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. 2010 Jul;2(4):261-72.
doi: 10.1177/1758834010367905.

Combination therapy in high-risk stage II or stage III colon cancer: current practice and future prospects

Diogo Assed Bastos  1 , Suilane Coelho Ribeiro, Daniela de Freitas, Paulo M Hoff
Affiliations

Combination therapy in high-risk stage II or stage III colon cancer: current practice and future prospects

Diogo Assed Bastos et al. Ther Adv Med Oncol. 2010 Jul.

Abstract

Colon cancer represents the second leading cause of cancer-related deaths. For patients who have undergone curative surgery, adjuvant therapy can reduce the risk of recurrence and death from relapsed or metastatic disease. Postoperative chemotherapy with a 5-fluorouracil-based regimen combined with oxaliplatin is the current standard of care for stage III patients. However, there is still controversy in stage II disease about the real impact of adjuvant monotherapy or combined therapy on survival. Better identification of a subgroup of patients with a higher risk of recurrence can select patients who might benefit from adjuvant therapy. For the elderly population, there is a well-established role for postoperative therapy, although the most appropriate regimen remains to be defined. Targeted agents for combined adjuvant therapy in stage II and III colon cancer is a promising area, but to date, there is no evidence supporting its use in this setting. Results from large prospective trials with targeted therapy have been disappointing and new drugs and strategies are needed to define the role of these types of agents in the adjuvant scenario of colon cancer.

Keywords: adjuvant chemotherapy; colon cancer; combined therapy; high-risk stage II; stage III.

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Figures

Figure 1.
Figure 1.
Disease-free survival for stage III colon cancer in landmark clinical trials of adjuvant therapy. BEV, bevacizumab; FOLFOX, 5-fluorouracil plus oxaliplatin; 5-FU, 5-fluorouracil; F/U, follow up; HR, hazard ratio; lev, levamisole; LV, leucovorin; yr, years. INT-0035 [Moertel et al. 1995]; NSABP C-04 [Wolmark et al. 1999]; X-ACT [Twelves et al. 2005]; MOSAIC [André et al. 2009]; NSABP C-08 [Wolmark et al. 2009].
Figure 2.
Figure 2.
Overall survival for stage III colon cancer in landmark clinical trials of adjuvant therapy. FOLFOX, 5-fluorouracil plus oxaliplatin; 5-FU, 5-fluorouracil; F/U, follow up; HR, hazard ratio; lev, levamisole; LV, leucovorin; yr, years. INT-0035 [Moertel et al. 1995]; NSABP C-04 [Wolmark et al. 1999]; X-ACT [Twelves et al. 2005]; MOSAIC [André et al. 2009].
Figure 3.
Figure 3.
Disease-free survival for stage II colon cancer in landmark clinical trials of adjuvant therapy. BEV, bevacizumab; FOLFOX, 5-fluorouracil plus oxaliplatin; 5-FU, 5-fluorouracil; F/U, follow-up; HR, hazard ratio; lev, levamisole; LV, leucovorin; yr, years. INT-0035 [Moertel et al. 1995]; NSABP C-04 [Wolmark et al. 1999]; QUASAR [Gray et al. 2007]; MOSAIC [André et al. 2009]; NSABP C-08 [Wolmark et al. 2009].
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