From the Guidelines
Yes, stage 3 colon cancer is treatable, and many patients can be cured with appropriate treatment. The standard approach typically involves surgery to remove the tumor and affected lymph nodes, followed by adjuvant chemotherapy. Common chemotherapy regimens include FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) or CAPOX (capecitabine and oxaliplatin), usually administered for about 3-6 months, as supported by the most recent guidelines from 2020 1.
Key considerations in treatment include:
- The addition of oxaliplatin to fluoropyrimidine has been shown to significantly improve disease-free survival (DFS) in stage III colon cancer, as demonstrated in landmark trials such as MOSAIC, NSABP C-07, and XELOXA 1.
- The duration of adjuvant chemotherapy can vary based on the patient's risk of recurrence, with 6 months recommended for high-risk patients (T4 and/or N2) and either 6 months or a shorter duration of 3 months considered for low-risk patients (T1, T2, or T3 and N1), according to the 2019 ASCO clinical practice guideline 1.
- Surgery aims to remove the primary tumor with clear margins and regional lymph nodes.
- The five-year survival rate for stage 3 colon cancer ranges from approximately 50-70%, depending on specific substages (3A, 3B, or 3C) and individual factors.
- Treatment effectiveness depends on several factors including the patient's overall health, age, specific tumor characteristics, and how well they tolerate therapy.
- Regular follow-up care is essential after treatment completion, typically including regular blood tests, imaging studies, and colonoscopies to monitor for recurrence.
From the FDA Drug Label
Oxaliplatin Injection, in combination with infusional fluorouracil and leucovorin, is indicated for: adjuvant treatment of stage III colon cancer in patients who have undergone complete resection of the primary tumor.
Yes, stage 3 (Stage III) colon cancer is treatable with oxaliplatin in combination with infusional fluorouracil and leucovorin for adjuvant treatment in patients who have undergone complete resection of the primary tumor 2.
From the Research
Treatment Options for Stage III Colon Cancer
- Adjuvant chemotherapy with the combination of oxaliplatin to a fluoropyrimidine (FOLFOX or CAPOX) is a standard of care for patients with stage III colon cancer 3.
- The duration of treatment can be reduced from 6 months to 3 months, depending on the regimen, for patients at low risk of recurrence, without loss of effectiveness and allowing a significant reduction in the risk of cumulative sensitive neuropathy 3.
- Fluoropyrimidine and oxaliplatin-based adjuvant chemotherapy delivered as 5-fluorouracil, leucovorin and oxaliplatin (FOLFOX), or capecitabine and oxaliplatin (CAPOX) is the standard of care for resected stage III colon cancer 4.
Efficacy of Treatment Options
- Patients who received CAPOX had similar OS rates when compared to those receiving FOLFOX in the adjuvant setting in spite of lower relative dose intensity (RDI) 4.
- In the high-risk population, CAPOX appears to demonstrate a superior 5-year disease-free survival (DFS) over FOLFOX 4.
- The use of cetuximab with adjuvant mFOLFOX6 compared with mFOLFOX6 alone did not result in improved disease-free survival among patients with stage III resected colon cancer 5.
- Patients with completely resected stage III colon cancer should be offered adjuvant chemotherapy, and treatment should depend on factors such as patient suitability and preference 6.
Prognostic Factors
- Primary tumor location (PTL) is an important factor for the long-term survival of colon cancer, and left-sided colon cancer (LCC) has better overall survival (OS) than right-sided colon cancer (RCC) 7.
- Histological subtype is also a prognostic factor, and mucinous adenocarcinoma (MAC) has worse OS than nonspecific adenocarcinoma (AC) in stage III colon cancer patients 7.
- Chemotherapy is a favorable prognostic factor for OS, and all subgroups of patients (RCC/MAC, RCC/AC, LCC/MAC, and LCC/AC) showed benefits from chemotherapy 7.