Skip to main content
SpringerLink
Log in

Traitement adjuvant : mise au point stades II, stades III, sujets âgés, biothérapies

Adjuvant treatment: an overview for stage II, stage III, elderly patients and biotherapies

  • Mise au Point / Update
  • Published:
Oncologie

Résumé

La problématique du traitement adjuvant est particulièrement complexe : traitement potentiellement toxique administré pour réduire un risque théorique de reprise évolutive, quelle est la durée optimale du traitement ?, quelle chimiothérapie ?, jusqu’à quel âge ?, etc., etc. Les traitements adjuvants permettent d’améliorer significativement la survie des patients opérés d’un cancer colique de stade III, l’association fluoropyrimidine et oxaliplatine pendant six mois est le standard. La chimiothérapie adjuvante après exérèse d’un cancer colique de stade II n’est pas consensuelle, elle doit néanmoins être discutée au cas par cas, en particulier pour les cancers de stade II à « haut risque » avec statut microsatellite stable. Une évaluation consciencieuse du bénéfice-risque d’un traitement adjuvant doit être réalisée pour chaque patient prenant en compte son âge et ses comorbidités. Il n’y a pas de place à l’heure actuelle pour les biothérapies dans le traitement adjuvant des cancers coliques.

Abstract

Adjuvant treatment is a particularly complex problem: a potentially toxic treatment administered to reduce the theoretical risk of relapse; what is the optimum treatment duration, which chemotherapy to choose and until what age, etc. Adjuvant treatments are enabling significant improvements in the survival of patients undergoing surgery for stage III colon cancer to be made, with the combination of fluoropyrimidine and oxaliplatin for six months being the standard therapy. Adjuvant chemotherapy after stage II colon cancer resection is not supported, however it should be discussed on a case per case basis, especially for “high risk” stage II cancers with a stable microsatellite status. A thorough assessment of the benefits and risks of adjuvant treatment should be carried out for each patient, taking into account their age and comorbidities. Currently, biotherapies do not have a role in the adjuvant treatment of colon cancers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Références

  1. Thésaurus de cancérologie digestive © SNFGE. http://www.tncd.org/

  2. American Joint Committee on Cancer (2004) AJCC Cancer Staging Manual. 7th edition, 2010. ISBN: 978-0-387-88440-0 and O’Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst 96: 1408–9

  3. Moertel CG, Fleming TR, Macdonald JS, et al. (1990) Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med 322: 399–401

    Article  Google Scholar 

  4. Twelves C, Wong A, Nowacki MP, et al. (2005) Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 352: 2696–704

    Article  CAS  PubMed  Google Scholar 

  5. Lembersky BC, Wieand HS, Petrelli NJ, et al. (2006) Oral uracil and tegafur plus leucovorin compared with intravenous fluorouracil and leucovorin in stage II and III carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project Protocol C-06. J Clin Oncol 24: 2059–64

    Article  CAS  PubMed  Google Scholar 

  6. André T, Colin P, Louvet C, et al. (2003) Bimonthly regimen of 5-fluorouracil and leucovorin (LV5-FU2) as adjuvant therapy in stage II and III colon cancer: 4-year results of a randomized trial. J Clin Oncol 21: 2896–903

    Article  PubMed  Google Scholar 

  7. André T, Boni C, Mounedji-Boudiaf L, et al. (2004) Oxaliplatin, 5-fluorouracil and leucovorin as adjuvant treatment of colon cancer: results of the international randomized MOSAIC trial. N Engl J Med 350: 2343–51

    Article  PubMed  Google Scholar 

  8. André T, Boni C, Navarro M, et al. (2009) Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC Trial. J Clin Oncol 27: 3109–16

    Article  PubMed  Google Scholar 

  9. de Gramont A, Tournigand C, André T, et al. (2007) Adjuvant therapy for stage II and III colorectal cancer. Semin Oncol 34: S37–S40

    Article  PubMed  Google Scholar 

  10. Haller D, Tabernero J, Maroun J, et al. (2009) 5LBA First efficacy findings from a randomized phase III trial of capecitabine + oxaliplatin vs bolus 5-FU/LV for stage III colon cancer (NO16968/XELOXA study) Eur J Cancer Supplement 7(3): 4

    Article  Google Scholar 

  11. Allegra CJ, Yothers G, O’Connell MJ, et al. (2011) Phase III trial assessing bevacizumab in stages II and III carcinoma of the colon: results of NSABP protocol C-08. J Clin Oncol 29: 11–6

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. de Gramont A, Van Cutsem E, Schmoll HJ, et al. (2012) Bevacizumab plus oxaliplatin-based chemotherapy as adjuvant treatment for colon cancer (AVANT): a phase 3 randomized controlled trial. Lancet Oncol 13: 1225–33

    Article  PubMed  Google Scholar 

  13. Alberts SR, Sargent DJ, Nair S, et al. (2012) Effect of oxaliplatin, fluorouracil, and leucovorin with or without cetuximab on survival among patients with resected stage III colon cancer: a randomized trial. JAMA 307: 1383–93

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Taieb J, Tabernero J, Mini E, et al. (2014) Oxaliplatin, fluorouracil, and leucovorin with or without cetuximab in patients with resected stage III colon cancer (PETACC-8): an open-label, randomized phase 3 trial. Lancet Oncol 15: 862–73

    Article  CAS  PubMed  Google Scholar 

  15. Quasar Collaborative Group, Gray R, Barnwell J, et al. (2007) Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomized study. Lancet 370: 2020–9

    Article  PubMed  Google Scholar 

  16. Sargent DJ, Goldberg RM, Jacobson SD, et al. (2001) A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med 345: 1091–97

    Article  CAS  PubMed  Google Scholar 

  17. Goldberg RM, Tabah-Fisch I, Bleiberg H, et al. (2006) Pooled analysis of safety and efficacy of oxaliplatin plus fluorouracil/leucovorin administered bimonthly in elderly patients with colorectal cancer. N Engl J Med 24: 4085–91

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. hépatogastroentérologie et oncologie digestive, Hôpital européen Georges-Pompidou, 20, rue Leblanc, F-75015, Paris, France

    J. Taieb

Authors
  1. J. Taieb
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Taieb.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taieb, J. Traitement adjuvant : mise au point stades II, stades III, sujets âgés, biothérapies. Oncologie 16, 504–508 (2014). https://doi.org/10.1007/s10269-014-2461-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10269-014-2461-4

Mots clés

Keywords

Search

Navigation