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The Role of Neoadjuvant Chemotherapy in Locally Advanced Colon Cancer

Authors Body A, Prenen H, Latham S, Lam M, Tipping-Smith S, Raghunath A, Segelov E

Received 19 November 2020

Accepted for publication 14 February 2021

Published 17 March 2021 Volume 2021:13 Pages 2567—2579


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Eileen O'Reilly

Amy Body,1,2 Hans Prenen,1,3 Sarah Latham,1 Marissa Lam,1 Samuel Tipping-Smith,1 Ajay Raghunath,1 Eva Segelov1,2

1Medical Oncology, Monash Medical Centre, Clayton, Melbourne, VIC, Australia; 2School of Clinical Sciences, Monash University, Clayton, Melbourne, VIC, Australia; 3Oncology Department, University Hospital Antwerp, Antwerp, Belgium

Correspondence: Amy Body
Monash Health Translational Precinct, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, VIC 3168, Australia
Email [email protected]

Abstract: Neoadjuvant systemic therapy has many potential advantages over up-front surgery, including tumor downstaging, early treatment of micrometastatic disease, and providing an in vivo test of tumor biology. Due to these advantages, neoadjuvant therapy is becoming the standard of care for an increasing number of tumor types. Currently, colon cancer patients are still routinely treated with up-front surgery, and neoadjuvant systemic therapy is not yet standard. Limitations to widespread use of neoadjuvant therapy have included inaccurate radiological staging, concerns about tumor progression while undergoing preoperative treatment rendering a patient incurable, and a lack of randomized data demonstrating benefit. However, there is great interest in neoadjuvant chemotherapy, and a number of trials are under way. Early follow up of the first phase III trial of neoadjuvant chemotherapy for colon cancer demonstrated tumor downstaging and suggested an improvement in disease-free survival with neoadjuvant chemotherapy, and it is hoped that this will translate into longer-term overall survival benefit. Clinicians should closely watch this developing field, consider the option of neoadjuvant chemotherapy for colon cancer patients, and actively seek out opportunities for their patients to participate in ongoing clinical trials to further inform this field in future.

Keywords: colorectal cancer, preoperative chemotherapy, perioperative chemotherapy, staging

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