Articles related to ADJUVANT TREATMENT

A literature review involving 24 recent studies yielded an update to ASCO’s recommendations on appropriate use of breast cancer biomarker assay results to guide adjuvant endocrine and chemotherapy decisions in early-stage breast cancer.

“For patients with T1cN1-2 or T2-4N0 (stage II or III), early-stage TNBC, the Panel recommends use of pembrolizumab (200 mg once every 3 weeks or 400 mg once every 6 weeks) in combination with neoadjuvant chemotherapy, followed by adjuvant pembrolizumab after surgery.”

Short-term radiotherapy with preoperative chemotherapy followed by surgery (total neoadjuvant therapy, TNT) was compared to standard long-term chemoradiotherapy in patients with locally advanced rectal cancer. At a median follow-up of 35.0 months, 3-year DFS was 64.5% and 62.3% in the TNT and CRT groups, respectively. There was no significant difference in metastasis-free survival or locoregional recurrence, but the TNT group had better 3-year overall survival than the CRT group (86.5% v 75.1%; P = .033). Treatment effects on DFS and overall survival were similar regardless of prognostic factors. The prevalence of acute grade III-V toxicities during preoperative treatment was 26.5% in the TNT group versus 12.6% in the CRT group (P < .001).

This retrospective cohort study included 2,833 patients with stage IB to IIIA NSCLC who enrolled in the Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trial (ALCHEMIST) screening study from August 18, 2014, to April 1, 2019. Although 93% received surgical resection, just 53% had adequate lymph node dissection and 57% received any adjuvant chemotherapy. The authors suggest more effort at optimizing use of proven therapies in this patient population.

Initial results of the PREOPANC trial — comparing the addition of neoadjuvant chemoradiation therapy of gemcitabine combined plus Gy radiotherapy to standard care — failed to demonstrate a statistically significant overall survival (OS) improvement versus standard care of upfront surgery followed by adjuvant therapy. The long-term results, however, demonstrate significant benefit with neoadjuvant chemoradiation therapy consisted of gemcitabine combined plus Gy radiotherapy. The five year OS rate was 20.5% (95% CI, 14.2 to 29.8) with neoadjuvant chemoradiotherapy and 6.5% with upfront surgery.

Interest in immune-modulating neoadjuvant therapy for melanoma is growing. It is possible that BRAF/MEK inhibition will be more effective in the neoadjuvant than in the adjuvant setting because of the effect of the tumor biomass. And the benefits neoadjuvant therapy would offer in assessing biologic response assessment to treatment are significant. In this review the authors discuss the rationale for this treatment approach, summarize completed and ongoing neoadjuvant clinical trials, and contextualize these findings within the growing body of knowledge about targeted and immune checkpoint therapy.