New Adjuvant Trial Designs in Colon Cancer

The treatment of colon cancer has evolved significantly since the discovery of 5-fluorouracil, and with continued innovation, it will continue to advance for the foreseeable future. In this review, we identify and discuss novel adjuvant trial designs which are currently being employed and that are forthcoming in the treatment of colon cancer. Novel approaches include investigation into whether a shorter duration of adjuvant therapy is as effective as the current standard, whether there is benefit of neoadjuvant chemotherapy in the treatment of nonmetastatic colon cancer, the role of circulating tumor cells and cell-free DNA on clinical decision making and their impact on long-term outcomes, identification, and individualized treatment of molecular subgroups of colon cancer (i.e., HER2 amplified, microsatellite instable, BRAF V600E mutated, etc.) and the efficacy of targeting cancer stem cells.