Top line:
The latest data from the OPRA trial shows that nearly half of patients are stage II/III. rectal cancer Patients treated with complete neoadjuvant therapy had their rectum preserved for 5 years, but local tumor regrowth occurred primarily within the first 2 years.
methodology:
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Many patients with locally advanced rectal cancer treated with fully neoadjuvant therapy in the OPRA trial achieved complete or near-complete tumor responses, and a watchful waiting strategy was initially proposed.
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However, nearly one-third of patients undergoing follow-up developed local tumor regrowth and ultimately required treatment. Total mesorectal resection (TME).
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The research team randomized 324 patients with stage II/III rectal cancer to induction chemotherapy followed by chemoradiation (n=158) or chemoradiation followed by consolidation chemotherapy (n=166). We report the latest organ salvage rates and oncologic outcomes from the assigned OPRA trial.
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Among 304 patients who underwent reoperation a median of 7.8 weeks after completion of all neoadjuvant therapy, researchers recommended TME in 26% and observation in 74% (n=225) .
remove:
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The researchers reported similar 5-year disease-free survival rates between patients in the induction chemotherapy group (71%) and consolidation chemotherapy group (69%). Estimated 5-year overall survival rates were also similar in the two groups: 88% in the induction group and 85% in the consolidation group.
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Of the patients who were followed up, 36% (n=81) experienced tumor regrowth. 94% occurred within her 2 years and 99% occurred within her 3 years.
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An estimated 39% of patients in the induction chemotherapy group and 54% of patients in the consolidation chemotherapy group achieved organ preservation at 5 years, representing about half of all patients.
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Among patients who underwent observation, salvage TME after tumor regrowth resulted in similar disease-free survival (64% of patients) as immediate TME (also 64%) after incomplete response to neoadjuvant therapy overall It seemed to bring about.
in fact:
The authors concluded that fully neoadjuvant therapy for patients with rectal cancer “led to long-term organ preservation in half of the patients.” Treatment sequence had no effect on survival, but consolidation chemotherapy was associated with “higher rates of organ preservation at 5 years.”
“Our results support the recommendations proposed by rectal cancer patients. [watch-and-wait] “Very close monitoring is required during the first 3 years after neoadjuvant therapy,” the authors added.
sauce:
The study was co-authored by lead author Floris S. Verheij, Ph.D., of Memorial Sloan Kettering Cancer Center in New York City. Published online October 26, 2023 Journal of Clinical Oncology.
Limitations:
The study is presented as an update on a clinical trial and does not include a discussion of limitations.
Disclosure:
Funding was provided by the National Cancer Institute. Several OPRA trial participants disclosed ties to various companies including Sironax, Janssen Oncology, Toray Industries Inc., Merck, and Intuitive Surgical (full list) available here).