Neoadjuvant Chemotherapy without Radiation in Colorectal Cancer

Abstract

In colon cancer, primary surgery followed by postoperative chemotherapy represents the standard of care. In rectal cancer, the standard of care is preoperative radiotherapy or chemoradiation, which significantly reduces local recurrence but has no impact on subsequent metastatic disease or overall survival. The administration of neoadjuvant chemotherapy (NACT) before surgery can increase the chance of a curative resection and improves long-term outcomes in patients with liver metastases. Hence, NACT is being explored in both primary rectal and colon cancers as an alternative strategy to shrink the tumor, facilitate a curative resection, and simultaneously counter the risk of metastases. Yet, this lack of clarity regarding the precise aims of NACT (downstaging, maximizing response, or improving survival) is hindering progress. The appropriate cytotoxic agents, the optimal regimen, the number of cycles, or duration of NACT prior to surgery or in the postoperative setting remains undefined. Several potential strategies for integrating NACT are discussed with their advantages and disadvantages.

Keywords

neoadjuvant - preoperative - colorectal cancer - colon cancer - rectal cancer - cytotoxic chemotherapy

Competing Interests

No funding was received for the preparation of this article.

Jyotsna Bhudia has no competing interests to declare.

Rob Glynne-Jones has received honoraria for lectures and advisory boards and has been supported in attending international meetings in the past 5 years by Merck, Pfizer, Sanofi-Aventis, and Roche. He has also, in the past, received unrestricted grants for research from Merck-Serono, Sanofi-Aventis, and Roche. He is principal investigator of a randomized phase II NACT study in the United Kingdom called “BACCHUS.”

Thomas Smith has no competing interests to declare.

Marcia Hall has received honoraria for lectures and advisory boards and has been supported in attending international meetings in the past 5 years by Roche, Merck, Astra Zeneca, Tesaro, and Clovis Oncology.

Authors' Contribution

All authors participated in the development of the manuscript. R.G.J., M.R.H., J.B., and T.S. participated in manuscript conception and provision of data and references. J.B. designed and conducted the literature search and collected data. All authors drafted the manuscript and made critical revisions. All authors approved the final manuscript.

Publication History

Article published online:
25 July 2020

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