In locally advanced rectal cancer, total neoadjuvant therapy may be a dud

  • EClinicalMedicine

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Total neoadjuvant therapy (TNT) does not appear to provide a survival benefit over neoadjuvant chemoradiation therapy (nCRT) in locally advanced rectal cancer.

Why this matters

  • Results suggest clinicians should avoid routine use of TNT in these patients until results from the PROSPECT or NRG-GI002 randomized trials demonstrate efficacy.

Study design

  • 2:1 propensity-matched analysis (372 TNT, 707 nCRT).
  • TNT consisted of multiagent induction chemotherapy ≥2 months before radiotherapy, followed by preoperative CRT and no adjuvant chemotherapy.
  • nCRT consisted of preoperative radiotherapy and chemotherapy initiated within 2 weeks of one another, followed by surgery with or without adjuvant chemotherapy.
  • Funding: None.

Key results

  • TNT and nCRT were associated with a similar OS Kaplan-Meier curve (P=.16).
  • 5-year OS did not reach statistical significance (78.5% vs 73.6%; P=.20).
  • Multivariable Cox proportional hazards regression showed no association between OS and TNT vs nCRT (HR, 1.21; P=.25).
  • TNT was associated with numerically higher pathologic complete response rate, but did not reach statistical significance (16.9% vs 13.1%; P=.12).
  • Multivariate logistic regression modeling showed no statistically significant association between TNT and pathological complete response (OR, 1.36; P=.13) or circumferential resection margin (OR, 1.77; P=.19).

Limitations

  • Retrospective analysis.

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