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In which patients with early stage rectal cancer treated according to the PROSPECT paradigm do you recommend adjuvant chemotherapy?
Current NCCN guidelines do not include adjuvant chemotherapy for patients treated in this fashion; however, in the PROSPECT trial itself, an additional 6 cycles of adjuvant FOLFOX was "suggested but not mandated", and 75% of patients did receive adjuvant chemotherapy.
Answer from: Medical Oncologist at Academic Institution
Great question and great observation. The most recent NCCN guidelines (version 1.2024-page REC-6) clearly listed neoadjuvant chemotherapy without radiation as an option for patients with no T4 disease eligible for sphincter-sparing surgery. After the neoadjuvant chemotherapy, if tumor regression is ...
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Answer from: Medical Oncologist at Community Practice
If I choose to pursue the PROSPECT regimen, I would pursue it in its entirety and would advocate for adjuvant chemo for all patients unless AC poses additional risks for any reason. The PROSPECT manuscript does not say why 25% of patients did not receive AC after the surgery. My guess is a significa...
Answer from: Medical Oncologist at Community Practice
When the PROSPECT trial data was published in the print form in the New England Journal of Medicine back in July 2023 (Schrag et al., PMID 37272534), we submitted our commentary to the New England Journal of Medicine addressing this very question in early August 2023. (Copur et al. N Eng J Med, unpu...