David Sebag-Montefiore: We strongly caution against the use of FOLFOX alone applied to the whole PROSPECT trial population

David Sebag-Montefiore shared on LinkedIn:

“Delighted to see our letter published in the New England Journal of Medicine co-authored with Andres Cervantes and Claus Rodel where we highlight important considerations in the interpretation of the PROSPECT rectal cancer trial from a global perspective.

Whilst the trial demonstrated excellent cancer outcomes for both 12 weeks oxaliplatin 5FU (FOLFOX) and 5.5 weeks fluoropyrimidine chemo-radiotherapy CRT in “locally advanced” rectal cancer we strongly caution against the use of FOLFOX alone applied to the whole PROSPECT trial population. Furthermore, we contend that both FOLFOX and CRT represent significant over-treatment of a substantial proportion of the PROSPECT trial population (38% of patients had T3N0 disease with tumour >3mm from the mesolectal fascia).

The media description that the use of chemotherapy alone allows patients to avoid the brutal side effects of radiotherapy is not balanced and misleading. The significant advances in radiation technology allow more precise treatment delivery with significantly lower rates of late toxicity. It also remains the case that the majority of late toxicity in rectal cancer treatment is due to major surgical resection with an additional (smaller) additional impact of radiation.

Researchers across the globe are currently working hard to develop effective organ preservation strategies that are underpinned by precision radiotherapy to avoid the need for major surgery and a colostomy. ”

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Source: David Sebag-Montefiore/LinkedIn

David Sebag-Montefiore is the Audrey and Stanley Burton Professor of Clinical Oncology at the University of Leeds and Honorary Clinical Oncologist at Leeds Teaching Hospitals NHS Trust.
He serves as the Clinical Director of Leeds Cancer Research Centre, Director of the Leeds Cancer Research UK Radiotherapy Research Centre of Excellence, and Clinical Director of the Leeds Cancer Research UK Clinical Trials Unit. He Chairs the National Cancer Institute Radiotherapy Research Group (CTRad) and previously chaired Cancer Research UK’s Clinical Trials Awards and Advisory Committee (CTAAC). Dr. Sebag-Montefiore’s research interests focus on personalized and adaptive radiotherapy including novel agent radiotherapy combinations through interdisciplinary research including artificial intelligence, computational modeling data science, and imaging to improve patient outcomes. As chief investigator of randomised clinical trials his research has determined standards of care internationally for patients with anal and rectal cancer. His current interests include novel and adaptive radiotherapy platform trials.