Adjuvant therapy pros and cons, or whether or not I should do adjuvant chemotherapy, is my next big decision. My name is Bernie Davis. I was diagnosed with colon cancer.
I’ve surgically removed my colon cancer. This is the first and most effective way to remove bad colon cancer cells.
But what is the most effective way to NOT relapse? Adjuvant therapy, according to research, reduces my risk of relapse. According to the content linked below, adjuvant therapy can “destroy residual cells.” But chemo comes with some nasty side effects. How do I decide if chemo is worth the damage?!?!
According to ChatGPT, the pros and cons of adjuvant chemo for me are below.
For a stage IIIC colon cancer patient who has undergone surgical resection, adjuvant chemotherapy is a standard recommendation because of the high risk of recurrence. Below is a balanced review of the pros and cons, incorporating clinical evidence and real-world experience.
🎯 Purpose of Adjuvant Chemotherapy
After surgery, microscopic cancer cells may remain in the bloodstream or lymph nodes. Adjuvant chemotherapy aims to destroy these residual cells and prevent relapse, particularly distant metastases (often liver or lung).
✅ Pros (Potential Benefits)
1. Improved Survival
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Large trials (e.g., MOSAIC, IDEA, NSABP C-07) show that adjuvant chemotherapy — typically FOLFOX (5-FU/leucovorin/oxaliplatin) or CAPOX (capecitabine/oxaliplatin) — improves:
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For stage IIIC, where multiple lymph nodes are involved, the benefit is even greater.
2. Reduced Recurrence Risk
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Without adjuvant therapy, the recurrence risk in stage IIIC colon cancer can be 50–60%.
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With chemotherapy, this can drop to 30–40% or less.
3. Standard of Care
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Recommended by NCCN, ASCO, and ESMO guidelines for stage III disease.
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Often covered fully by insurance.
4. Flexible Duration Options
⚠️ Cons (Risks and Drawbacks)
1. Toxicity
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Oxaliplatin neurotoxicity (CIPN): Tingling or numbness in hands and feet, which can persist for years.
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Myelosuppression: Fatigue, increased infection risk, low white blood cell counts.
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Gastrointestinal issues: Nausea, diarrhea, mucositis, appetite loss.
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Hand-foot syndrome (with capecitabine).
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Liver enzyme elevation or mild hepatic stress.
2. Quality of Life Impact
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Fatigue and neuropathy can affect mobility, work, and sleep.
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Emotional burden and time commitment for infusions or oral regimens.
3. Limited Benefit for Some
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Not all patients gain the same advantage — individuals with poor performance status, advanced age, or severe comorbidities may have more harm than benefit.
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Tumors with certain molecular features (e.g., MSI-high) respond differently — MSI-high tumors benefit less from fluoropyrimidine monotherapy.
4. Long-Term Effects
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Persistent neuropathy (up to 30% after oxaliplatin).
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Secondary effects on bone marrow, fertility, or cognitive function (“chemobrain”).
Here’s my problem. According to research, adjuvant chemotherapy reduces my risk of relapse by 10%-20%. There are a lot of adverse events aka side effects for only 10-20% risk of relapse reduction.
I have to wonder if I can meet or beat this risk reduction through nutrition, supplementation and lifestyle therapies.
Colon cancer survivors who have had adjuvant therapy, let me know your experiences, please. Scroll down the page, post a comment, and I will reply to you ASAP.
Thanks,
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Bernie Davis
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Colon Cancer Survivor
Adjuvant therapy can feasibly yield circulating tumor DNA (ctDNA) clearance in a portion of patients with colorectal cancer (CRC) and postoperative ctDNA positivity, with clearance correlating with superior disease-free survival (DFS) outcomes…
ctDNA dynamics data after the time of surgery or ablation revealed that 69% of patients had ctDNA negativity on all tests, while 18% had positive results on all tests.
- Additionally, 3.1% had ctDNA clearance on at least 2 tests,
- 2.4% had clearance on 1 test, and
- 8% converted from ctDNA negativity to positivity.
Furthermore, adjuvant therapy resulted in ctDNA clearance among 26% (n = 20/77) of patients with ctDNA-positive results after surgery, with 13 (17%) having clearance on at least 2 tests.
From the time of first ctDNA-positive test result in the stage I to III CRC population, DFS outcomes were significantly improved among those with clearance on at least 2 tests (P <.0001)…
Following adjuvant therapy,
- 70% of patients had ctDNA negativity on all tests,
- while 19% had positive results on all tests.
Other data showed that 1.5% had ctDNA negativity on at least 2 tests, 1.4% had clearance on 1 test, and 9% converted from ctDNA negativity to positivity.
The study population included 403 patients who had ctDNA-positive results at any time after surgery and adjuvant treatment, with 4.2% showing at least 1 subsequent negative reading without any intervention. Furthermore, 2.1% of this population had ctDNA-negative results on at least 2 sequential tests without any intervention, and 1.7% had no recurrences at the time of follow-up.
Among patients with spontaneous ctDNA clearance, the median duration of clearance was 11.2 months, and the mean tumor molecules per milliliter was 0.06 (range, 0.02-1.89).
“Adjuvant treatment can clear a quarter of the patients [who] are ctDNA positive postoperatively. Those with ctDNA clearance had superior DFS…” “The rate and durability of [spontaneous] ctDNA clearance was very low.”
According to Osterlund, previous studies have demonstrated how ctDNA can be employed to monitor minimal residual disease, with ctDNA positivity representing a strong risk factor for disease recurrence following procedures administered with curative intent.2
However, he noted limited findings on the rates and durability of spontaneous ctDNA clearance, the process of transitioning from ctDNA positivity to negativity without any intervention. Consequently, Osterlund and colleagues aimed to evaluate the behavior and clearance of ctDNA following procedures with curative intent among patients with stage I to IV CRC.
As part of the INTERCEPT program, 1301 patients with newly diagnosed or previously treated resectable stage I to IV CRC enrolled on the study, with 53% having stage I to III disease and 47% having stage IV disease.
Patients received standard-of-care therapy—surgical resection with or without neoadjuvant and adjuvant treatment—and underwent tissue collection and testing via ctDNA assays in the postoperative setting and/or following therapy.
Investigators then conducted routine surveillance via imaging & labs, with ctDNA assay testing occurring approximately every 3 months at each surveillance visit.
“ctDNA clearance is useful for seeing potential benefit in novel therapeutic studies,” Osterlund concluded.1
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