Katherine Van Loon, MD, gastrointestinal cancer specialist, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses the management of rectal cancer.

The management of local rectal cancer has changed dramatically in the last 5 years, says Van Loon. One of the biggest advancements is the incorporation of neoadjuvant chemotherapy into NCCN guidelines. Originally, Van Loon said that she thought that the only patients that would benefit from neoadjuvant chemotherapy would be those with poor risk factors such as T4 and N2 disease.

As it has been put into practice more regularly over the past year, Van Loon says that most patients tolerate neoadjuvant chemotherapy very well. Responses to neoadjuvant chemotherapy are generally very favorable, and Van Loon says that she is routinely offering it with FOLFOX, followed by chemoradiation.

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Katherine Van Loon, MD, gastrointestinal cancer specialist, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses the management of rectal cancer.
 

Dr. Van Loon Discusses the Management of Rectal Cancer

Katherine Van Loon, MD, gastrointestinal cancer specialist, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses the design of multicenter PROSPECT trial.

PROSPECT will inform our management of the disease, states Van Loon. The trial is randomizing patients to the standard of care, chemoradiation followed by surgery and adjuvant therapy, to neoadjuvant leucovorin calcium, fluorouracil, and oxaliplatin (FOLXFOX) for 6 cycles. The patients who undergo neoadjuvant FOLFOX then undergo restaging. Those who have a greater than 20% response rate proceed directly to surgery, potentially sparing them from pelvic radiation therapy.

Physicians eagerly anticipate the results of this trial as it will attempt to answer whether or not patients who respond well to neoadjuvant chemotherapy can be spared the toxicity of pelvic radiation therapy, and whether or not upfront chemotherapy can reduce the occurrence of distant metastatic disease down the road.

Katherine Van Loon, MD, gastrointestinal cancer specialist, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses the design of the multicenter PROSPECT trial.

Katherine Van Loon, MD

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Dr. Van Loon Discusses the Management of Rectal Cancer

Dr. Van Loon on the PROSPECT Trial