Systemic Anti-Cancer Therapy Regimen Library
CRC REC Neoadjuvant - PROSPECT Total Neoadjuvant Therapy
Treatment Overview
PROSPECT Total Neoadjuvant Therapy (TNT) consists of: Neoadjuvant chemotherapy with mFOLFOX6 [oxaliplatin, foliNIc acid, fluorouracil] for 6 cycles followed by restaging, then:
- If tumour regression is greater than 20%, total mesorectal excision is performed without radiation, or
- If tumour regression is less than 20%, radiotherapy with concurrent capecitabine or infusional fluorouracil usually for 5 and a half weeks is given prior to total mesorectal excision.
for 6 cycles.
Followed by restaging, then:
- If tumour regression is greater than 20%, surgery without radiation, or
- If tumour regression is less than 20%, chemoradiation prior to surgery with:
usually for 5 and a half weeks.
Commence with radiation therapy as per protocol.
or
usually for 5 and a half weeks.
Commence with radiation therapy as per protocol.
Supportive Care Factors
| Factor | Value |
|---|---|
| Diarrhoea risk: | Anti-diarrhoeals are usually prescribed with this treatment |
| Emetogenicity: | Variable |
References
Schrag D, Shi Q, Weiser MR, et al. PROSPECT: A randomized phase III trial of neoadjuvant chemoradiation versus neoadjuvant FOLFOX chemotherapy with selective use of chemoradiation, followed by total mesorectal excision (TME) for treatment of locally advanced rectal cancer (LARC) (Alliance N1048). J Clin Oncol. 2023 Jun 7;41(17): LBA2. Meeting Abstract: 2023 ASCO Annual Meeting II
* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.
s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.