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Adjuvant Therapy for High-Risk Stage II Colon Cancer
Given the relatively low risk of recurrence after resection of stage II colon cancer, treatment guidelines include consideration for observation alone or adjuvant chemotherapy. Patients with stage II disease and features including a T4 primary tumor, presentation with perforation or obstruction, or inadequate lymph sampling at surgery have a higher risk for recurrence and are more strongly considered for adjuvant chemotherapy. The adjuvant treatment of patients with high-risk stage II colon cancer with fluorinated pyrimidine (FP) alone or with the addition of oxaliplatin remains controversial.
Investigators now report an ACCENT database pooled analysis of data from the MOSAIC and C-07 randomized trials comparing 6 months of adjuvant FP-based chemotherapy with oxaliplatin versus without oxaliplatin after resection of stage II and III colon cancer. Of the 1595 patients with stage II disease, 57% had left-sided primaries, 14% had stage T4 cancer, 13% had poorly differentiated tumors, 45% had fewer than 12 lymph nodes sampled at surgery, and 24% presented with perforation or obstruction.
Overall survival did not differ between patients treated with FP alone or FP plus oxaliplatin (hazard ratio, 1.03). OS also did not differ with and without the addition of oxaliplatin in high-risk subgroups including patients with T4 disease (HR, 0.96) and those with fewer than 12 lymph nodes sampled (HR, 0.89).
Comment
This pooled analysis reinforces the absence of benefit from adding oxaliplatin to 6 months of adjuvant FP chemotherapy in high-risk stage II colon cancer, and one standard of care remains 6 months of FP chemotherapy. The recent pooled IDEA analysis of six international, randomized adjuvant therapy trials supports a shorter duration of 3 months of therapy with the combination of capecitabine and oxaliplatin for high-risk stage II disease (NEJM JW Oncol Hematol Jan 11 2021 and Lancet Oncol 2020; 21:1620).
Citation(s)
Author:
Chibaudel B et al.
Title:
Assessment of the addition of oxaliplatin to fluoropyrimidine-based adjuvant chemotherapy in patients with high-risk stage II colon cancer: An ACCENT pooled analysis.
Source:
J Clin Oncol
2024
Dec
10; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
David H. Ilson, MD, PhD