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ESMO WCGIC 2021 | Averectal: neoadjuvant short-course RT followed by chemo + avelumab in rectal adenocarcinoma

Post-surgery chemotherapy and chemoradiotherapy confer no survival advantage and have low patient compliance, only ~60-70% of patients will complete the treatment course. Alternatively, complete neoadjuvant therapy has been shown to increase compliance and pathologic complete response (pCR) rate. Ali I. Shamseddine, MD, FRCP, American University of Beirut Medical Center AUBMC, Beirut, Lebanon discusses the theory behind the Averectal study; a Phase II trial, investigating the safety and efficacy of neoadjuvant short-course radiotherapy (RT) followed by mFOLFOX6 chemotherapy and immunotherapy with the checkpoint inhibitor avelumab in locally advanced rectal adenocarcinoma (NCT03503630). The short course radiotherapy combined with avelumab may increase the pCR rate and overall survival (OS) over standard complete neoadjuvant therapy. Moreover, a positive correlation was found between patient immune score and pCR rate to treatment, this strategy may be used to select patients for chemoimmunotherapy. This interview took place at the ESMO World Congress on Gastrointestinal Cancer 2021.