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Current Issues in Adjuvant Treatment of Stage II Colon Cancer

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Abstract

Background

Adjuvant chemotherapy with 5-fluorouracil modulated by folinic acid, combined with oxaliplatin, has now become an accepted standard of care for patients with stage III colon cancer. In contrast, the use of adjuvant therapy for stage II patients remains controversial, and the identification of reliable prognostic factors to aid therapeutic decision making is crucial.

Methods

The authors critically review the results of clinical trials and meta-analyses investigating the value of adjuvant chemotherapy for stage II patients, emphasizing the heterogeneous nature of this population and the difficulty of performing clinical trials with sufficient power to reliably assess treatment efficacy. They also discuss the evidence concerning potential prognostic factors, particularly molecular markers.

Results

Available clinical trial data do not support the routine use of adjuvant chemotherapy for all stage II patients but suggest that it should be considered, particularly for certain high-risk patients. Recent guidelines advocate considering factors such as tumor differentiation, tumor perforation, number of lymph nodes examined, and T stage when assessing the likely benefit:risk ratio. Microsatellite instability and allelic imbalance seem to be strong predictors of good and poor prognosis, respectively, and in the near future, therapeutic decision-making models are likely to be further refined by the inclusion of such molecular markers.

Conclusions

There is growing evidence that the prognosis of certain stage II patients with unfavorable prognostic factors can be improved by adjuvant chemotherapy, and increasingly refined tools are now available to define those most likely to benefit. Referral of stage II patients for individual assessment is strongly recommended.

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Acknowledgments

This article was derived from discussions at a meeting on adjuvant therapy of colon cancer organized by Aimery de Gramont, with financial support from Sanofi-Synthelabo, in September 2003. The authors thank Paula Harry (MediBridge, France) for medical writing support.

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Authors and Affiliations

  1. Service d’Oncologie Médicale, Hôpital Tenon, 4 Rue de la Chine, 75970, Paris Cedex 20, France

    Thierry André MD

  2. CancerEst, Hôpital Saint Antoine, 184 Rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France

    Thierry André MD & Aimery de Gramont MD

  3. GERCOR (Franch Oncology Research Group), 22 Rue Malher, 75004, Paris, France

    Thierry André MD & Aimery de Gramont MD

  4. Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905

    Daniel Sargent PhD

  5. Vall d’Hebron University Hospital, P Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Josep Tabernero MD

  6. NSABP Foundation Research Program, 4 Allegheny Center, Pittsburgh, Pennsylvania, 15212

    Michael O’Connell MD

  7. IDDI, 430 Avenue Louise, BP 14, B 1050 Brussels, Belgium

    Marc Buyse ScD

  8. Ospedale S. Martino, Largo Benzi 10, Genova, 16132, Italy

    Alberto Sobrero MD

  9. Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France

    Jean-Louis Misset MD

  10. Arcispedale S. Maria Buova, Viale Resorgimento 80, Regio Emilia, 42100, Italy

    Corrado Boni MD

  11. Hôpital Saint-Antoine, 184 Rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France

    Aimery de Gramont MD

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  1. Thierry André MD
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Correspondence to Thierry André MD.

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André, T., Sargent, D., Tabernero, J. et al. Current Issues in Adjuvant Treatment of Stage II Colon Cancer. Ann Surg Oncol 13, 887–898 (2006). https://doi.org/10.1245/ASO.2006.07.003

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  • DOI: https://doi.org/10.1245/ASO.2006.07.003

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