Rectal cancer: lines of therapy
5 standard-of-care settings across 4 lines and 3 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | MSI-H / dMMR | Risk group |
|---|---|---|---|
| Early / localised | 1 | · | 1 |
| Locally advanced | 1 | · | · |
| Advanced, first line | 1 | · | · |
| Other settings | · | 1 | · |
Early / localised
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Early (cT1-2, node-negative) | Total mesorectal excision, increasingly robotic or laparoscopic; transanal local excision for small, well-differentiated T1 tumours; no radiotherapy. | NCCN Guidelines: Rectal Cancer | 40 | |
| Risk group | Intermediate risk, sphincter-sparing surgery planned | Six cycles of FOLFOX with chemoradiation only if the tumour shrinks by less than 20 percent (PROSPECT), then total mesorectal excision. | NCCN Guidelines: Rectal Cancer | 82 |
Locally advanced
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Locally advanced, higher risk | Total neoadjuvant therapy: short-course radiotherapy then CAPOX or FOLFOX (RAPIDO), or induction mFOLFIRINOX then chemoradiation (PRODIGE 23); chemoradiation then consolidation chemotherapy when organ preservation is the goal (OPRA); surgery or watch and wait for complete responders. | NCCN Guidelines: Rectal Cancer | 82 |
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Metastatic | As metastatic colorectal cancer: doublet chemotherapy with bevacizumab or, for RAS and BRAF wild-type left-sided tumours, an anti-EGFR antibody; primary tumour managed by symptoms; liver-limited disease resected. | NCCN Guidelines: Rectal Cancer | 98 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| MSI-H / dMMR | Mismatch-repair deficient | Six months of dostarlimab or another PD-1 antibody with non-operative management for complete responders; surgery reserved for the rare non-responder. | NCCN Guidelines: Rectal Cancer | 82 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.