Skip to main content
Free access
ORIGINAL REPORTS
May 05, 2014

Capecitabine and Oxaliplatin in the Preoperative Multimodality Treatment of Rectal Cancer: Surgical End Points From National Surgical Adjuvant Breast and Bowel Project Trial R-04

Publication: Journal of Clinical Oncology
PDF

Abstract

Purpose

The optimal chemotherapy regimen administered concurrently with preoperative radiation therapy (RT) for patients with rectal cancer is unknown. National Surgical Adjuvant Breast and Bowel Project trial R-04 compared four chemotherapy regimens administered concomitantly with RT.

Patients and Methods

Patients with clinical stage II or III rectal cancer who were undergoing preoperative RT (45 Gy in 25 fractions over 5 weeks plus a boost of 5.4 Gy to 10.8 Gy in three to six daily fractions) were randomly assigned to one of the following chemotherapy regimens: continuous intravenous infusional fluorouracil (CVI FU; 225 mg/m2, 5 days per week), with or without intravenous oxaliplatin (50 mg/m2 once per week for 5 weeks) or oral capecitabine (825 mg/m2 twice per day, 5 days per week), with or without oxaliplatin (50 mg/m2 once per week for 5 weeks). Before random assignment, the surgeon indicated whether the patient was eligible for sphincter-sparing surgery based on clinical staging. The surgical end points were complete pathologic response (pCR), sphincter-sparing surgery, and surgical downstaging (conversion to sphincter-sparing surgery).

Results

From September 2004 to August 2010, 1,608 patients were randomly assigned. No significant differences in the rates of pCR, sphincter-sparing surgery, or surgical downstaging were identified between the CVI FU and capecitabine regimens or between the two regimens with or without oxaliplatin. Patients treated with oxaliplatin experienced significantly more grade 3 or 4 diarrhea (P < .001).

Conclusion

Administering capecitabine with preoperative RT achieved similar rates of pCR, sphincter-sparing surgery, and surgical downstaging compared with CVI FU. Adding oxaliplatin did not improve surgical outcomes but added significant toxicity. The definitive analysis of local tumor control, disease-free survival, and overall survival will be performed when the protocol-specified number of events has occurred.

Introduction

The propensity of rectal carcinoma to relapse in local as well as distant sites after potentially curative surgery has long been known.1,2 In the absence of a curative systemic therapy, this dual pattern of relapse has led to the development of a combined-modality therapy of operable rectal cancer—surgical resection, regional radiation therapy, and chemotherapy. Early randomized clinical trials in the United States demonstrated improved outcomes with postoperative combined radiation and fluorouracil (FU) chemotherapy.35 In 1994, a national intergroup trial6 demonstrated further improvement in outcomes when FU was given continuously during postoperative radiation therapy with the use of ambulatory infusion pumps, and thus established a standard of care in clinical practice.
Subsequently, the oral fluorinated pyrimidine prodrug capecitabine (Xeloda, Roche, Basel, Switzerland) was shown to have antitumor activity in metastatic colorectal cancer7,8 and was administered concomitantly with radiation therapy as a radiation sensitizer.9 The selective activation of capecitabine to its active metabolite within tumor cells in preclinical models10 provided a rationale that the use of this agent might be associated with an improved therapeutic index in patients with cancer when administered with radiation therapy. If it was tolerable and at least as active as FU in the adjuvant therapy of rectal cancer, it would be possible to eliminate the need for cumbersome ambulatory infusion pumps.
Oxaliplatin (Eloxatin, sanofi-aventis, Paris, France) was approved by the US Food and Drug Administration in 2004 for use in combination with a fluorinated pyrimidine for the treatment of advanced metastatic colorectal cancer,11 and was subsequently shown to be of value in the postoperative adjuvant therapy of colon cancer.12,13 This platinum analog also had in vitro radiation-sensitizing properties,14 and therefore was a good test as a component of combined-modality adjuvant therapy of rectal cancer.
Many European investigators have favored the preoperative (versus postoperative) use of radiation and chemotherapy to treat operable rectal cancer over the past several decades.15,16 A landmark randomized controlled trial of preoperative versus postoperative rectal cancer adjuvant radiation and chemotherapy was conducted in Germany, which clearly established the superiority of the preoperative sequence of radiation and chemotherapy before surgery,17 and changed the treatment paradigm in the United States.
With this background, the National Surgical Adjuvant Breast and Bowel Project (NSABP) led a national randomized intergroup clinical trial to test the value of capecitabine and oxaliplatin as components of preoperative (neoadjuvant) combined-modality therapy in patients with clinical stage II and III rectal cancer. Our article details the impact of treatment on the surgical outcomes of pathologic complete response (pCR), sphincter-sparing surgery, and surgical downstaging.

Patients and Methods

Patient Eligibility

NSABP R-04 was approved by local human investigations committees or institutional review boards in accordance with assurances filed with and approved by the US Department of Health and Human Services. Written informed consent was required.
Patients were required to be at least 18 years old with an Eastern Cooperative Oncology Group performance score of 0 to 1 and a life expectancy of 5 years (Fig 1). Adenocarcinoma of the rectum diagnosis had to have been established via a biopsy technique, which left the major portion of the tumor intact within 42 days before random assignment. The distal border of the tumor was required to be less than 12 cm from the anal verge, and the tumor had to be palpable by digital rectal exam or accessible via proctoscope or sigmoidoscope. The tumor had to be confirmed clinically (by transrectal ultrasonography and computed tomography [CT] scan or magnetic resonance imaging [MRI]) to be stage II (T3-4N0) or stage III (T1-4N1-2, with a positive node defined as at least 1.0 cm in diameter on imaging). There must have been no evidence of metastatic disease on physical examination, chest x-ray, or CT scan of the abdomen and pelvis. If technically feasible, a complete colonoscopic examination was performed; otherwise, a proctoscopic or sigmoidoscopic examination was performed. Satisfactory hematologic parameters, liver function tests and renal function tests were required. Patients with nonmalignant systemic disease, which would preclude safe administration of therapy or prescribed follow-up, were excluded. The tumor had to be considered amenable to curative resection by the surgeon, and there could be no evidence of pelvic sidewall involvement on imaging studies. Before random assignment, the investigator had to specify whether a sphincter-sparing operation was feasible or whether nonsphincter-sparing surgery would be required.
Fig 1. CONSORT diagram for NSABP (National Surgical Adjuvant Breast and Bowel Project) R-04. CAPE, capecitabine; cCR, complete clinical response; FU, fluorouracil; OX, oxaliplatin; pCR, pathologic complete response.

Random Assignment and Treatment

Patients were stratified by institution, sex, intended operative procedure (sphincter-saving surgery or non–sphincter-saving surgery), and clinical tumor stage (stage II [T3-4N0] or stage III [T1-4N1-2]). Patients were randomly assigned to treatment groups using the NSABP biased-coin minimization algorithm.18

Radiation Therapy

Radiation therapy was delivered at 1.8 Gy per day, five days per week, for a total of 25 fractions over 5 weeks, for a total dose of 45 Gy to the large pelvic field. A minimum boost of 5.4 Gy (administered over 3 days in 1.8 Gy fractions) was required for patients with T3 nonfixed cancer and nondistal tumors (total cumulative dose of 50.4 Gy, including large pelvic fields). For patients with T4 fixed cancer and/or distal rectal tumors, a boost dose of 10.8 Gy (given over 3 days in 3.6 Gy fractions) was required (total cumulative dose of 55.8 Gy, including large pelvic fields).

Chemotherapy

NSABP R-04 began in July 2004, and patients were randomly assigned to receive either radiation therapy plus FU (group 1) or radiation therapy plus capecitabine (group 2). For group 1, 225 mg/m2/day FU was delivered by continuous intravenous infusion (CVI), 7 days per week beginning the day of the start of radiation therapy and ending the evening of the last dose of radiation therapy. For group 2, oral capecitabine 825 mg/m2 was administered twice per day throughout the course of radiation therapy, 7 days per week beginning the day of the start of radiation therapy and ending with the last dose of radiation therapy.

Protocol Amendment

In October 2005, the protocol was amended to add oxaliplatin (50 mg/m2 intravenous [IV] once per week for 5 weeks during radiation therapy), creating a 2 × 2 factorial design with four treatment groups: radiation therapy plus FU (group 3), radiation therapy plus FU plus oxaliplatin (group 4), radiation therapy plus capecitabine (group 5), and radiation therapy plus capecitabine plus oxaliplatin (group 6). The daily dose of chemotherapy remained the same, but the number of days of capecitabine and FU treatment was reduced from 7 days per week to five, with administration of chemotherapy only on days of planned radiation therapy to reduce the incidence of severe diarrhea.
The protocol required surgery to be performed within 6 to 8 weeks after the completion of radiation therapy.

End Points

The primary end point of NSABP R-04 is time from random assignment to first locoregional failure. This will be presented in a future article.
The secondary end points of pCR, sphincter-sparing surgery, surgical downstaging, and toxicity are the focus of this article. pCR was determined by gross and microscopic examination of tissue removed at surgery. pCR was defined as no histologic evidence of invasive tumor cells in the surgical specimen at the site of the primary tumor or in the lymph nodes (or in tissue in the area where the tumor had been if there was a complete clinical response). The intended operative procedure was specified before random assignment (non–sphincter-sparing surgery or sphincter-sparing surgery). Surgical downstaging was defined as conversion from intended non–sphincter-sparing surgery at random assignment to sphincter-sparing surgery following chemoradiotherapy. Sphincter-sparing surgery as an end point is the rate of sphincter-sparing surgery regardless of intended surgery.

Toxicity

Toxicity data was graded based on the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 4.0. All grade 2 and higher adverse events from random assignment up until but not including the day of surgery are included in the toxicity analysis. If surgery was not performed, all grade 2 and higher adverse events from random assignment up until 60 days after completing chemoradiotherapy were included.

Statistical Methods

Toxicity analyses included all postamendment patients, and Fisher's exact test was used to test for differences in toxicity. All other analyses were conducted using eligible patients only, as specified in the protocol.
A patient was considered an early consent withdrawal if they withdrew consent less than 56 days after the end of protocol therapy or within 91 days of random assignment if the patient had not begun protocol therapy. These patients would not be expected to report surgical outcomes.
Patients for whom no surgery form was submitted or whose surgery form reported the patient did not have a resection are included in the surgical outcomes analysis as failures. The only exceptions to this are patients who had a complete clinical response and no surgery or patients who were early consent withdrawals. These patients were excluded from the surgical outcome analyses.
Fisher's exact test was used to test the difference between proportions. Cochran-Mantel-Haenszel tests were used to test for treatment differences controlling for the other treatment not being tested. The Breslow-Day test of homogeneity of the odds ratio was used to test for an oxaliplatin-fluoropyrimidine interaction. P values were two-sided and P < .05 is considered significant. Exact fiducial CIs were calculated for proportions.19
Comparisons between FU and capecitabine were performed using both pre- and postamendment populations, except for toxicity. Because patients were not assigned to oxaliplatin/no oxaliplatin groups before the amendment, comparisons between oxaliplatin and no-oxaliplatin effects were conducted only on the postamendment population.

Results

Accrual

The first patient was randomly assigned to the original two-arm study September 14, 2004. There were 293 patients who were accrued to the original two-arm study (FU, n = 147; capecitabine, n = 146). After the protocol was amended to include oxaliplatin, 1,315 patients were randomly assigned to the four-arm study: 330 patients to radiation therapy plus FU, 329 patients to radiation therapy plus FU plus oxaliplatin, 326 patients to radiation therapy plus capecitabine, and 330 patients to radiation therapy plus capecitabine plus oxaliplatin. On August 16, 2010, accrual was successfully completed with 1,608 patients. This slightly exceeded our target accrual of 1,606 patients.

Patient Characteristics

Table 1 lists the distribution of patient characteristics by treatment group. Thirteen patients (< 1%) were determined to be ineligible. Patient characteristics are similar across treatments both before and after the amendment. Clinical stage was roughly evenly balanced between stage II and III, both before and after the amendment. However, the proportion of stage II patients increased subsequent to the amendment. Overall, 96.5% of patients had a staging MRI or ultrasound. Among the 3.5% of patients whose primary tumor was staged only with CT or positron emission tomography/CT were those found to be T4 or to have enlarged regional lymph nodes consistent with metastatic disease and were not required to undergo ultrasound or MRI.
Table 1. Patient Entry and Characteristics: NSABP R-04
Characteristic Before Amendment After Amendment CAPE (4 Arm) CAPE + OX (4 Arm)
FU (2 Arm) CAPE (2 Arm) FU (4 Arm) FU + OX (4 Arm)
No. of Patients % No. of Patients % No. of Patients % No. of Patients % No. of Patients % No. of Patients %
Among all patients                        
    Randomly assigned 147   146   330   329   326   330  
    Ineligible 1   5   2   2   1   2  
    Average months on study* 89.0   89.1   54.0   54.1   54.3   54.1  
Age, years                        
    ≤ 59   59.2   52.7   56.1   61.4   57.1   61.2
    ≥ 60   40.8   47.3   43.9   38.6   42.9   38.8
Sex                        
    Male   68.0   67.8   67.0   68.1   67.8   67.6
    Female   32.0   32.2   33.0   31.9   32.2   32.4
Clinical stage                        
    II   49.7   46.6   61.5   61.7   62.3   61.5
    III   50.3   53.4   38.5   38.3   37.7   38.5
Surgical intent                        
    Sphincter sparing   74.8   71.9   73.6   73.6   74.2   73.3
    Not sphincter sparing   25.2   28.1   26.4   26.4   25.8   26.7
Abbreviations: CAPE, capecitabine; FU, flourouracil; NSABP, National Surgical Adjuvant Breast and Bowel Project; OX, oxaliplatin.
*
As of December 31, 2012.
As reported at the time of random assignment.

Outcomes for FU Compared With Capecitabine

Outcomes for patients receiving FU or capecitabine (with or without oxaliplatin) are listed in Table 2. Of the patients receiving FU, 17.8% had a pCR compared with 20.7% of those receiving capecitabine (P = .14). The proportion of patients who underwent sphincter-sparing surgery was 59.4% in the FU group and 59.3% in the capecitabine group (P = .98). Surgical downstaging was also similar (FU, 21.3%; v capecitabine, 21.1%; P = .95). Of patients receiving both FU and capecitabine, 11.7% of patients experienced grade 3+ diarrhea.
Table 2. Comparison of FU With CAPE: NSABP R-04
End Point FU (± OX) CAPE (± OX) P
No. of Patients % 95% CI (%) No. of Patients % 95% CI (%)
pCR 138 of 777 17.8 15.1 to 20.6 161 of 779 20.7 17.9 to 23.7 .14
SSS 463 of 780 59.4 55.8 to 62.8 462 of 779 59.3 55.8 to 62.8 .98
SD 43 of 202 21.3 15.9 to 27.6 44 of 209 21.1 15.7 to 27.2 .95
Grade 3-5 diarrhea* 75 of 639 11.7 9.3 to 14.5 75 of 641 11.7 9.3 to 14.4 1.0
Abbreviations: CAPE, capecitabine; FU, flourouracil; NSABP, National Surgical Adjuvant Breast and Bowel Project; OX, oxaliplatin; pCR, pathologic complete response; SSS, sphincter-sparing surgery; SD, surgical downstaging.
*
Restricted to the postamendment population, groups 3-6.
Two patients in the CAPE + OX arm died as a result of diarrhea.

Outcomes for Oxaliplatin Versus No Oxaliplatin

Outcomes for patients receiving either oxaliplatin or no oxaliplatin (with FU or capecitabine) are listed in Table 3. Of the patients receiving oxaliplatin, 19.5% had a pCR compared with 17.8% among patients not receiving oxaliplatin (P = .42). Patients not receiving oxaliplatin had higher proportions of sphincter-sparing surgery and surgical downstaging than did patients who did receive oxaliplatin (sphincter-sparing surgery: no oxaliplatin, 61.0% v oxaliplatin, 57.8%; P = .24; surgical downstaging: no oxaliplatin, 23.5% v oxaliplatin, 17.9%; P = .20), although these differences were not statistically significant. Patients receiving oxaliplatin had significantly more grade 3+ diarrhea (oxaliplatin, 16.5% v no oxaliplatin, 6.9%; P < .001).
Table 3. OX Versus No OX: NSABP R-04*
End Point No OX (FU or CAPE) OX (FU or CAPE) P
No. of Patients % 95% CI (%) No. of Patients % 95% CI (%)
pCR 113 of 636 17.8 14.9 to 21.0 125 of 640 19.5 16.5 to 22.8 .42
SSS 388 of 636 61.0 57.1 to 64.8 372 of 644 57.8 53.8 to 61.6 .24
SD 39 of 166 23.5 17.2 to 30.7 30 of 168 17.9 12.4 to 24.5 .20
Grade 3-5 diarrhea 44 of 636 6.9 5.1 to 9.2 106 of 644 16.5 13.7 to 19.6 < .001
Abbreviations: CAPE, capecitabine; FU, fluorouracil; NSABP, National Surgical Adjuvant Breast and Bowel Project; OX, oxaliplatin; pCR, pathologic complete response; SSS, sphincter-saving surgery; SD, surgical downstaging.
*
Restricted to a postamendment population, groups 3-6.
Two patients in the CAPE + OX arm died as a result of diarrhea.

Fluoropyrimidine-Oxaliplatin Interaction

There were no significant interactions between FU/capecitabine and oxaliplatin for pCR (P = .99), sphincter-sparing surgery (P = .52), or surgical downstaging (P = .33), suggesting the effect of oxaliplatin was independent of the fluoropyrimidine chemotherapy.

Postoperative Complications

Complications occurring from surgery through 30 days after surgery were included in the analysis and are listed in Table 4. Surgical complication data was available for 1,501 patients. The rate of postoperative complications varied from a low of 30.7% for preamendment FU arm to a high of 40.5% for the postamendment capecitabine plus oxaliplatin arm.
Table 4. NSABP R-04 Postoperative Complications of Eligible Patients With Resection (% of patients)
Complication Before Amendment* After Amendment*
FU (n = 140) CAPE (n = 131) FU (n = 308) FU + OX (n = 309) CAPE (n = 304) CAPE + OX (n = 309)
Any complication* 30.7 37.4 37.3 37.5 36.2 40.5
Death 0.7 0.0 0.3 0.7 0.7 0.0
Second operation was necessary 5.0 9.2 6.5 6.2 5.9 5.2
Abdominal wound infection 2.1 3.1 3.6 4.9 3.3 4.2
Perineal wound infection 3.6 3.1 5.5 5.5 4.0 5.2
Wound dehiscence/fistula 2.1 6.1 3.9 3.2 3.0 4.9
Intra-abdominal abscess 2.1 2.3 3.3 4.2 4.3 3.6
Bowel obstruction/ileus 8.6 6.9 7.5 7.8 8.2 9.4
Cardiopulmonary complication 2.1 4.6 2.9 1.6 2.3 3.2
Urinary complication 10.0 13.7 10.4 10.7 7.2 7.8
Anastomotic leak 2.1 3.1 1.3 3.6 3.0 1.6
Other complication 9.3 17.6 16.9 15.5 12.8 17.8
Abbreviations: CAPE, capecitabine; FU, flourouracil; NSABP, National Surgical Adjuvant Breast and Bowel Project; OX, oxaliplatin.
*
There were no significant differences in the proportion of patients reporting any postoperative complications. Testing was completed separately for groups before and after amendment.

Toxicity

Toxicity is listed in Table 5. Diarrhea was the most frequently reported grade 3+ toxicity. The incidence of grade 3+ diarrhea decreased from approximately 16% in the preamendment study arms to 7% in postamendment CVI FU and capecitabine arms when chemotherapy was reduced to only being administered on days radiation therapy was delivered. Significantly more grade 3+ diarrhea occurred in patients receiving oxaliplatin (oxaliplatin, 16.5% v no oxaliplatin, 6.9%; P < .001). The treatment-related mortality rate was 0.9% for patients receiving oxaliplatin (six of 644 patients), and approximately 41% of patients receiving oxaliplatin with radiation therapy had at least one grade 3 to 5 toxicity.
Table 5. NSABP R-04: Toxicity as of December 31, 2012 (% of patients)
Toxicity Before Amendment After Amendment
FU (n = 141) CAPE (n = 146) FU (n = 317) FU + OX (n = 322) CAPE (n = 319) CAPE + OX (n = 322)
Greatest toxicity            
    Grade 3 28.4 35.6 25.6 37.0 26.6 36.6
    Grade 4 2.8 2.7 0.6 2.8 2.2 3.7
    Grade 5 0.7 0.7 0.3 0.3 1.3 1.6
    Grades 3-5 31.9 39.0 26.5 40.1 30.1 41.9
Toxicity, greatest grade observed            
    Diarrhea, grades 3-5 15.6 17.1 6.9 16.5 6.9 16.5
    Nausea, grade 3 1.4 2.7 0.3 0.6 1.3 2.2
    Vomiting, grade 3 0 3.4 0.3 1.6 0 1.2
    Fatigue, grade 3 3.5 6.8 1.3 4.0 2.2 5.9
    Abdominal pain, grade 3 2.1 3.4 1.6 2.8 0.3 1.9
    Anal pain, grade 3 1.4 5.5 3.2 4.0 3.4 3.1
    Radiation dermatitis, grades 3-4 2.1 7.5 2.5 2.2 2.5 1.2
    Dehydration, grade 3 5.0 8.2 0.3 2.8 2.2 4.0
    Hand-foot syndrome, grade 3 1.4 3.4 0.3 0 0.3 0.3
    Peripheral sensory neuropathy, grades 2-4 2.1 2.1 0.6 5.6 2.2 6.5
Abbreviations: CAPE, capecitabine; FU, flourouracil; NSABP, National Surgical Adjuvant Breast and Bowel Project; OX, oxaliplatin.

Chemotherapy Administered

The percentage of eligible patients who started at least one protocol agent was at least 95% on each arm (Table 6). The dose of single-agent FU delivered to postamendment FU patients was significantly higher (P < .05), as was the FU dose-intensity (P < .05) compared with the dose and dose-intensity of FU received by FU-plus-oxaliplatin patients. The dose of single-agent capecitabine delivered to postamendment capecitabine patients was significantly higher (P < .05) compared with the dose received by capecitabine-plus-oxaliplatin patients. No other relevant treatment comparisons were statistically significant.
Table 6. Dose Administered for Eligible Patients Who Started at Least One Protocol Agent: NSABP R-04
Dose Before Amendment After Amendment CAPE + OX (n = 322)
FU (n = 139) CAPE (n = 141) FU (n = 315) FU + OX (n = 319) CAPE (n = 319)
Median 95% CI Median 95% CI Median 95% CI Median 95% CI Median 95% CI Median 95% CI
Percent of eligible patients who started at least one protocol agent 95.2 100.0 96.0 97.6 98.2 98.2
FU                        
    Dose delivered, mg/m2 8,463 8,311 to 8,710     6,057 5,826 to 6,239 5,611 5,476 to 5,745        
    Dose-intensity, mg/m2/wk 1,467 1,411 to 1,509     1,078 1,050 to 1,102 1,018 981 to 1,039        
CAPE                        
    Dose delivered, mg/m2     61,414 59,553 to 62,432         44,868 43,982 to 45,593 43,027 42,108 to 44,158
    Dose-intensity, mg/m2/wk     10,576 10,167 to 10,876         7,834 7,658 to 7,971 7,777 7,597 to 7,873
OX                        
    Dose delivered, mg/m2             238.1 233.0 to 242.1     237.4 232.4 to 240.4
    Dose-intensity, mg/m2/wk             56.7 55.6 to 57.8     57.5 56.1 to 58.4
Abbreviations: CAPE, capecitabine; FU, flourouracil; NSABP, National Surgical Adjuvant Breast and Bowel Project; OX, oxaliplatin.

Discussion

This prospective randomized clinical trial of 1,608 patients suggests that there is no significant detrimental effect on pCR, sphincter-sparing surgery, or surgical downstaging when radiation therapy is combined with capecitabine instead of CVI FU for the neoadjuvant treatment of stage II and III rectal cancer among patients eligible for this clinical trial. The similarity in pathologic complete response rates we observed is consistent with previously reported nonrandomized retrospective comparisons of capecitabine and FU combined with preoperative radiation therapy for rectal cancer in which no statistically significant differences in pCR were observed.20,21
Toxicity from either single-agent fluoropyrimidine chemotherapy regimen was tolerable. Treatment-related mortality was less than 1% (seven of 923 patients) for patients receiving capecitabine or CVI FU without oxaliplatin. As expected, the most frequent toxicity was diarrhea. The incidence of grade 3 to 5 diarrhea decreased from approximately 16% to 7% when the protocol was amended to administer capecitabine or CVI FU only on the days radiation therapy was delivered (5 days per week), rather than continuously during neoadjuvant treatment. Grade 3 hand-foot syndrome was observed in only 0.3% of patients receiving either capecitabine or CVI FU 5 days per week combined with radiation therapy.
Capecitabine has the advantage of oral administration, without FU's cumbersome continuous intravenous infusion and its attendant risks of infection, bleeding, and thrombosis associated with central venous catheters, and it is clinically tolerable combined with pelvic radiation in the dosage schedule used in patients eligible for this clinical trial.
In contrast, there was no improvement in surgical outcomes when oxaliplatin was added to the fluorinated pyrimidine chemotherapy regimens in our study. Significantly increased grade 3 to 5 diarrhea was observed when oxaliplatin was administered (6.9% v 16.5%; P < .001). The treatment-related mortality rate was 0.9% for patients receiving oxaliplatin (six of 644 patients), and approximately 41% of patients receiving oxaliplatin with radiation therapy had at least one grade 3 to 5 toxicity. These results are consistent with results of the STAR-01 (Studio Terapia Adiuvante Retto) clinical trial,22 the ACCORD 12 (Actions Concertées dans les Cancers Colorectaux et Digestifs)/0405 PRODIGE 2 (Routage de Produits Intelligents) clinical trial,23,24 and the PETACC 6 (Pan European Trial Adjuvant Colon Cancer) clinical trial.25 Each of these studies evaluated adding oxaliplatin to fluoropyrimidine chemotherapy combined with radiation therapy in the rectal cancer neoadjuvant setting. None of those studies reported improved pCR rates or other measures of surgical outcome, and all of them observed increased toxicity with the addition of oxaliplatin.
The database associated with the NSABP R-04 clinical trial will serve as a rich resource for additional investigations of rectal cancer biology, prognosis, treatment, and survivorship. For example, more than 900 preoperative formalin-fixed paraffin-embedded tumor specimens or unstained slides, more than 100 preoperative tumor specimens preserved in RNA Later, and more than 400 post-treatment surgical specimens are stored in microarrays in the NSABP tissue bank. Genomic studies of these specimens will be of particular interest given the recent characterization of colorectal cancer by the Cancer Genome Atlas network.26 In addition, a comparative effectiveness study of sphincter-sparing surgery versus abdominoperineal resection in rectal cancer and a quality of life study are underway.27,28
Additional follow-up will be required to assess the primary study end point of the NSABP R-04 clinical trial: locoregional tumor relapse at 3 years. It will be of interest to correlate the pCR rate with the locoregional tumor relapse rate, a more clinically relevant parameter of local tumor control. Disease-free and overall survival will also be reported. This additional information should provide a definitive evaluation of the role of capecitabine and oxaliplatin in the preoperative combined-modality therapy of rectal cancer.
Listen to the podcast by Dr Miksad at www.jco.org/podcasts
Clinical trial information: NCT00058474.
The summary of supplementary materials could not be included.

Supplementary Material

File (miksad.xhtml)

Authors' Disclosures of Potential Conflicts of Interest

Although all authors completed the disclosure declaration, the following author(s) and/or an author's immediate family member(s) indicated a financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a “U” are those for which no compensation was received; those relationships marked with a “C” were compensated. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.
Employment or Leadership Position: None Consultant or Advisory Role: Norman Wolmark, sanofi-aventis (U) Stock Ownership: None Honoraria: None Research Funding: None Expert Testimony: None Patents, Royalties, and Licenses: None Other Remuneration: None

References

1.
LL Gunderson, DJ Sargent, JE Tepper, etal: Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer: A pooled analysis J Clin Oncol 22: 1785– 1796,2004
2.
LL Gunderson, JM Jessup, DJ Sargent, etal: Revised tumor and node categorization for rectal cancer based on Surveillance, Epidemiology, and End Results and rectal pooled analysis outcomes J Clin Oncol 28: 256– 263,2010
3.
Prolongation of the disease-free interval in surgically treated rectal carcinoma: Gastrointestinal Tumor Study Group N Engl J Med 312: 1465– 1472,1985 Gastrointestinal Tumor Study Group
4.
JE Krook, CG Moertel, LL Gunderson, etal: Effective surgical adjuvant therapy for high-risk rectal carcinoma N Engl J Med 324: 709– 715,1991
5.
N Wolmark, HS Wieand, DM Hyams, etal: Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02 J Natl Cancer Inst 92: 388– 396,2000
6.
MJ O'Connell, JA Martenson, HS Wieand, etal: Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery N Engl J Med 331: 502– 507,1994
7.
E Van Cutsem, C Twelves, J Cassidy, etal: Oral capecitabine compared with intravenous fluorouracil plus leucovorin in patients with metastatic colorectal cancer: Results of a large phase III study J Clin Oncol 19: 4097– 4106,2001
8.
RJ Mayer: Should capecitabine replace infusional fluorouracil and leucovorin when combined with oxaliplatin in metastatic colorectal cancer? J Clin Oncol 25: 4165– 4167,2007
9.
J Dunst, T Reese, T Sutter, etal: Phase I trial evaluating the concurrent combination of radiotherapy and capecitabine in rectal cancer J Clin Oncol 20: 3983– 3991,2002
10.
M Miwa, M Ura, M Nishida, etal: Design of a novel oral fluoropyrimidine carbamate, capecitabine, which generates 5-fluorouracil selectivity in tumours by enzymes concentrated in human liver and cancer tissue Eur J Cancer 34: 1274– 1281,1998
11.
ML Rothenberg, AM Oza, RH Bigelow, etal: Superiority of oxaliplatin and fluorouracil-leucovorin compared with either therapy alone in patients with progressive colorectal cancer after irinotecan and fluorouracil-leucovorin: Interim results of a phase III trial J Clin Oncol 21: 2059– 2069,2003
12.
T André, C Boni, L Mounedji-Boudiaf, etal: Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer N Engl J Med 350: 2343– 2351,2004
13.
JP Kuebler, HS Wieand, MJ O'Connell, etal: Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: Results from NSABP C-07 J Clin Oncol 25: 2198– 2204,2007
14.
A Cividalli, F Ceciarelli, E Livdi, etal: Radiosensitization by oxaliplatin in a mouse adenocarcinoma: Influence of treatment schedule Int J Radiat Oncol Biol Phys 52: 1092– 1098,2002
15.
GJ Frykholm, B Glimelius, L Påhlman: Preoperative or postoperative irradiation in adenocarcinoma of the rectum: Final treatment results of a randomized trial and an evaluation of late secondary effects Dis Colon Rectum 36: 564– 572,1993
16.
JP Gerard: The use of radiotherapy for patients with low rectal cancer: An overview of the Lyon experience Aust N Z J Surg 64: 457– 463,1994
17.
R Sauer, H Becker, W Hohenberger, etal: Preoperative versus postoperative chemoradiotherapy for rectal cancer N Engl J Med 351: 1731– 1740,2004
18.
SJ White, LS Freedman: Allocation of patients to treatment groups in a controlled clinical study Br J Cancer 37: 849– 857,1978
19.
YH Wang: Fiduciary intervals: What are they? Am Stat 54: 105– 111,2000
20.
P Das, EH Lin, S Bhatia, etal: Preoperative chemoradiotherapy with capecitabine versus protracted infusion 5-fluorouracil for rectal cancer: A matched-pair analysis Int J Radiat Oncol Biol Phys 66: 1378– 1383,2006
21.
VS Ramani, A Sun Myint, A Montazeri, etal: Preoperative chemoradiotherapy for rectal cancer: A comparison between intravenous 5-fluorouracil and oral capecitabine Colorectal Dis 12: 37– 46,2010 suppl 2
22.
C Aschele, L Cionini, S Lonardi, etal: Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: Pathologic results of the STAR-01 randomized phase III trial J Clin Oncol 29: 2773– 2780,2011
23.
JP Gérard, D Azria, S Gourgou-Bourgade, etal: Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: Results of the phase III trial ACCORD 12/0405-Prodige 2 J Clin Oncol 28: 1638– 1644,2010
24.
JP Gérard, D Azria, S Gourgou-Bourgade, etal: Clinical outcome of the ACCORD 12/0405 PRODIGE 2 randomized trial in rectal cancer J Clin Oncol 30: 4558– 4565,2012
25.
H-J Schmoll, K Haustermans, TJ Price, etal: Preoperative chemoradiotherapy and postoperative chemotherapy with capecitabine and oxaliplatin versus capecitabine alone in locally advanced rectal cancer: First results of the PETACC-6 randomized phase III trial J Clin Oncol 31: 212s,2013 suppl abstr 3531
26.
Comprehensive molecular characterization of human colon and rectal cancer Nature 487: 330– 337,2012 Cancer Genome Atlas Network
27.
PA Ganz, SH Lopa, G Yothers, etal: Comparative effectiveness of sphincter-sparing surgery (SSS) vs. abdomino-perineal resection (APR) in rectal cancer: Patient reported outcomes (PROs) from NSABP R-04 J Clin Oncol 30: 214s,2012 suppl 15s abstr 3545
28.
G Yothers, PA Ganz, SH Lopa, etal: Patient reported outcomes (PROs) comparison of 5-FU and capecitabine (cape) with concurrent radiotherapy (RT) for neoadjuvant treatment of rectal cancer: Results of NSABP R-04 J Clin Oncol 30,2012 suppl 9 abstr 391

Information & Authors

Information

Published In

Journal of Clinical Oncology
Pages: 1927 - 1934
PubMed: 24799484

History

Published online: May 05, 2014
Published in print: June 20, 2014

Permissions

Request permissions for this article.

Authors

Affiliations

Michael J. O'Connell [email protected]
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Linda H. Colangelo
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Robert W. Beart
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Nicholas J. Petrelli
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Carmen J. Allegra
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Saima Sharif
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Henry C. Pitot
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Anthony F. Shields
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Jerome C. Landry
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
David P. Ryan
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
David S. Parda
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Mohammed Mohiuddin
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Amit Arora
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Lisa S. Evans
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Nathan Bahary
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Gamini S. Soori
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Janice Eakle
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
John M. Robertson
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Dennis F. Moore Jr
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Michael R. Mullane
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Benjamin T. Marchello
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Patrick J. Ward
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Timothy F. Wozniak
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Mark S. Roh
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Greg Yothers
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Norman Wolmark
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital of Cook County, Chicago, IL; Benjamin T. Marchello, Montana Cancer Consortium, Billings, MT; Patrick J. Ward, Oncology/Hematology Care, Cincinnati, OH; Mohammed Mohiuddin, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Notes

Corresponding author: Michael J. O'Connell, MD, National Surgical Adjuvant Breast and Bowel Project (NSABP), 2 Allegheny Center, 12th Floor, Pittsburgh, PA 15212; e-mail: [email protected].

Author Contributions

Conception and design: Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Jerome C. Landry, David P. Ryan, David S. Parda, Mohammed Mohiuddin, Mark S. Roh, Greg Yothers, Norman Wolmark
Administrative support: Greg Yothers, Norman Wolmark
Provision of study materials or patients: Nicholas J. Petrelli, David S. Parda, Gamini S. Soori, Janice Eakle, Michael R. Mullane, Patrick J. Ward
Collection and assembly of data: Linda H. Colangelo, Robert W. Beart, Saima Sharif, Henry C. Pitot, David P. Ryan, Amit Arora, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers
Data analysis and interpretation: Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Carmen J. Allegra, Saima Sharif, Anthony F. Shields, David S. Parda, Lisa S. Evans, Mark S. Roh, Greg Yothers
Manuscript writing: All authors
Final approval of manuscript: All authors

Disclosures

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Funding Information

Supported by Public Health Service Grants No. U10-CA-12027, U10-CA-37377, U10-CA-69651, and U-10-CA-69974 from the National Cancer Institute, US Department of Health and Human Services; Cancer Support Grant No. CA22453 from the National Institutes of Health (A.F.S.); Southwest Oncology Group Treatment Grant No. CA032102 from the National Institutes of Health (A.F.S.); and Sanofi-Synthelabo and Roche Laboratories.

Metrics & Citations

Metrics

Altmetric

Citations

Article Citation

Download Citation

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format





Download article citation data for:
Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, Jerome C. Landry, David P. Ryan, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark
Journal of Clinical Oncology 2014 32:18, 1927-1934

View Options

View options

PDF

View PDF

Get Access

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Personal login Institutional Login

Purchase Options

Purchase this article to get full access to it.

Purchase this Article

Subscribe

Subscribe to this Journal
Renew Your Subscription
Become a Member

Media

Figures

Other

Tables

Share

Share

Share article link

Share