Managing Adjuvant Treatment in Colorectal Cancer, Part I

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Moderator, John L. Marshall, MD, introduces the panel for a unique discussion on advances and challenges in the management of colorectal cancer (CRC). Overall, the discussion will describe new therapies, treatment paradigms, and molecular targets with expert perspectives from Johanna Bendell, MD, Axel Grothey, MD, Claus-Henning Kohne, MD, PhD, and Heinz-Josef Lenz, MD.

Kohne begins the conversation by describing adjuvant treatment in stage II and III CRC, which, he believes, represents a major advance in treatment. For patients with stage III CRC, the number of lymph nodes involved helps gauge risk and the aggressiveness of treatment. However, he adds, most patients with stage III node positive CRC will receive adjuvant treatment with FOLFOX, regardless of the number of nodes involved. Elderly patients may require more precaution before treatment with FOLFOX or the administration of a different agent, such as capecitabine or oral fluoropyrimidines.

All patients with positive lymph nodes and stage III CRC should receive adjuvant therapy, Bendell believes. In general, the prime treatment should be FOLFOX or capecitabine and oxaliplatin. In the stage II setting, Bendell notes that patients with node negative CRC with large T3 or T4 tumors may have the same risk of recurrence as patients with stage III T2N1 tumor. In this situation, debate exists regarding the aggressiveness of adjuvant treatment.

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