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Related Concept Videos

Targeted Cancer Therapies02:57

Targeted Cancer Therapies

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The targeted cancer therapies, also known as “molecular targeted therapies,” take advantage of the molecular and genetic differences between the cancer cells and the normal cells. It needs a thorough understanding of the cancer cells to develop drugs that can target specific molecular aspects that drive the growth, progression, and spread of cancer cells without affecting the growth and survival of other normal cells in the body.
There are several types of targeted therapies against...
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Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...
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Immunotherapy is a treatment that boosts or manipulates the immune system to fight diseases, including cancer. For instance, by stimulating an immune response through vaccinations against viruses that cause cancers, like hepatitis B virus and human papillomavirus, these diseases can be prevented. Nonetheless, some cancer cells can avoid the immune system due to their rapid mutation and division. The immune response to many cancers involves three phases: elimination, equilibrium, and escape.
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Executive summary of American Radium Society Appropriate Use Criteria for the treatment of locoregionally recurrent rectal cancer.

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The Potential for Overtreatment With Total Neoadjuvant Therapy (TNT): Consider One Local Therapy Instead.

Christopher J Anker1, Nataniel H Lester-Coll1, Dmitriy Akselrod2

  • 1University of Vermont Cancer Center, Burlington, VT; Division of Radiation Oncology, University of Vermont Larner College of Medicine, Burlington, VT.

Clinical Colorectal Cancer
|January 15, 2022
PubMed
Summary

Total Neoadjuvant Therapy (TNT) for rectal cancer improves distant metastases-free survival but not overall survival. Tailoring treatment to patient preferences and considering de-escalation strategies like omitting radiation therapy can enhance quality of life.

Keywords:
Long courseNonoperative managementOncologic outcomesQuality of lifeRectal cancerShort courseTotal definitive therapyWatch and wait

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Radiation Oncology
  • Medical Oncology

Background:

  • Increasing therapeutic options for rectal cancer necessitate personalized treatment strategies.
  • Total Neoadjuvant Therapy (TNT) aims to improve survival by eliminating micrometastatic disease before surgery.
  • Patient preferences, particularly regarding quality of life (QoL), are crucial in treatment decision-making.

Purpose of the Study:

  • To evaluate Total Neoadjuvant Therapy (TNT) against alternative treatment options for operable rectal adenocarcinoma.
  • To compare QoL and oncologic outcomes between TNT and other therapeutic approaches.
  • To provide guidance on tailoring rectal cancer therapy based on patient preferences and evidence.

Main Methods:

  • Narrative review of studies assessing patients with operable adenocarcinoma of the rectum.
  • Analysis of survey data on patient preferences for treatment options.
  • Evaluation of oncologic outcomes (e.g., distant metastases-free survival, pathologic complete response) and QoL.

Main Results:

  • TNT demonstrates improved distant metastases-free survival compared to standard neoadjuvant chemoradiation.
  • TNT has not yet shown a significant overall survival benefit.
  • Higher pathologic complete response rates with TNT suggest potential for overtreatment with immediate surgery.

Conclusions:

  • De-escalation strategies, including watch-and-wait for clinical complete responders and selective omission of radiation therapy for low-risk patients, are emerging.
  • Total definitive therapy (chemoradiation followed by consolidation chemotherapy, reserving surgery for incomplete responders) is a promising alternative to TNT.
  • Personalizing rectal cancer treatment to balance oncologic outcomes with patient QoL preferences is paramount.