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Preoperative Chemoradiotherapy with Capecitabine and Oxaliplatin in Locally Advanced Rectal Cancer. A Phase I–II Multicenter Study of the Dutch Colorectal Cancer Group

¹ Medical Oncology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
² Medical Oncology, St. Radboud University Medical Center, Nijmegen, The Netherlands
³ Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
⁴ Gastroenterology, Netherlands Cancer Institute, Amsterdam, The Netherlands
⁵ Surgical Oncology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
⁶ Radiotherapy, St. Radboud University Medical Center, Nijmegen, The Netherlands
⁷ Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
⁸ Pathology, St. Radboud University Medical Center, Nijmegen, The Netherlands
⁹ Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands

Correspondence: Address correspondence and reprint requests to: Geke A. Hospers; E-mail: g.a.p.hospers{at}int.umcg.nl

Background: We studied the maximum tolerated dose (MTD) and efficacy of oxaliplatin added to capecitabine and radiotherapy (Capox-RT) as neoadjuvant therapy for rectal cancer.

Methods: T3-4 rectal cancer patients received escalating doses of oxaliplatin (day 1 and 29) with a fixed dose of capecitabine of 1000 mg/m² twice daily (days 1–14, 25–38) added to RT with 50.4 Gy and surgery after 6–8 weeks. The MTD, determined during phase I, was used in the subsequent phase II, in which R0 resection rate (a negative circumferential resection margin) was the primary end point.

Results: Twenty-one patients were evaluable. In the phase I part, oxaliplatin at 85 mg/m² was established as MTD. In phase II, the main toxicity was grade III diarrhea (18%). All patients underwent surgery, and 20 patients had a resectable tumor. An R0 was achieved in 17/21 patients, downstaging to T0-2 in 7/21 and a pCR in 2/21.

Conclusion: Combination of Capox-RT has an acceptable acute toxicity profile and a high R0 resection rate of 81% in locally advanced rectal cancer. However the pCR rate was low.

Key Words: Rectal cancer • Radiotherapy • Oxaliplatin • Capecitabine • Chemoradiation • Phase I–II study

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