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Vienna, Austria

ESTRO 2023

Session Item

Saturday
May 13
16:45 - 17:45
Hall A
Lower GI
Fatjona Kraja, Albania;
Karen-Lise Spindler, Denmark
Proffered Papers
Clinical
17:35 - 17:45
Capecitabine or 5-fluorouracil infusion with radiotherapy of anal cancers in the FFCD-Anabase cohort
Anne-Charlotte Delhiat, France
OC-0277

Abstract

Capecitabine or 5-fluorouracil infusion with radiotherapy of anal cancers in the FFCD-Anabase cohort
Authors:

Anne-Charlotte DELHIAT1, Claire Lemanski2, Karine Le-Malicot3, Angélique Saint4, Eleonor Rivin del Campo5, Pascal Pommier6, Pauline Regnault7, Nabil Baba-Hamed8, Philippe Ronchin9, Laurent Quéro10,11, Elodie Ménager-Tabourel12, Olivia Diaz13, Astrid Lièvre14,15, David Tougeron16, Françoise Mornex17, Anne Larrouy18, Nicolas Barbier19, Véronique Vendrely1,20

1CHU Bordeaux, Radiation Oncology, Bordeaux, France; 2Montpellier Cancer Institute (ICM) , Radiation Oncology, Montpellier, France; 3Fédération Francophone de Cancérologie Digestive, university of Burgundy, Biostatistics, Dijon, France; 4Antoine Lacassagne Cancer Center, Radiation Oncology, Nice, France; 5Tenon University Hospital, APHP, Sorbonne University, Radiation Oncology, Paris, France; 6Léon Bérard Cancer Center, Radiotherapy, Lyon, France; 7Tivoli Clinic, Radiotherapy, Bordeaux, France; 8Saint-Joseph Hospital group, Oncology, Paris, France; 9Azuréen Cancer Center, Radiotherapy, Mougins, France; 10Université Paris Cité, INSERM U1160, Paris, France; 11Saint Louis Hospital, APHP, Radiotherapy, Paris, France; 12Hospital of Vendée, Medical Oncology, La Roche sur Yon, France; 13Daniel Hollard Institute, Radiotherapy, Grenoble, France; 14Rennes University Hospital, Gastroenterology, Rennes, France; 15Rennes 1 University, Inserm U1242 COSS, Rennes, France; 16Poitiers University hospital, Hepatology and Gastroenterology , Poitiers, France; 17Université Claude Bernard Lyon 1, Radiation Oncology, Lyon, France; 18Cancer institute, North Paris, Radiation Oncology, Paris, France; 19Catalan Oncology Center, Medical Oncology, Perpignan, France; 20University of Bordeaux, BRIC (BoRdeaux Institute of onCology), UMR1312, INSERM, Bordeaux, France

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Purpose or Objective

Chemoradiotherapy (CRT) with intravenous 5-fluorouracil (5FU-IV) and mitomycin C (MMC) is the standard treatment for anal canal cancer. Capecitabine, an oral precursor of 5FU, can be proposed (option) as an alternative to 5FU-IV but its equivalence is not validated. Our study evaluates the efficacy and toxicity of capecitabine compared to 5FU-IV in combination with MMC and conformal intensity modulated radiotherapy (IMRT) in patients treated for squamous cell carcinoma of the anal canal (SCCA) from the FFCD-ANABASE cohort.

Material and Methods

Based on the FFCD-ANABASE cohort, a French national prospective multicenter observational study, we compared patients treated with CRT in IMRT, using MMC and 5FU-IV or MMC and capecitabine. The primary endpoint was 3-year recurrence-free survival (RFS). Secondary endpoints included overall survival (OS), anal cancer specific survival (ACSS), colostomy-free survival (CFS), tumor control rate, and toxicity (grade ≥ 3).

Results

Among 1015 patients treated for non-metastatic SCCA with IMRT between January 2015 and April 2020 in the FFCD-ANABASE cohort, 542 patients (401 women and 141 men) had a concomitant chemotherapy with 5FU-IV and MMC (n=404) or capecitabine and MMC (n=138). The median age was 64 years (35-92). Patient and tumor characteristics were not significantly different between groups. The median radiation dose was 60 Gy (IQ 59.4-64.8). The median follow-up was 35.94 months (95% CI 35.25-36.86). The 3-year RFS was 76.8% for the 5FU-IV-MMC group (95% CI 71.89-80.96%) and 76.59% for the capecitabine-MMC group (95% CI 66.92-83.77%) with no statistically significant difference. The 3-year OS was 85.35% and 82.89%, 3-year ACSS was 90.96% and 89.93%, CFS was 81.7% and 86.2%, respectively for the 5FU-IV-MMC and capecitabine-MMC groups. The tumor control rate was 83.4% for the 5FU-IV-MMC group and 84.8% for the capecitabine-MMC group. Acute toxicity grade 3 or higher was more frequent in the 5FU-IV-MMC group (n=189; 46.8%) compared to the capecitabine-MMC group (n=49; 35.5%), p=0.02. Radiotherapy interruption was required for 41.3% patients in the 5FU-IV-MMC group versus 17.4% in the capecitabine-MMC group, p<0.001.

Conclusion

Although there is no prospective randomized trial, our observational study showed in a large population of patients treated for SCCA, a similar efficacy of capecitabine compared to 5FU-IV in combination with MMC and IMRT. Treatment with 5FU-IV-MMC appeared to be more toxic, with a significantly higher number of treatment interruptions. Capecitabine is not only equivalent but also has reduced toxicity and should be recommended in combination with MMC and IMRT.