1-26-10.mp3

How aggressive should the chemo for rectal cancer be? A newly published study doesn't make the question any easier.

Publishing in Lancet Oncology, a British group treated patients with a combination of Xeloda and oxaliplatin initially, then Xeloda and radiation, then surgery.

In the 105 patients studied with poor risk disease, recurrences were rare at five years.

It should be noted that this new British study was not randomized. A pair of randomized studies were reported at ASCO in 2009, and the message oncologists repeat to themselves about these ASCO studies is that giving Oxaliplatin and Xeloda together with radiation adds toxicity but not improved outcomes.

Notwithstanding this, I got a phone call from a rectal surgeon imploring me to add oxaliplatin to a patient receiving Xeloda and radiation for a rectal tumor. I at least had the ASCO clinical trials to justify not doing that. His concept was that more aggressive treatment with the radiation would be more likely to induce a complete remission, therefore making his job as surgeon easier.

Though on paper it would seem intuitive that if some chemo is good, more is better, but in reality, it doesn't work like that.

The British group used a different approach, with an pre-radiation combo treatment, then regular Xeloda plus radiation, and they had good numbers. So maybe the key is to keep the radiation and Xeloda the way it is, but maximize chemo dosing prior to the radiation. Perhaps the preliminary British results reported this week will be the basis for future clinical trials.

http://www.healthfinder.gov/News/newsstory.aspx?docid=635309