Preoperative Chemoradiation using Capecitabine in Locally Advanced Rectal Cancer
Heather Jones, MD
University of Pennsylvania Cancer Center
Last Modified: November 4, 2001
Presenter: J.S. Kim
Affiliation: Department of Therapeutic Radiology, Chungnam National University, Taejon, South Korea
Studies indicate that preoperative chemoradiation can result in tumor downstaging with increase resectability and sphincter preservation in locally advanced rectal lesions. Capecitabine is a new fluoropyrimidine carbamate with antineoplastic activity. It is an orally administered systemic prodrug consisting of 5'-deoxy-5-fluorouridine (5'-dFUrd), which is converted to 5-fluorouracil (5-FU) by thymidine phosphorylase (dThdPase). dThdPase activity is from 3 to10 times higher in tumor tissue than in normal tissue and is up-regulated in human cancer xenografts after irradiation. Capecitabine orally also mimics the continuous infusion of 5 FU, the preferred administration of the drug. This study, evaluated the efficacy and toxicity of preoperative chemoradiation using capecitabine in locally advanced adenocarcinoma of the rectum.
Preoperative chemoradiation with capecitabine seems to be a safe, well-tolerated, effective neoadjuvant treatment modality. It does not increase perioperative complications. This preoperative treatment produces a considerable down-staging effect, and increases the possibility of sphincter-preserving surgery in distal rectal cancer.
In IV infusion studies there is a good record of how much drug is administrated and the compliance with administration schedule and dose intensity of the drug in question. The ability to record the amount of drug administered when using oral agents is more challenging. It would have been interesting to include in the presentation how compliance was assessed (ie pill count, pill diary or monitored administration). Nonetheless, these new oral chemotherapy agents continue to show promise in both the adjuvant setting and in the treatment of metastatic rectal disease.