CAPOX

Rapido established a total neoadjuvant approach significantly decreases rates of distant metastases.

The similarly designed Chinese Phase III STELLAR trial randomized 591 patients with mid to low locally advanced rectal cancer to short course radiation, 5 grade times 5, followed by 4 cycles of CAPOX, surgery, and then 2 additional CAPOX cycles, versus conventional long-course chemoradiation, 50 gray and 25 fractions with concurrent capecitabine, then surgery, then six cycles of CAPOX.

Once again, the TNT arm delivered more chemotherapy before surgery, so the trial cannot disentangle the effects of radiation fractionation from treatment sequencing and cumulative systemic therapy.

At five years, unlike Rapido, TNT here significantly improved proved overall survival, 78% versus 70%.