Adjuvant Therapy of Colon Carcinoma

In patients with stage III carcinoma of the colon, adjuvant chemotherapy is indicated after R0 resection. No age limitations exist. Combination chemotherapy with FOLFOX4 or (if oxaliplatin is contraindicated) monotherapy with a fluoropyrimidine, preferably capecitabine, can be regarded as the standard treatment. Because of its unfavorable toxicity profile, the 5-FU/folic acid bolus scheme (the Mayo scheme) should no longer be used, and combinations including irinotecan also do not play a part in colon carcinoma. The combination XELOX (oxaliplatin + capecitabine) is currently being studied in phase III trials. Data on the efficacy of the targeted drugs bevacizumab and cetuximab cannot be expected until at least 2010/2011. It is important that adjuvant treatment be started in a timely manner, within 8 weeks of surgery. As far as stage II disease is concerned, adjuvant chemotherapy analogous to that for stage III should be considered in high-risk patients (T4, emergency surgery, tumor perforation/tear, < 12 lymph nodes examined). The evidence for this recommendation is, however, based mainly on unplanned subgroup analyses of randomized trials. That low-risk stage II patients can also profit from adjuvant treatment was shown in the QUASAR trial (significant survival benefit of 3.6%), so this group of patients can be offered chemotherapy containing 5-FU. For treatments involving oxaliplatin in low-risk patients there is currently insufficient evidence.