Rectal Cancer: Adjuvant Chemotherapy May Improve OS After pCR

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After a median follow-up of 3.1 years, patients who received adjuvant chemotherapy had improved rates of survival.
After a median follow-up of 3.1 years, patients who received adjuvant chemotherapy had improved rates of survival.

Adjuvant chemotherapy may improve overall survival (OS) among patients with rectal cancer who have a pathologic complete response (pCR) after neoadjuvant chemoradiation and surgical resection, according to a study published in JAMA Oncology.1

For this retrospective propensity score-matched cohort study, researchers evaluated the survival outcomes of 2455 patients with advanced rectal cancer who achieved pCR after undergoing neoadjuvant chemoradiation and resection. Of these patients, 667 patients who received adjuvant chemotherapy and had at least 8 weeks of follow-up post-surgery were matched with patients who did not. The mean patient age was 59.5 years and nearly 60% were men.

After a median follow-up of 3.1 years, patients who received adjuvant chemotherapy had improved rates of survival (hazard ratio [HR], 0.44; 95% CI, 0.28-0.70). The 3-year OS rate was 97.6% among patients in the adjuvant chemotherapy group vs 94.0% among patients who did not receive adjuvant chemotherapy. Similar outcomes were observed for the 5-year OS rate (adjuvant chemotherapy group, 95.0%; non-adjuvant chemotherapy group, 88.2%).

Further analysis after stratifying by pretreatment nodal status showed, however, that only patients with pretreatment node-positive disease benefited from adjuvant chemotherapy (HR, 0.24; 95% CI, 0.10-0.58).

The authors concluded that “the use of adjuvant treatment should be considered in patients treated with neoadjuvant chemoradiotherapy who achieve pCR. Recognizing the trade-offs between improving survival and the toxic effects of chemotherapy, the decision to administer [adjuvant chemotherapy] in this subset of patients with excellent survival should be individualized.”

Reference

  1. Dossa F, Acuna SA, Rickles AS, et al. Association between adjuvant chemotherapy and overall survival in patients with rectal cancer and pathological complete response after neoadjuvant chemotherapy and resection. JAMA Oncol. 2018 Apr 19. doi: 10.1001/jamaoncol.2017.5595

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