Neoadjuvant Treatment Approaches for Stage II–III Rectal Cancer

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Steven Nurkin
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Excellent long-term outcomes are being achieved with contemporary treatment strategies for localized rectal cancer. A “watch-and-wait” nonoperative strategy seems to be a safe option for patients experiencing a complete clinical response. Total neoadjuvant therapy (TNT) has shown many advantages over standard chemoradiotherapy, although the optimal sequencing—with induction or consolidation chemotherapy—is still debated. The use of FOLFIRINOX can boost the benefit of TNT. Of note, in the small subset of patients whose tumors have mismatch repair deficiency, checkpoint inhibition has led to responses in most patients, eliminating the need for further treatment.

Disclosures: Dr. Nurkin has disclosed serving as a consultant for Merck & Co., Inc.

Correspondence: Steven Nurkin, MD, MS, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263. Email: steven.nurkin@roswellpark.org
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  • 1.

    Habr-Gama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 2004;240:711717; discussion 717–718.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Bahadoer RR, Peeters KCMJ, Beets GL, et al. Watch and wait after a clinical complete response in rectal cancer patients younger than 50 years. Br J Surg 2021;109:114120.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Smith JJ, Chow OS, Gollub MJ, et al. Organ Preservation in Rectal Adenocarcinoma: a phase II randomized controlled trial evaluating 3-year disease-free survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy, and total mesorectal excision or nonoperative management. BMC Cancer 2015;15:767.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Maas M, Lambregts DM, Nelemans PJ, et al. Assessment of clinical complete response after chemoradiation for rectal cancer with digital rectal examination, endoscopy, and MRI: selection for organ-saving treatment. Ann Surg Oncol 2015;22:38733880.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Cercek A, Roxburgh CSD, Strombom P, et al. Adoption of total neoadjuvant therapy for locally advanced rectal cancer. JAMA Oncol 2018;4:e180071.

  • 6.

    Garcia-Aguilar J, Chow OS, Smith DD, et al. Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial. Lancet Oncol 2015;16:957966.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Marco MR, Zhou L, Patil S, et al. Consolidation mFOLFOX6 chemotherapy after chemoradiotherapy improves survival in patients with locally advanced rectal cancer: final results of a multicenter phase II trial. Dis Colon Rectum 2018;61:11461155.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Garcia-Aguilar J, Patil S, Gollub MJ, et al. Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy. J Clin Oncol 2022;40:25462556.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Thompson H, Kim JK, Yuval JB, et al. Survival and organ preservation according to clinical response after total neoadjuvant therapy in locally advanced rectal cancer patients: a secondary analysis from the organ preservation in rectal adenocarcinoma (OPRA) trial. J Clin Oncol 2021; 39(Suppl):Abstract 3509.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Bahadoer RR, Dijkstra EA, van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol 2021;22:2942.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Dijkstra EA, Nilsson PJ, Hospers GAP, et al. Locoregional failure during and after short-course radiotherapy followed by chemotherapy and surgery compared with long-course chemoradiotherapy and surgery: a five-year follow-up of the RAPIDO trial. Ann Surg. Published online January 20, 2023. doi:10.1097/SLA.0000000000005799.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Conroy T, Bosset JF, Etienne PL, et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 2021;22:702715.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Cercek A, Lumish M, Sinopoli J, et al. PD-1 blockade in mismatch repair-deficient, locally advanced rectal cancer. N Engl J Med 2022;386:23632376.

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