Adjuvant therapy in colon cancer

Colon cancer is the second leading cause of cancer death worldwide. Approximately three quarters of patients are diagnosed with disease limited to the bowel wall or surrounding lymph nodes. Over the past decade, significant progress has been made in the treatment of localized colon cancer. The use of adjuvant chemotherapy has improved prognosis in stage III disease, but much work remains to be done in optimizing adjuvant treatment. The FOLFOX4 regimen is now considered standard treatment for stage III disease. Combinations of irinotecan and 5-fluorouracil (5-FU) have not proven to be more effective than 5-FU/folinic acid. In stage II, the value of post-operative treatment remains controversial, but the identification of histopathological and molecular prognostic factors would allow selection of patients who can benefit from adjuvant treatment. The inclusion of molecular targeted agents in combination regimens with cytotoxins, which have already proven effective in advanced disease, is the main field of development in the most recent protocols of adjuvant therapy.