Dr Alessio Amatu talks to ecancer at ESMO 2024 about the phase two NO-CUT trial in patients with proficient mismatch repair locally advanced rectal cancer (pMMR LARC), aimed at assessing if non-operative management jeopardised distant relapse-free survival, and whether predictive biomarkers of clinical complete response can be identified by multiomic analyses in tumour and blood samples.

Total neoadjuvant treatment followed by rectal surgery is standard of care in proficient mismatch repair locally advanced rectal cancer, but Dr Amatu's research suggests this could change.

In patients achieving clinical complete response after total neoadjuvant treatment, non operative management consisting of intensive follow-up was proposed as an alternative to surgery.

From 2018 to 2024, 180 patients underwent Total neoadjuvant treatment. The primary endpoint of NO-CUT trial was met, finding that this novel approach led to a 25.5% non-operative management rate with a distant relapse-free survival at 30 months of 96.9%.