68-year-old female with High Risk Stage II Colon Cancer - Right Sided - p MMR intact pT3pN0s/p Right colectomy earlier this year with only LVI as high risk feature
Surgical Pathology
COLON, RIGHT (RIGHT COLECTOMY):
Her only High risk feature for stage II is LVI positive- ct DNA not done. She is Moderately differentiated, there was no obstruction, no perforation, positive LVI was noted, no perineural invasion identified, all margins were clear, 0/20 lymph nodes identified. She has done 6 cycle of FOLFOX (3months). Does she need to complete additional 6 cycles with 5 FU alone or can she stop treatment now post 3 months.
I probably would have observed if ctDNA negative or given 3 months of capecitabine, she probably has had more than enough if she’s already had 3 cycles of FOLFOX, would still do ctDNA (could consider another 3 months if positive). There is no survival benefit from oxaliplatin in stage II, we sometimes consider in high risk (e.g. T4 disease) but wouldn’t just for +LVI. IDEA showed no benefit of 6 months over 3 months for stage III except for maybe T4 and/or N2.
CRC Specialist 2:
There is obviously no right answer here. I do not even always give adjuvant therapy for LVI alone. If I do, I give 3 months of an oxaliplatin doublet, just as you suggested. I do not think there’s a role in completing six months of therapy for this patient.
Note: this community oncologist requested input from two separate Primum experts
