Future direction of total neoadjuvant therapy for locally advanced rectal cancer Review

  


Authors: Kagawa, Y.; Smith, J. J.; Fokas, E.; Watanabe, J.; Cercek, A.; Greten, F. R.; Bando, H.; Shi, Q.; Garcia-Aguilar, J.; Romesser, P. B.; Horvat, N.; Sanoff, H.; Hall, W.; Kato, T.; Rödel, C.; Dasari, A.; Yoshino, T.
Review Title: Future direction of total neoadjuvant therapy for locally advanced rectal cancer
Abstract: Despite therapeutic advancements, disease-free survival and overall survival of patients with locally advanced rectal cancer have not improved in most trials as a result of distant metastases. For treatment decision-making, both long-term oncologic outcomes and impact on quality-of-life indices should be considered (for example, bowel function). Total neoadjuvant therapy (TNT), comprised of chemotherapy and radiotherapy or chemoradiotherapy, is now a standard treatment approach in patients with features of high-risk disease to prevent local recurrence and distant metastases. In selected patients who have a clinical complete response, subsequent surgery might be avoided through non-operative management, but patients who do not respond to TNT have a poor prognosis. Refined molecular characterization might help to predict which patients would benefit from TNT and non-operative management. Specifically, integrated analysis of spatiotemporal multi-omics using artificial intelligence and machine learning is promising. Three prospective trials of TNT and non-operative management in Japan, the USA and Germany are collaborating to better understand drivers of response to TNT. Here, we address the future direction for TNT. © Springer Nature Limited 2024.
Keywords: immunohistochemistry; protein expression; treatment response; cancer surgery; bevacizumab; fluorouracil; capecitabine; neoadjuvant therapy; metastasis; quality of life; tumor regression; pathology; proteomics; transcriptomics; distant metastasis; irinotecan; artificial intelligence; colonoscopy; oxaliplatin; hemicolectomy; rectal neoplasms; intestine function; rectum cancer; rectum tumor; sigmoidoscopy; therapy; chemoradiotherapy; personalized medicine; colostomy; tumor microenvironment; conformal radiotherapy; feces incontinence; procedures; humans; human; article; liquid biopsy
Journal Title: Nature Reviews Gastroenterology & Hepatology
Volume: 21
Issue: 6
ISSN: 1759-5045
Publisher: Nature Publishing Group  
Date Published: 2024-06-01
Start Page: 444
End Page: 455
Language: English
DOI: 10.1038/s41575-024-00900-9
PUBMED: 38485756
PROVIDER: scopus
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85187897074&doi=10.1038%2fs41575-024-00900-9&partnerID=40&md5=ce943d94db712e83dd60564d8518456d
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record -- Source: Scopus
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MSK Authors
  1. Andrea Cercek Hanjis
    351 Cercek Hanjis
  2. Julio Garcia Aguilar
    347 Garcia Aguilar
  3. Paul Bernard Romesser
    189 Romesser
  4. Jesse Joshua Smith
    217 Smith
  5. Natally Horvat
    101 Horvat
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