One of the interesting themes in cancer treatment over the last few years has been “de-escalation” of traditional treatment strategies; in other words, eliminating certain types of treatment that may not be necessary to achieve a good outcome.
An example of this concept has been highlighted in the recent PROSPECT trial for rectal cancer. Pelvic radiation plus chemotherapy before surgery (neoadjuvant therapy) has been standard care for locally advanced rectal cancer. A randomized trial of neoadjuvant FOLFOX alone was compared with neoadjuvant chemotherapy and radiation in adults with clinical T2 node-positive, T3 node-negative, or T3 node-positive rectal cancer who were candidates for sphincter-sparing surgery.
At a median follow-up of 58 months, patients receiving FOLFOX alone had the same disease-free survival as patients receiving chemotherapy and radiation (80.8% in the FOLFOX group and 78.6% in the chemoradiotherapy group). This is just one example of ongoing trials that are aimed at eliminating certain treatment methods that hopefully will reduce both cost and adverse events, but have similar outcomes when unnecessary treatments are deleted.