title: Neoadjuvant capecitabine and oxaliplatin (XELOX) combined with bevacizumab for high-risk localized rectal cancer.
abstract: OBJECTIVE
  Chemoradiotherapy followed by total mesorectal excision (TME) is the standard treatment for locally advanced rectal cancer. Although this approach decreases the risk of local recurrence, pelvic radiation is associated with long-term morbidity and delays systemic treatment. We conducted this study to evaluate the feasibility of neoadjuvant capecitabine and oxaliplatin (XELOX) plus bevacizumab as a treatment for high-risk localized rectal cancer.
  
  
  METHODS
  Patients with T4 or lymph node-positive rectal cancer were treated with three cycles of XELOX plus bevacizumab and one additional cycle of XELOX. This was followed by TME performed 3-8 weeks after the last chemotherapy session.
  
  
  RESULTS
  Twenty-five patients were recruited between December 2009 and November 2011. In seven of the patients (28.0 %), grade 3-4 adverse events occurred. After preoperative chemotherapy, the frequency of tumor (T) downstaging was 69.6 %, and that of lymph node (N) downstaging was 78.9 %. Seven patients discontinued the treatment after 2-3 cycles of XELOX plus bevacizumab. The frequency of subsequent surgery was 92 %, and all patients underwent R0 resections. Postoperative complications occurred in six patients (26.1 %). One patient achieved a pathological complete response (pCR) for the primary tumor and lymph nodes, whereas an additional four patients achieved near-pCR. After a median follow-up of 31 months, five patients displayed metastatic progression, including one who suffered local recurrence.
  
  
  CONCLUSIONS
  XELOX plus bevacizumab followed by TME is feasible for high-risk localized rectal cancer, as it achieves good tumor regression and causes manageable toxicity.
authors.affiliation: Clinical Study Group of Osaka University (CSGO), Colorectal Group, Suita, Osaka, Japan, j-hasegawa@orh.go.jp.
authors.forename: Junichi
authors.initials: J
authors.lastname: Hasegawa
authors.forename: Junichi
authors.initials: J
authors.lastname: Nishimura
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Mizushima
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Miyake
authors.forename: Ho Min
authors.initials: HM
authors.lastname: Kim
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Takemoto
authors.forename: Hroshi
authors.initials: H
authors.lastname: Tamagawa
authors.forename: Shingo
authors.initials: S
authors.lastname: Noura
authors.forename: Makoto
authors.initials: M
authors.lastname: Fujii
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Fujie
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kato
authors.forename: Hideaki
authors.initials: H
authors.lastname: Miwa
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takemasa
authors.forename: Masataka
authors.initials: M
authors.lastname: Ikeda
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Mistugu
authors.initials: M
authors.lastname: Sekimoto
authors.forename: Riichiro
authors.initials: R
authors.lastname: Nezu
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000068258:Bevacizumab; D000069287:Capecitabine; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000077150:Oxaliplatin; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000964:Antimetabolites, Antineoplastic; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000068258:Bevacizumab; D000069287:Capecitabine; D005472:Fluorouracil