
Irinotecan's role in rectal cancer neoadjuvant chemoradiotherapy (nCRT) remains uncertain regarding optimal dosing. Involving 101 eligible patients with UGT1A128 and UGT1A16 genotypes, the study team administered preoperative radiotherapy with irinotecan and capecitabine. Analyzing SN-38 concentrations at various intervals, the study observed that the 49 h concentration was optimal for predicting efficacy and toxicity. The Q4 group, exhibiting higher SN-38 levels, demonstrated a significantly increased complete-response rate and higher adverse events. Our study establishes a recommended 49 h SN-38 concentration range (0.5–1.0 ng/mL) and underscores the clinical relevance of UGT1A16 and UGT1A128 polymorphisms in guiding irinotecan administration, providing valuable insights for personalized dosing.
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