Adjuvant Chemotherapy for Stage III Colon Cancer

Abstract

In patients with stage III colon cancer (CC), adjuvant chemotherapy with the combination of oxapliplatin to a fluoropyrimidine (FOLFOX or CAPOX) is a standard of care. The duration of treatment can be reduced from 6 months to 3 months, depending on the regimen, for patients at low risk of recurrence, without loss of effectiveness and allowing a significant reduction in the risk of cumulative sensitive neuropathy. However, our capacity to identify patients that do really need this doublet adjuvant treatment remains limited. In fact, only 30% at the most will actually benefit from this adjuvant treatment, 50% of them being already cured by the surgery and 20% of them experiencing disease recurrence despite the adjuvant treatment. Thus, it is necessary to be able to better predict individually for each patient the risk of recurrence and the need for adjuvant chemotherapy together with the need of new treatment approaches for specific subgroups. Many biomarkers have been described with their own prognostic weight, without leading to any change in clinical practices for now. In this review, we will first discuss the recommendations for adjuvant chemotherapy, and then the different biomarkers described and the future perspectives for the management of stage III CC.

Development and clinical validation of a novel six-gene signature for accurately predicting the recurrence risk of patients with stage II/III colorectal cancer

“…The current stage of CRC is classified based on the tumor-node-metastasis (TNM) system issued by the American Joint Committee on Cancer (AJCC), which is routinely standard for the prognostic management and determination of adjuvant chemotherapy (ACT) of early-stage CRC [ 2 ]. After surgery, ACT is a conventional therapy for stage III and a subset of stage II CRC patients (eg, high grade, T4) [ 3 , 4 ]. The goal of ACT is to eradicate residual cancer cells after surgical resection, thus reducing the recurrence rate or extending the time to recurrence.…”

Spiky Gold Nanoparticles for the Photothermal Eradication of Colon Cancer Cells

“…CRC is commonly treated by surgery; however, up to half of patients diagnosed with early-stage CRC experience recurrent disease after a surgical resection and may also develop a metastatic disease. As such, neoadjuvant and adjuvant therapies have a crucial role against CRC [ 2 ]. These include chemotherapy, radiotherapy, interventional therapy, and biotherapy [ 2 , 3 ].…”

“…As such, neoadjuvant and adjuvant therapies have a crucial role against CRC [ 2 ]. These include chemotherapy, radiotherapy, interventional therapy, and biotherapy [ 2 , 3 ]. Unfortunately, systemic toxic effects, which impair the patient quality of life, and the development of resistance during therapy limit the long-term efficacy of these therapeutic approaches, especially in metastatic cases.…”

Optimal adjuvant chemotherapy completion time for stage III colon cancer: a cohort study

“…Even with radical surgery, the postoperative recurrence rate with stage III colon cancer is still as high as 50-80% (3). Previously published studies have found that adjuvant chemotherapy could reduce the risk of recurrence and improve survival for patients stage III colon cancer (4). Therefore, adjuvant chemotherapy is routinely recommended for stage III colon cancer for 6 months following surgery by the National Comprehensive Cancer Network (5).…”