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Patients and methods: Chemo<strong>the</strong>rapy-naïve patients with unresectable liver<br />
metastases of CRC and no o<strong>the</strong>r metastatic sites were enrolled. Criteria of<br />
unresectability were defined as: more than3livermetastasesincluding>50%<br />
hepatic involvement and requiring a major hepatectomy with controlateral<br />
wedge resection or any metastases requiring a resection that does not preserve<br />
two contiguous hepatic segments. Since November 2008 only patients bearing<br />
wild type KRAS were included. All patients received neoadjuvant XELOX plus<br />
panitumumab (P-XELOX) and were reevaluated for resectability every four<br />
cycles. Primary endpoint was radiological objective response rate (ORR).<br />
Secondary endpoints were overall survival (OS), progression free survival<br />
(PFS), percentage of patients whose disease became radically resectable, and<br />
safety.<br />
Results: Forty-nine patients were recruited, of which 35 were KRAS wild type, and<br />
14 (enrolled before study amendment), were unknown (9 patients) or mutated (5<br />
patients). Forty-six were evaluable for response. Following neoadjuvant P-XELOX,<br />
<strong>the</strong> ORR in <strong>the</strong> general population was 54%, with 3 CR, 22 PR, 14 SD. In wild type<br />
KRAS patients ORR reached 65% (3 CR, 18 PR, 7 SD), and this allowed 15 patients<br />
with initial unresectable liver metastasis to be converted to resectability. Survival<br />
analysis showed median PFS and OS of 8.5 months and 22.1 months, respectively.<br />
Resected patients had significantly better OS if compared to unresected (p =<br />
0.00014). The most common toxicities were cutaneous, gastrointestinal, and<br />
neurologic.<br />
Conclusion: Neoadjuvant P-XELOX yields high response rates for patients with<br />
metastatic CRC and extensive liver involvement, and leads to remarkable conversion<br />
to resectability of liver metastasis.<br />
Disclosure: All authors have declared no conflicts of interest.<br />
606P BODY MASS INDEX AND IMPAIRED FASTING BLOOD<br />
GLUCOSE AS PREDICTIVE FACTORS OF EFFICACY IN<br />
CETUXIMAB-BASED COLORECTAL CANCER TREATMENT<br />
F.M. Guida1 , F. Pantano1 , E. Vasile2 , M. Rodriguez Garrote3 , E. Grande3 ,<br />
N. Silvestris4 , B. Vincenzi1 , D. Santini1 , A. Falcone5 , G. Tonini1 1 2<br />
Medical Oncology, University Campus Bio-Medico, Rome, ITALY, Oncologia,<br />
Trapianti e Nuove Tecnologie in Medicina, Polo Oncologico - Azienda<br />
Ospedaliero-Universitaria Pisana - Istituto Toscano Tumori, Pisa, ITALY, 3 Medical<br />
Oncology, University Hospital, Madrid, Madrid, SPAIN, 4 Medical and<br />
Experimental Oncology Unit, Cancer Institute Giovanni Paolo II, Bari, ITALY,<br />
5<br />
Dept. of Oncology-Presidio Ospedaliero, Azienda Ospedaliero Univesitaria S.<br />
Chiara, Pisa, ITALY<br />
Introduction: Cetuximab is an anti-EGFR monoclonal antibody with antitumor<br />
efficacy in metastatic colorectal cancer harboring wild-type K-Ras gene.<br />
However, not all patients K-Ras wild-type benefit from Cetuximab,<br />
underscoring <strong>the</strong> need for additional markers to help in patient selection.<br />
Preclinical evidences suggest that <strong>the</strong> EGFR and Insulin-like Growth Factor-1<br />
Receptor (IGF-1R) pathways interact to drive tumor growth and survival. It’s<br />
well known that in hyperinsulinemic state, higher insulin levels upregulate<br />
IGF-1 production, leading this state a potential biomarker for Cetuximab<br />
efficacy. The aim of our study was to evaluate <strong>the</strong> feasibility to stratify patients<br />
more likely to benefit from Cetuximab treatment using two well known signs<br />
of hyperinsulinemic state such as <strong>the</strong> high Body Mass Index (BMI) and<br />
impaired Fasting Blood Glucose (FBG).<br />
Methods: We retrospectively collected 250 K-Ras wild-type metastatic colorectal<br />
cancer patients treated with Cetuximab containing regimens in first to fifth line<br />
setting. From this cohort we selected 76 patients treated with Cetuximab +<br />
CPT11 after failure of first line CPT11 based containing regimen. We divided<br />
this population into two groups according to <strong>the</strong> presence of both elevated BMI<br />
(cut-off 24.99 sec. WHO Criteria) and high FBG (cut-off 100 mg/dL sec<br />
American Diabetes Association) and we evaluated <strong>the</strong> Time To Progression<br />
(TTP) of <strong>the</strong>se two groups.<br />
Results: We found a statistically significant lower TTP in patients with both elevated<br />
BMI and FBG compared to patients with presence of none or only one of <strong>the</strong> two<br />
parameters (median TTP 4.3 months, CI95%:2.5-5.4 vs 5.6 months, CI95%:2.5-5.8;<br />
P = 0.034).<br />
Conclusions: The statistically significant poorer outcome in patients with both<br />
BMI and FBG treated with Cetuximab + CPT11 after CPT11 failure could be<br />
explained by <strong>the</strong> reduction of Cetuximab efficacy due to <strong>the</strong> probable presence of<br />
upregulation of vicar pathways such as IGF-1R linked to hyperinsulinemic state.<br />
If confirmed in larger populations and in perspective studies <strong>the</strong><br />
hyperinsulinemic state may represent a new predictive marker of efficacy in this<br />
type of population.<br />
Disclosure: All authors have declared no conflicts of interest.<br />
Annals of Oncology<br />
607P EFFICACY AND SAFETY OF TWO NEOADJUVANT<br />
STRATEGIES WITH BEVACIZUMAB IN LOCALLY ADVANCED<br />
RESECTABLE RECTAL CANCER: INTERIM RESULTS OF A<br />
RANDOMIZED, NON-COMPARATIVE PHASE II STUDY<br />
J. Bosset 1 , G. Mantion 2 ,T.André 3 , F. Boudghène 4 , F. Piard 5 , F. Mornex 6 ,<br />
P. Maingon 7 , A. Adenis 8 , M. Piutti 9 , C. Borg 10<br />
1 Radio<strong>the</strong>rapy, CHU Jean Minjoz, Besançon, FRANCE, 2 Service de Chirurgie<br />
Digestive Et Vasculaire, Hôpital Jean Minjoz, Besançon, FRANCE, 3 Medical<br />
Oncologie, Hôpital Saint Antoine, Paris, FRANCE, 4 Service Imagerie Médicale,<br />
Hôpital Tenon, Paris, FRANCE, 5 Service D’anatomo-pathologie, CHU de Dijon,<br />
Dijon, FRANCE, 6 Radiothérapie-oncologie, Centre Hospitalier Lyon-Sud, Lyon,<br />
FRANCE, 7 Radiothérapie, Centre Georges-François-Leclerc, Dijon, FRANCE,<br />
8 Medical Oncology, Centre Oscar Lambret, Lille Cedex, FRANCE, 9 Responsable<br />
Etudes Cliniques, Laboratoires Roche, Boulogne-Billancourt, FRANCE, 10 Medical<br />
Oncology, Hopital Minjoz, Besançon, FRANCE<br />
Background: Current <strong>the</strong>rapy of locally advanced resectable rectal cancer<br />
(LARC) involves a combination of chemo<strong>the</strong>rapy (CT), radiation <strong>the</strong>rapy, (RT)<br />
and total mesorectal excision (TME) surgery. Two neoadjuvant strategies with<br />
bevacizumab (Bv) were assessed in a randomized, open-label, multicentre, phase<br />
II study.<br />
Method: Patients (pts) were treated with a sequential strategy including induction<br />
Bv/6 cycles (5mg/2weeks) + Folfox4, followed by CT-RT (Bv/6 cycles + 5-FU/5<br />
cycles) + RT(45Gy) <strong>the</strong>n TME in Arm A and <strong>the</strong> same CT-RT, <strong>the</strong>n TME in Arm<br />
B. Primary end-point was tumor sterilization rate (pCR) - at least 10% in each arm.<br />
Efficacy and safety were reviewed by an independent committee. Results at 8 weeks<br />
post-surgery are presented.<br />
Results: Pts characteristics in Arm A (n = 46) and in Arm B (n= 45) were: men 67%,<br />
age 60 ± 9 years, ECOG score 0 (85%), mid-rectum (60%), low-rectum (40%), MRI<br />
stage: T3N0M0/T3N1M0/T3N2M0 (20%/65%/15%). In Arm A, 94% pts completed<br />
induction and 91% had CT-RT and surgery; in Arm B 100% had CT-RT and 98%<br />
surgery. Resection was macroscopically complete in 91% pts. Median post-surgery<br />
hospitalization duration was 15 [0-84] days. In <strong>the</strong> ITT population, pCR (ypT0-N0)<br />
rate was 23.8% [12.1%-39.5%] in Arm A (p = 0.015) and 11.4% [3.8%-24.6%] in Arm<br />
B (p = 0.91), both compared to <strong>the</strong> 10% pCR initial hypo<strong>the</strong>sis. Central review found<br />
similar results for pCR. At surgery and 4 weeks post-surgery grade 3/4 adverse events<br />
(AE) were reported in 10 (22%) of pts in both arms. At 8 weeks post-surgery, grade<br />
3/4 adverse events (AE) were reported in 59% of pts in Arm A and 36% in Arm<br />
B. Grade 3/4 AEs of special interest for bevacizumab were reported in 20% of pts in<br />
Arm A and 22% in Arm B. No death was reported at 8 weeks post-surgery follow-up.<br />
Conclusions: Interim results in patients with LARC treated with 2 neoadjuvant<br />
strategies showed that bevacizumab combination to neoadjuvant CT-RT did not<br />
significantly increase pCR in Arm B. The neoadjuvant strategy assessed in Arm A<br />
seems promising and deserves fur<strong>the</strong>r investigation. Safety was comparable in Arms<br />
A and B at 8 weeks post-surgery.<br />
Disclosure: T. André: Consultant: Roche Honoraries: Amgen, Merck, Sanofi. F.<br />
Boudghène: Honoraries : Roche. M. Piutti: Employment: Roche. All o<strong>the</strong>r authors<br />
have declared no conflicts of interest.<br />
608P EXCITE: A PHASE II TRIAL OF PREOPERATIVE CETUXIMAB,<br />
IRINOTECAN AND CAPECITABINE PLUS RADIOTHERAPY (RT)<br />
IN MRI-DEFINED LOCALLY ADVANCED RECTAL CANCER<br />
(LARC)<br />
S. Gollins 1 , A.S. Myint 2 , M.P. Saunders 3 , S. Susnerwala 4 , D. Sebag-Montefiori 5 ,<br />
S. Beare 6 , E. Williams 6 , N. West 7 , M. Jitlal 6<br />
1 Clinical Oncology, North Wales Cancer Treatment Centre, Rhyl, UNITED<br />
KINGDOM, 2 Clinical Oncology, Clatterbridge Cancer Centre, Liverpool, UNITED<br />
KINGDOM, 3 Clinical Oncology, The Christie Hospital NHS Foundation Trust,<br />
Manchester, UNITED KINGDOM, 4 Clinical Oncology, Royal Preston Hospital,<br />
Preston, UNITED KINGDOM, 5 Oncology, University of Leeds, Leeds, UNITED<br />
KINGDOM, 6 CR UK & UCL Cancer Trials Centre, University College London,<br />
London, UNITED KINGDOM, 7 Pathology & Tumour Biology, University of Leeds,<br />
Leeds, UNITED KINGDOM<br />
Introduction: This phase II trial examined combining cetuximab, irinotecan and<br />
capecitabine concurrently with RT in <strong>the</strong> preoperative downstaging of LARC.<br />
Methods: Patients (pts) had rectal adenocarcinoma with locally advanced/borderline<br />
unresectable disease on MRI. KRAS/BRAF was not assessed before treatment. Pts<br />
had pelvic RT to 45 Gy in 25 daily fractions over 5 weeks with concurrent oral<br />
capecitabine at 650 mg/m 2 twice daily 5 days/week. They also received intravenous<br />
(IV) cetuximab at 400 mg/m 2 one week before RT <strong>the</strong>n weekly at 250 mg/m 2 weeks<br />
1-5 of RT plus IV irinotecan weekly at 60 mg/m 2 weeks 1-4 of RT. Surgical resection<br />
ix206 | <strong>Abstract</strong>s Volume 23 | Supplement 9 | September <strong>2012</strong>