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Complete pathological response to bevacizumab and chemoradiation in advanced rectal cancer

Nature Clinical Practice Oncology volume 4, pages 316–321 (2007)Cite this article

Abstract

Background Localized rectal cancer responds well to 5-fluorouracil and radiation-based regimens. A phase I–II trial is currently testing the efficacy of adding bevacizumab, a VEGF-specific antibody, to standard chemoradiotherapy. The case presented here is a complete pathological response seen in a patient with extensive and locally invasive carcinoma after receiving this combined treatment.

Investigations Physical examination, rectal ultrasound, PET–CT scan, laboratory tests, proctoscopic examination, chest radiograph, rectal forcep biopsies with immunohistochemistry, and protein and flow cytometric analyses.

Diagnosis Large, invasive, ultrasound stage T4 carcinoma of the rectum, which was positive for survivin.

Management One 2-week cycle of bevacizumab alone, followed by 3 cycles of bevacizumab with continuous 5-fluorouracil infusion, and external-beam radiation therapy given 5 days per week to the pelvis, abdominoperineal resection with posterior vaginectomy, hysterectomy and bilateral salpingo-oophorectomy.

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Figure 1: Combination treatment schema for patients with rectal cancer enrolled in a clinical trial
Figure 2: Evaluation of tumor response using imaging
Figure 3: Microscopic evaluation of tumor response

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Acknowledgements

DGD, EdT and YB contributed equally to this work. The authors thank J Ashton, S Roberge, and C Smith for outstanding technical support. This study was supported by National Cancer Institute research grants (R21- CA099237 to CGW, PO1-CA80124 to RKJ and RO1-CA98706 to YB) and a National Foundation for Cancer Research grant (to RKJ and CGW). The research of DGD and EdT is supported in part by a grant from the American Association for Cancer Research-Genentech BioOncology and by a Claflin Award, respectively.

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Authors and Affiliations

  1. and Z Vujaskovic is an Associate Professor in the Department of Radiation Oncology; M Poleski is a Professor, and J Bendell is an Assistant Professor in the Department of Medicine; R Bentley is an Associate Professor in the Department of Pathology; E Paulson is a Professor and TZ Wong is an Assistant Professor in the Department of Radiology; and KA Ludwig is an Assistant Professor of Surgery and the Chief of Colorectal and Gastrointestinal Surgery, CG Willett is the Prosnitz Professor of Radiation Oncology and Chairman, BG Czito is an Assistant Professor, G Vlahovic and HI Hurwitz are Associate Professors, all at the Duke University Medical Center, Durham, NC, USA.,

    Christopher G Willett, Brian G Czito, Zeljko Vujaskovic, Johanna Bendell, Herbert I Hurwitz, Rex Bentley, Martin Poleski, Terence Z Wong, Erik Paulson & Kirk A Ludwig

  2. and J Bendell is an Assistant Professor in the Department of Medicine, M Poleski is a Professor, G Vlahovic and HI Hurwitz are Associate Professors,

    Christopher G Willett, Brian G Czito, Zeljko Vujaskovic, Johanna Bendell, Herbert I Hurwitz, Rex Bentley, Martin Poleski, Terence Z Wong, Erik Paulson & Kirk A Ludwig

  3. Y Boucher is an Associate Professor and DG Duda and E di Tomaso are Instructors in the Department of Radiation Oncology; KS Cohen is an Instructor in the Department of Hematology/Oncology; and GY Lauwers is an Associate Professor of Pathology, RK Jain is the Cook Professor of Tumor Biology and Director of the Steele Laboratory, and Director of the Gastrointestinal Pathology Service, all at the Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.,

    Dan G Duda, Emmanuelle di Tomaso, Yves Boucher, Kenneth S Cohen, Gregory Y Lauwers & Rakesh K Jain

  4. KS Cohen is an Instructor in the Department of Hematology/Oncology,

    Dan G Duda, Emmanuelle di Tomaso, Yves Boucher, Kenneth S Cohen, Gregory Y Lauwers & Rakesh K Jain

Authors
  1. Christopher G Willett
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  2. Dan G Duda
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  3. Emmanuelle di Tomaso
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  4. Yves Boucher
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  5. Brian G Czito
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  6. Zeljko Vujaskovic
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  7. Gordana Vlahovic
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  8. Johanna Bendell
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  9. Kenneth S Cohen
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  10. Herbert I Hurwitz
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  11. Rex Bentley
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  12. Gregory Y Lauwers
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  13. Martin Poleski
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  14. Terence Z Wong
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  15. Erik Paulson
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  16. Kirk A Ludwig
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  17. Rakesh K Jain
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Corresponding author

Correspondence to Christopher G Willett.

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Competing interests

CG Willett has received honaria for lectures, BG Czito is a recipient of research support and J Bendell serves as a consultant for Genentech. HI Hurwitz has received honaria, is recipient of clinical research support and serves as consultant for Genentech and Roche. RK Jain is a recipient of a research grant from AstraZeneca and serves as a consultant. RK Jain has been a consultant for Novartis, Thrombogenics, Pfizer and Dyax, and has received honorarium from Nektar, Pfizer and Roche. The other authors declared they have no competing interests.

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Willett, C., Duda, D., di Tomaso, E. et al. Complete pathological response to bevacizumab and chemoradiation in advanced rectal cancer. Nat Rev Clin Oncol 4, 316–321 (2007). https://doi.org/10.1038/ncponc0813

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