researchers are hopeful that a compound they tested on both mice and on human cells in a petri dish takes a positive step toward ...

Study may explain failure of retinoic acid trials against breast cancer

July 25, 2017
Estrogen-positive breast cancers are often treated with anti-estrogen therapies. But about half of these cancers contain a subpopulation of cells marked by the protein cytokeratin 5 (CK5), which resists treatment—and breast ...

Breaking the genetic resistance of lung cancer and melanoma

July 25, 2017
Researchers from Monash University and the Memorial Sloan Kettering Cancer Center (MSKCC, New York) have discovered why some cancers – particularly lung cancer and melanoma – are able to quickly develop deadly resistance ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.