ESMO updates colon cancer treatment guidelines

  • ESMO guidelines

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Changes to European Society for Medical Oncology guidelines update management of local/regional colon cancer.

Why this matters

Key points

  • Stage II tumors:
    • Follow-up is recommended for low-risk disease.
    • High-risk tumors should be treated with fluoropyrimidine adjuvant chemotherapy. High risk is defined as T4, fewer than 12 lymph nodes examined, primary tumor perforation or occlusion, or tumor grade 3 without microsatellite instability.
    • Very high risk tumors (microsatellite stable and T4 or ≥1 other risk factor) are candidates for addition of oxaliplatin.
    • High-risk tumors are candidates for 3 months of CAPOX (capecitabine and oxaliplatin).
  • Stage III tumors:
    • Adjuvant choice may incorporate high-risk (T4 and/or N2) and low-risk (T1-3, N1) stratification, but this was based on a post hoc, nonsignificant for interaction combination in the IDEA analysis.
    • Oxaliplatin-based adjuvant therapy duration can be tailored to:
      • 3 months for CAPOX (T1-3 N1 disease).
      • 6 months for CAPOX (T4 or N2 disease).
      • 6 months for 5-fluorouracil, leucovorin, oxaliplatin (T4 or N2 disease).
    • Patients unfit for oxaliplatin can be offered 6 months of capecitabine or LV5FU2 (de Gramont) infusion.