Capecitabine with Mitomycin Reduces Acute Hematologic Toxicity and Treatment Delays in Patients undergoing Definitive Chemoradiation using Intensity Modulated Radiotherapy for Anal Cancer

Publication date: Available online 22 March 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Karyn A. Goodman, Diana Julie, Andrea Cercek, Lajhem Cambridge, Kaitlin M. Woo, Zhigang Zhang, Abraham J. Wu, Diane L. Reidy, Neil H. Segal, Zsofia K. Stadler, Leonard B. Saltz
PurposeTo assess the impact on acute toxicity of replacing 5-fluorocuracil (5-FU) with capecitabine in definitive chemoradiation (CRT) for patients with anal squamous cell carcinoma (ASCC).Methods & MaterialsWe retrospectively reviewed the records of 107 consecutive patients with non-metastatic ASCC treated with definitive CRT from 01/09 – 5/14. In 2011, based on the non-inferiority of capecitabine vs 5-FU, our institutional practice shifted to use capecitabine instead of 5-FU for ASCC. Of 107 patients, 63 were treated with infusional 5-FU (1000 mg/m2/day for 4 days) and MMC (10 mg/m2) during weeks 1 and 5, and 44 pts were treated with capecitabine (825mg/m2 BID) M-F throughout RT and MMC (10mg/m2) during weeks 1 and 5. The incidence of Grade 3/4 acute toxicity was compared between the two groups.ResultsThe median age at diagnosis was 59 years and 78 (73%) were female. Patient characteristics were similar between the two treatment groups. All patients in both groups were treated with IMRT (median dose of 56 Gy). In the 5-FU group, 52% developed Grade 3/4 neutropenia compared with 20% the capecitabine group (p=0.001). Treatment breaks due to toxicity, primarily related to Grade 3+ hematalogic toxicity, were necessary for 42% treated with 5-FU versus 16% treated with capecitabine (p=0.006).ConclusionsPelvic radiotherapy with mitomycin plus capecitabine was well tolerated, and appeared to have less Grade 3+ acute hematologic toxicity and fewer treatment interruptions when compared to a population of ASCC patients undergoing definitive CRT with MMC and 5-FU.

Teaser

Replacing infusional 5-FU with capecitabine as part of definitive chemoradiation with concurrent Mitomycin C and pelvic radiotherapy for anal cancer resulted in a reduction in acute hematologic toxicity, in particular the neutropenia rates, as compared to patients treated with the standard 5-FU. The decreased acute hematologic toxicity resulted in fewer treatment delays which may ultimately translate into improved outcomes.


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