Neoadjuvant Radiochemotherapy Combined With Panitumumab in Locally Advanced KRAS Wild-type Rectal Cancer
Significant progress in the management of locally advanced rectal cancer has been achieved
during the last decade. This includes surgical techniques as the widespread implementation
of total mesorectal excision as well as preoperative radiochemotherapy (RCTX). The results
of the recent randomized trials led to a current standard in which most (radio-) oncologists
now use continuous-infusion 5-FU concomitantly with preoperative radiotherapy. It has been
demonstrated that this provides improved tumor downstaging and local control; however, no
significant differences have yet been achieved in the 5-year disease-free and overall
survival rates.
Thus, the challenge is to integrate more effective systemic therapy into the
combined-modality programs. The combination of RCTX with novel chemotherapeutic agents like
oxaliplatin and irinotecan in phase I/II trials suggested higher rates of histopathological
complete remission (pCR) compared with 5-FU RCTX alone. However, due to the lack of results
from randomized trials, to date no improvement of the long-term outcomes could be
demonstrated, moreover, for some studies the increased pCR rate was associated with an
increase in toxicity.
Another strategy to improve outcome is to incorporate newer, biologically active, targeted
therapies into established RCTX regimens. Because of its key role in signalling
proliferation, inhibition of apoptosis and angiogenesis the epidermal growth factor receptor
(EGFR) is a promising target of antitumor treatment. To date a few clinical phase I/II
studies of preoperative RCTX have been initiated to evaluate EGFR inhibitors as
radiosensitizer in rectal cancer. These trials demonstrated that a combination of cetuximab
and RCTX could be safely applied without dose compromises of the respective treatment
components. However, the pCR rates could not be improved in these studies.
Given the strong preclinical rationale to combine EGFR inhibition with RCTX in rectal cancer
patients, this study aims to investigate the combination of panitumumab and a 5-FU-based
RCTX in patients with locally advanced KRAS wild-type rectal cancer.
Interventional
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Histopathological complete response rate (pCR)
pCR determined by means of the resection specimens
at week 14 after tumor resection
No
Dirk Jaeger, Prof. Dr
Principal Investigator
National Center of Tumor Disease, Heidelberg
Germany: Paul-Ehrlich-Institut
NCT-0001021
NCT01443377
July 2011
September 2013
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