[Adjuvant treatment of colorectal cancer]

Abstract

Colorectal cancer is a real national healthy problem because of high frequency and high rate of mortality. Folfox4 is the new standard treatment since publication of Mosaic' results. Irinotecan associated with 5 fluorouracil (5FU) and leucovorin (LV) failed to demonstrate superiority over LV modulated 5FU. Oral fluoropyrimidines (capecitabine or UFT + LV) are an effective alternative to intravenous 5FU and LV. In stage II colon cancer, treatment strategies are more debated. Some data suggest that chemotherapy is not mandatory for stage II tumors low risk (T3N0 without risk factors). For stage II tumors with high risk factors (T4 or bowel obstruction, perforation, poorly differenciated tumor or, < 10 examined lymphs nodes), Folfox4 and fluoropyrimidine (oral and LV5FU2) should be candidate as adjuvant treatment. Now studies evaluate the role of bevacizumab (Avant, NSABP C08) and cetuximab (Petacc 8 and NCCTG-N0147) in combination with Folfox4 in stage III tumors.