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Lower GI: Total neoadjuvant therapy (FOLFIRINOX)

Free question published 25 August 2026

Lower GITotal neoadjuvant therapy (FOLFIRINOX)

A fit 54-year-old woman has a cT3 N1 M0 rectal adenocarcinoma. The MDT considers total neoadjuvant therapy with neoadjuvant mFOLFIRINOX followed by chemoradiotherapy, citing PRODIGE 23. Compared with preoperative chemoradiotherapy alone, what did PRODIGE 23 demonstrate for the FOLFIRINOX-containing arm?

  1. AImproved 3-year disease-free survival but no significant change in the pathological complete response rate
  2. BA pathological complete response benefit confined to the subgroup with BRAF-mutant tumours
  3. CImproved disease-free survival but a lower pathological complete response rate
  4. DNo difference in disease-free survival but a higher pathological complete response rate
  5. E3-year disease-free survival improved and pathological complete response rate doubled

Why E is correct

PRODIGE 23 showed that adding neoadjuvant mFOLFIRINOX before chemoradiotherapy improved 3-year disease-free survival to 76% versus 69% (HR 0.69, P = .034) and approximately doubled the pathological complete response rate, from 12% to 28% (P<0.001). This established total neoadjuvant therapy as an option for fit patients with locally advanced rectal cancer.

And why the others are not

  • AIncorrect. The pathological complete response rate did not stay unchanged; it roughly doubled from 12% to 28% (P<0.001).
  • BIncorrect. The benefit was across the trial population; PRODIGE 23 was not a BRAF-selected study.
  • CIncorrect. The pathological complete response rate was higher, not lower, in the FOLFIRINOX arm.
  • DIncorrect. Disease-free survival was improved, not unchanged.

Source PRODIGE 23 trial — total neoadjuvant therapy with FOLFIRINOX in locally advanced rectal cancer — Conroy T, Bosset JF, Etienne PL, et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2021.

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