Kai-Keen Shiu, MRCP, PhD, of University College London Hospitals NHS Foundation Trust, London, UK, speaks to us about future directions for the treatment of rectal cancer at the UK Oncology Forum (OF) 2018, held in Liverpool, UK. He discusses the possibility of a new treatment strategy using total neoadjuvant therapy with reduced oxaliplatin dosage, as well as the prospect of using circulating tumor (ct)DNA in an adjuvant setting to identify patient prognoses. Dr Shiu emphasises the need for more clinical trials in this field, in order to properly care for patients using these new tools.