Complete pathological response to bevacizumab and chemoradiation in advanced rectal cancer

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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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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