What is the preferred number of cycles of CAPOX for rectal cancer receiving total neoadjuvant chemotherapy?

The treatment of rectal cancer is probably more confusing than ever before!

The typical approach to “TNT” has been to give 4 months (8 cycles) of FOLFOX.

The optimal duration of Capox is less defined.

One reasonable option would be to aim for the same duration of 4 months. This would be ~5-6 cycles of every 3 week Capox.

A valid critique of a TNT approach is whether we are overtreating some patients, as the IDEA collaboration (albeit in colon cancer primarily) documented that 3 months of Capox was a...

As with Dr. @Dr. First Last's excellent advice, I aim for 6 cycles of CAPOX in neoadjuvant therapy for advanced rectal cancer that I am treating with a TNT approach.

Similarly, I worry that we may be over-treating a not insignificant subset of patients with a universal TNT approach. As such, I typically treat with neoadjuvant chemoRT alone in clinical Stage II patients and those with borderline N1a clinical disease, and then tailor my adjuvant therapy based on data from the ADORE trial, using 4 m...