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Cure in Colon Cancer???
What is the definition of a cure in colon cancer? The study linked and excerpted below tries to answer this weighty question. Unfortunately, as a long-term cancer survivor myself, I disagree with the idea of a “practical definition.” And I’ll explain why.
First and foremost, let me say that the concept of curing cancer, any cancer, is difficult. The problem is that the cancer patient must die of something else before they can say they were cured of such and such cancer. So the thinking discussed below, that after remaining cancer-free for six years translates into the colon cancer survivor having a recurrence rate below 0.5%.
But having said that, I am quick to say that a tiny recurrence rate does not mean that the patient is cured. I think oncologists should use terms like:
- relapse-free survival
- recurrence-free survival
- disease-free survival
etc. You get the idea. No colon cancer, but I don’t have a crystal ball, so…
I am working with a newly diagnosed colon cancer patient named Bernie Davis. Though it’s still early in Bernie’s life as a colon cancer survivor, I have to say that there are many therapies for Bernie to achieve a long, relapse-free survival.
Are you a colon cancer survivor? What/when were you diagnosed? How long have you been in remission? Scroll down the page, post a comment or a question and I will reply ASAP.
thanks,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
Cure in Colon Cancer: A Practical Definition?
TOPLINE:
Analysis of 35,213 patients with stage II-III colon cancer revealed that recurrence risk drops below 0.5% at 6 years post-surgery, supporting a practical definition of cure. Women showed a significantly lower recurrence risk with a hazard ratio (HR) of 0.58.
METHODOLOGY:
- The definition of cure in stages II-III colon cancer remains unclear due to limitations in conventional endpoints, which include deaths and second primary tumors as events.
- Researchers conducted a pooled analysis of individual patient-level data from 15 phase 3 randomized clinical trials assessing time to colon cancer-related relapse using Kaplan-Meier and Aalen-Johansen methods.
- A total of 35,213 patients with stages II-III colon cancer who underwent adjuvant chemotherapy were included, with mean age of 60.2 years and 54.9% being men.
- Analysis included separating competing events from colon cancer recurrence, including death without recurrence and second primary tumors.
- Participants received adjuvant chemotherapy regimens including fluoropyrimidines alone or combined with oxaliplatin or biologic agents, with median follow-up of at least 6 years.
TAKEAWAY:
- The incidence rate of recurrence peaked at 6.4% between months 6 and 12 and then decreased continuously until year 10, never exceeding 0.5% after year 6.
- Women demonstrated a significantly lower cumulative incidence of relapse when death was a competing event (HR, 0.58; 95% CI, 0.45-0.76; P < .001).
- Patients aged 40 years or older showed a higher cumulative incidence of events than younger patients (HR, 2.93; 95% CI, 1.09-7.83; P = .02).
- Analysis revealed that death and second primary tumors inflated the apparent recurrence rate, particularly affecting older patients.
IN PRACTICE:
“From a scientific perspective, we still face challenges in the definition of cure in the adjuvant colon cancer setting. When answering patients’ questions about cure, we should use a restrictive definition of relapse-free survival, considering local and/or distant recurrence; this should be reported in adjuvant studies as a relevant secondary endpoint. In the setting of colon cancer, this leads us to advocate for 6 years after surgery free of relapse as constituting cure,” the authors of the study wrote.
SOURCE:
The study was led by Alessandro Pastorino, MD, IRCCS Ospedale Policlinico San Martino in Genova, Italy. It was published online on October 2 in JAMA Oncology.
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