Many patients with locally advanced rectal cancer who do not have high-risk disease can skip radiotherapy to the pelvic area, and instead be treated with chemotherapy alone and then surgery, say researchers reporting results from the PROSPECT trial.
“This study establishes preoperative therapy with FOLFOX and only selective use of chemoradiation for patients with locally advanced rectal cancer,” commented principal investigator Deborah Schrag, MD, MPH, gastrointestinal oncologist at Memorial Sloan Kettering Cancer Center, New York City.
“Having this option is important for several reasons,” she said. “First, in many parts of the world, radiation therapy is not readily accessible. An all-chemotherapy approach may make curative intent treatment accessible for patients in these resource-constrained settings.
“Additionally, given the rising rates of colorectal cancer in young patients, this provides an option for patients who wish to preserve fertility or avoid early menopause,” she said.
Reacting to the findings, Pamela Kunz, MD, leader of the Gastrointestinal Cancers Program at Yale Cancer Center, New Haven, Connecticut, commented: “What’s important here is that radiation can be safely omitted in many patients with clinically advanced rectal cancer — this is really ‘less is more.’ “
“We can spare select patients from receiving radiation without compromising efficacy,” she said. “This leads to improved quality of life, and reduced side effects, including things like early menopause and infertility.”
Kunz spoke at a press briefing where the results were highlighted prior to being presented today at a plenary session here at the American Society of Clinical Oncology annual meeting. She said the trial was “practice changing, and it aligns incredibly well with the theme at this year’s annual meeting around de-escalation of therapy and partnering with patients.”
Julie R. Gralow, MD, ASCO chief medical officer and executive vice president, added that the theme may be de-escalation, but in this case it is “really more accurately optimization, because you were able to de-escalate in 91%, but you found the 9% who really needed that escalation, if you will.”
Co-investigator Ethan Basch, MD, MSc, chief of medical oncology, and director of the Cancer Outcomes Research Program at University of North Carolina Lineberger Comprehensive Cancer Center in Chapel Hill, wrote in a statement, “Patients ideally will understand the potential impact of treatments on how they feel and function when making choices, so as oncologists we need to talk with our patients about their options and the consequences of those options.”
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