Systematic review of treatment intensification using novel agents for chemoradiotherapy in rectal cancer

R Clifford, N Govindarajah, J L Parsons, S Gollins, N P West, D Vimalachandran

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: With the well established shift to neoadjuvant treatment for locally advanced rectal cancer, there is increasing focus on the use of radiosensitizers to improve the efficacy and tolerability of radiotherapy. There currently exist few randomized data exploring novel radiosensitizers to improve response and it is unclear what the clinical endpoints of such trials should be.

METHODS: A qualitative systematic review was performed according to the PRISMA guidelines using preset search criteria across the PubMed, Cochrane and Scopus databases from 1990 to 2017. Additional results were generated from the reference lists of included papers.

RESULTS: A total of 123 papers were identified, of which 37 were included; a further 60 articles were obtained from additional referencing to give a total of 97 articles. Neoadjuvant radiosensitization for locally advanced rectal cancer using fluoropyrimidine-based chemotherapy remains the standard of treatment. The oral derivative capecitabine has practical advantages over 5-fluorouracil, with equal efficacy, but the addition of a second chemotherapeutic agent has yet to show a consistent significant efficacy benefit in randomized clinical assessment. Preclinical and early-phase trials are progressing with promising novel agents, such as small molecular inhibitors and nanoparticles.

CONCLUSION: Despite extensive research and promising preclinical studies, a definite further agent in addition to fluoropyrimidines that consistently improves response rate has yet to be found.

Original languageEnglish
Pages (from-to)1553-1572
Number of pages20
JournalBritish Journal of Surgery
Volume105
Issue number12
DOIs
Publication statusPublished - Nov 2018

Bibliographical note

© 2018 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

Keywords

  • Angiogenesis Inhibitors/administration & dosage
  • Antimetabolites, Antineoplastic/administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols/therapeutic use
  • Bevacizumab/administration & dosage
  • Capecitabine/administration & dosage
  • Chemoradiotherapy/methods
  • Clinical Trials, Phase II as Topic
  • Clinical Trials, Phase III as Topic
  • ErbB Receptors/antagonists & inhibitors
  • Fluorouracil/administration & dosage
  • Humans
  • Immunotherapy/methods
  • Irinotecan/administration & dosage
  • Neoadjuvant Therapy
  • Oxaliplatin/administration & dosage
  • Poly(ADP-ribose) Polymerase Inhibitors/administration & dosage
  • Radiation-Sensitizing Agents/administration & dosage
  • Randomized Controlled Trials as Topic
  • Rectal Neoplasms/therapy
  • Sorafenib/administration & dosage

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