Adjuvant Chemotherapy in Colorectal Cancer: Mournful, Hopeful Perpetual Motion Machine Heads to Dim Light at End of Tunnel

Abstract

To the Editor.— Buyse and colleagues 1 thoroughly reviewed the extensive literature on randomized, controlled trials of adjuvant chemotherapy for colorectal carcinoma. Coincidentally, this month the Southwest Oncology Group reported their fully mature adjuvant colorectal study, 2 seven years after the last patient accrual, and concluded that semustine and fluorouracil did not improve survival in treated patients compared with concurrent controls. It should be abundantly clear that adjuvant treatment for colorectal carcinoma with currently available drugs is a failure. It is not merely that we have yet to show a potential benefit; we have actually repeatedly and consistently failed to show a benefit sufficient to be meaningful to an individual patient. Indeed, few treatments in modern oncology have such a wealth of data documenting the futility of the approach. It is true that some trials have shown a tiny benefit for the adjuvant approach; however, even when a trial accrues