[Adjuvant therapy of colon carcinoma]

In patients with stage III carcinoma of the colon, adjuvant chemotherapy is indicated after R0 resection. No age limitations exist. Combination chemotherapy with FOLFOX4 or (if oxaliplatin is contraindicated) monotherapy with a fluoropyrimidine, preferably capecitabine, can be regarded as the standard treatment. Because of its unfavorable toxicity profile, the 5-FU/folic acid bolus scheme (the Mayo scheme) should no longer be used, and combinations including irinotecan also do not play a part in colon carcinoma. The combination XELOX (oxaliplatin + capecitabine) is currently being studied in phase III trials. Data on the efficacy of the targeted drugs bevacizumab and cetuximab cannot be expected until at least 2010/2011. It is important that adjuvant treatment be started in a timely manner, within 8 weeks of surgery. As far as stage II disease is concerned, adjuvant chemotherapy analogous to that for stage III should be considered in high-risk patients (T4, emergency surgery, tumor perforation/tear, < 12 lymph nodes examined). The evidence for this recommendation is, however, based mainly on unplanned subgroup analyses of randomized trials. That low-risk stage II patients can also profit from adjuvant treatment was shown in the QUASAR trial(significant survival benefit of 3.6%), so this group of patients can be offered chemotherapy containing 5-FU. For treatments involving oxaliplatin in low-risk patients there is currently insufficient evidence.