Personalizing Treatment for Rectal Cancer: Total Neoadjuvant Therapy Is Leading the Way
A partir d'une revue systématique de la littérature publiée jusqu'en juillet 2020 (7 études, 2 416 patients atteints d'un cancer colorectal de stade localement avancé), cette méta-analyse compare l'efficacité, du point de vue du taux de réponse pathologique complète, de la survie sans maladie et de la survie globale, d'un traitement néoadjuvant total par rapport au traitement standard comportant une chimioradiothérapie concomitante suivie d'une chirurgie et d'une chimiothérapie adjuvante
In this issue of JAMA Network Open, Kasi et al report the results of a systematic review and meta-analysis comparing the use of total neoadjuvant therapy (TNT) followed by surgery vs standard chemoradiotherapy (CRT) followed by surgery and adjuvant chemotherapy for patients with locally advanced rectal cancer. In their meta-analysis, which included 6 prospective trials with more than 1500 patients, a TNT approach was associated with higher rates of pathologic complete response (PCR) at the time of surgery and with improved disease-free survival (DFS) in the 3 studies that reported DFS. None of the 6 studies they analyzed provided data on overall survival (OS), and thus, the authors correctly conclude that longer follow-up of these studies is required to better understand the association between PCR, DFS, and eventual OS in patients with locally advanced rectal cancer. However, as more studies continue to complete accrual and present their results, the preponderance of evidence appears to support a TNT approach.
JAMA Network Open 2020