Managing Adjuvant Treatment in Colorectal Cancer, Part II

Panelists: Johanna Bendell, MD, Sarah Cannon; Axel Grothey, MD, Mayo Clinic; Claus-Henning Köhne, MD, PhD, Klinikum Oldenburg; John L. Marshall, MD, Georgetown-Lombardi;
Heinz-Josef Lenz, MD, USC Norris
Published Online: Friday, April 5, 2013
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Researchers continue to explore the optimal duration of adjuvant chemotherapy for patients with colorectal cancer (CRC). As more data become available the standard duration has slowly declined from 18 months to the current standard of 12 cycles over the course of 6 months and a 3-month course is currently being examined.

Claus-Henning Kohne, MD, PhD, believes the most exciting research currently in stage III CRC is the examination of ever-shorter durations of treatment. Moreover, Kohne notes, it remains unclear whether FOLFOX is the optimal treatment in this space.

Axel Grothey, MD, states that approximately two-thirds of adjuvant FOLFOX efficacy is derived from fluoropyrimidine and one-third from oxaliplatin. As side effects occur, it may become necessarily to omit oxaliplatin from the regimen. In general, Grothey finds, it is a rare event for patients to complete 12 full cycles of adjuvant FOLFOX and as a result it may be best to back off treatment.

In stage II disease, Kohne and other members of the panel are reluctant to offer oxaliplatin. In general, many of the benefits of FOLFOX are derived by fluoropyrimidine alone. Omitting oxaliplatin remains especially beneficial for elderly patients, Kohne notes. However, some patients with high risk factors may still be candidates for this treatment, causing even further uncertainty. In general, the dilemma of determining which patients benefit the most from adjuvant therapy calls for effective predictive markers.

Johanna Bendell, MD, notes that studies are currently looking at high microsatellite instability (MSI) or DNA Mismatch Repair (MMR) deficiency as an indicator of resistance to fluorouracil therapy, which denotes less benefit from adjuvant therapy. Additionally, she adds, patients with Lynch Syndrome should also receive genetic testing.

In terms of gene profiling, the panel does not feel confident in the predictive accuracy of commercially available tests. In general, they feel these test are not adequately explaining recurrence and need to be further refined. The effectiveness of these tests is further confounded by non-concordant results between tests.

View >>> Managing Adjuvant Treatment in Colorectal Cancer, Part I
View More From This Discussion
Episode 1 Managing Adjuvant Treatment in Colorectal Cancer, Part I
Episode 2 Managing Adjuvant Treatment in Colorectal Cancer, Part II
Episode 3 Understanding the Role of Aspirin in Colorectal Cancer
Episode 4 Exploring the Neoadjuvant Treatment of Rectal Cancer
Episode 5 Treating Resectable Metastatic Colorectal Cancer
Episode 6 Treating Unresectable Metastatic Colorectal Cancer
Episode 7 Treatment Sequencing in Metastatic Colorectal Cancer
Episode 8 Determining Optimal Treatments in mCRC
Episode 9 Second-Line Therapies for Patients With mCRC
Episode 10 Case Study: Treating Metastatic Colorectal Cancer
Episode 11 Conclusion: Optimal Side Effect Management in CRC
Expert Panelists
Dr. John L. Marshall

John L. Marshall, MD

Professor, Chief, Division of Hematology/Oncology,
Georgetown University Hospital,
Associate Director, Clinical Research,
Lombardi Comprehensive Cancer Center,

Johanna Bendell, MD

Director, GI Oncology Research
Associate Director, Drug Development Unit
Sarah Cannon Research Institute
Nashville, TN

Axel Grothey, MD

Professor of Oncology and Consultant
Division of Medical Oncology
Department of Oncology, Mayo Clinic
Rochester, MN

Claus-Henning Köhne, MD, PhD

Professor of Medicine,
Department of Oncology/Hematology
Klinikum Oldenburg
Oldenburg, Germany

Heinz-Josef Lenz, MD

Co-Director, Colorectal Center and GI Oncology Program, USC Norris Comprehensive Cancer Center, Los Angeles, CA
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