Adjuvante Therapie des Kolonkarzinoms

Adjuvant Therapy in Colon Cancer The goal of improving adjuvant
treatment can be reached in two ways: firstly, by developing more
effective drugs and protocols and, secondly, by selecting suitable
patients on the basis of clinical and molecular factors. In UICC
(Union internationale contre le cancer) stage II, microsatellite
instability (MSI) is a strong prognostic factor. Whether it can
also be used as a predictive marker is currently a matter of
controversy because the available data are contradictory. The
question whether or not the MSI status should be checked before
treatment decisions are made in stage II patients can therefore not
be clearly answered at present. For adjuvant treatment in stage
III, with capecitabine/oxaliplatin (XELOX) there is now a new
protocol available that is based on the orally administered prodrug
capecitabine. With regard to the question of how much older
patients in this stage may also benefit from a combination
chemotherapy, new - and contradictory - data have emerged recently:
firstly, preliminary results of two new studies have given rise to
safety concerns and, secondly, an analysis by the `ACCENT
Collaborative Group' indicated lower efficacy of the `newer'
adjuvant protocols in older people. These findings, however, have
now been called into question as a result of a new subgroup
analysis from the XELOXA study. The expert group therefore
recommended that the decision whether to treat patients older than
70 years with an ( oral) fluoropyrimidine alone or in combination
with oxaliplatin should be based on clinical parameters such as
biological age and comorbidities.