EvidenceRectal cancer

For mismatch repair-deficient rectal cancer, six months of a single antibody now replaces chemotherapy, radiotherapy and an operation, and the same appears to be true for early-stage mismatch repair-deficient cancers of other organs.

The numbers behind the argument that the screening programme is working for the people it covers and failing everyone below its start age; the stage shift going into reverse is the most uncomfortable figure on this roadmap.

Selected patients with intermediate-risk rectal cancer can avoid radiotherapy altogether, with chemotherapy alone before surgery, trading neuropathy for better long-term bowel and sexual function.

Organ preservation became a plan rather than an accident: consolidation chemotherapy after chemoradiotherapy gives the best chance of keeping the rectum, and salvage surgery after regrowth does not appear to cost survival.

The second total neoadjuvant therapy schedule to change practice, and the one that shows the advantage is partly deliverability: chemotherapy given before an operation is completed by far more patients than chemotherapy given after one.

Induction FOLFIRINOX-based total neoadjuvant therapy is a preferred strategy for locally advanced rectal cancer, and the first to show a survival gain.

Total neoadjuvant therapy is now a standard for high-risk rectal cancer, improving compliance with chemotherapy and enabling organ preservation, though the locoregional recurrence signal favours long-course chemoradiation in some patients.

The first total neoadjuvant therapy trial to change practice in high-risk rectal cancer, and the schedule that makes organ preservation possible by giving the tumour months rather than weeks to respond.