J.Jpn. Surg. Soc.. 123(3): 234-239, 2022

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Feature topic

NEOADJUVANT CHEMOTHERAPY FOR COLON CANCER

The Japanese standard treatment for resectable advanced colon cancer is surgical resection with or without postoperative adjuvant chemotherapy. Neoadjuvant chemotherapy is not standard for locally advanced colon cancer. On the other hand, National Comprehensive Cancer Network guidelines state that neoadjuvant FOLFOX or CAPOX should be considered in patients with advanced colon cancer with bulky nodal disease or clinical T4b disease. There is still little evidence on the use of neoadjuvant chemotherapy in resectable colon cancer, and indications and availability have not been established. The first phase III trial (FOxTROT trial) did not confirm a statistically significant benefit but suggested that neoadjuvant chemotherapy for resectable locally advanced colon cancer may be promising. Based on the results, the JCOG2006 randomized phase II study comparing preoperative adjuvant chemotherapy with mFOLFOX6 versus FOLFOXIRI for resectable locally advanced colon cancer has started for “high-risk colon cancer” but has not yet obtained sufficient treatment results for comparison with the standard Japanese treatment. It is necessary to collect evidence regarding the indications for and treatment regimen of neoadjuvant chemotherapy for resectable colon cancer in addition to knowledge of neoadjuvant chemotherapy for obstructive colorectal cancer and neoadjuvant immunotherapy.

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