Real world outcomes for neoadjuvant capecitabine versus infusional 5-fluorouracil in the treatment of locally advanced rectal cancer
- Loft, M; Wong, HL; Kosmider, S; Lee, M; Tie, J; Wong, R; Jones, IT; Croxford, M; Steel, M; Faragher, I; Guerrieri, M; Christie, M; Gibbs, P;
Publication Year 2021-08-01, Volume 51, Issue #8, Page 1262-1268 (epub Sep 8 2020)
- Journal Title
- Internal Medicine Journal
- Publication Type
- Journal article
- BACKGROUND: Neoadjuvant chemoradiation therapy (CRT) is standard of care treatment for locally advanced rectal cancer (LARC). A pathologic complete response (pCR) following CRT is an early indicator of treatment benefit and associated with excellent survival outcomes. As capecitabine replaces infusional 5-fluorouracil (5-FU) as the fluoropyrimidine of choice in routine care of LARC, on the back of clinical trial data demonstrating equivalence, it is important to confirm that efficacy is maintained in the real-world setting. METHODS: We analysed data from a prospectively maintained colorectal cancer database at 3 Australian hospitals including patients diagnosed January 2009 to December 2018. Pathological response was determined as either complete or incomplete and compared for patients receiving 5FU or capecitabine. RESULTS: 657 patients were analysed, 498 receiving infusional 5-FU and 159 capecitabine. Capecitabine use has markedly increased from approval in 2014 in Australia, now being used in more than 80% of patients. Patient characteristics were similar by treatment, including age, tumour location and pre-treatment stage. pCR was reported in 22/159 (13.8%) of capecitabine treated patients and 118/380 (23.7%) that received 5-FU (p = <0.01). More capecitabine-treated patients received post-operative oxaliplatin (44.2% vs 6.3%, p < 0.01). Two-year progression free survival was similar (84.9% vs 88.0%, p = 0.34). CONCLUSION: Capecitabine is now the dominantly used neoadjuvant chemotherapy in LARC. Capecitabine use was associated with a lower rate of pCR versus infusional 5-FU, a difference not explained by examined patient or tumour characteristics. Poor treatment compliance with oral therapy in the real-world setting is one possible explanation. This article is protected by copyright. All rights reserved.
- WEHI Research Division(s)
- Personalised Oncology
- PubMed ID
- Publisher's Version
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Creation Date: 2020-10-02 10:28:03Last Modified: 2021-10-20 11:30:39