rectal cancer<\/a>. The method has been shown to improve outcomes over older approaches.<\/p>\nHowever, the proportion of patients whose tumours disappear entirely under the microscope after treatment, known as a pathological complete response, has remained stuck at around 30% across multiple studies.<\/p>\n
Researchers have increasingly looked to immune checkpoint inhibitors to push that figure higher, building on evidence that radiotherapy and immunotherapy can work in tandem to produce a stronger anti-tumour effect than either alone.<\/p>\n
Several recent trials have suggested that short-course radiotherapy in particular may pair well with these types of drugs.<\/p>\n
Higher Response Rates, Similar Safety<\/p>\n
For this study, 118 patients with locally advanced rectal cancer were randomised into two categories, to receive short-course radiotherapy followed by chemotherapy with or without tislelizumab, before undergoing surgery.<\/p>\n
Among the 111 patients who began treatment, 45.3% of those in the immunotherapy group achieved a complete pathological response, compared with 27.6% in the chemotherapy-only group.<\/p>\n
While this difference fell just short of statistical significance, a broader measure of strong tumour regression, known as major pathological response, was significantly higher with the addition of tislelizumab, at 50.9% versus 31.0%.<\/p>\n
Among patients who completed the full treatment protocol, those who received the immunotherapy combination were also more likely to undergo sphincter-sparing surgery, preserving normal bowel function, and showed deeper tumour regression on pathology review.<\/p>\n
Rates of severe side effects during treatment were comparable between the two groups, with anaemia the most common in both.<\/p>\n
Mild thyroid-related side effects, a known consequence of immunotherapy, were more frequent in the combination group but were manageable. No cases of severe immune-related lung or pituitary toxicity were recorded, and postoperative complications were similar across both arms.<\/p>\n
Survival Data Still Maturing<\/p>\n
Early signs on longer-term outcomes were encouraging, with three-year progression-free survival and overall survival both numerically higher in the immunotherapy group, though neither difference reached statistical significance.<\/p>\n
Researchers noted that with a median follow-up of just under three years, survival differences between the groups may not yet have had time to fully emerge.<\/p>\n
Subgroup analysis suggested that certain patients, including those aged 60 or younger, those with higher PD-L1 expression, and those with more advanced local tumour features, may benefit most from the combination approach, echoing patterns seen in similar international trials.<\/p>\n
The findings as preliminary evidence that adding immunotherapy to short-course radiotherapy-based neoadjuvant treatment can meaningfully improve tumour regression in locally advanced rectal cancer.<\/p>\n
The scientists stipulate that a larger, multi-centre phase III trial would be needed before the approach could shift standard practice.<\/p>\n
Reference<\/p>\n
Fengpeng W et al. Short-Course Radiotherapy-Based Total Neoadjuvant Therapy plus Tislelizumab for Locally Advanced Rectal Cancer (Neo-STAR): Early Outcomes of a Randomized Phase II Trial. Cancer Commun. 2026. 46:0041.DOI:10.34133\/canc<\/p>\n
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