Aaron Teoh, Advanced Clinical Oncology Pharmacist at The Clatterbridge Cancer Centre NHS Foundation Trust, shared a post on LinkedIn:
“Credits to Xenofon Vakalis
Total neoadjuvant therapy (TNT) for rectal cancer – summarised and condensed:
Common TNT sequencing strategies:
- Induction chemotherapy → CRT → surgery
- CRT → consolidation chemotherapy → surgery (often gives higher pCR)
- Short-course RT → chemotherapy → surgery
Phase 1 :
Standard long-course: 45–50.4 Gy in 25–28 fractions
Or short-course RT: 25 Gy in 5 fractions
Concurrent chemotherapy
Capecitabine orally
Or 5-FU infusion
Purpose:
This aims to shrink the tumour and improve resectability.
Phase 2:
Typical regimens:
- FOLFOX (5-FU, leucovorin, oxaliplatin)
- CAPOX (Capecitabine + Oxaliplatin)
Purpose:
- Treat micrometastatic disease early
- Increase pathological complete response (pCR)
- Improve sphincter preservation
- Reduce distant recurrence
TnT aims:
- Maximise tumour regression
- Improve pCR and chances of non-operative ‘watch-and-wait’
- Reduce metastases
- Ensure patients receive all systemic therapy (many skip adjuvant chemo if given post-op)”
More posts about Rectal Cancer.