Eur J Cancer:奥沙利铂/卡培他滨联合放疗(OxCapRT)对比紫杉醇/卡铂联合放疗(CarPacRT)新辅助治疗对可切除食管腺癌的疗效和安全性:NeoSCOPE长期随访结果

2021-06-25 yd2015 MedSci原创

对于可手术切除的食管腺癌患者,紫杉醇/卡铂联合放疗对比奥沙利铂/卡培他滨联合放疗作为新辅助治疗有OS和PFS获益。同时,远处转移较局部复发更常见。

NeoSCOPE是英国开展的一项开放标签、多中心、随机、II期试验。纳入2013年10月至2015年2月 cT3 and/or cN1 (TNM v7)可手术切除的食管腺癌(OAC)或胃食管连接处(GOJ)腺癌患者。评估奥沙利铂/卡培他滨联合放疗(OxCapRT)对比紫杉醇/卡铂联合放疗(CarPacRT)用于此类患者术前新辅助治疗的疗效和安全性。主要研究终点为病理完全缓解率(pCR),次要研究终点为毒性,PFS、OS和进展模式。2017年已经报道,CarPacRT组和OxCapRT组的pCR率分别为29.3%11.1%。近期,European Journal of Cancer杂志发表了长期随访的结果。

研究纳入85例患者,两组中位随访时间分别为43.4个月 (95% CI: 37.7-53.6) 和51.0个月 (95% CI: 45.5-54.3)。 OxCapRT组中位OS为41.7个月(95%可信区间[CI] 19.6至未达),而CarPacRT组中位OS未达到(HR = 0.48, 95% CI: 0.24 -0.95, P= 0.035)。OxCapRT组的3年和5年的OS率分别为52% (95% CI: 35%-67%)和 39% (95% CI: 21%-56%); CarPacRT组的3年和5年的OS率分别为 74% (95% CI: 58%-85%) 和54% (95% CI: 33%-70%)。按肿瘤退缩级别(TRG)分为TRG3/4和TRG1/2两组,TRG3/4组患者中位OS为49.6个月 (95% CIs: 30.1 to not reached) ,而TRG 1/2组患者中位OS未达到,两组没有统计学差异 (HR=1.49, 95% CI: 0.70-3.17, P =0.301)。

                 os

OxCapRT组中位无进展生存期(PFS)为32.6个月(95% CI: 17.1-未达到), 而CarPacRT组中位无进展生存期(PFS)未达到(HR= 0.54, 95%CI: 0.29-1.01, P= 0.053)。两组的1年PFS率为68% [95% CI: 52-80] vs 81% [95% CI: 66-90]), 3年PFS率为47% [95% CI: 30-61] vs 63% [95% CI: 47e75]) 以及 5 年PFS率为19%[95% CI: 2e51]) vs 51% [95% CI: 32e67])。在两组中,出现远处转移进展是局部进展的两倍。

            PFS

在6个月时,OxCapRT组观察到更多的3/4级毒性反应,为15% 对比3%,但是没有统计学差异(p=0.069)。

综上,对于可手术切除的食管腺癌患者,紫杉醇/卡铂联合放疗对比奥沙利铂/卡培他滨联合放疗作为新辅助治疗有OS和PFS获益。同时,远处转移较局部复发更常见。

原始出处:

Somnath Mukherjee , Christopher Hurt , Ganesh Radhakrishna,et al. Oxaliplatin/capecitabine or carboplatin/paclitaxel-based preoperative chemoradiation for resectable oesophageal adenocarcinoma (NeoSCOPE): Long-term results of a randomised controlled trial. Eur J Cancer. 2021 Jun 19;153:153-161. doi: 10.1016/j.ejca.2021.05.020. Online ahead of print.

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1728998, encodeId=6f561e2899837, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Sat Mar 12 10:24:48 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1818821, encodeId=613118188210a, content=<a href='/topic/show?id=9687984e5e3' target=_blank style='color:#2F92EE;'>#随访结果#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98475, encryptionId=9687984e5e3, topicName=随访结果)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3ff68, 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2022, time=2022-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1967227, encodeId=1634196e227ab, content=<a href='/topic/show?id=87729e0451f' target=_blank style='color:#2F92EE;'>#长期随访#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97045, encryptionId=87729e0451f, topicName=长期随访)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4aa106, createdName=crystal0562, createdTime=Tue Jun 07 01:24:48 CST 2022, time=2022-06-07, status=1, ipAttribution=)]
  6. 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href='/topic/show?id=292f965e5b5' target=_blank style='color:#2F92EE;'>#铂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96575, encryptionId=292f965e5b5, topicName=铂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ca4034296500, createdName=ms3153534357578991, createdTime=Thu Jan 13 22:24:48 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1821022, encodeId=6c851821022ec, content=<a href='/topic/show?id=3488101119e7' target=_blank style='color:#2F92EE;'>#食管腺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101119, encryptionId=3488101119e7, topicName=食管腺)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bb182500058, createdName=yuhaisheng_ibp_32061711, createdTime=Tue Jan 25 06:24:48 CST 2022, time=2022-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1967227, encodeId=1634196e227ab, content=<a href='/topic/show?id=87729e0451f' target=_blank style='color:#2F92EE;'>#长期随访#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97045, encryptionId=87729e0451f, topicName=长期随访)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4aa106, createdName=crystal0562, createdTime=Tue Jun 07 01:24:48 CST 2022, time=2022-06-07, status=1, ipAttribution=)]
    2021-12-11 smlt2008
  7. 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多项研究表明,新辅助放化疗(NCRT)可有效降低局部晚期直肠癌的分期,并在大约20%的患者中达到病理完全缓解(pCR)。

JAMA Surg:局部晚期食管癌食管切除术前是新辅助放化疗还是新辅助化疗?

局部晚期食管癌患者采用单纯手术治疗往往会复发或转移,导致患者预后不良,术前是额外予以新辅助放化疗还是新辅助化疗?

Radiology:灌注CT评价胰腺导管内腺癌新辅助放化疗的效果

背景:CT图像中肿瘤大小尚不足以有效地评价新辅助放化疗(CRT)的治疗效果,且与组织学分级相关性较差。本研究旨在验证利用灌注CT预测胰腺导管内腺癌(PDA)对CRT的治疗反应。

Nat Commun:哪些局部晚期直肠癌患者才能从化疗中获益?

辅助化疗只能降低DM的风险,并只在某些亚组患者中提供额外的生存获益,还有一些患者在治疗后甚至可能获得更糟糕的结果。因此,如何检测出可以从辅助化疗中获益的LARC患者至关重要。