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Sequencing of Total Neoadjuvant Therapy for Rectal Cancer
The use of total neoadjuvant treatment — the administration of chemoradiotherapy (CRT) and chemotherapy (CT) prior to surgery — has been shown to improve rates of clinical and pathologic complete response (PCR). However, the optimal scheduling of CRT and CT in this setting has not been established.
The prior multicenter, randomized, phase II trial of 306 German patients with stage II or III rectal cancer receiving total neoadjuvant therapy (CAO/ARO/AIO-12; J Clin Oncol 2019; 37:3212) showed that a higher rate of PCR (the primary endpoint) was achieved when CRT (5-FU and oxaliplatin plus radiotherapy) was given before CT versus the reverse sequence (25% vs. 17%), with comparable surgical outcomes. More than 80% of patients had clinical stage T3 and N1-2 disease, and 41% of tumors were ≤5 cm from the anal verge.
Now, the investigators have conducted a secondary analysis of the CAO/ARO/AIO-12 trial. At a median follow up of 43 months, 3-year disease-free survival was similar between CRT followed by CT or the reverse sequence (73%), as were rates of locoregional recurrence (5% and 6%), distant metastasis (16% and 18%), and overall survival (88% and 92%). Quality-of-life and long-term toxicity measures also did not differ between the two groups.
Comment
This trial adds supporting evidence for total neoadjuvant therapy in rectal cancer. The results indicate that no compromise in long-term outcomes occurs when CRT is administered prior to CT and that greater potential PCR may be achieved when CRT is given first. This therapy sequence may increase the potential use of nonoperative management in rectal cancer.
Citation(s)
Author:
Fokas E et al.
Title:
Chemoradiotherapy plus induction or consolidation chemotherapy as total neoadjuvant therapy for patients with locally advanced rectal cancer: Long-term results of the CAO/ARO/AIO-12 randomized clinical trial.
Source:
JAMA Oncol
2021
Nov
18; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
David H. Ilson, MD, PhD