Oxaliplatin With Lower-Dose Capecitabine Active in Metastatic GI and Esophageal Cancers

Publication
Article
Oncology NEWS InternationalOncology NEWS International Vol 14 No 8
Volume 14
Issue 8

ROCHESTER, MINNESOTA-A phase II study from the NorthCentral Cancer Treatment Group(NCCTG) showed that oxaliplatin(Eloxatin) combined with lower-dosecapecitabine (Xeloda) is active as first

ROCHESTER, MINNESOTA-A phase II study from the NorthCentral Cancer Treatment Group(NCCTG) showed that oxaliplatin(Eloxatin) combined with lower-dosecapecitabine (Xeloda) is active as firstlinetreatment of a variety of metastaticgastrointestinal and esophageal cancersand should be studied further inthis setting, according to Aminah Jatoi,MD, of the Mayo Clinic in Rochester,Minnesota (abstract 4059).Dr. Jatoi said that this study appearsto be the first trial of oxaliplatin/capecitabine in the first-line setting inpatients with metastatic adenocarcinomaof the esophagus, gastroesophagealjunction, and gastric cardia. Thestudy included 44 patients who werevirtually chemotherapy-naive (4 hadundergone prior radiosensitizing chemotherapy).Patients were initially treated withoxaliplatin (130 mg/m2 IV on day 1)and capecitabine (1,000 mg/m2 orallytwice daily) on days 1-14 of a 21-daycycle. The capecitabine dose was reducedto 850 mg/m2 orally twice dailyon days 1-14 after three treatmentrelateddeaths occurred in the first 24patients treated at the higher dose.New Ideas From Work inColon Cancer"We got ideas for new approachesto metastatic gastric and esophagealcancers from some of the work donein colon cancer, where studies advancefaster because so many more patientsare available for clinical trials. Some ofthese regimens, ironically, are relyingon oral therapies. Patients can oftenswallow oral treatments, although thisapproach might seem odd at first inesophageal cancer, but if patients canswallow, these regimens are much lesscumbersome than others," Dr. Jatoisaid.Encouraging Response RateOxaliplatin/capecitabine producedpartial responses in 34% of patients.The median time to tumor progres-sion was 3.8 months, and the mediansurvival was 6.4 months.Dr. Jatoi said that there have been30 deaths. Three were treatment-related(one due to an infection, twofrom myocardial infarction) and occurredprior to the capecitabine dosereduction.Grade 4 adverse events includeddiarrhea (two patients), vomiting (3),dyspnea (1), thrombosis (2), and anorexia(2). Grade 3 events includednausea (12 patients), diarrhea (12),fatigue (10), abdominal pain (7), vomiting(6), dyspnea (6), dehydration (5),hypokalemia (5), and infection (3)."Esophageal cancer often has a verylow response rate, and we are veryencouraged by the 34% response ratein this study. We think this combinationshould go forward in larger trials,"Dr. Jatoi concluded.

Recent Videos
Findings from the CodeBreak 300 study have cemented sotorasib/panitumumab as a third-line treatment option for KRAS G12C-mutated colorectal cancer.
Sotorasib plus panitumumab may offer improved survival compared with previously approved treatment options in KRAS G12C-mutated colorectal cancer.
Additional local, regional, or national policy may bolster access to screening for colorectal cancer, according to Aasma Shaukat, MD, MPH.
The mechanism of action for daraxonrasib inhibits effectors and signaling while forming a relatively unstable tri-complex with codon 12 mutations.
Almost all patients evaluable for efficacy reported a decrease in ctDNA when treated with daraxonrasib for RAS-mutant pancreatic ductal adenocarcinoma.
Additional progression-free survival data from the phase 3 BREAKWATER trial will be presented at future meetings.
As patients are nearing the end of life, different management strategies, such as opioids, may be needed to help mitigate pain or fatigue.
Kelley A. Rone, DNP, RN, AGNP-c, highlights the importance of having end-of-life discussions early in a patient’s cancer treatment course.
Immunotherapy may be an “elegant” method of managing colorectal cancer, says Gregory Charak, MD.
Administering neoadjuvant therapy to patients with colorectal cancer may help surgical oncologists attain a negative-margin resection.
Related Content