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How would you approach the treatment of early stage rectal adenocarcinoma in patients with confirmed Lynch Syndrome?
Do you worry about fluoropyrimidine resistance with concurrent chemoRT? Is there any role for neoadjuvant immunotherapy?
Answer from: Medical Oncologist at Academic Institution
If this patient has T3+ or N+ disease, I would favor "TNT" - total neoadjuvant therapy with FOLFOX where you can carefully monitor for response (or lack of response). Lynch Syndrome does not predict for lack of response with oxaliplatin regimens. See for example Yacoub et al., PMID 23730227. With ra...
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Answer from: Medical Oncologist at Community Practice
There is an active clinical trial at MSK (Cercek) looking at these exact questions. Patients receive pembrolizumab in the neoadjuvant setting and if they have a CR, can potentially be observed. They do not necessarily "require" chemotherapy or radiation if they have responded to IO.