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Adjuvant Chemotherapy for Colon Cancer
I was diagnosed with stage 3 colon cancer in mid-2025. I underwent surgery to remove the tumor in my colon. I am thinking through adjuvant chemotherapy for colon cancer.
Surgically removing the tumor from my colon is a great first step in removing bad colon cancer cells from my body. However, oncology tells me that I still have a 30%-40% chance of relapsing in the next five years if I don’t have chemotherapy.
Adjuvant chemotherapy is the treatment that is designed to kill any remaining cancer cells swiming around my body. The trade-off is that the treatments outlined below are toxic and therefore bring a serious risk of short-term, long-term and late-stage side effects.
So the question is one of risk-benefit. Are the risks of adjuvant chemotherapy worth the possible benefits?
What are adjuvant chemotherapy regimens prescribed for stage 3 colon cancer?
The most common adjuvant chemotherapy regimens for stage 3 colon cancer are
FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) and CAPEOX (capecitabine and oxaliplatin). The duration of treatment can be 3 or 6 months, with a 3-month course often used for patients with lower-risk disease, as it can be just as effective while reducing toxicity like neuropathy from oxaliplatin. Patients with a higher risk of recurrence may receive the 6-month regimen.
Common chemotherapy regimens
- FOLFOX: This is a combination of three drugs:
- 5-fluorouracil (5-FU)
- Leucovorin
- Oxaliplatin
- CAPEOX: This combination uses an oral and an intravenous drug:
- Capecitabine (an oral chemotherapy that the body converts to 5-FU)
- Oxaliplatin
Treatment duration
- 3 months: A 3-month duration of either FOLFOX or CAPEOX is often used for patients at a lower risk of recurrence, based on findings from studies like the IDEA trial.
- 6 months: A 6-month course of either regimen is the historical standard and may be used for patients at a higher risk of recurrence.
Other considerations
- In certain cases, especially for older patients or those with other health issues, a less intensive regimen of just 5-FU with leucovorin or capecitabine alone may be prescribed.
- The choice of regimen and duration is a shared decision between the patient and their doctor, taking into account the cancer’s risk factors and the potential for side effects.
The key factors that I’m using to debate my adjuvant chemotherapy for colon cancer are:
Cancer and risk factors
- Lymph node status: The number of positive lymph nodes is a primary factor. More positive nodes indicate a higher risk.
- Tumor characteristics: Larger tumors and higher-grade tumors are more likely to recur and benefit from chemotherapy. Other factors include T4 stage, perforation, or obstruction.
- Genetic profile: The cancer’s genetic makeup can influence the choice of chemotherapy or whether targeted therapy should be added.
- Number of lymph nodes examined: A lower number of examined lymph nodes can indicate higher risk, as it may mean the cancer has already spread beyond what was found.
Patient-specific factors
- General health: Overall health and fitness level impact the ability to tolerate side effects.
- Comorbidities: Conditions like heart disease or diabetes can influence which chemotherapy drugs are selected.
- Age: Age can be a factor, especially in relation to kidney function and other health issues.
- Preferences: Patient preferences should be considered, especially when different therapy options are available.
Treatment-related factors
- Drug regimen: Regimens like FOLFOX (fluorouracil, leucovorin, and oxaliplatin) or CAPOX (capecitabine and oxaliplatin) are often used.
- Treatment duration: For stage 3, a 6-month treatment is often standard, though 3-month durations are being evaluated for lower-risk patients to potentially limit side effects like neuropathy.
- Timing: Chemotherapy should ideally be started within 8 weeks of surgery, as starting later can reduce survival benefits.
- Side effects: Potential side effects, such as neuropathy from oxaliplatin, need to be discussed and monitored.
- Personalized risk assessment: While traditional factors are important, emerging techniques like ctDNA testing (circulating tumor DNA) can offer more precise risk stratification to avoid overtreatment or undertreatment.
Are you a colon cancer survivor? Do you have any experience with the issues outlined above? I am looking for input, be it good, bad, or ugly…Scroll down the page and send me your experience.
Thanks,
- Bernie Davis
- Colon Cancer Survivor
Adjuvant Chemotherapy for Stage III Colon Cancer
Simple Summary
“In patients with stage III colon cancer, adjuvant chemotherapy with a fluoropyrimidine combined with oxaliplatin reduces the risk of recurrence and mortality, with a treatment duration that may be shortened from 6 to 3 months in certain situations allowing to limit toxicities, especially cumulative sensitive neuropathy.
However, it is difficult to effectively predict the risk of recurrence individually for each patient. It is indeed necessary not to over-treat patients with potential toxicities of chemotherapy and, conversely, not to under-treat patients at high risk of recurrence, and also to find new treatment approaches for specific subgroups. Though no single biomarker have sufficient predictive value to adapt the therapeutic strategy, we have considerably improved our knowledge of these biomarkers predictive of recurrence in localized colon cancer and many trials testing their ability to guide treatment are ongoing.
Abstract
In patients with stage III colon cancer (CC), adjuvant chemotherapy with the combination of oxapliplatin to a fluoropyrimidine (FOLFOX or CAPOX) is a standard of care. The duration of treatment can be reduced from 6 months to 3 months, depending on the regimen, for patients at low risk of recurrence, without loss of effectiveness and allowing a significant reduction in the risk of cumulative sensitive neuropathy.
However, our capacity to identify patients that do really need this doublet adjuvant treatment remains limited.
In fact, only 30% at the most will actually benefit from this adjuvant treatment, 50% of them being already cured by the surgery and 20% of them experiencing disease recurrence despite the adjuvant treatment.
Thus, it is necessary to be able to better predict individually for each patient the risk of recurrence and the need for adjuvant chemotherapy together with the need of new treatment approaches for specific subgroups.
Many biomarkers have been described with their own prognostic weight, without leading to any change in clinical practices for now…”
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