The PROSPECT trial found that neoadjuvant FOLFOX alone resulted in similar survival and disease control outcomes compared to chemoradiation for relatively low risk rectal cancer. Here we have CONVERT, which was a phase 3 trial designed to test the noninferiority of neoadjuvant CAPOX for locally advanced rectal cancer without mesorectal fascia involvement. It included 589 patients with N+ or cT3-4 disease that was mostly in the mid to upper rectum not involving or abutting the MRF. They received either 50/45 Gy in 25 fractions with capecitabine or 4 cycles of CAPOX. While there was no significant difference in the primary endpoint of locoregional recurrence free survival (97.4% CRT v 96.3% CT), there were not enough events to meet the noninferiority threshold. DFS at 3 years was 87.9% CRT v 89.2% CT. Of note, the subset of patients with tumors <5cm from the anal verge had borderline worse LRRFS with CT alone (HR 3.6, p=0.06). There were no significant differences in acute adverse events. There were no differences in overall late adverse events or late grade 3+ AEs between groups, however late grade 2+ events were higher in the CRT arm (26.3% v 16%). | Mei, J Clin Oncol 2026
