Locally advanced rectal cancer: total neoadjuvant therapy improves response

  • Petrelli F & al.
  • Ann Surg
  • 15 Jul 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Addition of induction or consolidation chemotherapy to standard neoadjuvant chemoradiotherapy (total neoadjuvant therapy, TNT) leads to a higher complete pathologic response (pCR) in locally advanced rectal cancer.
  • Larger confirmatory trials should be carried out before strong recommendations can be made regarding TNT.

Why this matters

  • Total neoadjuvant therapy may have better compliance than adjuvant therapy, and a clinical complete response after TNT could trigger a watch-and-wait strategy rather than immediate surgery.

Study design

  • Meta-analysis of 28 studies (n=3579).
  • Funding: None disclosed.

Key results

  • TNT can include various strategies, including full-dose chemotherapy for 3-4 months followed by standard chemoradiotherapy and surgery, as well as other courses of treatment such as short-course radiotherapy after chemotherapy. Another approach is chemotherapy immediately before surgery but after radiotherapy.
  • Among those treated with TNT, the pooled pCR rate was 22.4% (95% CI, 19.4%-25.7%; 27 studies; I2=59%; P<.001>
  • Comparison data (10 studies) showed that TNT increased the odds of pCR vs standard chemoradiation (OR, 1.40; P=.01).

Limitations

  • The majority of studies were prospective and observational, and most of these were not randomized.

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