Thierry Conroy, MD, on Rectal Cancer: Long-Term Results on mFOLFIRINOX vs Preoperative Chemoradiation Therapy
2023 ASCO Annual Meeting
Thierry Conroy, MD, of the Institut de Cancérologie de Lorraine, discusses phase III findings from the PRODIGE 23 trial, showing that neoadjuvant chemotherapy with mFOLFIRINOX followed by chemoradiotherapy, surgery, and adjuvant chemotherapy improved all outcomes, including overall survival, in patients with locally advanced rectal cancer compared with standard chemoradiotherapy, surgery, and adjuvant chemotherapy (Abstract LBA3504).
Disclaimer: This video transcript has not been proofread or edited and may contain errors.
Prodige 23 is a phase three randomized trial that we perform in France in 35 centers. And we have presented the seven-year result of that study. And we confirm all the benefit we had in this study, and we already published. It was a comparison between the standard of care preoperative chemoradiation ventium surgery and six month of adjuvant chemotherapy in patients with locally advanced rectal cancer. And we compare it to three month of induction chemotherapy using the modify Folfirinox regimen than preoperative chemo radiation TME and three month of adjuvant chemotherapy. All patients receive six month of chemotherapy.
We have now a follow-up of 82 month. It means quite seven year, and we confirm a very important reduction of metastases as from 10%. We have still a benefit in the primary endpoint, which is DFS. Also benefiting cancer specific survival. One important point is that we had no increase in local relapse in the experimental arm, which is lower than 5%. And the other point is that the survival at metastatic disease was exactly the same in the two arms, and it was not reduced in the experimental arm.
We had an overall survival benefit, and this is the major point of this study, as we had the 7% overall survival benefit when quality of life improve faster and higher levels in the experimental alarm. To conclude, this is the very positive trial and very good news for patients. The next step will be to know if with induction chemotherapy with Folfirinox some patients may not receive chemo chemo radiation, especially in case of good response to induction chemotherapy. The other point is to know if induction chemotherapy will increase the rate of organ preservation.
Nirav N. Shah, MD, of the Medical College of Wisconsin, discusses phase II results showing that split-dose R-CHOP offers older patients with diffuse large B-cell lymphoma (DLBCL) an equivalent dose intensity as R-CHOP-21 through a fractionated dosing schedule, improving tolerability. At the end of treatment for these older patients, a complete response rate of 71% was comparable to outcomes with R-CHOP in younger patients with the disease (Abstract 7554).
Arlene O. Siefker-Radtke, MD, of The University of Texas MD Anderson Cancer Center, discusses phase III findings showing that for patients with advanced or metastatic urothelial carcinoma and FGFR alteration who already had been treated with a PD-(L)1 inhibitor, erdafitinib significantly improved overall and progression-free survival, as well as overall response rate, compared with investigator’s choice of chemotherapy (LBA4619).
Alberto Bossi, MD, of Institut Gustave Roussy, discusses phase III findings showing that combining prostate radiotherapy with systemic treatment did not improve overall survival in men with de novo metastatic castration-sensitive prostate cancer and low metastatic burden. However, best outcomes (radiographic progression–free-survival and overall survival) were observed in men receiving the standard of care plus abiraterone acetate plus prednisone with radiotherapy (Abstract LBA5000).
Tycel J. Phillips, MD, of City of Hope National Medical Center, and Emanuele Zucca, MD, of the Oncology Institute of Southern Switzerland and the International Extranodal Lymphoma Study Group, discuss findings from the largest prospective study of patients with primary mediastinal B-cell lymphoma. The trial data support omitting radiotherapy in patients who achieve complete metabolic response after immunochemotherapy (Abstract LBA7505).
Narjust Florez, MD, of Dana-Farber Cancer Institute, and Ticiana Leal, MD, of Winship Cancer Institute of Emory University, discuss the use of tumor treating fields therapy, in which electric fields disrupt processes critical for cancer cell viability. Already approved by the FDA to treat glioblastoma and mesothelioma, the treatment has extended overall survival in this phase III study of patients with metastatic non–small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy, without exacerbating systemic toxicities (Abstract LBA9005).