Neoadjuvant Chemotherapy for Colon Cancer

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Simple SummaryNeoadjuvant chemotherapy is commonly used in several solid tumor malignancies, but remains understudied in the setting of locally advanced colon cancer. Advantages of this strategy extrapolated from other disease sites include early treatment of micro-metastatic disease, the ability to decrease local disease burden potentially leading to more effective resections and improved treatment tolerability. Approaches for accurate staging and safe administration of systemic treatment are being investigated in large, randomized clinical trials, but available data are either not mature enough or have not demonstrated a convincing argument for adoption into standard practice warranting further investigation. Early stage colon cancer is typically managed with surgical resection, although not all patients experience a durable remission. Adjuvant chemotherapy with a fluoropyrimidine, with or without oxaliplatin, is commonly utilized to increase the chance of cure, but its efficacy in the neoadjuvant setting is not well established. Preoperative chemotherapy has demonstrated safety and efficacy in other gastrointestinal malignancies, but there is a paucity of data from large, prospective randomized trials, although multiple are ongoing. In this review, we will discuss the theoretical risks and benefits, logistical difficulties, and available safety and efficacy data pertaining to the use of chemotherapy in locally advanced colon cancer.