Current Colorectal Cancer Reports

, Volume 7, Issue 3, pp 241–245 | Cite as

Reduced Chemotherapy Duration: A Good Idea?

Article

Abstract

Over the past three decades, survival outcomes of high-risk stage II and stage III colon cancer have improved with the use of adjuvant chemotherapy. Oxaliplatin and fluoropyrimidine combination regimens, given for 6 months, are the current standard of care. However, chronic peripheral neuropathy can result as a side effect of oxaliplatin use. Investigators have questioned whether the recommended duration of adjuvant therapy is necessary. This review discusses the history of adjuvant therapy for colon cancer and provides a rationale for an ongoing clinical trial collaboration addressing the optimal duration of adjuvant therapy.

Keywords

Colon cancer Adjuvant therapy 5-fluorouracil Oxaliplatin Chemotherapy-induced sensory neuropathy Peripheral neuropathy 

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Jemal A, Siegel R, Xu J, et al. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.PubMedCrossRefGoogle Scholar
  2. 2.
    O'Connell MJ. Current status of adjuvant therapy for colorectal cancer. Oncology (Williston Park). 2004;18:751–5. discussion 755–8.Google Scholar
  3. 3.
    Moertel CG, Fleming TR, Macdonald JS, et al. Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med. 1990;322:352–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Moertel CG, Fleming TR, Macdonald JS, et al. Fluorouracil plus levamisole as effective adjuvant therapy after resection of stage III colon carcinoma: a final report. Ann Intern Med. 1995;122:321–6.PubMedGoogle Scholar
  5. 5.
    Wolmark N, Rockette H, Fisher B, et al. The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03. J Clin Oncol. 1993;11:1879–87.PubMedGoogle Scholar
  6. 6.
    Haller DG, Catalano PJ, Macdonald JS, et al. Phase III study of fluorouracil, leucovorin, and levamisole in high-risk stage II and III colon cancer: final report of Intergroup 0089. J Clin Oncol. 2005;23:8671–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators. Lancet. 1995;345:939–44.CrossRefGoogle Scholar
  8. 8.
    Andre T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004;350:2343–51.PubMedCrossRefGoogle Scholar
  9. 9.
    Haller D, Tabernero J, Maroun J, et al.: First efficacy findings from a randomized phase III trial of capecitabine + oxaliplatin vs. bolus 5-FU/LV for stage III colon cancer (NO16968/XELOXA study) Presented at the Joint ECCO 15 - 34TH ESMO Multidisciplinary Congress, Berlin September 20–24, 2009.Google Scholar
  10. 10.
    •• Kuebler JP, Wieand HS, O'Connell MJ, et al.: Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: results from NSABP C-07. J Clin Oncol 2007, 25:2198–2204. This study provides the rationale for the use of lower cumulative doses of oxaliplatin in the adjuvant setting.PubMedCrossRefGoogle Scholar
  11. 11.
    •• Andre T, Boni C, Navarro M, et al.: Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 2009, 27:3109–3116. A report of the updated results from the MOSAIC trial demonstrating an overall survival benefit with oxaliplatin in the adjuvant setting. PubMedCrossRefGoogle Scholar
  12. 12.
    Saini A, Norman AR, Cunningham D, et al. Twelve weeks of protracted venous infusion of fluorouracil (5-FU) is as effective as 6 months of bolus 5-FU and folinic acid as adjuvant treatment in colorectal cancer. Br J Cancer. 2003;88:1859–65.PubMedCrossRefGoogle Scholar
  13. 13.
    Chau I, Norman AR, Cunningham D, et al. A randomised comparison between 6 months of bolus fluorouracil/leucovorin and 12 weeks of protracted venous infusion fluorouracil as adjuvant treatment in colorectal cancer. Ann Oncol. 2005;16:549–57.PubMedCrossRefGoogle Scholar
  14. 14.
    Raymond E, Chaney SG, Taamma A, et al. Oxaliplatin: a review of preclinical and clinical studies. Ann Oncol. 1998;9:1053–71.PubMedCrossRefGoogle Scholar
  15. 15.
    Grothey A. Clinical management of oxaliplatin-associated neurotoxicity. Clin Colorectal Cancer. 2005;5 Suppl 1:S38–46.PubMedCrossRefGoogle Scholar
  16. 16.
    Land SR, Kopec JA, Cecchini RS, et al. Neurotoxicity from oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: NSABP C-07. J Clin Oncol. 2007;25:2205–11.PubMedCrossRefGoogle Scholar
  17. 17.
    Neugut AI, Matasar M, Wang X, et al. Duration of adjuvant chemotherapy for colon cancer and survival among the elderly. J Clin Oncol. 2006;24:2368–75.PubMedCrossRefGoogle Scholar
  18. 18.
    Link KH, Kornmann M, Staib L, et al. Increase of survival benefit in advanced resectable colon cancer by extent of adjuvant treatment: results of a randomized trial comparing modulation of 5-FU + levamisole with folinic acid or with interferon-alpha. Ann Surg. 2005;242:178–87.PubMedCrossRefGoogle Scholar
  19. 19.
    Kornmann M, Formentini A, Ette C, et al. Prognostic factors influencing the survival of patients with colon cancer receiving adjuvant 5-FU treatment. Eur J Surg Oncol. 2008;34:1316–21.PubMedGoogle Scholar
  20. 20.
    Alberts SR, Sargent DJ, Smyrk TC, et al.: Adjuvant mFOLFOX6 with or without cetuxiumab (Cmab) in KRAS wild-type (WT) patients (pts) with resected stage III colon cancer (CC): Results from NCCTG Intergroup Phase III Trial N0147. [Abstract CRA3507]. Presented at the 2010 ASCO Annual Meeting Chicago, IL; June 4–8, 2010.Google Scholar
  21. 21.
    Oxaliplatin, Leucovorin Calcium, and Fluorouracil With or Without Celecoxib in Treating Patients With Stage III Colon Cancer Previously Treated With Surgery. Available at http://www.clinicaltrials.gov/ct2/show/NCT01150045. Assessed February 13, 2011.
  22. 22.
    FOLFOX-4 3 months Versus 6 Months and Bevacizumab as Adjuvant Therapy for Patients With Stage II/III Colon Cancer (TOSCA). Available at http://www.clinicaltrials.gov/ct2/show/NCT00646607. Assessed February 13, 2011.
  23. 23.
    Combination Chemotherapy After Surgery in Treating Patients With High-Risk Stage II or Stage III Colorectal Cancer. Available at http://www.clinicaltrials.gov/ct2/show/NCT00749450. Assessed February 13, 2011.
  24. 24.
    Combination Chemotherapy for 3 Months or 6 Months in Treating Patients With Stage III Colon Cancer. Available at http://www.clinicaltrials.gov/ct2/show/NCT00958737. Assessed February 13, 2011.
  25. 25.
    A Multicenter Trial Investigating the Duration of Adjuvant Therapy(3 vs. 6 Months) With the FOLFOX 4 or XELOX Regimen for Patients With High Risk Stage II or Stage III Colon Cancer. Available at http://www.clinicaltrials.gov/ct2/show/NCT01308086?term=NCT01308086. Assessed June 6, 2011.

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Division of Medical OncologyMayo ClinicRochesterUSA

Personalised recommendations