Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Argilés, Guillem; Tabernero, Josep; Labianca, Roberto; Hochhauser, Daniel; Salazar, Ramón; Iveson, Tim; Laurent‐Puig, Pierre; Quirke, Philip; Yoshino, Takayuki; Taı̈eb, Julien; Martinelli, Erika; Arnold, Dirk

doi:10.1016/j.annonc.2020.06.022

Cited by 756 publications

(812 citation statements)

References 103 publications

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“…In consideration of the heterogeneity of stage II, risk determination and stratification are fundamental to guide therapeutic decisions on adjuvant therapy in these patients. According to international guidelines, stage II colon cancer patients should be stratified into low and high risk of recurrence [ 4 , 5 , 6 ]. The risk stratification is based on the presence of specific histopathological, clinical, and molecular characteristics.…”

Section: The Great Divide Within Stage Ii: Low Vs High Riskmentioning

confidence: 99%

Adjuvant Chemotherapy for Stage II Colon Cancer

Rebuzzi

Pesola

Martelli

et al. 2020

Cancers

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In stage II colon cancer management, surgery alone has shown a high cure rate (about 80%), and the role of adjuvant chemotherapy is still a matter of debate. Patients with high-risk features (T4, insufficient nodal sampling, grading, etc.) have a poorer prognosis and, usually, adjuvant chemotherapy is recommended. The purpose of the present study is to highlight and discuss what is still unclear and not completely defined from the previous trials regarding risk stratification and therapeutic benefit of adjuvant chemotherapy. With all the limitations of generalizing, we make the effort of trying to quantify the relative contribution of each prognostic factor and the benefit of adjuvant chemotherapy for stage II colon cancer. Finally, we propose a decision algorithm with the aim of summarizing the current evidence and translating it to clinical practice.

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Section: The Great Divide Within Stage Ii: Low Vs High Riskmentioning

confidence: 99%

Adjuvant Chemotherapy for Stage II Colon Cancer

Rebuzzi

Pesola

Martelli

et al. 2020

Cancers

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show abstract

“…Many patients with stage II that previously were at sufficient risk of recurrence (1 risk factor) probably have such a limited recurrence risk (<10%) that adjuvant treatment is not motivated. Nevertheless, some (maybe 20%) stage II patients (presence of the high-risk factors pT4 or <12 lymph nodes or 2 or more other risk factors) [3] still may have a sufficiently high risk (about 15-20%) to motivate additional treatment, although not necessarily with oxaliplatin. Conversely, some (maybe 20-25%) stage III patients have such a low recurrence risk (about 20%) that the addition of oxaliplatin can be questioned.…”

Section: Discussionmentioning

confidence: 99%

“…In early stages (stages I-III), constituting 75-80% of newly diagnosed cases, adjuvant chemotherapy is often administered since it may kill sub-clinical disease and, thereby, decrease the risk of recurrence and improve survival. After colon cancer surgery, it is routine therapy in stage III and in stage II with risk factors for recurrence [2][3][4][5][6], whereas it is less established in rectal cancer, particularly if pre-operative radiotherapy/chemoradiotherapy (RT/CRT) has been administered. The randomized rectal cancer trials have not unequivocally shown enough benefit [7,8].…”

Section: Introductionmentioning

confidence: 99%

Recurrence Risk after Radical Colorectal Cancer Surgery—Less Than before, But How High Is It?

Osterman

Hammarström

Imam

et al. 2020

Cancers

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Adjuvant chemotherapy aims at eradicating tumour cells sometimes present after radical surgery for a colorectal cancer (CRC) and thereby diminish the recurrence rate and prolong time to recurrence (TTR). Remaining tumour cells will lead to recurrent disease that is usually fatal. Adjuvant therapy is administered based upon the estimated recurrence risk, which in turn defines the need for this treatment. This systematic overview aims at describing whether the need has decreased since trials showing that adjuvant chemotherapy provides benefits in colon cancer were performed decades ago. Thanks to other improvements than the administration of adjuvant chemotherapy, such as better staging, improved surgery, the use of radiotherapy and more careful pathology, recurrence risks have decreased. Methodological difficulties including intertrial comparisons decades apart and the present selective use of adjuvant therapy prevent an accurate estimate of the magnitude of the decreased need. Furthermore, most trials do not report recurrence rates or TTR, only disease-free and overall survival (DFS/OS). Fewer colon cancer patients, particularly in stage II but also in stage III, today display a sufficient need for adjuvant treatment considering the burden of treatment, especially when oxaliplatin is added. In rectal cancer, neo-adjuvant treatment will be increasingly used, diminishing the need for adjuvant treatment.

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“…Current guidelines recommend that all dMMR stage II CC patients, regardless of high-risk factors, should not receive 5-FUbased adjuvant therapy (11,(19)(20)(21)(22)(23)(24)(25). For dMMR stage III CC patients, adjuvant therapy with CAPOX or FOLFOX regimen is recommended, but the role of the MMR status as a predictive biomarker is still not completely clear (23,24,(26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

Duration of FOLFOX Adjuvant Chemotherapy in High-Risk Stage II and Stage III Colon Cancer With Deficient Mismatch Repair

Wang

et al. 2020

Front. Oncol.

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BackgroundWe evaluated the impact of 3 months of mFOLFOX6 adjuvant chemotherapy or surgery alone in comparison with 6 months of mFOLFOX6 on disease-free survival (DFS) in deficient mismatch repair (dMMR) colon cancer (CC) patients.MethodsThis retrospective study identified a cohort of patients with high-risk stage II and III dMMR CC who underwent curative surgery between May 2011 and July 2019. DFS was compared using the Kaplan-Meier survival methods and Cox proportional hazards models. Propensity-score matching was performed to reduce imbalance in baseline characteristics.ResultsA total of 242 dMMR CC patients were identified; 66 patients received 6 months of mFOLFOX6, 87 patients received 3 months of mFOLFOX6, and 89 patients were treated with surgery alone. The 3-year DFS rate was 72.8% in 3-month therapy group and 86.1% in 6-month therapy group, with a hazard ratio (HR) of 2.78 (95CI%, 1.18 to 6.47; P= 0.019). The difference in DFS between surgery alone group and 6-month therapy group was also observed but was nonsignificant (HR= 2.30, 95%CI, 0.99 to 5.38; P=0.054). The benefit of 6-month therapy in DFS compared with 3-month therapy group was pronounced for patients with stage III (HR=2.81, 95%CI, 1.03 to 7.67; P=0.044) but not for high-risk stage II patients. Propensity score matched analysis confirmed a DFS benefit in the 6-month therapy group.ConclusionThis study suggested that a 6-month duration of mFOLFOX6 adjuvant chemotherapy in dMMR CC patients may be associated with improved DFS compared with 3-month therapy, particularly in patients with stage III. The observational nature of the study implies caution should be taken in the interpretation of these results.

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Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Cited by 756 publications

References 103 publications

Adjuvant Chemotherapy for Stage II Colon Cancer

Adjuvant Chemotherapy for Stage II Colon Cancer

Recurrence Risk after Radical Colorectal Cancer Surgery—Less Than before, But How High Is It?

Duration of FOLFOX Adjuvant Chemotherapy in High-Risk Stage II and Stage III Colon Cancer With Deficient Mismatch Repair

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