Dr. Shields on Optimal Adjuvant Therapy for CRC

Anthony Shields, MD, PhD, oncologist, Department of Oncology, Molecular Imaging and Diagnostics Program, Karmanos Cancer Institute, discusses the challenge of identifying the optimal adjuvant therapy for the treatment of patients with colorectal cancer (CRC).

The big question that needs to be addressed in the field is whether patients need the standard 6-month regimen of either FOLFOX (5-fluorouracil plus leucovorin and oxaliplatin) or CAPOX (capecitabine and oxaliplatin). When physicians began giving adjuvant therapy with 5-FU chemotherapy alone, it was administered for 1 year until subsequent studies suggested that 6 months was adequate, Shields says. Other research suggested that infusional 5-FU could be given adequately for just 3 months.

Shields adds that there are data which propose that giving a more intensive 2-drug regimen—such as oxaliplatin and fluoropyrimidine—for 3 months may be sufficient. However, it is especially difficult to test this hypothesis; in order to prove the noninferiority of a shorter dosing schedule, thousands of patients must be enrolled in a clinical trial.

One international study organized in part by the late Daniel Sargent, PhD, of the Mayo Clinic, set out to determine what the optimal duration of adjuvant therapy is in patients with colon cancer. The study involved 6 different trials in 12 countries and around 13,000 patients and took 10 years to collect the data and follow-up, says Shields.