Top Line: Does immunotherapy improve the response rate to neoadjuvant therapy for rectal cancer?
The Study: In the recent phase 2 TORCH trial, we saw that adding immunotherapy to total neoadjuvant therapy for rectal cancer resulted in favorable response rates. However, iTNT in TORCH wasn’t directly compared with a standard TNT regimen. Although it didn’t use a pure TNT approach, the UNION investigated the benefit of adding immunotherapy to neoadjuvant and adjuvant therapy for rectal cancer. In the trial, 231 patients with T3-4 N+ rectal adenocarcinoma were randomized to receive 1) long course CRT followed by 2 cycles of CAPOX and 6 cycles of adjuvant CAPOX or 2) short course RT followed by 2 cycles of CAPOX plus camrelizumab and 6 cycles of adjuvant CAPOX plus camrelizumab. The primary outcome of pathologic complete response rate was significantly higher in the camrelizumab arm (39.8% v 15.3%). There were no differences in toxicity between arms. The pCR rate in the later arm was lower than those seen in larger TNT trials. Also, we’re once again left wondering whether outcomes in the camrelizumab arm would have been any different with long course CRT.
TBL: In the UNION trial, a neoadjuvant regimen containing camrelizumab improved the pCR rate compared with standard chemotherapy and radiation in patients with locally advanced rectal cancer. | Lin, Ann Oncol 2024
The Study: In the recent phase 2 TORCH trial, we saw that adding immunotherapy to total neoadjuvant therapy for rectal cancer resulted in favorable response rates. However, iTNT in TORCH wasn’t directly compared with a standard TNT regimen. Although it didn’t use a pure TNT approach, the UNION investigated the benefit of adding immunotherapy to neoadjuvant and adjuvant therapy for rectal cancer. In the trial, 231 patients with T3-4 N+ rectal adenocarcinoma were randomized to receive 1) long course CRT followed by 2 cycles of CAPOX and 6 cycles of adjuvant CAPOX or 2) short course RT followed by 2 cycles of CAPOX plus camrelizumab and 6 cycles of adjuvant CAPOX plus camrelizumab. The primary outcome of pathologic complete response rate was significantly higher in the camrelizumab arm (39.8% v 15.3%). There were no differences in toxicity between arms. The pCR rate in the later arm was lower than those seen in larger TNT trials. Also, we’re once again left wondering whether outcomes in the camrelizumab arm would have been any different with long course CRT.
TBL: In the UNION trial, a neoadjuvant regimen containing camrelizumab improved the pCR rate compared with standard chemotherapy and radiation in patients with locally advanced rectal cancer. | Lin, Ann Oncol 2024