Should Oxaliplatin Be Added to 5FU-Based Regimens in Adjuvant Chemotherapy for Locally Advanced Rectal Cancer?
The question represents an issue of active debate. In fact, on one hand, three options are pursued by oncologists following appropriate locoregional management of locally advanced rectal cancer: no additional adjuvant chemotherapy, fluoropyrimidines alone, and oxaliplatin-based adjuvant chemotherapy. On the other hand, the last version of US National Comprehensive Cancer Network guidelines recommends the use of FOLFOX or XELOX as adjuvant treatment for stage II/III rectal cancer, irrespective of the locoregional treatment delivered . The appropriate definitive answer to the question regarding the role of adjuvant oxaliplatin can be given by a trial that, after optimal locoregional management including completion of preoperative chemoradiotherapy and subsequent TME, randomizes patients with pathological stage II/III rectal cancer, therefore pathologically staged, to receive adjuvant FOLFOX/XELOX versus fluorouracil/capecitabine alone. Actually, this trial exists. It is the Korean phase II randomized ADORE trial, recently published . However, in order to adequately answer such an important question, at least one appropriately powered phase III trial is needed, not just a phase II as the Korean study. Because other phase III trials with similar (not identical) designs exist, we will consider the results of these trials as well.
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