Effect of neoadjuvant treatment on locally advanced rectal mucinous adenocarcinoma or signet-ring cell carcinoma: A post-hoc analysis from 3 prospective studies.

Authors

null

Jianwei Zhang

The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

Jianwei Zhang , Yanhong Deng , Yue Cai , Huabin Hu , Zehua Wu , Jiayu Ling

Organizations

The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, Sun Yat-sen University, Guangzhou, China, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

Research Funding

Other

Background: Mucinous adenocarcinoma and signet-ring cell carcinoma were uncommon in locally advanced rectal cancer. And it has been reported that both mucinous adenocarcinoma and signet-ring cell carcinoma showed poor response to standard neoadjuvant chemoradiotherapy. Here, we tried to compare the efficacy of different neoadjuvant treatment regimen on locally advanced rectal mucinous adenocarcinoma or signet-ring cell carcinoma (M/S). Methods: We enrolled patients with locally advanced rectal cancer from 3 prospective clinical trials (NCT01211210, NCT02217020 and NCT02887313), including FOWARC study (N = 309), mFOLFOXIRI neoadjuvant chemotherapy trial (N = 103) and the total neoadjuvant treatment with FOLFOX and radiotherapy (N = 129). Among the 541 patients, 41 (7.6%) patients were M/S and 500 were non-M/S. Totally, 7 M/S patients and 84 non-M/S patients received 5FU concurrent with radiotherapy (Group A), 20 M/S patients and 208 non-M/S underwent FOLFOX concurrent with radiation or total neoadjuvant treatment (Group B), 11 M/S patients and 92 non-M/S patients underwent mFOLFOXIRI neoadjuvant chemotherapy alone (Group C). Other 3 M/S patients and 116 non-M/S patients received FOLFOX neoadjuvant chemotherapy alone (Group D). Results: Among M/S patients, only 4 (9.7%) achieved pathologic complete response (pCR), and 6 (14.6%) patients had tumor downstaging to ypstage 0-I. In group A, the pCR rate was 14.3% and 11.9% (p = 0.85), and the tumor downstaging rate was 14.3% and 36.9% (p = 0.22) in M/S and non-M/S patients, respectively. In group B, the pCR rate was 15.0% and 34.6% (p = 0.07), and the tumor downstaging rate was 25.0% and 60.1% (p = 0.002) in M/S and non-M/S patients, respectively. However, in group C and group D with chemotherapy alone as neoadjuvant treatment, no M/S patients showed pCR or tumor downstaging; while in non-M/S patients higher tumor downstaging rate was observed. Conclusions: M/S showed resistance to neoadjuvant chemotherapy along regimens. Even with chemoradiotherapy, M/S patients showed poorer response than that of non/M/S patients. Further study was warranted to explore the new regimen for M/S patients.

RegimensHistologyNpCRPypStage 0-IP
5FU+RTM/S71 (14.3%)0.851 (14.3%)0.22
Non-M/S8410 (11.9%)31 (36.9%)
FOLFOX+RTM/S203 (15.0%)0.075 (25.0%)0.002
Non-M/S20872 (34.6%)125 (60.1%)
mFOLFOXIRIM/S1100.0700.0001
Non-M/S9221 (22.8%)44 (47.8%)
FOLFOXM/S300.6400.17
Non-M/S1168 (6.9%)45 (38.8%)

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Abstract Details

Meeting

2019 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal (Colorectal) Cancer

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Colorectal Cancer–Local-Regional Disease

Citation

J Clin Oncol 37, 2019 (suppl; abstr 3608)

DOI

10.1200/JCO.2019.37.15_suppl.3608

Abstract #

3608

Poster Bd #

100

Abstract Disclosures