Guideline question |
Is adjuvant therapy recommended for patients with stage II colon cancer? |
Target population |
Patients with stage II colon cancer. |
Target audience |
The target audience includes medical oncologists, surgical oncologists, and other clinicians treating patients with stage II colon cancer. |
Methods |
An Expert Panel was convened to develop clinical practice guideline recommendations on the basis of a systematic review of the medical literature. |
Recommendations |
Recommendation 1.1. Adjuvant chemotherapy (ACT) should not routinely be offered to patients with stage II colon cancer (type: evidence-based; harms outweigh benefits; evidence quality: moderate; strength of recommendation: strong). NOTE: Refer to Recommendations 1.3 and 1.4 for scenarios where ACT may be appropriate for specific subgroups of patients with stage II colon cancer. |
Recommendation 1.2. ACT should not routinely be offered to patients who are at low risk for recurrence, including patients with stage IIA (T3) tumors with at least 12 sampled lymph nodes of the surgical specimen, tumors without perineural or lymphovascular invasion, poor or undifferentiated tumor grade, clinical intestinal obstruction, tumor perforation, and less than grade BD3 tumor budding (type: evidence-based; harms may outweigh benefits; evidence quality: low; strength of recommendation: weak). Qualifying statement: There is no compelling evidence to suggest that age of patient should alter this recommendation. Specifically, there is no evidence that younger low-risk stage II patients should be offered ACT on the basis of their age alone. |
Recommendation 1.3. ACT should be offered to patients with stage IIB and stage IIC colon cancer (ie, T4, lesions either penetrating visceral peritoneum or invasive of surrounding organ, respectively), with a discussion of the potential benefits and risks of harm associated with ACT (type: evidence-based; benefits may outweigh harms; evidence quality: moderate; strength of recommendation: weak). |
Recommendation 1.4. ACT may be offered to patients with stage IIA (ie, T3) colon cancer with high-risk features, including sampling of fewer than 12 lymph nodes in the surgical specimen, perineural or lymphovascular invasion, poorly or undifferentiated tumor grade, intestinal obstruction, tumor perforation, and/or grade BD3 tumor budding (≥10 buds) (type: evidence-based; benefits may outweigh harms; evidence quality: low; strength of recommendation: weak). Qualifying statements:
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Recommendation 2.1. Adjuvant fluoropyrimidine-only chemotherapy is not routinely recommended for patients with exhibit mismatch repair deficiency (dMMR) or high microsatellite instability (MSI) tumors (type: evidence-based; harms outweigh benefits; evidence quality: moderate; strength of recommendation: strong). Qualifying statements:
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Recommendation 3.1. There is insufficient evidence to routinely recommend the addition of oxaliplatin to fluoropyrimidine-based chemotherapy for patients with high-risk stage II colon cancer (type: evidence-based; benefits may outweigh harms; evidence quality: low; strength of recommendation: weak). Qualifying statements:
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Recommendation 4.1. In patients who are candidates for adjuvant doublet chemotherapy, adjuvant oxaliplatin-containing chemotherapy may be offered for a duration of 3 or 6 months, after a discussion with the patient of the potential benefits and risks of harm associated with the options for treatment duration (type: evidence-based; benefits outweigh harms; evidence quality: moderate; strength of recommendation: weak). NOTE:
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ASCO believes that cancer clinical trials are vital to inform medical decisions and improve cancer care and that all patients should have the opportunity to participate. |