Adjuvant Chemotherapy for Stage II Colon Cancer: A Clinical Dilemma

Kannarkatt, Joseph; Joseph, Joe; Kurniali, Peter C.; Al-Janadi, Anas; Hrinczenko, Borys

doi:10.1200/jop.2016.017210

Cited by 147 publications

(133 citation statements)

References 48 publications

Supporting

Mentioning

131

Contrasting

Unclassified

Order By: Relevance

“…Combination regimens in which oxaliplatin is given in addition to fluoropyrimidine were not included in IMPACT, although these combination regimens are nowadays recommended in Dutch and international guidelines . Furthermore, the trials included in IMPACT were not optimally designed to determine the treatment effect in Stage II colon cancer as patients with rectal cancer or Stage III disease were included as well, leading to relatively few Stage II colon cancer patients …”

Section: Introductionmentioning

confidence: 99%

“…1,20 Furthermore, the trials included in IMPACT were not optimally designed to determine the treatment effect in Stage II colon cancer as patients with rectal cancer or Stage III disease were included as well, leading to relatively few Stage II colon cancer patients. 21 Therefore, the aim of our study was to estimate adjuvant treatment effects in Stage II colon cancer patients using pooled DFS data from RCTs. Given the dilemma regarding applicability of outcomes from RCTs to the real-world population, our secondary aim was to compare the RCT estimates to estimates based on a national oncology registry.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Estimating adjuvant treatment effects in Stage II colon cancer: Comparing the synthesis of randomized clinical trial data to real‐world data

Jongeneel

Klausch

Erning

et al. 2019

Intl Journal of Cancer

View full text Add to dashboard Cite

There is an ongoing discussion regarding the impact of adjuvant chemotherapy in Stage II colon cancer. We therefore estimated adjuvant treatment effect in Stage II colon cancer using pooled disease‐free survival (DFS) data from randomized clinical trials (RCT approach) and compared this to real‐world data (RWD approach) estimates. First, we estimated the treatment effect in RCTs by (i) searching relevant trials reporting DFS data, (ii) generating patient‐level data from reported DFS data and (iii) estimating treatment effect in the patient‐level data. Second, the treatment effect was estimated in an observational cohort of 1,947 patients provided by the Netherlands Cancer Registry using three propensity score methods; matching, weighting and stratification. In the RCT approach, patient‐level data of 4,489 patients (events: 853) were generated from seven trials which compared two of the following treatment arms: control, 5FU/LV or FOLFOX. A Cox model was used to estimate a hazard ratio (HR) of 0.77 (0.43;1.10) for 5FU/LV vs. control and 0.93 (0.72;1.15) for FOLFOX vs. 5FU/LV. In the RWD approach, HRs for any adjuvant treatment vs. control were 0.95 (0.50;1.80), 0.88 (0.24;3.21) and 1.05 (0.04;2.06) using matching, weighting and stratification, respectively. There was no significant difference with the estimates from the RCT approach (interaction test, p > 0.10). The RCT data suggest a clinically relevant benefit of adjuvant chemotherapy in terms of DFS, but the estimate did not reach statistical significance. Stratified analyses are required to evaluate whether treatment effect differs in specific subgroups.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Estimating adjuvant treatment effects in Stage II colon cancer: Comparing the synthesis of randomized clinical trial data to real‐world data

Jongeneel

Klausch

Erning

et al. 2019

Intl Journal of Cancer

View full text Add to dashboard Cite

show abstract

“…Previous reports described a "high-risk stage II CRC" subgroup which present several known risk factors of recurrence, including the pathological T4 status, suboptimal lymph node retrieval, bowel obstruction or perforation, and lymphatic and venous invasion [3][4][5]. However, the prognostic impact of these risk factors and benefits of adjuvant chemotherapy in these subgroups remain controversial [6]. While oxaliplatin and fluoropyrimidine-based chemotherapies are the standard adjuvant treatments for stage III CRC [7][8][9], these chemotherapy regimens often have little effect and can be severely toxic to some patients.…”

Section: Introductionmentioning

confidence: 99%

MicroRNA-9-5p-CDX2 Axis: A Useful Prognostic Biomarker for Patients with Stage II/III Colorectal Cancer

Nishiuchi

Hisamori

Sakaguchi

et al. 2019

Cancers

View full text Add to dashboard Cite

A lack of caudal-type homeobox transcription factor 2 (CDX2) protein expression has been proposed as a prognostic biomarker for colorectal cancer (CRC). However, the relationship between CDX2 levels and the survival of patients with stage II/III CRC along with the relationship between microRNAs (miRs) and CDX2 expression are unclear. Tissue samples were collected from patients with stage II/III CRC surgically treated at Kyoto University Hospital. CDX2 expression was semi-quantitatively evaluated by immunohistochemistry (IHC). The prognostic impacts of CDX2 expression on overall survival (OS) and relapse-free survival (RFS) were evaluated by multivariable statistical analysis. The expression of miRs regulating CDX2 expression and their prognostic impacts were analyzed using The Cancer Genome Atlas Program for CRC (TCGA-CRC). Eleven of 174 CRC tissues lacked CDX2 expression. The five-year OS and RFS rates of patients with CDX2-negative CRC were significantly lower than those of CDX2-positive patients. Multivariate analysis of clinicopathological features revealed that CDX2-negative status is an independent marker of poor prognosis in stage II/III CRC. miR-9-5p was shown to regulate CDX2 expression. TCGA-CRC analysis showed that high miR-9-5p expression was significantly associated with poor patient prognosis in stage II/III CRC. In conclusion, CDX2, the post-transcriptional target of microRNA-9-5p, is a useful prognostic biomarker in patients with stage II/III CRC.

show abstract

“…[ [59][60][61][62][63][64][65][66][67] RAS Prognosis/Therapy choice Testing for RAS in patient blood may predict whether a patient will be resistant to EGFR-ab therapies. [68][69][70] PIK3CA mutations Prognosis/Therapy choice Mutations in PIK3CA may be predictive for the effectiveness of adjuvant aspirin therapies.…”

Section: Cimp Prognosismentioning

confidence: 99%

Personalized Medicine—Current and Emerging Predictive and Prognostic Biomarkers in Colorectal Cancer

Koulis

Yap

Engel

et al. 2020

Cancers

View full text Add to dashboard Cite

Colorectal cancer (CRC) is the third most common cancer diagnosed worldwide and is heterogeneous both morphologically and molecularly. In an era of personalized medicine, the greatest challenge is to predict individual response to therapy and distinguish patients likely to be cured with surgical resection of tumors and systemic therapy from those resistant or non-responsive to treatment. Patients would avoid futile treatments, including clinical trial regimes and ultimately this would prevent under- and over-treatment and reduce unnecessary adverse side effects. In this review, the potential of specific biomarkers will be explored to address two key questions—1) Can the prognosis of patients that will fare well or poorly be determined beyond currently recognized prognostic indicators? and 2) Can an individual patient’s response to therapy be predicted and those who will most likely benefit from treatment/s be identified? Identifying and validating key prognostic and predictive biomarkers and an understanding of the underlying mechanisms of drug resistance and toxicity in CRC are important steps in order to personalize treatment. This review addresses recent data on biological prognostic and predictive biomarkers in CRC. In addition, patient cohorts most likely to benefit from currently available systemic treatments and/or targeted therapies are discussed in this review.

show abstract

Adjuvant Chemotherapy for Stage II Colon Cancer: A Clinical Dilemma

Cited by 147 publications

References 48 publications

Estimating adjuvant treatment effects in Stage II colon cancer: Comparing the synthesis of randomized clinical trial data to real‐world data

Estimating adjuvant treatment effects in Stage II colon cancer: Comparing the synthesis of randomized clinical trial data to real‐world data

MicroRNA-9-5p-CDX2 Axis: A Useful Prognostic Biomarker for Patients with Stage II/III Colorectal Cancer

Personalized Medicine—Current and Emerging Predictive and Prognostic Biomarkers in Colorectal Cancer

Contact Info

Product

Resources

About