TY - JOUR
T1 - Current issues in adjuvant treatment of stage II colon cancer
AU - André, Thierry
AU - Sargent, Daniel
AU - Tabernero, Josep
AU - O'Connell, Michael
AU - Buyse, Marc
AU - Sobrero, Alberto
AU - Misset, Jean Louis
AU - Boni, Corrado
AU - De Gramont, Aimery
N1 - Funding Information:
This article was derived from discussions at a meeting on adjuvant therapy of colon cancer organized by Aimery de Gramont, with financial support from Sanofi-Synthelabo, in September 2003. The authors thank Paula Harry (MediBridge, France) for medical writing support.
PY - 2006/6
Y1 - 2006/6
N2 - Background: Adjuvant chemotherapy with 5-fluorouracil modulated by folinic acid, combined with oxaliplatin, has now become an accepted standard of care for patients with stage III colon cancer. In contrast, the use of adjuvant therapy for stage II patients remains controversial, and the identification of reliable prognostic factors to aid therapeutic decision making is crucial. Methods: The authors critically review the results of clinical trials and meta-analyses investigating the value of adjuvant chemotherapy for stage II patients, emphasizing the heterogeneous nature of this population and the difficulty of performing clinical trials with sufficient power to reliably assess treatment efficacy. They also discuss the evidence concerning potential prognostic factors, particularly molecular markers. Results: Available clinical trial data do not support the routine use of adjuvant chemotherapy for all stage II patients but suggest that it should be considered, particularly for certain high-risk patients. Recent guidelines advocate considering factors such as tumor differentiation, tumor perforation, number of lymph nodes examined, and T stage when assessing the likely benefit:risk ratio. Microsatellite instability and allelic imbalance seem to be strong predictors of good and poor prognosis, respectively, and in the near future, therapeutic decision-making models are likely to be further refined by the inclusion of such molecular markers. Conclusions: There is growing evidence that the prognosis of certain stage II patients with unfavorable prognostic factors can be improved by adjuvant chemotherapy, and increasingly refined tools are now available to define those most likely to benefit. Referral of stage II patients for individual assessment is strongly recommended.
AB - Background: Adjuvant chemotherapy with 5-fluorouracil modulated by folinic acid, combined with oxaliplatin, has now become an accepted standard of care for patients with stage III colon cancer. In contrast, the use of adjuvant therapy for stage II patients remains controversial, and the identification of reliable prognostic factors to aid therapeutic decision making is crucial. Methods: The authors critically review the results of clinical trials and meta-analyses investigating the value of adjuvant chemotherapy for stage II patients, emphasizing the heterogeneous nature of this population and the difficulty of performing clinical trials with sufficient power to reliably assess treatment efficacy. They also discuss the evidence concerning potential prognostic factors, particularly molecular markers. Results: Available clinical trial data do not support the routine use of adjuvant chemotherapy for all stage II patients but suggest that it should be considered, particularly for certain high-risk patients. Recent guidelines advocate considering factors such as tumor differentiation, tumor perforation, number of lymph nodes examined, and T stage when assessing the likely benefit:risk ratio. Microsatellite instability and allelic imbalance seem to be strong predictors of good and poor prognosis, respectively, and in the near future, therapeutic decision-making models are likely to be further refined by the inclusion of such molecular markers. Conclusions: There is growing evidence that the prognosis of certain stage II patients with unfavorable prognostic factors can be improved by adjuvant chemotherapy, and increasingly refined tools are now available to define those most likely to benefit. Referral of stage II patients for individual assessment is strongly recommended.
KW - 5-Fluorouracil
KW - Adjuvant chemotherapy
KW - Colon cancer, stage II
KW - Leucovorin
KW - Oxaliplatin
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U2 - 10.1245/ASO.2006.07.003
DO - 10.1245/ASO.2006.07.003
M3 - Review article
C2 - 16614880
AN - SCOPUS:33646589659
SN - 1068-9265
VL - 13
SP - 887
EP - 898
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 6
ER -