Capecitabine with Mitomycin Reduces Acute Hematologic Toxicity and Treatment Delays in Patients undergoing Definitive Chemoradiation using Intensity Modulated Radiotherapy for Anal Cancer
Menée à partir de données portant sur 107 patients atteints d'un carcinome épidermoïde de l'anus traité entre 2009 et 2011 (âge médian au diagnostic : 59 ans ; 73% de femmes), cette étude met en évidence, du point de vue de la toxicité aiguë, l'intérêt de remplacer le 5-fluorouracile par la capécitabine dans le cadre d'un traitement définitif combinant une chimiothérapie par mitomycine et une radiothérapie avec modulation d'intensité ciblant la région pelvienne
Purpose : To 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 & Materials : We 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. Results : The 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). Conclusions : Pelvic 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.