Subgroups and prognostication in stage III colon cancer: future perspectives for adjuvant therapy.
Fiche publication
Date publication
mai 2017
Journal
Annals of oncology : official journal of the European Society for Medical Oncology
Auteurs
Membres identifiés du Cancéropôle Est :
Dr VERNEREY Dewi
Tous les auteurs :
Auclin E, Zaanan A, Vernerey D, Douard R, Gallois C, Laurent-Puig P, Bonnetain F, Taieb J
Lien Pubmed
Résumé
Since the MOSAIC study, oxaliplatin-based adjuvant chemotherapy has been the standard treatment of stage III colon cancer. Combination therapy with fluoropyrimidines and oxaliplatin has improved overall survival (OS) and reduced the risk of recurrence in patients with resected stage III colon cancer. However, only 20% of patients really benefit from adjuvant chemotherapy, exposing 80% of patients to unnecessary toxicity. Recent analyses of large multicenter adjuvant studies have focused on the prognostication of OS and disease-free survival in stage III colon cancer in order to reduce over-treatment and to find more accurate prognostic tools than those used for adjuvant treatment decision-making in stage II disease. Indeed, clinical and pathological prognostic factors, although important, are not sufficient to decide which stage III patients will benefit from adjuvant therapy, and biomarkers will help select patient that need adjuvant treatment. Molecular markers such as microsatellite status and BRAF and KRAS mutations have recently been explored, and molecular signatures have been identified as promising prognostic factor for OS. Furthermore, recent studies have highlighted the prognostic value of immune infiltration. This review focuses on pathologic, immunologic and molecular prognostic markers for stage III colon cancer that could help clinicians tailor adjuvant treatment in a comprehensive transversal approach.
Mots clés
Chemotherapy, Adjuvant, Colonic Neoplasms, diagnosis, CpG Islands, DNA Mismatch Repair, Disease-Free Survival, Gene Expression Regulation, Neoplastic, Humans, Molecular Diagnostic Techniques, Mutation, Neoplasm Staging, Prognosis
Référence
Ann. Oncol.. 2017 05 1;28(5):958-968