FOLFOX with selective use of 5FUCRT is non-inferior to 5FUCRT for treatment of LARC prior to low anterior resection with TME

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Published: 20 Jun 2023
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Dr Martin Weiser - Memorial Sloan Kettering Cancer Center, New York City, USA

Dr Martin Weiser speaks to ecancer at ASCO 2023 about the results from the PROSPECT trial. This was a phase III trial of neoadjuvant chemoradiation versus neoadjuvant FOLFOX chemotherapy with selective use of chemoradiation, followed by total mesorectal excision (TME) for treatment of locally advanced rectal cancer (LARC).

He reports that the patients in the experimental arm received chemotherapy and only received radiation if they did not respond to the chemotherapy.

Dr Weiser reports that the patients in the experimental group did just as well as the patients who all received radiation.

Read more here.

The study was a prospective randomised trial that asked the question if locally advanced rectal cancer can be treated with chemotherapy and selective radiation rather than routine radiation.

What was the design of the study?

It was a prospective randomised trial, a 1:1 randomisation. Patients received either standard treatment, which was chemoradiation, rectal surgery and adjuvant chemotherapy, and in the experimental arm they received chemotherapy and they only received radiation if they did not respond to the chemotherapy. Patients went on to have surgery and additional chemotherapy afterwards.

What did you find?

The results showed us that in the experimental group where they had selective radiation, the patients did as well as if they all had radiation. So that tells us that we don’t necessarily have to use radiation for locally advanced rectal cancers that met the inclusion criteria of the study.

How do you think these results can impact the future treatment of rectal cancer?

I do think the results have a big impact in the treatment of rectal cancer. Patients now have a choice of how they want to be treated for rectal cancer. There is an option to use selective radiation, potentially avoid radiation in many patients.