- Changes to European Society for Medical Oncology guidelines update management of local/regional colon cancer.
Why this matters
- The updates to 2013 guidelines incorporate findings from the IDEA pooled analysis and other recent studies.
- 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.