Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial

Clinical Applications of Minimal Residual Disease Assessments by Tumor-Informed and Tumor-Uninformed Circulating Tumor DNA in Colorectal Cancer

“…In either neoadjuvant approach, watchful waiting (WW) or organ preservation strategies in LARC are increasingly being investigated given that complete response (CR) rates approach 30% following neoadjuvant therapy [49,50]. While data in the WW setting require further maturation, TNT is generally the preferred approach if organ preservation is desired [7][8][9][10]. Not surprisingly, several groups have explored the role of ctDNA in predicting responses to neoadjuvant and surgical therapy in LARC to potentially assist in personalization of LARC treatments (Table 3).…”

“…It has been recently proposed that 3 months of adjuvant CAPOX can be used for all stage III colon cancer [5]. In locally advanced rectal cancer (LARC), neoadjuvant therapy and surgery are mainstays of treatment although total neoadjuvant therapy (TNT) has increasingly been recognized as an alternative to classical neoadjuvant chemoradiation therapy with promising clinical response rates, especially if organ preservation is preferred or in high-risk LARC [7][8][9][10].…”

Radiomics in the Setting of Neoadjuvant Radiotherapy: A New Approach for Tailored Treatment

“…This strategy is currently used mainly in locally advanced rectal cancer and sarcoma and in a subset of non-small cell lung cancer and esophageal cancer, whereas in other diseases it is still under investigation [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. An evaluation of the efficacy of the induction strategy is made possible by performing imaging investigations before and after the neoadjuvant therapy.…”

Molecular and Dynamic Evaluation of Proteins Related to Resistance to Neoadjuvant Treatment with Chemoradiotherapy in Circulating Tumor Cells of Patients with Locally Advanced Rectal Cancer

“…On the other hand, for non-responders, the standard NCRT must be reevaluated in order to avoid unnecessary toxicities or, eventually, establish new treatment strategies capable of optimizing the response of these patients, such as the adoption of more intense treatments according to the reasoning proposed by the TNT’s strategy [ 7 , 49 ]. In view of this, numerous efforts with studies evaluating the intensification of NCRT are underway and the recently published RAPIDO study and the PRODIGE 23 phase III study reinforced the importance of the TNT strategy with the addition of chemotherapy (FOLFOX/CAPOX or FOLFIRINOX) in increasing the rate of pCR and reducing about 7% of distant metastases [ 8 , 9 ]. However, we reinforce with our results that the risk stratification must be improved and the incorporation of the liquid biopsy in these studies must be considered, in order to avoid overtreatment for some patients.…”

“…More recently, two phase III trials demonstrated an improvement in disease free survival (DFS) for patients treated with total neoadjuvant therapy (TNT) when compared to conventional NCRT [ 8 , 9 ]. Distal rectal carcinoma is even more challenging since the great majority of patients are eventually submitted to rectal amputation and definitive colostomy, generating a high social and psychological impact.…”