From the Guidelines
The primary purpose of the PROSPECT trial is to evaluate the effectiveness of selective use of neoadjuvant chemoradiotherapy for locally advanced rectal cancer, aiming to reduce radiation-related side effects while maintaining oncologic outcomes. The trial's design allows for the identification of patients who can safely avoid radiation therapy, thereby minimizing the risk of radiation-induced toxicity, such as radiation-induced injury and hematologic toxicities 1. Key aspects of the PROSPECT trial include:
- The use of neoadjuvant FOLFOX chemotherapy for 6 cycles, followed by restaging to determine clinical response
- Patients with clinical response proceeding directly to surgery, while non-responders receive standard chemoradiation before surgery
- The potential for approximately 30% of patients to avoid radiation therapy without compromising disease-free survival rates
- The reduction of radiation-related side effects, such as sexual dysfunction, bowel dysfunction, and secondary malignancies, while maintaining cancer control The PROSPECT approach represents a shift toward personalized rectal cancer treatment, using response to initial chemotherapy to determine which patients truly need radiation therapy, ultimately aiming to improve quality of life for many rectal cancer patients 1.
From the Research
Purpose of the PROSPECT Trial
The PROSPECT (Preoperative Radiation Or Surgery Plus Chemotherapy for Rectal cancer) trial is designed to evaluate the treatment of rectal cancer, specifically for patients with intermediate-risk disease.
- The trial aims to compare the outcomes of preoperative radiation therapy followed by surgery versus preoperative chemotherapy alone, and then surgery, in patients with intermediate-risk rectal cancer 2.
- The study also investigates the use of preoperative multidrug chemotherapy and its effects on local response and control, while avoiding the morbidity associated with concurrent radiation therapy and multidrug chemotherapy 2.
- The PROSPECT trial eligibility criteria are used to select patients for the study, and the results show that patients who meet these criteria achieve favorable response and morbidity rates compared to conventional treatment approaches 2.
Key Objectives of the PROSPECT Trial
The primary objectives of the PROSPECT trial include:
- Achieving T stage downstaging (ypT < cT) in patients with rectal cancer 2
- Evaluating preoperative grade 3+ gastrointestinal morbidity and comparing it to historical controls 2
- Assessing the efficacy of preoperative treatment regimens, including radiation therapy and multidrug chemotherapy, in improving local control and overall survival rates 2, 3
Relevance to Rectal Cancer Treatment
The PROSPECT trial is relevant to the treatment of rectal cancer, as it investigates the optimal preoperative treatment strategy for patients with intermediate-risk disease.