Abstract
Adjuvant chemotherapy use in stage II colon cancer is controversial. Current prognostic risk factors do not take the tumor immune microenvironment into account. Consideration of the Immunoscore, which measures the host immune response at the tumor site, may assist clinicians in reducing adjuvant chemotherapy use in patients who are unlikely to benefit from it. This study sought to determine the potential clinical utility of the Immunoscore, via its effect on medical oncologists' recommendations for management of patients with stage II colon cancer. De-identified vignettes of 10 patients with stage II colon cancer were presented to 25 practicing medical oncologists. Each participant completed surveys indicating recommendations for adjuvant chemotherapy and surveillance strategies. An educational session was subsequently conducted, and the same patient profiles were re-presented but included immunoscore results. Participants were again asked to provide their recommendations. A participant was counted as influenced if their responses were altered after immunoscore test results were provided. All but one participant (96%) altered a management recommendation for ≥1 case. For individual cases, a mean of 55% (range, 40-80%) of participants altered their recommendations for adjuvant chemotherapy and/or surveillance. For the immunoscore-high cases (low-risk of recurrence), recommendations for adjuvant chemotherapy use decreased from 60% to 31%. These results indicate a willingness by oncologists to integrate immunoscore information into clinical practice recommendations. Incorporation of immunoscore data resulted in the reduction of nonvalue care in the simulated population. Confirmation in prospective studies is planned.
Highlights
Each year in the United States, more than 100,000 patients are diagnosed with colon cancer [1], with approximately 25% having stage II disease
Participants were accrued over a period of 3 months
Twenty-five medical oncologists participated in the survey: 17 (68%) from academic medical centers, 4 (16%) in community private practice, and 4 (16%) from community hospital health centers
Summary
Each year in the United States, more than 100,000 patients are diagnosed with colon cancer [1], with approximately 25% having stage II disease. While adjuvant chemotherapy (AC) with a fluoropyrimidine and oxaliplatin confers a clear survival advantage in most patients with stage III colon cancer [2], the use of AC in patients with stage II disease remains controversial [5,6,7]. In a retrospective study of unselected SEER-Medicare patients with stage II disease, AC with fluoropyrimidines with or without oxaliplatin was not shown to provide a survival advantage [16]. Adjuvant chemotherapy use in stage II colon cancer is controversial. This study sought to determine the potential clinical utility of the Immunoscore, via its effect on medical oncologists’ recommendations for management of patients with stage II colon cancer. A mean of 55% (range, 40–80%) of participants altered their recommendations for adjuvant chemotherapy and/or surveillance.
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