Total neoadjuvant therapy with immunotherapy in locally advanced rectal cancer
Mené sur 98 patients atteints d'un adénocarcinome du rectum de stade localement avancé (durée médiane de suivi : 25 mois ; 31 % de femmes), cet essai randomisé de phase II évalue l'efficacité, du point de vue du taux de réponse complète, et la sécurité d'un traitement néoadjuvant total comportant une radiothérapie de courte durée suivie d'une chimiothérapie à base de capécitabine et d'oxaliplatine, avec ou sans immunothérapie
The type of neoadjuvant treatment for rectal cancer depends on stage, risk criteria, and the intent of treatment. The overall goal with neoadjuvant treatment is to balance toxicity and tolerance with a relevant risk reduction of locoregional recurrence and distant metastasis for optimal disease-specific survival. Also, a non-operative (organ-sparing) approach of watch-and-wait surveillance might be offered to select patients with clinical complete response. Although the organ-sparing approach increases the patient's options and offers shared decision making, it might also clutter reporting of endpoints in trials and make clinical interpretation more difficult. Additional to this are the remarkable pathological complete response rates and clinical complete response rates from biomarker-driven immunotherapy for colon cancer and rectal cancer with deficient mismatch repair (dMMR), which have led to a surge in immunotherapy-driven trials4 for both dMMR and proficient mismatch repair (pMMR) tumours. Hence, the quest for optimal neoadjuvant treatment in rectal cancer is ongoing and far from settled.
The Lancet Oncology , commentaire, 2025