Adjuvant Therapy for Stage II Colon Cancer: ASCO Guideline Update

Author(s): Nancy N. Baxter, MD, PhD1; Erin B. Kennedy, MHSc2; Emily Bergsland, MD3; Jordan Berlin, MD4; Thomas J. George, MD5; Sharlene Gill, MD, MPH, MBA6; Philip J. Gold, MD7; Alex Hantel, MD8; Lee Jones, MBA9; Christopher Lieu, MD10; Najjia Mahmoud, MD11; Arden M. Morris, MD, MPH12; Erika Ruiz-Garcia, MD, MS13; Y. Nancy You, MD, MHSc14; and Jeffrey A. Meyerhardt, MD, MPH15
Source: DOI: 10.1200/JCO.21.02538 Journal of Clinical Oncology Published online December 22, 2021. PMID: 34936379
Lucio Gordan MD

Dr. Lucio Gordan's Thoughts

Role adjuvant chemotherapy in this setting will change significantly with incorporation of MRD evaluation post-surgery with prospective validation.


ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice.


Twenty-one observational studies and six randomized controlled trials met the systematic review inclusion criteria.


Adjuvant chemotherapy (ACT) is not routinely recommended for patients with stage II colon cancer who are not in a high-risk subgroup. Patients with T4 tumors are at higher risk of recurrence and should be offered ACT, whereas patients with other high-risk factors, including sampling of fewer than 12 lymph nodes in the surgical specimen, perineural or lymphatic invasion, poorly or undifferentiated tumor grade, intestinal obstruction, tumor perforation, or grade BD3 tumor budding, may be offered ACT. The addition of oxaliplatin to fluoropyrimidine-based ACT is not routinely recommended, but may be offered as a result of shared decision making. Patients with mismatch repair deficiency/microsatellite instability tumors should not be routinely offered ACT; if the combination of mismatch repair deficiency/microsatellite instability and high-risk factors results in a decision to offer ACT, oxaliplatin-containing chemotherapy is recommended. Duration of oxaliplatin-containing chemotherapy is also addressed, with recommendations for 3 or 6 months of treatment with capecitabine and oxaliplatin or fluorouracil, leucovorin, and oxaliplatin, with decision making informed by key evidence of 5-year disease-free survival in each treatment subgroup and the rate of adverse events, including peripheral neuropathy

Author Affiliations

1University of Melbourne, Melbourne, Australia; 2American Society of Clinical Oncology, Alexandria, VA; 3UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; 4Vanderbilt University Medical Center, Nashville, TN; 5University of Florida, Gainesville, FL; 6BC Cancer, Vancouver, Canada; 7Swedish Cancer Institute, Seattle, WA; 8Edward Elmhurst Healthcare, Naperville, IL; 9Arlington, VA; 10University of Colorado Cancer Center, Aurora, CO; 11Penn Medicine, Philadelphia, PA; 12Stanford University Medical Center, Palo Alto, CA; 13Instituto Nacional de Cancerologia, Mexico City, Mexico; 14University of Texas M.D. Anderson Cancer Center, Houston, TX; 15Dana-Farber Cancer Institute, Boston, MA

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