Adjuvant Chemotherapy for Stage III Colon Cancer

This article discusses the use of adjuvant chemotherapy in stage III colon cancer. It covers different chemotherapy regimens, the duration of treatment, and considerations for elderly patients. The article also provides perspectives on (neo)adjuvant chemotherapy and includes relevant references.

Adjuvant Chemotherapy for
Stage III Colon Cancer

Contents
MAIN BODY..................................................................................................................................1
Chemotherapy Regimens.............................................................................................................1
Duration of Adjuvant Chemotherapy: IDEA Collaboration........................................................1
Adjuvant Chemotherapy in Elderly Patients...............................................................................1
Neo-Adjuvant Chemotherapy for Locally Advanced Colon Cancer...........................................2
Perspectives for (Neo)Adjuvant Chemotherapy in Stage III Colon Cancer................................2
REFERENCES................................................................................................................................3

MAIN BODY
Chemotherapy Regimens
It has been analysed that first adjuvant chemotherapy regimen who has demonstrated their
efficacy was the localised CC and then it was been compared to surgery alone FULV regimen.
Thus, the only regimens validated in stage III CC are the oxaliplatin-based chemotherapy. It has
also been analysed that FOLFOX and CAPOX regimen is only been used for the doublet
treatment. Comparison between the FOLFOX and the CAPOX regimen has been done. It has
been analysed that when comparing FOLFOX with CAPOX they have benefits of not having to
insert central venous access device. In this the number of injections which are been given for
oxaliplatin is also been reduced down. DPD deficiency before adjuvant chemotherapy needs to
be measured (Bregni and et.al., 2020).
Duration of Adjuvant Chemotherapy: IDEA Collaboration
Cumulative sensory neuropathy can be considered as one of the biggest toxicities of
adjuvant chemotherapy. It has been analysed that this can affect the wellbeing and quality of life
of patients. Randomised controlled trials including three phase has been done and also in this
12934 patients were being included (Spring and et.al., 2020). The stage three patients of CC have
been classified in low and high risk sub groups which basically depends on their T and N stage.
FOLFOX was been given for the low risk patients and that also for 3 months. It has also been
analysed that CAPOX was been given to those patients who are at high risk. It was also been
analysed that tolerance for chemotherapy was broadly better in the 2 months arms. It was also
being evaluated that tolerance can also be decreased with the span of time.
Adjuvant Chemotherapy in Elderly Patients
Few specific data were being collected on adjuvant chemotherapy. The patients which
were included in this study was over 80 years. They were rarely being included in the adjuvant
therapeutic trials (Liu and et.al., 2020). Compared to patients under 70 years old, elderly patients
over 70 years old have a comparable benefit and safety profile of adjuvant fluorouracil-based
chemotherapy compared to surgery alone in this patients with 70 years olds are provided with
comparable benefit for and safety profile of adjuvant fluorouracil-based chemotherapy compared
to surgery alone. The addition oxaliplatin which was been given, can not appear to give any
benefit. It does not give any benefit from 70-75 years of age of elderly patients. It has been
analysed that adjuvant chemotherapy is necessary to be taken for elderly patients. For this it is
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also necessary to take into account co-morbidities and their presumed life expectancy. Their
performance status and expectations in the difficult situation also needs to be taken in
consideration (Sunami and et.al., 2020).
Neo-Adjuvant Chemotherapy for Locally Advanced Colon Cancer
It has also been analysed that Neo-Adjuvant Chemotherapy for Locally Advanced Colon
Cancer in patients of elderly aged can link to shrinkage of tumours. Tumour cell also sheds
during the time of surgery in this type of chemotherapy. It can be taken in consideration for the
elderly aged patients. The PRODIGE 22 phase initial trial was been done. In this neo adjuvant
chemotherapy was been done for FOLFOX with locally advanced CC, it was being done. It has
also been analysed that this therapy was considered beneficial for lowering down the shrinkages
of tumour. Primary tumour was being cured by giving the neo adjuvant chemotherapy and also it
was analysed that in some cases in elderly aged patients, the survival was even difficult after
providing them with this type of chemotherapy for colon cancer. The benefits of neo adjuvant is
also been proven in various randomised controlled trial (Cercek and et.al., 2020).
Perspectives for (Neo)Adjuvant Chemotherapy in Stage III Colon Cancer
The molecular characterisation which was been based on CC, in the last stage splitting was
been allowed and this has caused homogenous disease spread in several entities. In this alteration
related to tumour cells is been done. This therapy is usually being given within the 8 weeks. It is
being given when patients condition is not well and has developed stage III colon cancer. This
type of therapy is being provided at that stage (Taieb, Gallois 2020). It has also been analysed
that this therapy might be effective and might be not. In elderly aged patients the therapy has
shown their significant results, enhancing wellbeing and health outcome of patients is being
improved by giving them therapy of this type.
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REFERENCES
Books and Journals
Cercek, A. and et.al., 2020. Mismatch repair–deficient rectal cancer and resistance to
neoadjuvant chemotherapy. Clinical Cancer Research, 26(13), pp.3271-3279.
Liu, N. and et.al., 2020. National underutilization of neoadjuvant chemotherapy for gastric
cancer. Journal of Gastrointestinal Surgery, 24(4), pp.949-958.
Spring, L.M. and et.al., 2020. Pathological complete response after neoadjuvant chemotherapy
and impact on breast cancer recurrence and survival: a comprehensive meta-
analysis. Clinical Cancer Research.
Bregni G, Akin Telli T, Camera S, Deleporte A, Moretti L, Bali AM, Liberale G, Holbrechts S,
Hendlisz A, Sclafani F. Adjuvant chemotherapy for rectal cancer: Current evidence and
recommendations for clinical practice. Cancer Treat Rev. 2020 Feb;83:101948. doi:
10.1016/j.ctrv.2019.101948. Epub 2019 Dec 10. PMID: 31955069.
Taieb J, Gallois C. Adjuvant Chemotherapy for Stage III Colon Cancer. Cancers (Basel). 2020
Sep 19;12(9):2679. doi: 10.3390/cancers12092679. PMID: 32961795; PMCID:
PMC7564362.
Sunami E, Kusumoto T, Ota M, Sakamoto Y, Yoshida K, Tomita N, Maeda A, Teshima J,
Okabe M, Tanaka C, Yamauchi J, Itabashi M, Kotake K, Takahashi K, Baba H, Boku N,
Aiba K, Ishiguro M, Morita S, Takenaka N, Okude R, Sugihara K. S-1 and Oxaliplatin
Versus Tegafur-uracil and Leucovorin as Postoperative Adjuvant Chemotherapy in
Patients With High-risk Stage III Colon Cancer (ACTS-CC 02): A Randomized, Open-
label, Multicenter, Phase III Superiority Trial. Clin Colorectal Cancer. 2020 Mar;19(1):22-
31.e6. doi: 10.1016/j.clcc.2019.10.002. Epub 2019 Oct 18. PMID: 31917122.
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