Rectal cancer patients may have a new, less painful treatment option.
Announced at the annual meeting of the American Society of Clinical Oncology (ASCO) and led by researchers at Memorial Sloan Kettering Cancer Center (MSK), a clinical trial found a potentially new way forward in treatment for rectal cancer patients that would bypass the painful, often disruptive regimen of radiation therapy for operation.
This data was collected from more than 1,100 study participants with locally advanced rectal cancer. Participants received either FOLFOX – a chemotherapy regimen containing 5-fluorouracil (5FU), oxaliplatin and leucovorin – or a standard combination of chemotherapy before surgery.
The study authors found that subjects who had undergone FOLFOX experienced results that were as favorable as the more traditional, painful chemotherapy and radiation therapy.
The clinical trial provides a window into understanding possible treatments for people with this type of cancer, which could potentially improve a person’s overall quality of life.
“I think it’s a huge game changer,” said Martin Weiser, MD, lead investigator of the surgical trial. Health.
By avoiding radiation and relying solely on chemotherapy, individuals with locally advanced rectal cancer may avoid inhibited sex and fertility—just two of the many complications that radiation therapy can often cause.
“The NCCN guidelines generally recommend radiation for this group, which can now be eliminated in most patients without harming the oncologic outcome. This will reduce toxicity and improve sex, bladder and bowel function,” said Dr. Weiser.
Radiation therapy has long played a crucial role in cancer treatment, but often has many difficult and complex side effects.
People with rectal cancer face a number of complications from radiation confined to a part of the body that is particularly sensitive and important to some of our most important bodily functions. It could lead to infertility, early menopause, damage to the reproductive system, weakened pelvic bones, bladder irritation, and even changes in bowel habits, among other complications.
It is understandable why finding an alternative form of treatment would be a huge improvement for rectal cancer patients.
“The study data is important because it identifies a select group of low-risk rectal cancer patients who can be successfully treated without the use of radiation therapy,” Hyun Kim, MD, associate professor and chief of gastrointestinal services at Washington University School of Medicine, explained for Health.
He added that while the data is exciting, it only applies to a select group of low-risk patients.
Dr. Kim, who is unaffiliated with the study and is also chief of MR clinical services and co-director of the Young Onset CRC Center at Washington University School of Medicine and Siteman Cancer Center, said it’s also important to consider cancer treatment — whether radiation, chemotherapy or surgery – poses a risk of side effects.
“The study showed that there were twice the incidence of severe treatment-related toxicities in the chemotherapy group compared to the chemotherapy group,” he said. “The rate of neuropathy was more than 4 times higher in the chemotherapy group.
This means that patients who can’t risk losing their dexterity—musicians, seamstresses, surgeons—might want to opt for conventional chemotherapy.
When he was asked what stood out the most from the results of the study, Dr. Weiser, a colon and rectal surgeon at Memorial Sloan Kettering Cancer Center, said he and the rest of the team were “very pleased” with the results.
“Bowel, bladder and sexual function improved in the chemotherapy – experimental arm of the study,” he said.
In recent years, doctors have seen an increase in colon cancer among younger generations.
In fact, research projects that colorectal cancer rates and deaths among people aged 20 to 49 will rise over the next two decades and become the second leading cancer among younger people by 2040.
With that in mind, the results of this study may be particularly appealing to younger people undergoing rectal cancer treatment.
“These data are exciting in that younger patients interested in fertility preservation can now be reassured that their rectal cancer can be safely treated without radiation if they meet these trial criteria,” said Dr. Kim.
“Young women will also be able to avoid premature ovarian failure, which is often the result of pelvic radiation,” he added.
Dr. Weiser agreed with these points. He said that since younger people being treated for cancer are expected to live longer and would generally tolerate the toxic effects of radiation for much longer, this new approach is a positive step forward.
Even with newer treatment options, there are some people who still need a more traditional approach to treating rectal cancer.
Dr. Weiser identified situations where “very bulky tumors” invade the sphincter of the anus or penetrate the outer layers of the anus. In these cases, the traditional method of pelvic cancer treatment may be chosen.
“Despite the exciting finding that chemotherapy and surgery are non-inferior to chemotherapy and surgery, it is important to remember that this is not universally true,” said Dr. Kim.
He noted that the trial was selective for patients with low-risk, mid- to high-grade rectal cancer. Patients who are at high risk or have lower grade cancers may still need radiation.
Dr. Kim also pointed to a movement to treat patients non-operatively with radiation and chemotherapy and forgo surgery altogether.
“It is possible that patients treated with chemotherapy and radiotherapy – without surgery – may report an even better quality of life than patients treated with chemotherapy and surgery – without radiotherapy,” he explained. “Fortunately, many clinical trials are underway evaluating these exciting new treatment strategies.
According to Dr. Kim said the results of the study will allow providers and patients to choose treatment options that best meet the needs of people with low-risk rectal cancer.
More evidence, with prospective clinical trials, will be needed to understand whether this type of treatment “is safe and effective in patients with locally advanced rectal cancer,” he said.
Dr. Weiser said the size of the study makes the results compelling, and he expects this approach to be “relevant in many areas where oncologic outcomes are similar and function improves in chemotherapy-only patients.”
“Eliminating the long-term effects of pelvic radiation will be attractive to patients and physicians,” said Dr. Weiser. “Additionally, in rural areas where access to linear accelerators, or beam machines, can be limiting and require traveling many kilometers each day, chemotherapy alone would facilitate treatment.”
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