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Molecular markers to individualize adjuvant therapy for colon cancer

Nature Reviews Clinical Oncology volume 7, pages 318–325 (2010)Cite this article

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Abstract

While many patients with early-stage colon cancer are cured with surgery alone, the standard of care remains a uniform approach to adjuvant chemotherapy based primarily on tumor stage. Recently, increasing awareness of the need for more individualized decision-making in cancer care has led to the development of several potential prognostic and predictive markers in colon cancer. While adjuvant chemotherapy with 5-fluorouracil, leucovorin and oxaliplatin is clearly beneficial to patients with stage III disease, well-validated molecular markers might help define which patients with stage II disease are likely to benefit from adjuvant therapy as well. Here, we review the data on the clinical development of molecular markers to individualize adjuvant therapy in colon cancer.

Key Points

  • While adjuvant chemotherapy is the standard of care for patients with stage III colon cancer, certain patients with stage II disease are at high risk for recurrence and might also benefit from adjuvant therapy

  • We recommend testing for deficient mismatch repair by microsatellite instability in patients with stage II sporadic colon cancer who are being considered for adjuvant chemotherapy

  • Patients with stage II disease who have deficient mismatch repair (MSI-high tumors) have an excellent prognosis without treatment and are unlikely to benefit from adjuvant 5-fluorouracil chemotherapy

  • The development of molecular markers that are both prognostic and predictive of response to therapy will further define which patients are likely to benefit from adjuvant chemotherapy

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Section of Hematology-Oncology and Comprehensive Cancer Center, University of Chicago, 5841 South Maryland Avenue, MC 2115, Chicago, 606037, IL, USA

    Tara Gangadhar & Richard L. Schilsky

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Gangadhar, T., Schilsky, R. Molecular markers to individualize adjuvant therapy for colon cancer. Nat Rev Clin Oncol 7, 318–325 (2010). https://doi.org/10.1038/nrclinonc.2010.62

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