Nancy N Baxter1, Erin B Kennedy2, Emily Bergsland3, Jordan Berlin4, Thomas J George5, Sharlene Gill6, Philip J Gold7, Alex Hantel8, Lee Jones9, Christopher Lieu10, Najjia Mahmoud11, Arden M Morris12, Erika Ruiz-Garcia13, Y Nancy You14, Jeffrey A Meyerhardt15. 1. University of Melbourne, Melbourne, Australia. 2. American Society of Clinical Oncology, Alexandria, VA. 3. UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA. 4. Vanderbilt University Medical Center, Nashville, TN. 5. University of Florida, Gainesville, FL. 6. BC Cancer, Vancouver, Canada. 7. Swedish Cancer Institute, Seattle, WA. 8. Edward Elmhurst Healthcare, Naperville, IL. 9. Arlington, VA. 10. University of Colorado Cancer Center, Aurora, CO. 11. Penn Medicine, Philadelphia, PA. 12. Stanford University Medical Center, Palo Alto, CA. 13. Instituto Nacional de Cancerologia, Mexico City, Mexico. 14. University of Texas M.D. Anderson Cancer Center, Houston, TX. 15. Dana-Farber Cancer Institute, Boston, MA.
Abstract
PURPOSE: To develop recommendations for adjuvant therapy for patients with resected stage II colon cancer. METHODS: ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS: Twenty-one observational studies and six randomized controlled trials met the systematic review inclusion criteria. RECOMMENDATIONS: Adjuvant chemotherapy (ACT) is not routinely recommended for patients with stage II colon cancer who are not in a high-risk subgroup. Patients with T4 tumors are at higher risk of recurrence and should be offered ACT, whereas patients with other high-risk factors, including sampling of fewer than 12 lymph nodes in the surgical specimen, perineural or lymphovascular invasion, poorly or undifferentiated tumor grade, intestinal obstruction, tumor perforation, or grade BD3 tumor budding, may be offered ACT. The addition of oxaliplatin to fluoropyrimidine-based ACT is not routinely recommended, but may be offered as a result of shared decision making. Patients with mismatch repair deficiency/microsatellite instability tumors should not be routinely offered ACT; if the combination of mismatch repair deficiency/microsatellite instability and high-risk factors results in a decision to offer ACT, oxaliplatin-containing chemotherapy is recommended. Duration of oxaliplatin-containing chemotherapy is also addressed, with recommendations for 3 or 6 months of treatment with capecitabine and oxaliplatin or fluorouracil, leucovorin, and oxaliplatin, with decision making informed by key evidence of 5-year disease-free survival in each treatment subgroup and the rate of adverse events, including peripheral neuropathy.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
PURPOSE: To develop recommendations for adjuvant therapy for patients with resected stage II colon cancer. METHODS: ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS: Twenty-one observational studies and six randomized controlled trials met the systematic review inclusion criteria. RECOMMENDATIONS: Adjuvant chemotherapy (ACT) is not routinely recommended for patients with stage II colon cancer who are not in a high-risk subgroup. Patients with T4 tumors are at higher risk of recurrence and should be offered ACT, whereas patients with other high-risk factors, including sampling of fewer than 12 lymph nodes in the surgical specimen, perineural or lymphovascular invasion, poorly or undifferentiated tumor grade, intestinal obstruction, tumor perforation, or grade BD3 tumor budding, may be offered ACT. The addition of oxaliplatin to fluoropyrimidine-based ACT is not routinely recommended, but may be offered as a result of shared decision making. Patients with mismatch repair deficiency/microsatellite instability tumors should not be routinely offered ACT; if the combination of mismatch repair deficiency/microsatellite instability and high-risk factors results in a decision to offer ACT, oxaliplatin-containing chemotherapy is recommended. Duration of oxaliplatin-containing chemotherapy is also addressed, with recommendations for 3 or 6 months of treatment with capecitabine and oxaliplatin or fluorouracil, leucovorin, and oxaliplatin, with decision making informed by key evidence of 5-year disease-free survival in each treatment subgroup and the rate of adverse events, including peripheral neuropathy.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
Authors: Yuting Zhang; Zehua Wu; Bin Zhang; Huabin Hu; Jianwei Zhang; Yi Chen; Miaomiao Ding; Yabing Cao; Yanhong Deng Journal: Ann Transl Med Date: 2022-06
Authors: Damiano Caruso; Michela Polici; Marta Zerunian; Antonella Del Gaudio; Emanuela Parri; Maria Agostina Giallorenzi; Domenico De Santis; Giulia Tarantino; Mariarita Tarallo; Filippo Maria Dentice di Accadia; Elsa Iannicelli; Giovanni Maria Garbarino; Giulia Canali; Paolo Mercantini; Enrico Fiori; Andrea Laghi Journal: Cancers (Basel) Date: 2022-07-15 Impact factor: 6.575