Neoadjuvant Therapy Sequencing May Improve Outcome in Rectal Cancer

There has been a move to total neoadjuvant therapy for patients with locally advanced rectal cancer both to optimize therapy delivery and potentially improve response, leading to nonoperative management and organ preservation in patients who achieve a clinical complete response. Investigators now report results of the open-label, multicenter, phase 2 Organ Preservation for Rectal Adenocarcinoma (OPRA) trial, which randomized patients to either induction chemotherapy with FOLFOX or capecitabine/oxaliplatin for 4 months followed by capecitabine and radiotherapy (INCT-CRT) or the reverse sequence of CRT followed by consolidation chemotherapy (CRT-CNCT). Total mesorectal excision (TME) was performed in patients not achieving a clinical complete…