Point: Treating stage II colon cancer: the quest for personalized adjuvant care

The development of treatment decision strategies to guide the use of adjuvant chemotherapy in patients with stage II colon cancer continues to challenge many oncologists. Clearly, recurrence risk and prognosis for patients with stage II colon cancer can be variable, with subsets of patients with stage II disease at potentially higher risk than some with stage III. Adjuvant chemotherapy seems to produce a consistent relative risk reduction for recurrence across studies. Using clinical calculators to predict individual recurrence risk based on histopathologic and patient data allows this relative risk reduction to be translated into absolute benefit to the patient. In addition, gene expression assays in combination with these histopathologic data may further improve the accuracy of recurrence risk calculations and allow more accurate absolute benefit estimations. This absolute benefit should be discussed with the patient, taking into account the risk of morbidity from chemotherapy and individual preferences to arrive at a shared medical decision regarding adjuvant chemotherapy.