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Multidisciplinary treatment of rectal cancer. Medical oncology

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Multidisciplinary treatment of rectal cancer. Medical oncology

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    1. Multidisciplinary treatment of rectal cancer. Medical oncology Carlo Aschele E.O. Ospedali Galliera – Genova - Italy

    2. Multidisciplinary treatment of rectal cancer

    3. Standard treatment of locally advanced rectal cancer

    4. Role of chemotherapy PRE-OP RT +/- CONCOMITANT CT

    5. Role of chemotherapy PRE-OP RT +/- CONCOMITANT CT

    7. Standard treatment of locally advanced rectal cancer

    11. PRE-OP CHEMORADIATION: ORAL FP’s

    13. Decline in the rates of local failure: 1980s–2000s Local failure: the war we are winning · SX only: 30% norvegese 25% NSABP R-01 24% GITSG 1* · SX + RT: 25% Mayo-NCCTG* 20% GITSG 1* 16% NSABP R-01 · SX + CMT: 16% GITSG 2* 13% Mayo-NCCTG* 12% norvegese 11% GITSG 1* 11% INT 0114 3-y (media) 8% NSABP R02* 7% INT-PVI (media) · TME +RT : 3% Dutch Local failure: the war we are winning · SX only: 30% norvegese 25% NSABP R-01 24% GITSG 1* · SX + RT: 25% Mayo-NCCTG* 20% GITSG 1* 16% NSABP R-01 · SX + CMT: 16% GITSG 2* 13% Mayo-NCCTG* 12% norvegese 11% GITSG 1* 11% INT 0114 3-y (media) 8% NSABP R02* 7% INT-PVI (media) · TME +RT : 3% Dutch

    14. Proportion of patients with distant metastases: 1980s–2000s Local failure: the war we are winning · SX only: 30% norvegese 25% NSABP R-01 24% GITSG 1* · SX + RT: 25% Mayo-NCCTG* 20% GITSG 1* 16% NSABP R-01 · SX + CMT: 16% GITSG 2* 13% Mayo-NCCTG* 12% norvegese 11% GITSG 1* 11% INT 0114 3-y (media) 8% NSABP R02* 7% INT-PVI (media) · TME +RT : 3% Dutch Local failure: the war we are winning · SX only: 30% norvegese 25% NSABP R-01 24% GITSG 1* · SX + RT: 25% Mayo-NCCTG* 20% GITSG 1* 16% NSABP R-01 · SX + CMT: 16% GITSG 2* 13% Mayo-NCCTG* 12% norvegese 11% GITSG 1* 11% INT 0114 3-y (media) 8% NSABP R02* 7% INT-PVI (media) · TME +RT : 3% Dutch

    15. ONGOING STUDIES OF COMBINATION CHEMOTHERAPY IN LARC Post-op E3201 E5204 Chronicle Pre-op STAR NASBP R-04 Pre and post-op PETACC-6

    16. Rationale for incorporation of new agents in the treatment of rectal cancer To improve control at distant sites To improve R0 resection rates (esp. big T3, T4 and tethered tumours) To enhance down-sizing and SPS (Potential) prognostic value of pCR and down-staging

    18. PRE-OP CHEMORADIATION INCORPORATION OF BIOLOGICS Cetuximab + FU (1) pCR=12% + cape (1) pCR=5% + cape/ox (1) pCR=8% + cape/iri (2) pCR=25-20% ??: adk=squamous - ras - arrest of cell cycle progression Bevacizumab + FU (1) no pCR at the RD / surrogate markers + cape/oxa (1) pcR: 18% ??: toxicity - normalization vs antivascular effect - timing

    19. MULTIDISCIPLINARY TREATMENT OF RECTAL CANCER

    20. PRE-OP CHEMORADIATION INCORPORATION OF BIOLOGICS Better understanding of underlying biology Definition of optimal timing and duration (induction vs concomitant or both) Definition of an appropriate back-bone regimen Patient selection

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