COMMENTARY

Will Adjuvant Oxaliplatin Data Change Practice in Colon Cancer?

John L. Marshall, MD

Disclosures

May 26, 2017

Editorial Collaboration

Medscape &

Big day here at Georgetown University. It's graduation day. I've got my cap and gown on, ready to go over there and hand out a few diplomas and a few awards. We're excited here. A pretty summer day even though it's May. It's also 2 weeks to ASCO. The abstracts came out a couple of days ago and the question is, what's going to happen?

I think there are some big issues that are going to be addressed. My favorite one is the adjuvant study comparing 3 versus 6 months of chemotherapy in stage II and stage III colon cancer. So far, in the abstracts that we have seen, one says that there's no difference and one says that maybe 6 months is a little better. We are going to see a meta-analysis at the plenary session that's a late-breaking abstract.[1] We don't have that data yet.

If it's true that 3 months of chemotherapy is just as good as 6 months, it would be transformative in many ways. It would not only change our current management of patients with stage II and III colon cancer, but I think it will also have an effect in rectal cancer, the perioperative setting, metastasectomy, and the like. We'll get the full spin in a couple of weeks. If you've got patients currently on adjuvant therapy, at least give them a heads-up that these data may be hitting their local news channel and certainly their local newspapers. Watch out for that 3 months versus 6 months of chemotherapy in colon cancer.

We're going to see more evidence around right-sided versus left-sided colon cancer.[2,3,4] This is really interesting biomarker work to try to understand—what it is about those cancers and why right-sided colon cancers are worse than left-sided cancers and don't respond to EGFRs. The punchline there, as far as I can tell, is that nothing really has emerged as yet. We don't know beyond anatomical location why one is different from the other. For the moment, distinguish right-sided versus left-sided colon cancer. Put in the right ICD-10 code.

As with every other cancer, we're going to see more and more data around immune therapy—gastric cancer, hepatic cellular carcinoma, certainly in the colon cancers with microsatellite instability (MSI), and some new combination regimens in other settings. We're continuing to build the story around this. We're fully expecting, pretty soon, to have some approvals for a checkpoint inhibitor in MSI-high colon cancers and maybe some of the other diseases as well.

Molecular profiling is still really important. Understanding how to use this complex genetic information in our patient decision-making is really what it's all about. You've got to go to ASCO or at least watch Medscape to see what happens, to get the real spin after we digest all of this in the 50,000-people mosh pit that will be Chicago in a couple of weeks. I hope to see many of you there. I know it's always a busy week, but it's a fun week too, to get together as an industry, discuss what progress we've made in the world of cancer, and discuss the question "When are we going to cure all of these diseases?"

Hope to see you in Chicago. John Marshall for Medscape.

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