John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Neoadjuvant chemotherapy for colon cancer: A new concept? Volume 19, issue 7, Septembre 2012

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Authors
Groupe Hospitalier Pitié Salpêtrière, Université Pierre et Marie Curie (Paris VI), service de chirurgie digestive et hépato-bilio-pancréatique et transplantation hépatique, 42-83 Bd de l’Hôpital, 75013 Paris, Hôpital Européen Georges Pompidou, Université Descartes (Paris V), service d’hépato-gastroentérologie et d’oncologie digestive, 20 rue Leblanc, 75015 Paris

In patients with locally advanced colon cancer (high risk stage II and stage III), curative surgery followed by adjuvant FOLFOX4 chemotherapy has become the standard of care. However, for 30 to 40 % of these patients, the current curative treatment strategy of surgical excision followed by adjuvant chemotherapy fails either to clear locoregional spread or to eradicate distant micrometastasis, leading to disease recurrence. Several randomized trials have demonstrated the benefit of combining pre- and postoperative chemotherapy and/or radiotherapy in various gastrointestinal tumors (oesophageal, gastric, rectal and colorectal liver metastases). It is noteworthy that for these gastrointestinal tumors, a correlation between histological response to preoperative treatment and clinical outcome has also been demonstrated. In colon cancer, recent advances in radiology, which allows a good prediction of tumor penetration for advanced stages, and of nodal involvement and the histological response observed in primary tumors treated by systemic chemotherapy, strengthen the potential benefit of such neoadjuvant strategy in locally advanced disease. For patients with locally advanced non metastatic colon cancer, administration of optimal systemic therapy at the earliest possible opportunity may be more effective at eradicating distant metastases than the same treatment given after the delay and immunological stress of surgery. Added to this, shrinking the primary tumor before surgery may reduce the risk of incomplete surgical excision, and the risk of tumor cell shedding during surgery. Two phase II trials (the English FOxTROT trial and the French Prodige 22-ECKINOXE trial) designed to assess the safety and the efficacy of neoadjuvant chemotherapy strategy in patients with locally advanced colon carcinoma are currently ongoing.