Shortening adjuvant chemotherapy in stage III colon cancer: are we ready for a change?

Oxaliplatin-based adjuvant chemotherapy for 6 months is considered the standard of care after a curative resection in patients with stage III colon cancer. The addition of oxaliplatin provides a benefit on overall survival confirmed in three randomised phase 3 trials1–3 with an long-term absolute increase ranging from 2.7% to 6%. Since oxaliplatin was incorporated into the adjuvant setting more than a decade ago, the standard in adjuvant therapy has remained unchanged because of the lack of novel agents with relevant activity in this scenario. Unfortunately, this combination can have also acute and long-term side effects that can interfere with daily life activities in potentially cured patients. According to the MOSAIC trial, the incidence of grade 3 acute peripheral sensory neurotoxicity among oxaliplatin-treated patients was 12%, and a similar proportion developed chronic peripheral neurotoxicity that unpredictably could last for years.1 In addition, the risk and severity of oxaliplatin-induced sensory neurotoxicity is associated with the cumulative dose administered. This toxicity may sometimes increase several months after the last dose of the drug. It is always changing for a physician to predict the exact risk of a patient to develop oxaliplatin-induce neurotoxicity while they are on active therapy. Besides, there are no established methods for preventing chemotherapy-induced neuropathy other than limiting exposure. Therefore, the rationale …