Adjuvant treatment for stage III colon cancer

Transcription

1 ESMO Preceptorship Programme Rectal cancer Singapur November 2017 Adjuvant treatment for stage III colon cancer Andrés Cervantes

2 Disclosures Consulting and advisory services, speaking or writing engagements, public presenations: Servier, Merck Serono, Amgen, Roche, Lilly, Bayer, Novartiis, Takeda, Beigene Direct research support to the responsible project lead: Servier, Roche, Genentech, Bayer, Janssen, Merck Serono, Medimmune

3 CURRENT APPROACH TO LOCALISED COLON CANCER Clinical Staging Surgical resection Pathology assessment and estimation of risk Treatment based upon TNM stage Postoperative chemotherapy for 6 months: standard of care in stage III Postoperative chemotherapy of value for some stage II colon cancers

4

5

6

7

8 Adding Oxaliplatin to 5-FU based adjuvant therapy in localised colon cancer Trial N Control Exp. Stage DFS HR P value MOSAIC FULV2 FOLFOX4 II/III NSABP FULV C07 2 Roswell XELOXA FULV Mayo FLOX II/III CAPEOX III OS HR P value Absolute Gain in OS 4,2% at 6 y stage III 2,7 at 5 y Stage III G3 Neuro Tox 12% 8,2% 6 % at 7 y 11% 1 André T, et al. J Clin Oncol 2007; 27: Kuebler JP, et al. J Clin Oncol 2007; 25: Schmoll HJ et al. J Clin Oncol 2015; 33:

9 Current approach to localised colon cancer MUST DO Postoperative chemotherapy standard of care in stage III Oxaliplatin based treatment for 6 months FOLFOX4, CAPOX, FLOX In patients without comorbidities and younger than 70 yo. Pay attention to sensory peripheral neurotoxicity during treatment

10 Adding Oxaliplatin to 5-FU based adjuvant therapy for stage III colon cancer according to nodal status. 10 year follow-up of the MOSAIC trial. anyt N1 anyt N2 André T, et al. J Clin Oncol 2015; 33:

11 Current approach to localised colon cancer MUST DO Postoperative chemotherapy standard of care in stage III Oxaliplatin based treatment for 6 months FOLFOX4, CAPOX, FLOX In patients without comorbidities and younger than 70 yo. Pay attention to sensory peripheral neurotoxicity during treatment

12 Current approach to localised colon cancer MUST NEVER DO Postoperative chemotherapy stage II or III Irinotecan-BASED Adding Bevacizumab or other antiangiogenics Adding Cetuximab or other anti-egfr antibodies

13 Current questions on adjuvant therapy colon cancer Duration of treatment: 3 versus 6 months? How should elderly patients be treated? How and till when should be follow up our patients? Any role for neoadjuvant chemotherapy? Any role for Precision Medicine?

14 Study Schema Presented By Qian Shi at 2017 ASCO Annual Meeting

15 IDEA Trials Summary Presented By Qian Shi at 2017 ASCO Annual Meeting

16 Non-inferiority Hypothesis Testing Presented By Qian Shi at 2017 ASCO Annual Meeting

17 Primary DFS Analysis (mitt) Presented By Qian Shi at 2017 ASCO Annual Meeting

18 Primary DFS Analysis (mitt), cont. Presented By Qian Shi at 2017 ASCO Annual Meeting

19 DFS Comparison by Risk Groups, cont. Presented By Qian Shi at 2017 ASCO Annual Meeting

20 Summary Presented By Qian Shi at 2017 ASCO Annual Meeting

21 Current questions on adjuvant therapy colon cancer Duration of treatment: 3 versus 6 months? How should elderly patients be treated? How and till when should be follow up our patients? Any role for neoadjuvant chemotherapy? Any role for Precision Medicine?

22 OS according to age in the NSABP C07 trial Yothers G et al. J Clin Oncol 2011; 29:

23 How to consider age when prescribing adjuvant CT in localised colon cancer? McCleary NJ et al. J Clin Oncol 2013; 31:

24

25 Current questions to adjuvant therapy colon cancer Duration of treatment: 3 versus 6 months? How should elderly patients be treated? How and till when should be follow up our patients? Any role for neoadjuvant chemotherapy? Any role for Precision Medicine?

26 Adapting follow-up to timimg and risk of relapse in localised colon cancer Shah M et al. J Clin Oncol 2016; 34:

27 Current questions on adjuvant therapy colon cancer Duration of treatment: 3 versus 6 months? How should elderly patients be treated? How and till when should be follow up our patients? Any role for neoadjuvant chemotherapy? Any role for Precision Medicine?

28 Neoadjuvant therapy for colon cancer FOxTROT Colaborative Group. Lancet Oncol 2012; 13:

29 Current questions on adjuvant therapy colon cancer Duration of treatment: 3 versus 6 months? How should elderly patients be treated? How and till when should be follow up our patients? Any role for neoadjuvant chemotherapy? Any role for Precision Medicine?

30 Schematic representation of colo-rectal cancer subtypes Dienstmann R, et al. Nat Rev Cancer 2017; ahead of print

31 Colorectal Carcinogenesis and Transcriptomic Subtypes Dienstmann R, et al. Nat Rev Cancer 2017; ahead of print

32 Thank you