What are the treatment options for colon cancer?

From the Guidelines

Treatment for colon cancer should be individualized based on the stage of the disease, with surgery being the primary treatment for most colon cancers, and chemotherapy regimens such as FOLFOX, FOLFIRI, or CAPOX being used for advanced cases, as recommended by the most recent guidelines 1.

Local Colon Cancer Treatment

For local colon cancer, surgery alone may be sufficient, involving removal of the tumor and nearby lymph nodes through procedures like colectomy or laparoscopic surgery.

• The goal of surgery is to remove the tumor and any affected lymph nodes, with the aim of achieving a complete resection.
• Adjuvant chemotherapy may be recommended for patients with high-risk features, such as poorly differentiated adenocarcinoma, vascular invasion, or high CEA levels, as shown in a study published in the Annals of Oncology 1.

Advanced Colon Cancer Treatment

For advanced colon cancer, chemotherapy is the primary treatment, with regimens such as FOLFOX, FOLFIRI, or CAPOX being commonly used.

• The combination of 5-fluorouracil (5-FU)/leucovorin (LV) plus oxaliplatin has been shown to significantly improve disease-free survival in stage II and III colon cancer, and overall survival in stage III colon cancer, as demonstrated in a study published in the Journal of Clinical Oncology 1.
• Targeted therapies like bevacizumab, cetuximab, or panitumumab may be added to chemotherapy regimens for patients with specific genetic mutations.
• Immunotherapy drugs such as pembrolizumab or nivolumab are options for patients with certain genetic characteristics.

Metastatic Colon Cancer Treatment

For metastatic colon cancer, treatment options are focused on palliation and improving quality of life.

• Chemotherapy regimens such as FOLFOX, FOLFIRI, or CAPOX may be used to control symptoms and slow disease progression.
• Targeted therapies and immunotherapy may also be used in selected patients.
• The duration of oxaliplatin-containing adjuvant therapy for stage III colon cancer should be tailored to the individual patient's risk of recurrence, with shorter durations being considered for patients at low risk of recurrence, as recommended by the ASCO clinical practice guideline 1.

From the FDA Drug Label

1. 1 Metastatic Colorectal Cancer Avzivi, in combination with intravenous fluorouracil-based chemotherapy, is indicated for the first-or second-line treatment of patients with metastatic colorectal cancer (mCRC) The recommended dosage when Avzivi is administered in combination with intravenous fluorouracil-based chemotherapy is: • 5 mg/kg intravenously every 2 weeks in combination with bolus-IFL. • 10 mg/kg intravenously every 2 weeks in combination with FOLFOX4. • 5 mg/kg intravenously every 2 weeks or 7. 5 mg/kg intravenously every 3 weeks in combination with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy in patients who have progressed on a first-line bevacizumab product-containing regimen. In a randomized clinical study conducted by the Mayo Clinic and the North Central Cancer Treatment Group (Mayo/NCCTG) in patients with advanced metastatic colorectal cancer three treatment regimens were compared: Leucovorin (LV) 200 mg/m2 and 5-fluorouracil (5-FU) 370 mg/m2 versus LV 20 mg/m2 and 5-FU 425 mg/m2 versus 5-FU 500 mg/m2 Response rates were 26% (p=0.04 versus 5-FU alone), 43% (p=0.001 versus 5-FU alone) and 10% for the high dose leucovorin, low dose leucovorin and 5-FU alone groups respectively.

The treatment options for colon cancer are:

• Local colon cancer: The provided drug labels do not directly address the treatment options for local colon cancer.
• Advanced colon cancer: Treatment options include leucovorin (LV) in combination with 5-fluorouracil (5-FU), with response rates of 26% and 43% for high and low dose leucovorin regimens, respectively 2.
• Metastatic colon cancer: Treatment options include bevacizumab (Avzivi) in combination with intravenous fluorouracil-based chemotherapy, with recommended dosages of 5 mg/kg every 2 weeks or 10 mg/kg every 2 weeks 3.

From the Research

Treatment Options for Colon Cancer

The treatment options for colon cancer vary depending on the stage and location of the cancer. The following are some of the treatment options available:

• Local colon cancer:
  • Surgery is the primary treatment for local colon cancer 4
  • Adjuvant chemotherapy with 5-fluorouracil/leucovorin, capecitabine, and oxaliplatin-related regimens may be used for high-risk stage II or III colon cancer 4
• Advanced colon cancer:
  • Chemotherapy with capecitabine, oxaliplatin, and irinotecan, plus bevacizumab may be used as first-line treatment 5
  • Capecitabine plus oxaliplatin (XELOX) versus 5-fluorouracil/folinic acid plus oxaliplatin (FOLFOX-4) may be used as second-line therapy 6
• Metastatic colon cancer (mCRC):
  • FOLFOXIRI regimens (5-fluorouracil/leucovorin, oxaliplatin, irinotecan) with/without bevacizumab may be used as first-line treatment 5
  • Bevacizumab in association with de Gramont 5-fluorouracil/folinic acid may be used in patients with oxaliplatin-, irinotecan-, and cetuximab-refractory colorectal cancer 7

Chemotherapy Regimens

The following chemotherapy regimens may be used for colon cancer:

• 5-fluorouracil/leucovorin (5-FU/LV) 4, 8
• Capecitabine 6, 4, 8
• Oxaliplatin-related regimens (FLOX/OX) 4
• FOLFOX-4 (5-fluorouracil/folinic acid plus oxaliplatin) 6
• XELOX (capecitabine plus oxaliplatin) 6
• FOLFOXIRI (5-fluorouracil/leucovorin, oxaliplatin, irinotecan) with/without bevacizumab 5

Targeted Therapies

The following targeted therapies may be used for colon cancer:

• Bevacizumab 5, 7
• Cetuximab 7