ASCO 2011- Updates in Colorectal Cancer -Axel GrotheyProfessor of OncologyMayo Clinic RochesterNoteworthy at ASCO for CRC?No practice-changing information, but confirmation of standards of care• Early rectal cancer:• Capecitabine can be used as radiosensitizer in neoadjuvant therapy• Addition of oxaliplatin more toxic, no increase in pCR rate• Is there a role for TNT (Total Neoadjuvant Therapy)?Noteworthy at ASCO for CRC?• Early colon cancer:• Value of oxaliplatin as adjuvant therapy in stage II cancers debatable • Palliative therapy of CRC:• IGF-R1 inhibitors conclusively ineffective• Not all KRAS mutations are created equal• Aflibercept (VEGF-TRAP) is active and improves OS in 2nd line added to FOLFIRI(to be presented in Barcelona)The Impact of Capecitabine and Oxaliplatin in the Preoperative Multimodality Treatment of Patients with Carcinoma of the Rectum: NSABP R-04MS Roh, GA Yothers, MJ O'Connell, RW Beart, HC Pitot, AF Shields, DS Parda, S Sharif, CJ Allegra, NJ Petrelli, JC Landry, DP Ryan, A Arora, TL Evans, GS Soori,L Chu, RV Landes, M Mohiuddin, S Lopa, N Wolmark1400 PatientsGroup 4Capecitabine 825 mg/m2 PO BID + Oxaliplatin 50 mg/m2/week X 5+4600cGy + 540-1080cGyAdenocarcinoma of rectum amenable to surgical resection located < 12 cm from anal vergeSTRATIFICATIONGenderClinical Tumor Stage II or IIIIntent for Type of Surgery (sphincter saving; non-sphincter saving)RANDOMIZATIONGroup 3Capecitabine 825 mg/m2 PO BID +4600cGy + 540-1080cGyGroup 25FU (CVI 225mg/m2 5d/week) + Oxaliplatin 50 mg/m2/week X 5 +4600cGy + 540-1080cGyGroup 15FU (CVI 225mg/m2 5d/week)+4600cGy + 540-1080cGySURGERYRoh et al. ASCO 2011Gastrointestinal Toxicity5-Fu or CAPE vs addition of OxaliplatinGI Toxicity**No OxaliOxaliTotal< Grade 3...
