Optimal Treatment of Stage III Colon Cancer: What is the Big IDEA? Benjamin A. Weinberg, M.D. Assistant Professor of Medicine Lombardi Comprehensive Cancer Center Georgetown University
The Old Standard: • All eligible patients should receive 6 months of FOLFOX or CAPOX for stage III disease André et al. J Clin Oncol 2015.
MOSAIC Trial: N1 vs. N2 Disease André et al. J Clin Oncol 2015.
Stage III Colorectal Cancer 50% 25% 25% 50% cured by surgery alone 25% cured by 25% not cured surgery + by surgery or chemo chemo
Stage III Colorectal Cancer 5% cured by addition of oxaliplatin 50% 25% 25% 50% cured by surgery alone 25% cured by 25% not cured surgery + by surgery or chemo chemo
Does Everyone Really Need 6 Months? Grothey et al. N Engl J Med 2018.
IDEA Collaboration Grothey et al. N Engl J Med 2018.
IDEA Collaboration Grothey et al. N Engl J Med 2018.
IDEA Collaboration Grothey et al. N Engl J Med 2018.
IDEA Collaboration Grothey et al. N Engl J Med 2018.
Sobrero et al. ESMO GI 2019.
Can We Be Smarter? • Treatment selection based on 19 th century technology (sorry pathologists…) • What about 20 th -21 st century technologies? – Immunoscore: CD3+ and CD8+ T cells in the center and periphery of the tumor – Circulating tumor DNA
Pagès et al. ASCO AM 2019.
Pagès et al. ASCO AM 2019.
Pagès et al. ASCO AM 2019.
Pagès et al. ASCO AM 2019.
ctDNA Detection Post-Op and After Completion of Adjuvant Chemo Predicts for Recurrence in Stage III Colon Cancer Presented By Jeanne Tie at 2019 Gastrointestinal Cancer Symposium
Slide 23 Presented By Jeanne Tie at 2019 Gastrointestinal Cancer Symposium
Conclusions – Stage III Colon Cancer • 3 months of adjuvant FOLFOX/CAPOX is technically not non-inferior to 6 months • But, 3 months can be preferred in T1-3N1 (low risk) stage III colon cancers with significant reduction in peripheral neuropathy • Immunoscore and ctDNA may inform treatment selection in the future (trials underway)
Questions? • baw12@gunet.georgetown.edu • @benweinbergmd
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