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Review
. 2024 Apr 26;13(9):2562.
doi: 10.3390/jcm13092562.

Advancing Personalized Medicine in the Treatment of Locally Advanced Rectal Cancer

Francesco Giulio Sullo  1 , Alessandro Passardi  1 , Chiara Gallio  1 , Chiara Molinari  2 , Giorgia Marisi  2 , Eleonora Pozzi  3 , Leonardo Solaini  3 , Alessandro Bittoni  1
Affiliations
Review

Advancing Personalized Medicine in the Treatment of Locally Advanced Rectal Cancer

Francesco Giulio Sullo et al. J Clin Med. .

Abstract

Rectal cancer presents a significant burden globally, often requiring multimodal therapy for locally advanced cases. Long-course chemoradiotherapy (LCRT) and short-course radiotherapy (SCRT) followed by surgery have been conventional neoadjuvant approaches. Recent trials favor LCRT due to improved local control. However, distant tumor recurrence remains a concern, prompting the exploration of total neoadjuvant therapy (TNT) as a comprehensive treatment strategy. Immune checkpoint inhibitors (ICIs) show promise, particularly in mismatch repair-deficient (dMMR) or microsatellite instability-high (MSI-H) tumors, potentially revolutionizing neoadjuvant regimens. Nonoperative management (NOM) represents a viable alternative post-neoadjuvant therapy for selected patients achieving complete clinical response (cCR). Additionally, monitoring minimal residual disease (MRD) using circulating tumor DNA (ctDNA) emerges as a non-invasive method for the assessment of treatment response. This review synthesizes current evidence on TNT, ICIs, NOM, and ctDNA, elucidating their implications for rectal cancer management and highlighting avenues for future research and clinical application.

Keywords: ctDNA; immune checkpoint inhibitors; nonoperative management; rectal cancer; total neoadjuvant treatment.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Advances in the multidisciplinary management of locally advanced rectal cancer.
See this image and copyright information in PMC

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