N Engl J Med 2018 Mar 29
Duration of Adjuvant Chemotherapy for Stage III Colon Cancer.
Related Questions
What are your top takeaways in GI Cancers from ASCO 2025?
ATOMIC - adding atezolizumab checkpoint inhibitor for 1 year to 6 months of adjuvant FOLFOX is the new standard of care for MSI-High stage III colon cancer. MATTERHORN trial - adding durvalumab to perioperative FLOT in resectable gastric adenocarcinoma significantly improved event-free survival...
Would you offer additional systemic treatment to a stage II or III resected colon cancer that received 3 months of adjuvant capecitabine/oxaliplatin and now is presenting with a solitary lung metastasis?
Thanks for the question!First, it is important to clarify whether this lesion developed during or right after adjuvant CAPEOX, if so, there is no point in continuing adjuvant CAPEOX (it is very important to compare with baseline restaging scans performed before starting adjuvant therapy, as solitary...
Which group of Stage III MSI-H colon cancer patients can be excluded from receiving adjuvant chemotherapy?
10% to 15% of patients with early-stage, and 4% of patients with metastatic colorectal cancer (CRC) test positive for dMMR. In stage II-III colon cancers, MSI-H/dMMR status is predictive of resistance to 5-fluorouracil as monotherapy, (Sargent et al., PMID 20498393) such that the addition of oxalipl...
Would you give a fit <40 year old with T3N1b low risk Stage IIIB colon adenocarcinoma 6 months of adjuvant chemo or feel comfortable limiting to 3 months of CAPOX?
For T3N1 disease, 3 months of therapy with oxaliplatin and fluoro-pyrimidine is non-inferior to 6 months. Statistically equivalent with an upper limit of 95% CI <1.12. Furthermore, on retrospective subset analysis (choice of FOLFOX or CapeOX not randomized), 3 months of CapeOX was superior to 6 mont...
What adjuvant chemotherapy would you recommend in an elderly patient with resected stage III colon cancer with MMR deficiency with MLH1 promoter hypermethylation?
This is a great question and actually a quite common situation we see in the clinic. Majority of the dMMR colorectal cancer is actually due to MLH1 promotor hypermethylation (about 75% of all dMMR colorectal cancer) while a small portion of dMMR colorectal cancer is due to Lynch syndrome. These pati...
Would you continue adjuvant FOLFOX for a patient with stage III colon cancer and triple-vessel coronary artery disease who developed NSTEMI after the first cycle?
This is a challenging scenario where the patient has existing triple vessel CAD and developed NSTEMI after 1st cycle. We all agree that 5-FU based therapy is the backbone for adjuvant therapy of stage III colon cancers. There are no clear cut guidelines in this case and management is per expert reco...
What adjuvant therapy would you offer for rectosigmoid junction adenocarcinoma after initial LAR?
The ideal treatment of rectosigmoid cancers is often nebulous, as depending on their presentation, they can be approached like rectal cancer or colon cancer.Given that this patient had initial surgery, I would approach this patient as a higher risk stage 2 colon cancer, based on the perforation as w...
In a patient with low risk T3N1 stage III colon cancer unable to tolerate CAPOX due to profound GI toxicity, would you switch to FOLFOX and extend to 6 months of adjuvant therapy?
While I certainly agree the problem lies with the capecitabine far more than the oxaliplatin, I would approach this patient a little differently. Consider that we are told that the patient had “profound” diarrhea, and no other toxicity (at least, none is mentioned). That would be a bit unusual for c...
What is the preferred number of cycles of CAPOX for rectal cancer receiving total neoadjuvant chemotherapy?
The treatment of rectal cancer is probably more confusing than ever before!The typical approach to “TNT” has been to give 4 months (8 cycles) of FOLFOX.The optimal duration of Capox is less defined.One reasonable option would be to aim for the same duration of 4 months. This would be ~5-6 cycles of ...