Cetuximab in Combination With Capecitabine, Oxaliplatin, and Concomitant Radiotherapy (Cet-Capox-RT) as Preoperative Therapy for Rectal Cancer
Cetuximab is a monoclonal antibody to the EGF-receptor and has been shown to improve outcomes in metastatic colorectal cancer and in combination with radiation therapy for head and neck cancers. Previous research has demonstrated that tumors that overexpress EGFR are less likely to respond to preoperative radiation therapy. A multicenter trial was done to evaluate the safety and efficacy of a regimen containing capecitabine, oxaliplatin, and cetuximab in combination with radiation, all given before surgical resection of locally advanced and/or low-lying rectal cancers.
Patients in the study had T3 or T4 disease with or without lymph node involvement. Somewhat surprisingly, the response rate with this combination was lower than the same regimen without cetuximab. Further research should attempt to figure out which patients might benefit from cetuximab as a part of their regimen. It may be the case that this drug only benefits a subset of patients with a particular molecular make-up of their tumor. It also may be the case that cetuximab is more active with radiation alone that in combination with radiation and chemotherapy. Regardless, the data needs be verified and repeated, as it would be premature to abandon this compound in rectal cancer just yet.