Transcript Patterns of Care in Medical Oncology

Patterns of Care in
Medical Oncology
Neoadjuvant and Adjuvant
Treatment of Rectal Cancer
To approximately how many patients with rectal
cancer have you administered neoadjuvant
chemoradiation therapy in the past year?
Median
16
8
In approximately what percent of these patients was an
endorectal ultrasound performed?
Average percent
Clinical investigators
89%
Practicing oncologists
64%
Preoperative radiation therapy combined with
capecitabine and oxaliplatin versus radiation
therapy combined with 5-FU and oxaliplatin
for patients with resectable rectal cancer
Protocol ID: NSABP-R-04, Target Accrual: 1,606 (Open)
5-FU + radiation therapy
R
Continuous infusion 5-FU 225 mg/m2 per day for
5 days per week on days of planned radiation
therapy (RT*)
5-FU + radiation therapy + oxaliplatin
Same as arm 1, with oxaliplatin 50 mg/m2 weekly
x 5 during RT*
* 4,500 cGy in 25 fractions over five weeks with a 540-cGy boost in three fractions for
nonfixed tumors or a 1,080-cGy boost in six fractions for fixed tumors
Source: NSABP-R-04 Protocol, November 24, 2008.
Preoperative radiation therapy combined with
capecitabine and oxaliplatin versus radiation
therapy combined with 5-FU and oxaliplatin
for patients with resectable rectal cancer
Protocol ID: NSABP-R-04, Target Accrual: 1,606 (Open)
Capecitabine + radiation therapy
R
Capecitabine 825 mg/m2 BID 5 days per week on
days of planned RT*
Capecitabine + radiation therapy + oxaliplatin
Same as arm 3, with oxaliplatin 50 mg/m2 weekly
x 5 during RT*
* 4,500 cGy in 25 fractions over five weeks with a 540-cGy boost in three fractions for
nonfixed tumors or a 1,080-cGy boost in six fractions for fixed tumors
Source: NSABP-R-04 Protocol, November 24, 2008.
When administering a fluoropyrimidine
during radiation therapy, which regimen do
you generally recommend?
Continuous infusion 5-FU/LV
68%
67%
Capecitabine
32%
31%
Bolus 5-FU/LV
0%
2%
Clinical investigators
Practicing oncologists
Patients who receive 5-FU/LV with radiation
therapy for neoadjuvant treatment of rectal
cancer and have positive nodes in the resection
specimen postoperatively should generally
receive which of the following regimens?
100%
73%
FOLFOX + biologic (bev or cetuximab)
0%
13%
5-FU/LV
0%
8%
Capecitabine
0%
5%
FOLFIRI
0%
1%
FOLFOX
Clinical investigators
Practicing oncologists
Have you used oxaliplatin off protocol as
part of neoadjuvant chemoradiation therapy
for rectal cancer?
% answering yes
48%
22%
For approximately how many patients have you used
oxaliplatin off protocol as part of neoadjuvant chemoradiation
therapy for rectal cancer?
Median
13
CI n = 12; PO n = 22
Clinical investigators
Practicing oncologists
3
Have you used bevacizumab off protocol
as part of neoadjuvant chemoradiation
therapy for rectal cancer?
0%
% answering yes
7%
For approximately how many patients have you used
bevacizumab off protocol as part of neoadjuvant
chemoradiation therapy for rectal cancer?
0
Median
CI n = 0; PO n = 7
Clinical investigators
Practicing oncologists
5
For the patient with rectal cancer at the
anal verge who achieves a clinical complete
response with a negative biopsy of the primary
site after neoadjuvant chemoradiation therapy,
surveillance with delayed resection at
recurrence is acceptable.
Agree
4%
29%
In between
8%
22%
Disagree
88%
29%
I don’t know
0%
20%
Clinical investigators
Practicing oncologists
Case 6: Rectal Cancer
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A 65-year-old man in average health
T3N0 rectal cancer by endoscopic ultrasound
Lesion is 8 centimeters from the anal verge
Which of the following treatment strategies are you most likely to
recommend for this patient?
Chemoradiation therapy followed by resection
+ chemotherapy
76%
58%
Chemoradiation therapy followed by resection
alone
8%
14%
Resection followed by adjuvant chemotherapy
8%
2%
Neoadj radiation therapy followed by resection
and chemotherapy
4%
10%
Immediate resection
4%
2%
Resection followed by adjuvant
chemoradiation therapy
0%
8%
Other
0%
6%
Clinical investigators
Practicing oncologists
Case 7: Rectal Cancer
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A 65-year-old man in average health
T3N1 rectal cancer (2 enlarged lymph nodes on endoscopic ultrasound)
Lesion is 8 centimeters from the anal verge
Which of the following treatment strategies are you most likely to
recommend for this patient?
Chemoradiation therapy followed by resection
+ chemotherapy
88%
68%
Radiation therapy followed by resection +
chemotherapy
12%
11%
Resection followed by adjuvant
chemoradiation therapy
0%
5%
Chemoradiation therapy followed by resection
alone
0%
5%
Chemotherapy followed by resection +
chemoradiation therapy
0%
5%
Other
0%
6%
Clinical investigators
Practicing oncologists
Case 8: Rectal Cancer After Neoadjuvant Treatment
and with Complete Pathologic Response Evident on
Resection, Including Absence of Residual Nodal Disease
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Man in average health
T3N1 rectal cancer (2 enlarged lymph nodes on endoscopic ultrasound)
Lesion is 8 centimeters from the anal verge
Undergoes neoadjuvant chemoradiation therapy with XELOX/CAPOX
Complete pathologic response evident on resection
Which postoperative therapy are you most likely to recommend for this
patient?
FOLFOX
64%
49%
XELOX/CAPOX
24%
19%
5-FU/LV (infusion or bolus) ± biologic
8%
7%
FOLFOX + bevacizumab
0%
6%
FLOX
0%
6%
Other systemic therapy
4%
6%
Observation / I would not recommend systemic
therapy
0%
7%
Clinical investigators
Practicing oncologists