5FU Oxaliplatin in Rectal Cancer

In the Lancet Oncology this week,

An interesting phase III study from Germany is reported, finding a modest increase in pathologic complete response in patients treated with oxaliplatin + 5FU + RT, vs 5FU + RT alone.  This is interesting in that a prior report in the JCO, demonstrated no such increase.  How to square these two accounts?  I think firstly the benefit is modest with a pCR rate of 17% with oxaliplating and 14% without.  This could have been missed in the STAR-01 trial as it was a smaller study.  I think fundamentally, however, we need to follow both of these trials for long term outcome.  Oxaliplatin surely has not been a slam dunk for increasing the pCR rates to 30%+ as some may have hoped; it may however still have some benefit in long term followup.

Link

[Articles] Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial: Inclusion of oxaliplatin into modified fluorouracil-based combined modality treatment was feasible and led to more patients achieving a pathological complete response than did standard treatment. Longer follow-up is needed to assess DFS.