Neoadjuvant Therapy: Shrinking Tumors Before Surgery

Neoadjuvant Therapy refers to treatment administered before surgery to shrink tumors and increase the success of surgical removal, especially for locally advanced colorectal cancer. This approach helps lower the risk of recurrence and prevents cancer from spreading.

Objectives of Neoadjuvant Therapy

1. Shrink tumors to ease surgical removal and reduce surgical risks.
2. Lower recurrence risk by eliminating microscopic cancer cells.
3. Increase the chance of curative surgery, especially for hard-to-reach tumors.
4. Preserve sphincter function, reducing the need for a permanent colostomy in rectal cancer near the anus.

Types of Neoadjuvant Therapy

1. Chemoradiotherapy

• Standard for Stage II-III rectal cancer.
• Combines radiation therapy with chemotherapy drugs like 5-Fluorouracil (5-FU) or Capecitabine.
• Reduces tumor size and limits cancer spread.

2. Neoadjuvant Chemotherapy

• Common for non-metastatic colon cancer.
• Drug regimens include FOLFOX (5-FU, Leucovorin, Oxaliplatin) or CAPOX (Capecitabine, Oxaliplatin).
• Shrinks tumors and targets potential metastases.

3. Targeted Therapy

• Used alongside chemotherapy for genetic mutations (e.g., RAS, BRAF).
• Drugs like Bevacizumab (Avastin) and Cetuximab are effective for RAS wild-type cancers.

4. Immunotherapy

• For cancers with MSI-H (Microsatellite Instability-High) or dMMR (Mismatch Repair Deficiency).
• Pembrolizumab (Keytruda) and Nivolumab (Opdivo) boost immune responses to attack cancer cells.
• Helps stimulate the immune system to destroy cancer cells.

Treatment Options

1. Begin with Neoadjuvant Therapy to shrink the tumor.
2. Evaluate response with MRI or CT scans.
3. Perform surgery, such as Total Mesorectal Excision (TME) for rectal cancer.
4. Continue with Adjuvant Therapy if recurrence risk persists.