TY - JOUR
T1 - Future direction of total neoadjuvant therapy for locally advanced rectal cancer
AU - Kagawa, Yoshinori
AU - Smith, J. Joshua
AU - Fokas, Emmanouil
AU - Watanabe, Jun
AU - Cercek, Andrea
AU - Greten, Florian R.
AU - Bando, Hideaki
AU - Shi, Qian
AU - Garcia-Aguilar, Julio
AU - Romesser, Paul B.
AU - Horvat, Natally
AU - Sanoff, Hanna
AU - Hall, William
AU - Kato, Takeshi
AU - Rödel, Claus
AU - Dasari, Arvind
AU - Yoshino, Takayuki
N1 - Publisher Copyright:
© Springer Nature Limited 2024.
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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.
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U2 - 10.1038/s41575-024-00900-9
DO - 10.1038/s41575-024-00900-9
M3 - Article
AN - SCOPUS:85187897074
SN - 1759-5045
JO - Nature Reviews Gastroenterology and Hepatology
JF - Nature Reviews Gastroenterology and Hepatology
ER -