In rectal cancer, neoadjuvant therapy is tied to improved DFS

  • Diefenhardt M & al.
  • JAMA Oncol
  • 9 Jul 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Completion of neoadjuvant therapy, but not adjuvant therapy, is linked to longer DFS in rectal cancer.

Why this matters

  • The findings underline the need to optimize dose and schedule and for supportive strategies to enhance adherence to neoadjuvant chemoradiotherapy (nCRT) in rectal cancer.

Study design

  • Post hoc analysis of a phase 3 randomized controlled trial (CAO/ARO/AIO-04; N=1232 from 80 centers) in patients with T3 to T4 or node-positive rectal adenocarcinoma.
  • Patients underwent fluorouracil-based nCRT or fluorouracil-based nCRT with oxaliplatin.
  • Near-complete adherence: 45 Gy or more of radiotherapy and 80% of concurrent chemotherapy.
  • Reduced adherence:
  • Funding: German Cancer Aid.

Key results

  • 3-year DFS in the as-treated population was 71.1% in the fluorouracil group and 75.8% in the fluorouracil-oxaliplatin group:
    • HR: 0.803 (P=.04).
  • nCRT adherence was associated (HRs) with a better 3-year DFS:
    • Fluorouracil group:
      • Complete vs near complete: 1.325 (P=.09). 
      • Complete vs reduced: 1.877 (P=.01).
    • Fluorouracil-oxaliplatin group:
      • Complete vs near complete: 1.501 (P=.06).
      • Complete vs reduced: 1.724 (P=.009).
  • Completers and noncompleters of nCRT had similar DFS in the fluorouracil group and the fluorouracil plus oxaliplatin group.

Limitations

  • Post hoc analysis.