Multi-agent Chemotherapy Not Recommended To Replace Chemoradiotherapy in Rectal Cancer
Neoadjuvant chemotherapy is superior to neoadjuvant multi-agent chemotherapy for the treatment of stage II or III rectal adenocarcinoma.
Neoadjuvant chemotherapy (NCRT) is superior to neoadjuvant multi-agent chemotherapy (NMAC) for the treatment of stage II or III rectal adenocarcinoma, according to a study published in Cancer.1
For more than 20 years, the standard treatment for stage II or III rectal cancer has been NCRT followed by surgery. Radiotherapy is, however, associated with toxicity in up to half of treated patients. To determine whether multi-agent chemotherapy can be substituted for chemoradiotherapy for some specific disease stages, researchers are recruiting patients for a phase 2/3 study, titled PROSPECT (Chemotherapy Alone or Chemotherapy Plus Radiation Therapy in Treating Patients With Locally Advanced Rectal Cancer Undergoing Surgery; ClinicalTrials.gov Identifier: NCT01515787).
For the present paper, researchers identified 21,707 patients eligible for the PROSPECT trial to evaluate the overall survival of patients who received NCRT against that of those who received NMAC. Of the evaluated patients, 21,433 received NCRT and 274 received NMAC.
The 1-year overall survival rates were 92.1% and 95.5% for NMAC and NCRT, respectively; the 5-year overall survival rates were 67.2% and 75% for NMAC and NCRT, respectively.
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The authors conclude that NMAC should be used only in clinical studies, and that it is not a recommendable treatment for patients in a non-research setting. Though it is conceded that the NCRT benefit for overall survival may be explained by other causes of mortality, the authors do not discuss the limitation of the small sample size of the NMAC group.
- Cassidy RJ, Liu Y, Patel K, et al. Can we eliminate neoadjuvant chemoradiotherapy in favor of neoadjuvant multiagent chemotherapy for select stage II/III rectal adenocarcinomas: Analysis of the National Cancer Database. Cancer. 2016 Oct 25. doi: 10.1002/cncr.30410 [Epub ahead of print]