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Duration of adjuvant therapy for colorectal cancer: are we overtreating our patients?

Nature Clinical Practice Oncology volume 2, pages 276–277 (2005)Cite this article

An estimated 945,000 new cases of colorectal cancer are diagnosed each year, of which approximately 40% will be nonmetastatic lymph node-positive (stage III) disease, and 15–20% will be T3–T4 disease without lymph node involvement (stage II). While several large randomized trials conducted over the past two decades in patients with high-risk resected colon cancer have demonstrated the benefit of adjuvant 5-fluorouracil (5-FU)-based chemotherapy using varying schedules and permutations of 5-FU delivery, the optimal duration of therapy remains controversial. In current practice, 6 months of postoperative 5-FU-based chemotherapy is accepted as the standard for adjuvant care, but is this amount of therapy appropriate for most patients with limited-stage disease?

To begin to examine the question of adjuvant therapy duration, a historical perspective is required. In the Intergroup 0035 study, 929 patients with resected stage III colon cancer were randomized to observation, levamisole for 12 months, or levamisole plus 5-FU for 12 months. This study reported a 40% reduction in disease recurrence and a 33% reduction in mortality (5-year OS 57% vs 41%) for levamisole/5-FU compared with observation.1 On the basis of these results, the 1990 NIH Consensus Conference recommended 12 months of adjuvant chemotherapy with 5-FU and levamisole for stage III and selected high-risk stage II colon cancer.

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Authors and Affiliations

  1. Professor of Medicine at the University of North Carolina at Chapel Hill, NC, USA

    Richard M Goldberg

  2. Assistant Professor of Medicine at the University of British Columbia, Vancouver, BC, Canada

    Sharlene Gill

Authors
  1. Sharlene Gill
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  2. Richard M Goldberg
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Correspondence to Richard M Goldberg.

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The authors declare no competing financial interests.

Glossary

NCCTG

North Central Cancer Treatment Group

NCIC-CTG

National Cancer Institute of Canada Clinical Trials Group

IMPACT

International Multicentre Pooled Analysis of Adjuvant Colon Cancer Trials

INTACC

Italian National Intergroup of Adjuvant Therapy Chemotherapy in Colon Cancer

MOSAIC

Multicentre International Study of Oxaliplatin/5-Fluorouracil/Leucovorin in the Adjuvant Treatment of Colon Cancer

ESMO

European Society for Medical Oncology

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Gill, S., Goldberg, R. Duration of adjuvant therapy for colorectal cancer: are we overtreating our patients?. Nat Rev Clin Oncol 2, 276–277 (2005). https://doi.org/10.1038/ncponc0192

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