Total neoadjuvant therapy for locally advanced rectal cancer: a narrative review

Abstract

Locally advanced rectal cancer has traditionally been treated with chemoradiotherapy (CRT) followed by surgery and adjuvant chemotherapy. However, a new strategy, total neoadjuvant therapy, involves the administration of CRT and neoadjuvant chemotherapy with the aim of eradicating micrometastases earlier and achieving greater control of the disease. The use of total neoadjuvant therapy has shown higher rates of pathological complete response and resectability compared with CRT, including improved survival. Nevertheless, distant relapse is the main cause of morbidity and mortality in locally advanced rectal cancer. To address this, new biomarkers are being developed to predict disease response.

Tweetable abstract

Exciting breakthrough and results in rectal cancer treatment with total neoadjuvant therapy. Chemoradiotherapy and presurgery chemotherapy for better disease control. Higher complete response rates and improved survival. Ongoing search for new biomarkers. #FutureOncology

Keywords::

• biomarkers
• chemotherapy
• LARC
• pathological complete response
• radiotherapy
• rectal cancer
• total neoadjuvant therapy

Author contributions

Article writing and table preparation: E Gomis Sellés, D Gonsalves Pieretti, P Peleteiro Higuero, E González Del Portillo, V Morillo Macías, M Mateos Domínguez, R Fuentes Mateos. Review of the article and pertinent modifications: all authors.

Financial & competing interests disclosure

F Couñago declares sponsored research: Janssen; consulting, advisory role: Janssen, AstraZeneca; lectures and educational activities: Janssen, Roche Farma, AstraZeneca, Astellas; travel, accommodations, expenses: AstraZeneca, Astellas, Janssen, Roche Farma. F Lopez Campos declares consulting, advisory role: Janssen, AstraZeneca, Bayer, Astellas, Casen Recordati; lectures and educational activities: Janssen, AstraZeneca, Bayer, Astellas, Casen Recordati; travel accommodations, expenses: Janssen, AstraZeneca, Bayer, Astellas, Casen Recordati. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Additional information

Funding

F Couñago declares sponsored research: Janssen; consulting, advisory role: Janssen, AstraZeneca; lectures and educational activities: Janssen, Roche Farma, AstraZeneca, Astellas; travel, accommodations, expenses: AstraZeneca, Astellas, Janssen, Roche Farma. F Lopez Campos declares consulting, advisory role: Janssen, AstraZeneca, Bayer, Astellas, Casen Recordati; lectures and educational activities: Janssen, AstraZeneca, Bayer, Astellas, Casen Recordati; travel accommodations, expenses: Janssen, AstraZeneca, Bayer, Astellas, Casen Recordati. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.