In Deciphering the Future of Adjuvant Treatment in Colon Cancer, the Journey Matters More than the Achievements

Abstract

The development of adjuvant treatment in colon cancer has followed the same paradigm as in other solid tumors, transposing the drug regimens found to perform the best in the advanced setting into the adjuvant setting. However, despite numerous studies, no progress has been recorded for patients with stage II and III colon cancer since the publication of the MOSAIC trial more than 10 years ago. We performed a comprehensive review of randomized phase III trials both already published and currently recruiting, and revisited the scientific rationale of adjuvant treatment in colon cancer and the philosophical roots of its development in order to challenge the current paradigms and to consider future perspectives. This analysis provides ground for new approaches based on the identification of patients unlikely to benefit from standard therapies with the aim to spare them needless toxicities and to identify a subgroup of patients who would be candidates for advanced research with new therapies.