Côlon & Rectum

, Volume 7, Issue 3, pp 143–149 | Cite as

Chimiothérapie (néo)adjuvante du cancer colique

Dossier Thématique / Thematic File
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Résumé

Le risque de récidive d’un cancer du côlon de stade III justifie la prescription d’une chimiothérapie adjuvante qui a fait la preuve de son bénéfice dans cette indication. Le standard est une chimiothérapie selon le schéma FOLFOX pendant 6 mois. En cas de cancer de stade II, le bénéfice d’une chimiothérapie adjuvante est plus modeste et de ce fait n’est pas un standard, mais il existe un consensus pour la proposer en cas de facteurs de mauvais pronostic. Le bon pronostic des cancers du côlon de phénotype moléculaire MSI (microsatellite instability) est actuellement un élément décisionnel pour ne pas proposer de traitement adjuvant en cas de cancer du côlon de stade II de phénotype MSI. Les thérapies ciblées (bévacizumab et cétuximab), qui ont fait la preuve de leur efficacité en situation métastatique, n’apportent pas de bénéfice en situation adjuvante. Les enjeux à venir seront de déterminer de nouveaux facteurs prédictifs et/ou pronostiques, notamment moléculaires, permettant de personnaliser au mieux l’administration d’un traitement adjuvant en termes d’efficacité et de tolérance. Chez les patients âgés, le bénéfice d’une chimiothérapie adjuvante est sujet à discussion.

Mots clés

Cancer du côlon Chimiothérapie adjuvante 

(Neo)adjuvant chemotherapy of colonic cancer

Abstract

The use of adjuvant chemotherapy for patients with stage III colon cancer is justified by the relatively high risk of recurrence. The combination therapy with 5-fluorouracil, folinic acid and oxaliplatin during 6 months is the reference treatment after surgical resection for stage III colon cancers. While beneficial for stage III patients, the role of adjuvant chemotherapy is unestablished in stage II colon cancers. Patients with high-risk stage II disease can be considered for adjuvant chemotherapy. MSI is a marker of a more favorable outcome in patient with stage II colon cancer. MSI testing is recommended for patient with high-risk stage II because it must influenced adjuvant therapy decision in stage II disease. Bevacizumab and cetuximab have failed to show a benefit in the adjuvant treatment of colon cancer. Better tools are needed to identify patients at highest risk of recurrence who stand to get the most benefit from adjuvant chemotherapy in terms of efficacy and safety. Question regarding the benefit of adjuvant chemotherapy in older patient is difficult to answer.

Keywords

Colonic cancer Adjuvante chemotherapy 

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Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Université François-Rabelais de ToursToursFrance
  2. 2.Service d’hépato-gastroentérologie et de cancérologie digestiveCHU de ToursTours cedex 9France

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