Adjuvant therapy for colorectal cancer

Abstract

Adjuvant therapy has afforded improved outcomes following resection of locoregional colorectal cancer. In stage III colon cancer, the addition of oxaliplatin to fluoropyrimidines represents the standard in the adjuvant setting. The role of adjuvant therapy in stage II colon cancer remains controversial, though adjuvant therapy (oxaliplatin-based combination therapy or fluoropyrimidine monotherapy) could be considered and justified in stage II disease with high-risk features for recurrence. The development of various gene expression signatures may provide additional information in determining candidates for adjuvant therapy in stage II colon cancer, particularly those at low risk of recurrence. In locally advanced rectal cancer, neoadjuvant chemoradiation followed by total mesorectal excision and adjuvant fluoropyrimidine and oxaliplatin-based therapy represents a currently favored treatment approach. There are growing data to support the use of perioperative or adjuvant therapy in resectable colorectal liver and pulmonary metastases. In this chapter, we highlight the historical development and recent advances in the adjuvant therapy of locally advanced colorectal cancer and resectable colorectal metastases.