The New England Journal of MedicinePreoperative Treatment of Locally Advanced Rectal Cancer

FOLFOX vs. Chemoradiotherapy: A Comparative Study in Locally Advanced Rectal Cancer Treatment

A recent study has shed light on the efficacy of neoadjuvant FOLFOX (fluorouracil, leucovorin, and oxaliplatin) as an alternative to chemoradiotherapy in treating locally advanced rectal cancer. The findings suggest a potential shift in the standard care approach.

• The study was a multicenter, unblinded, noninferiority, randomized trial comparing neoadjuvant FOLFOX to chemoradiotherapy in locally advanced rectal cancer.
• Participants were adults with clinically staged T2 node-positive, T3 node-negative, or T3 node-positive rectal cancer, eligible for sphincter-sparing surgery.
• The primary end point was disease-free survival, with noninferiority claimed if the hazard ratio for disease recurrence or death did not exceed 1.29.
• From 2012 to 2018, 1,194 patients were randomized, and 1,128 started treatment; 585 in the FOLFOX group and 543 in the chemoradiotherapy group.
• At a median follow-up of 58 months, FOLFOX was found to be noninferior to chemoradiotherapy for disease-free survival (hazard ratio, 0.92; P=0.005 for noninferiority).
• Five-year disease-free survival was 80.8% in the FOLFOX group and 78.6% in the chemoradiotherapy group.
• Overall survival and local recurrence rates were similar between the two groups.