medwireNews: Patients with locally advanced rectal cancer who receive total neoadjuvant therapy (TNT) are more likely to adhere to chemotherapy and to experience a complete response than those treated with preoperative chemoradiation (CRT) followed by postoperative adjuvant chemotherapy, according to the findings of a retrospective cohort analysis.
The TNT strategy of giving induction fluorouracil- and oxaliplatin-based chemotherapy plus CRT before surgery achieved significantly higher average doses of both these agents and fewer dose reductions than the conventional regimen.
As an example, Martin Weiser (Memorial Sloan Kettering Cancer Center, New York, USA) and colleagues found that 84% of patients in the TNT group versus 55% of those in the CRT group received more than 90% of the planned dose of fluorouracil, while 61% versus 28%, respectively, received over 90% of the planned dose of oxaliplatin.
Similarly, significantly greater proportions of patients in the TNT group received more than 75% of their planned doses, and more than six cycles of therapy.
The results, published in JAMA Oncology, also indicate a better response in patients treated with TNT. At 12 months, the total complete response rate (including pathologic and sustained clinical complete responses) was 35.7% in the TNT group, compared with 21.3% in the conventional group. Regression analysis found TNT to be associated with significantly higher 2.06-fold odds of a complete response at 12 months.
To obtain these findings, the researchers retrieved data on 628 patients with T3/T4 or node-positive locally advanced rectal cancer attending the Memorial Sloan Kettering Cancer Center from 2009 to 2015, 308 of whom received TNT, while 320 received the conventional regimen.
The researchers note that although longer-term results are required, “[t]otal neoadjuvant therapy was associated with improved delivery of systemic therapy and increased response to treatment, and it provides a promising platform for nonoperative watch-and-wait protocols.”
Commenting on the findings, Theodore Hong and David Ryan (both from Harvard Medical School, Boston, Massachusetts, USA) described this as a “terrific study” and note that “[the] results indicate that TNT may be a better choice for most patients with locally advanced rectal cancer regarding short-term outcomes.”
They conclude that “TNT can be considered standard of care for select patients with high-risk, locally advanced disease,” but sound a note of caution against the use of this strategy in patients with lower-risk disease, as they may not need any chemotherapy.
By Catherine Booth
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