Colon cancer – neoadjuvant treatment of non-metastatic disease

Czech version

Authors: J. Tomášek ¹; L. Fiala ²
Authors‘ workplace: Klinika komplexní, onkologické péče, LF MU a MOÚ, Brno ¹; Klinika operační onkologie, LF MU a MOÚ, Brno ²
Published in: Rozhl. Chir., 2025, roč. 104, č. 3, s. 97-100.
Category: Review
doi: https://doi.org/10.48095/ccrvch202597

Overview

Neoadjuvant treatment for colon cancer, unlike rectal cancer, is rarely used. Its position in the treatment algorithm is not precisely defined. This treatment should be considered for locally significantly advanced tumors (cT4) with extensive nodal involvement. The neoadjuvant treatment plan should be determined in a multidisciplinary team setting. We describe the main clinical trials focused on neoadjuvant chemotherapy in colon cancer. A special subgroup is dMMR/MSI-high tumors, patients with such cancers are candidates for immunotherapy treatment. Immunotherapy can induce complete remission, but can also be accompanied by long-term or permanent toxicity of the treatment. Neoadjuvant immunotherapy of non-metastatic colon cancer is the subject of a number of clinical trials. Currently, no immunotherapy is registered in the EU for the neoadjuvant treatment of early colon cancer.

Keywords:

neoadjuvant therapy – early stage – colon cancer

Sources

1. Pazdírek F, Vjaclovský M, Grega M et al. Effect of neoadjuvant therapy on early postoperative complications in rectal cancer. Rozhl Chir 2023; 102(10): 402–406. doi: 10.33699/PIS.2023.102.10.402-406.

2. Argilés G, Tabernero J, Labianca R et al. Localised colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2020; 31(10): 1291–1305. doi: 10.1016/j.annonc.2020.06.022.

3. Zavoral M, Urban O, Suchánek Š et al. Pozdní kolorektální karcinom (klinická stadia III. a IV.) – diagnostika a léčba. 2022 [online]. Dostupné z: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://kdp.uzis.cz/res/guideline/7-pozdni-kolorektalni-karcinom-klinicka-stadia-iii-iv-final.pdf.

4. Linkos. Modrá kniha České onkologické společnosti. 2024 [online]. Dostupné z: https://www.linkos.cz/lekar-a-multidisciplinarni-tym/personalizovana-onkologie/modra-kniha-cos/aktualni-vydani-modre-knihy/.

5. NCCN. Colon cancer, version 4.2024. 2024 [online]. Dostupné z: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1428.

6. Linkos. Česká onkologická společnost České lékařské společnosti J. E. Purkyně. 2024 [online]. Dostupné z: www.linkos.cz.

7. Deha A, Graff-Baker AN, Vuong B et al. Neoadjuvant chemotherapy improves survival in patients with clinical T4b colon cancer. J Gastrointest Surg 2018; 22(2): 242–249. doi: 10.1007/s11605-017-3566-z.

8. Karoui M, Rullier A, Piessen G et al. Perioperative FOLFOX 4 versus FOLFOX 4 plus cetuximab versus immediate surgery for high-risk stage II and III colon cancers: a phase II multicenter randomized controlled trial (PRODIGE 22). Ann Surg 2020; 271(4): 637–645. doi: 10.1097/SLA.0000000000003454.

9. Morton D, Seymour M, Magill L et al. Preoperative chemotherapy for operable colon cancer: mature results of an International Randomized Controlled Trial. J Clin Oncol 2023; 41(8): 1541–1552. doi: 10.1200/JCO.22.00046.

10. Hu H, Zhang J, Li Y et al. Neoadjuvant chemotherapy with oxaliplatin and fluoropyrimidine versus upfront surgery for locally advanced colon cancer: the randomized, phase III OPTICAL trial. J Clin Oncol 2024; 42(25): 2978–2988. doi: 10.1200/JCO.23.01889.

11. Jensen LH, Kjaer ML, Larsen FO et al. Phase III randomized clinical trial comparing the efficacy of neoadjuvant chemotherapy and standard treatment in patients with locally advanced colon cancer: the NeoCol trial. J Clin Oncol 2023; 41(Suppl 17): LBA3503. doi: 10.1200/JCO.2023.41.17_suppl.LBA3503.

12. Karoui M, Gallois C, Piessen G et al. Does neoadjuvant FOLFOX chemotherapy improve the prognosis of high-risk stage II and III colon cancers? Three years‘ follow-up results of the PRODIGE 22 phase II randomized multicentre trial. Colorectal Dis 2021; 23(6): 1357–1369. doi: 10.1111/codi.15585.

13. Ryan R, Gibbons D, Hyland JM et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology 2005; 47(2): 141–146.

14. Verschoor YL, van den Berg JG , Beets GL et al. Neoadjuvant nivolumab, ipilimumab, and celecoxib in MMR-proficient and MMR-deficient colon cancers: final clinical analysis of the NICHE study. J Clin Oncol 2022; 40(Suppl 16): 3511. doi: 10.1200/JCO.2022.40.16_suppl.3511.

15. Chalabi M, van den Dungen L, Verschoor Y et al. Neoadjuvant immunotherapy in locally advanced MMR-deficient colon cancer 3-year disease-free survival from NICHE-2. Ann Oncol 2024; 35(Suppl 2): S1217–S1218. doi: 10.1016/j.annonc.2024.08.2263.

16. Chalabi M, Verschoor YL, Tan PB et al. Neoadjuvant immunotherapy in locally advanced mismatch repair-deficient colon cancer. N Engl J Med 2024; 390(21): 1949–1958. doi: 10.1056/NEJMoa2400634.

17. de Gooyer PG, Verschoor YL, van den Dungen LDW et al. Neoadjuvant nivolumab (nivo) plus relatlimab (rela) in MMR-deficient colon cancer: results of the NICHE-3 study. Ann Oncol 2024; 35(Suppl 2): S428–S429. doi: 10.1016/j.annonc.2024.08.572.

18. Shiu KK, Jiang Y, Saunders M et al. NEOPRISM-CRC: Neoadjuvant pembrolizumab stratified to tumour mutation burden for high risk stage 2 or stage 3 deficient-MMR/MSI-high colorectal cancer. J Clin Oncol 2024; 42(Suppl 17): LBA3504. doi: 10.1200/jco.2024.42.17_suppl.lba3504.

MUDr. Jiří Tomášek, Ph.D.

Klinika komplexní onkologické péče

LF MU a MOÚ

Žlutý kopec 7

656 53 Brno

jiri.tomasek@mou.cz