Total neoadjuvant therapy for rectal cancer: An emerging option

Area of Science:

• Oncology
• Gastrointestinal Surgery
• Medical Oncology

Background:

• Locally advanced rectal cancer (LARC) treatment improved with neoadjuvant chemoradiotherapy (CRT), reducing local recurrence.
• Distant metastasis remains the primary cause of mortality in LARC patients.
• The benefit of adjuvant chemotherapy (ChT) after neoadjuvant CRT and surgery is unclear due to poor compliance and inconsistent results.

Purpose of the Study:

• To review promising results of total neoadjuvant therapy (TNT) for LARC.
• To highlight the potential of TNT to improve treatment compliance and reduce toxicity.
• To discuss ongoing trials evaluating long-term outcomes and organ preservation with TNT.

Main Methods:

• Review of prospective trials investigating TNT for LARC.
• Analysis of studies focusing on pathologic complete response rates.
• Identification of ongoing phase 2 and 3 trials assessing long-term disease-related outcomes.

Main Results:

• TNT incorporates both chemotherapy (ChT) and chemoradiotherapy (CRT) in the neoadjuvant setting.
• TNT has shown promising pathologic outcomes, including high rates of pathologic complete response.
• TNT may improve compliance, reduce toxicity, and decrease distant relapse rates compared to traditional treatment sequencing.

Conclusions:

• TNT is a promising approach for LARC, potentially improving survival and reducing distant metastases.
• Further research is ongoing to confirm long-term survival benefits and evaluate organ preservation potential.
• Shifting systemic therapy to the neoadjuvant setting with TNT may enhance treatment efficacy for LARC.