Stage II and Stage III Colon Cancer: Treatment Advances and ... : The Cancer Journal (original) (raw)

Special Issue on Chemotherapy for Colorectal Cancer: Review Article

Treatment Advances and Future Directions

Rousseau, Benoît MD*; Chibaudel, Benoist MD*; Bachet, Jean-Baptiste MD†; Larsen, Annette K. DVM, PhD‡; Tournigand, Christophe MD*‡; Louvet, Christophe MD*‡; André, Thierry MD†‡§; de Gramont, Aimery MD*‡§ for GERCOR (French Oncology Research Group)

From the *Service d’Oncologie Médicale, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris; †Hôpital La Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris; ‡Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S 938; and §Université Pierre et Marie Curie (Paris 6), Paris, France.

Reprints: Dr. Aimery de Gramont, Service d’Oncologie Médicale, Hôpital Saint-Antoine, Paris 75012, France. E-mail: [email protected].

Abstract

Because of its frequency and mortality rate, colorectal cancer represents a major public health problem. Adjuvant chemotherapy has improved the prognosis. Six months of oxaliplatin and fluoropyrimidine in combination is the standard adjuvant treatment in stage III patients. Two monoclonal antibodies, bevacizumab targeting vascular endothelial growth factor and cetuximab targeting epidermal growth factor receptor 1, are being assessed in addition to chemotherapy in the adjuvant setting. Preliminary results of 2 trials have shown disappointing results. Duration of therapy is another other critical issue for the future. Adjuvant chemotherapy in patients with stage II colon cancer is still a subject of controversy. The potential biomarkers that can accurately select patients with stage II or III cancer who are at risk for recurrence to individualize therapy from microsatellite instability to gene signature are reviewed. Adjuvant therapy in elderly patients is another matter of debate due to the lack of survival advantage in the recent trials.