Lack of familiarity with CT staging and concern for overstaging limits use of NAC. We should at least use NAC for patients at highest risk-cT4b, which is routinely reported on CT.“
Apr 8, 2024, 12:20
Smitha Krishnamurthi: Neoadjuvant chemo (NAC) has benefit in OPTICAL and FOxTROT!
Smitha Krishnamurthi, Gastrointestinal Medical Oncologist at Cleveland Clinic, shared on X/Twitter:
“Neoadjuvant chemo (NAC) has benefit in OPTICAL and FOxTROT!
Congrats to all authors!
While OPTICAL was powered for larger DFS effect (HR 0.67), the HR of 0.74 (95%CI 0.54-1.03) suggests a larger study may have been positive.
FOxTROT enrolled a larger but similar patient population. Rate ratio for risk of recurrence or residual cancer at 2 years was 0.72 (95% CI 0.54-0.98).
NAC resulted in absolute 4.6% ⬆️ in DFS at 3 years in OPTICAL and absolute 4.6% ⬇️ in recurrence/ residual cancer in FOxTROT at 2 years. Love the coincidence!
Check out the correlation between AJCC TRG with DFS! Similar to finding in FOxTROT.
Need more info as to why NAC was more beneficial in females vs males. Path CR was doubled 12% v 6%. Any difference in toxicity/ dose intensity?
Significant OS benefit was unexpected without similar DFS effect. Authors caution subsequent therapies unknown. Was there OS difference by sex?
Proceed to the article.
Source: Smitha Krishnamurthi/X