Читать книгу Surgical Management of Advanced Pelvic Cancer - Группа авторов - Страница 52

Long‐term outcome data following induction or consolidation chemotherapy are lacking, and whether the total neoadjuvant approach can improve survival remains to be elucidated. Several prospective randomized trials are currently ongoing to evaluate long‐term disease‐specific outcomes, including the PROSPECT and TNTCRT trials [75]. The awaited North American PROSPECT trial will show us if some high‐risk patients who respond well to induction FOLFOX can omit neoadjuvant radiotherapy. GRECCAR12 (lower‐risk patients) is still recruiting and builds on GRECCAR2 comparing neoadjuvant FOLFIRINOX followed by CRT to CRT alone [76, 77]. In both arms, good responders will have local excision of the primary to avoid major surgery. Similarly, the Chinese TNTCRT trial is designed to assess whether induction and consolidation CAPOX, nCRT, and TME improves DFS compared with standard nCRT and TME with adjuvant chemotherapy (NCT03177382). Circulating tumor DNA (ctDNA) is under investigation to guide adjuvant chemotherapy in stage II colon cancer [78, 79]. The DESTINY‐CRC01 trial proved that a drug–antibody conjugate (trastuzumab deruxtecan to target the HER2 receptor) is active against metastatic colon cancer that appropriately express the molecular target [80]. A deeper understanding of radiobiology may lead to molecularly targeted radio‐sensitizing agents [81, 82]. It may become possible to use immunotherapy in MSS LARC.