TY - JOUR
T1 - Adjuvant Therapy for Stage II Colon Cancer
T2 - ASCO Guideline Update
AU - Baxter, Nancy N.
AU - Kennedy, Erin B.
AU - Bergsland, Emily
AU - Berlin, Jordan
AU - George, Thomas J.
AU - Gill, Sharlene
AU - Gold, Philip J.
AU - Hantel, Alex
AU - Jones, Lee
AU - Lieu, Christopher
AU - Mahmoud, Najjia
AU - Morris, Arden M.
AU - Ruiz-Garcia, Erika
AU - You, Y. Nancy
AU - Meyerhardt, Jeffrey A.
N1 - Funding Information:
The Expert Panel (see Appendix Table A1) would like to thank Dr Shishir Maithel, MD, and Dr Kelsey Klute, MD, and the Evidence Based Medicine Committee for their thoughtful reviews and insightful comments on this guideline.
Publisher Copyright:
© 2021 by American Society of Clinical Oncology
PY - 2022/3/10
Y1 - 2022/3/10
N2 - PURPOSE To develop recommendations for adjuvant therapy for patients with resected stage II colon cancer. METHODS ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Twenty-one observational studies and six randomized controlled trials met the systematic review inclusion criteria. RECOMMENDATIONS Adjuvant chemotherapy (ACT) is not routinely recommended for patients with stage II colon cancer who are not in a high-risk subgroup. Patients with T4 tumors are at higher risk of recurrence and should be offered ACT, whereas patients with other high-risk factors, including sampling of fewer than 12 lymph nodes in the surgical specimen, perineural or lymphovascular invasion, poorly or undifferentiated tumor grade, intestinal obstruction, tumor perforation, or grade BD3 tumor budding, may be offered ACT. The addition of oxaliplatin to fluoropyrimidine-based ACT is not routinely recommended, but may be offered as a result of shared decision making. Patients with mismatch repair deficiency/microsatellite instability tumors should not be routinely offered ACT; if the combination of mismatch repair deficiency/microsatellite instability and high-risk factors results in a decision to offer ACT, oxaliplatin-containing chemotherapy is recommended. Duration of oxaliplatin-containing chemotherapy is also addressed, with recommendations for 3 or 6 months of treatment with capecitabine and oxaliplatin or fluorouracil, leucovorin, and oxaliplatin, with decision making informed by key evidence of 5-year disease-free survival in each treatment subgroup and the rate of adverse events, including peripheral neuropathy.
AB - PURPOSE To develop recommendations for adjuvant therapy for patients with resected stage II colon cancer. METHODS ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Twenty-one observational studies and six randomized controlled trials met the systematic review inclusion criteria. RECOMMENDATIONS Adjuvant chemotherapy (ACT) is not routinely recommended for patients with stage II colon cancer who are not in a high-risk subgroup. Patients with T4 tumors are at higher risk of recurrence and should be offered ACT, whereas patients with other high-risk factors, including sampling of fewer than 12 lymph nodes in the surgical specimen, perineural or lymphovascular invasion, poorly or undifferentiated tumor grade, intestinal obstruction, tumor perforation, or grade BD3 tumor budding, may be offered ACT. The addition of oxaliplatin to fluoropyrimidine-based ACT is not routinely recommended, but may be offered as a result of shared decision making. Patients with mismatch repair deficiency/microsatellite instability tumors should not be routinely offered ACT; if the combination of mismatch repair deficiency/microsatellite instability and high-risk factors results in a decision to offer ACT, oxaliplatin-containing chemotherapy is recommended. Duration of oxaliplatin-containing chemotherapy is also addressed, with recommendations for 3 or 6 months of treatment with capecitabine and oxaliplatin or fluorouracil, leucovorin, and oxaliplatin, with decision making informed by key evidence of 5-year disease-free survival in each treatment subgroup and the rate of adverse events, including peripheral neuropathy.
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U2 - 10.1200/JCO.21.02538
DO - 10.1200/JCO.21.02538
M3 - Article
C2 - 34936379
AN - SCOPUS:85125964782
SN - 0732-183X
VL - 40
SP - 892
EP - 910
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 8
ER -