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Six cycles of a three-drug chemotherapy before the usual chemoradiotherapy raised three-year disease-free survival from 69 to 76 percent, and left patients with less nerve damage than giving the chemotherapy afterwards.
Conroy, Bosset, Etienne and colleagues ran a phase 3 open-label randomised trial at 35 French hospitals in adults aged 18 to 75 with newly diagnosed biopsy-proven cT3 or cT4 M0 rectal adenocarcinoma and WHO performance status 0 to 1. The neoadjuvant chemotherapy group received six cycles of FOLFIRINOX, then chemoradiotherapy (50 Gy over five weeks with concurrent capecitabine), total mesorectal excision and three months of adjuvant chemotherapy; the standard-of-care group received chemoradiotherapy, total mesorectal excision and six months of adjuvant chemotherapy. The primary endpoint was three-year disease-free survival in the intention-to-treat population.
Serious adverse events during adjuvant therapy were markedly fewer in the neoadjuvant group, which is the tolerability argument for moving chemotherapy forward.
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.
Shares Short-course radiotherapy followed by chemotherapy before total mesorectal excision versus preoperative chemoradiotherapy in locally advanced rectal cancer (RAPIDO), Total mesorectal excision (TME), Radiotherapy, Chemoradiation (chemoradiotherapy, CRT) and the tag colorectal-evidence.
Shares PRODIGE 23, Short-course radiotherapy followed by chemotherapy before total mesorectal excision versus preoperative chemoradiotherapy in locally advanced rectal cancer (RAPIDO), Total neoadjuvant therapy (TNT, rectal cancer), Total mesorectal excision (TME) and the tag colorectal-evidence.
Shares Short-course radiotherapy followed by chemotherapy before total mesorectal excision versus preoperative chemoradiotherapy in locally advanced rectal cancer (RAPIDO), Total neoadjuvant therapy (TNT, rectal cancer), Total mesorectal excision (TME), Radiotherapy and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Chemoradiation (chemoradiotherapy, CRT), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, IMRT / IGRT (modern external beam) and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, IMRT / IGRT (modern external beam) and the tag colorectal-evidence.
Shares UNICANCER, Oxaliplatin, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, The Lancet Oncology and the tag colorectal-evidence.
Shares Irinotecan (and liposomal irinotecan), FOLFIRINOX / mFOLFIRINOX, Oxaliplatin, The Lancet Oncology and the tag colorectal-evidence.