RATIONALE: Drugs used in chemotherapy, such as capecitabine and oxaliplatin, work in
different ways to stop the growth of tumor cells, either by killing the cells or by stopping
them from dividing. Selenomethionine may slow the growth of tumor cells. Radiation therapy
uses high-energy x-rays to kill tumor cells. Giving combination chemotherapy together With
selenomethionine and radiation therapy may kill more tumor cells.
PURPOSE: This phase II trial is studying how well selenomethionine works when given together
with capecitabine, oxaliplatin, and radiation therapy in treating patients undergoing surgery
for newly diagnosed stage II or stage III rectal cancer.
- To determine the complete pathological response rate of the combination of capecitabine,
oxaliplatin, selenomethionine, and radiotherapy in patients with stage II or III rectal
- To determine the T-downstaging rate with this regimen in patients with stage II or III
- To determine the safety of this regimen by assessing toxicity and dose intensity of the
various components of this regimen.
- To determine the rate of local relapse.
- To determine the rate of distant relapse.
OUTLINE: Patients receive neoadjuvant therapy comprising oral selenomethionine twice daily
for 1 week prior to radiotherapy and then once daily for 6 weeks. Patients also receive
oxaliplatin IV over 2 hours on days 1-7 and oral capecitabine twice daily on days 1-5 for 6
weeks and undergo radiotherapy 5 days a week for 6 weeks. Treatment continues in the absence
of disease progression or unacceptable toxicity.
Within 4-8 weeks after completion of neoadjuvant therapy, patients undergo curative-intent
surgery. Beginning 4-8 weeks after surgery, patients may receive up to 9 courses of standard
adjuvant combination chemotherapy (FOLFOX).
Blood samples are collected at baseline and weekly during treatment and analyzed by
absorption spectrophotometry for selenium measurement of drug concentration. Pharmacokinetic
studies are also performed.
After completion of study treatment, patients are followed for up to 5 years.
- Histologically confirmed rectal adenocarcinoma that is involving the distal 12 cm of
the rectum (above the anal verge)
- Staged within 8 weeks prior to initiation of study by endoscopic ultrasound OR
MRI or CT scan if endorectal ultrasound is non-conclusive or non-tolerable
- T3-T4 tumor or evidence of lymph node involvement defined by the presence of at
least 1 enlarged peri-rectal lymph node
- No evidence of distant or known metastases
- ECOG performance status (PS) 0-1 OR Karnofsky PS 70-100%
- Life expectancy > 1 year
- Leukocytes ≥ 3,000/µL
- Absolute neutrophil count ≥ 1,500/µL
- Platelet count ≥ 100,000/µL
- Total bilirubin ≤ upper limit of normal (ULN)
- AST/ALT ≤ 2.5 times ULN
- Creatinine ≤ ULN OR creatinine clearance ≥ 60 mL/min
- Able to receive oral medication
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- No other concurrent or previous malignancies unless disease free for > 5 years
(excluding nonmelanoma skin cancer)
- No neuropathy ≥ grade 2
- No history of allergic reaction attributed to compounds of similar chemical or
biologic composition to oxaliplatin, capecitabine, or selenomethionine
- No uncontrolled intercurrent illness including, but not limited to, any of the
- Ongoing or active infection
- Symptomatic congestive heart failure
- Unstable angina pectoris
- Cardiac arrhythmia
- Psychiatric illness/social situations that would limit compliance with study
PRIOR CONCURRENT THERAPY:
- No prior radiotherapy to the pelvis
- No prior chemotherapy
- No other concurrent investigational or anticancer agents or therapies
- No concurrent vitamin B6 supplementation (except as part of a standard, multivitamin