Adjuvant Fluorouracil, Leucovorin, and Oxaliplatin in Stage II to III Colon Cancer: Updated 10-Year Survival and Outcomes According to BRAF Mutation and Mismatch Repair Status of the MOSAIC Study

Abstract

The OS benefit of oxaliplatin-based adjuvant chemotherapy, increasing over time and with the disease severity, was confirmed at 10 years in patients with stage II to III colon cancer. These updated results support the use of FOLFOX in patients with stage III disease, including those with dMMR or BRAF mutation.

The current value of determining the mismatch repair status of colorectal cancer: A rationale for routine testing

“…Andre et al and colleagues in an analysis of the Multicenter International Study of Oxaliplatin/5-Fluorouracil/Leucovorin in the Adjuvant Treatment of Colon Cancer (MOSAIC) study evaluated MMR status in 986 of the 2240 enrolled patients. A DFS benefit from FOLFOX compared with 5-FU alone was observed in a small number of patients with dMMR CRC (Andre et al, 2015). Moreover, a recent study involving 433 dMMR stage-II and stage-III tumours found that adjuvant FOLFOX improved DFS compared to 5-FU alone, with the benefit limited to stage-III tumours and to sporadic cases only (Tougeron et al, 2016).…”

“…In prospectively col- (Andre et al, 2015;Gavin et al, 2013;Guastadisegni et al, 2010;Klingbiel et al, 2015;Popat et al, 2005;Roth et al, 2012;Sinicrope et al, 2015). lected tumor tissue MSI was detected in 314 of 2580 stage-III CRCs and was prognostic overall for time to relapse (TTR), but not for DFS or OS (Sinicrope et al, 2013a).…”

“…A paucity of long-term survival data for dMMR rectal cancers has meant that the prognosis for disease treated with conventional therapy has not been fully elucidated (Hong et al, 2012), this is despite evidence that colon and rectal cancers with dMMR differ biologically (Andre et al, 2015). Unlike MSI colon cancers, where there is a predominance of proximal cancers in elderly females, one Japanese group found that over a third of MSI CRC in men developed in the rectum (Ishikubo et al, 2004).…”

Investigating the poor outcomes ofBRAF-mutant advanced colorectal cancer: analysis from 2530 patients in randomised clinical trials

“…Results were consistent between both firstBline trials, independent of chemotherapy strategy and other standard prognostic factors. OxFU is a commonly used firstBline therapy in aCRC, and was the firstBline regimen used in the majority of patients analysed herein, and indeed oxaliplatin may provide particular benefits in Bmutant patients [3,21] .…”

S3-Leitlinie – Kolorektales Karzinom

“…Defektes MMR (dMMR) wurde bei 9,4 % der Studienpopulation nachgewiesen. Unter FOLFOX4 konnte kein signifikant verbesser-tes Überleben in der dMMR-Gruppe (Stadium II/III) nachgewiesen werden (HR 0,41; 95 % CI:0,16 -1,07) [886].…”