Is Capecitabine New Standard in Pre-op Rectal Cancer?

David J. Kerr, CBE, MD, DSc, FRCP, FMedSci


January 15, 2016

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Hi. I'm David Kerr, professor of cancer medicine at the University of Oxford. As you know, I have an abiding interest in the management and treatment of colorectal cancer. A very nice study has been published by Carmen Allegra and colleagues in the Journal of the National Cancer Institute.[1] It looked at the benefits—or disbenefits—of combination chemotherapy given in the neoadjuvant setting with radiation therapy for patients with rectal cancer.

It was a lovely trial design with about 1600 patients. They used a factorial trial design, and they compared continuous infusion of 5-FU vs capecitabine plus or minus oxaliplatin in combination with radiation therapy. The primary outcome of the study was local-regional tumor control, a very relevant endpoint for rectal cancer. What they showed was that capecitabine can be substituted fairly and squarely for continuous infusion of 5-FU. There are savings in terms of health economics and practical issues for patients. But the addition of oxaliplatin added nothing other than extra toxicity. These are clear results that the combination treatment of choice for neoadjuvant chemoradiation is oral capecitabine and that there is no role for oxaliplatin whatsoever.

Thanks to Carmen and colleagues for a good trial design. We like factorial trial designs because we get to ask and answer two questions with the same number of patients in the study and get this very clear result.

As always, thanks for listening. We'd be very interested in any comments that you would care to make or post online. For the time being, Medscapers, ahoy. Take care out there.


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