How much is enough: 3 versus 6 months of adjuvant therapy for colon cancer

摘要

The evolution of adjuvant therapy in stage III colon cancer Important principles There is no question that adjuvant chemotherapy is one of the great successes in oncology. The reality that treating someone with systemic therapy in conjunction with a surgical resection of the primary tumor increases the cure rate drives us all to identify and treat all appropriate patients to ensure that no single patient relapses and dies of their cancer if it could have been avoided. As the surgeon is 'pulling the weed' by the roots, we are 'treating the yard' to ensure that no subsequent metastasis (seeds) ever grow. Our successes in adjuvant therapy across all tumor types have contributed significantly to our growing number of cancer survivors around the world. However, we also must acknowledge our virtually indiscriminate use of adjuvant therapy as one of our great failures - we are terrible at patient selection. We expose large populations of patients to toxic agents, some of whom do not need treatment because there was no microscopic metastatic disease (the surgeon really did 'get it all') and some who do have microscopic metastatic disease but do not benefit from the therapy (we assume either resistant to the therapy or the metastases are beyond cure - the seeds have grown roots). Our reality is that in virtually every disease type, there is only a relatively small subset of patients who benefit from adjuvant therapy and are subsequently converted to 'cured' by adjuvant treatment. Everyone experiences toxicity, everyone experiences anxiety, only a few are positively affected. While we are working toward the development of biomarkers that will predict who should get therapy and who should not, we are still in an era of empiric decision-making.