How would you approach the treatment of early stage rectal adenocarcinoma in patients with confirmed Lynch Syndrome?

If this patient has T3+ or N+ disease, I would favor "TNT" - total neoadjuvant therapy with FOLFOX where you can carefully monitor for response (or lack of response). Lynch Syndrome does not predict for lack of response with oxaliplatin regimens. See for example Yacoub et al., PMID 23730227. With ra...

There is an active clinical trial at MSK (Cercek) looking at these exact questions. Patients receive pembrolizumab in the neoadjuvant setting and if they have a CR, can potentially be observed. They do not necessarily "require" chemotherapy or radiation if they have responded to IO.