Next-generation, genome- and mutational landscape heterogeneity-based novel biomarkers for personalized neoadjuvant treatment and laparoscopic rectal cancer resection

Excerpt

Based on previous phase 3 randomized clinical trials suggesting patient’s benefits, preoperative chemoradiotherapy has become popular for selected patients with advanced (T3, T4 tumors or node-positive) rectal cancer. However, meta-analyses published this year reporting data from recent phase 3 trials raise concerns on the clinical utility of this neoadjuvant chemoradiotherapy [1, 2]. Preoperative tumor responsiveness to this treatment was approximately 40–50 %, and the overall resistance and complications rates balanced with the benefits. These latest clinical results reveal the urgent need of biomedical research for developing robust biomarkers for tailoring neoadjuvant treatment to sensitive tumors only and explain the recent focus of next-generation sequencing (NGS)-based biomarkers [3, 4]. Although ideally laparoscopic rectal surgery should follow neoadjuvant treatment in selected patients with predictable tumor responsiveness, it is important to obtain data evaluating the impact of this preoperative multimodal treatment in the safety and efficacy of subsequent laparoscopic surgery. Therefore, either using conventional or novel genome-based selection criteria this information is important for laparoscopic surgeons. …