Optimal Stage 3 Colon Cancer Treatment: Surgery, Chemotherapy, and Oral Options

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• Surgery and Accurate Staging
• Adjuvant Chemotherapy Goal
• Standard Chemotherapy Regimen
• 5-FU Administration Methods
• Oral Capecitabine Advantages
• Clinical Trial Evidence
• Full Transcript

Surgery and Accurate Staging

Stage 3 colon cancer treatment begins with optimum surgery. Dr. Hans-Joachim Schmoll, MD, emphasizes that the surgical method must be adapted to the local tumor stage. The operation should be as minimal as possible while still being completely effective. A critical component of this surgery is the removal of more than twelve lymph nodes. Dr. Hans-Joachim Schmoll, MD, notes this is often not achieved in many hospitals globally.

This extensive lymph node removal is vital for accurate staging. Examining enough lymph nodes confirms whether cancer has spread. Stage 2 colon cancer means no lymph node involvement. Stage 3 colorectal cancer is defined by known lymph node involvement. Establishing the cancer stage with certainty is highly relevant for determining prognosis and guiding subsequent treatment decisions.

Adjuvant Chemotherapy Goal

Once stage 3 colon cancer is confirmed, patients receive prophylactic, or adjuvant, chemotherapy. Dr. Hans-Joachim Schmoll, MD, clarifies that this treatment is not targeted therapy. It is classical chemotherapy designed to eliminate any remaining microscopic cancer cells after surgery. The primary goal of this adjuvant therapy is to increase the overall survival of patients.

This approach aims to cure the cancer and prevent recurrence. The treatment is administered after the patient has recovered from surgery. It is a systemic therapy, meaning it travels throughout the body to kill cancer cells that may have escaped the primary tumor site.

Standard Chemotherapy Regimen

The current standard for stage 3 colon cancer is a "doublet" chemotherapy combination. Dr. Hans-Joachim Schmoll, MD, specifies the use of 5-Fluorouracil (5-FU) and oxaliplatin. Clinical trials tested adding a third medication, like the targeted therapy bevacizumab (Avastin), but it did not provide additional benefit. Therefore, the two-drug regimen remains the cornerstone of treatment.

Patients typically receive this combination for 4 to 6 months. The addition of oxaliplatin to 5-FU is crucial. Dr. Hans-Joachim Schmoll, MD, states it cures an additional 5% of stage 3 colorectal cancer patients. This means 5 more out of 100 patients will be cured because of oxaliplatin. Overall, this combination increases the cure rate by 10% to 15% compared to surgery alone.

5-FU Administration Methods

Administering 5-Fluorouracil effectively is a key consideration. Dr. Hans-Joachim Schmoll, MD, outlines two primary methods. One option is a bolus injection, which is a rapid infusion. The other, more common method is a continuous infusion over 24 or 48 hours, repeated every two weeks.

The continuous infusion method often requires a special IV infusion port and an external pump. Dr. Schmoll describes this as very uncomfortable for the patient. It also makes controlling chemotherapy side effects more challenging if they arise. This logistical difficulty and patient discomfort motivated the search for a better administration route over a decade ago.

Oral Capecitabine Advantages

The solution to infusion challenges is an oral chemotherapy drug called capecitabine (Xeloda). Dr. Hans-Joachim Schmoll, MD, explains that capecitabine is a pro-drug, meaning the body converts it into the active 5-FU compound. This oral administration eliminates the need for IV ports, pumps, and frequent clinic visits for infusions.

Dr. Hans-Joachim Schmoll, MD, highlights that capecitabine is an easy treatment for patients. It offers replicable results and works well even in elderly patients over the age of 70. The convenience and comparable efficacy make it a highly attractive option for both patients and oncologists, improving quality of life during treatment.

Clinical Trial Evidence

Robust clinical evidence supports the use of capecitabine. Dr. Hans-Joachim Schmoll, MD, references a large international clinical trial involving 1,900 patients with stage 3 colon cancer. The trial compared the oral combination of capecitabine and oxaliplatin to intravenous 5-FU-based regimens.

The results were definitive. The oral chemotherapy combination had similar efficacy to intravenous administration. In fact, capecitabine was significantly better than single-agent 5-FU chemotherapy and caused fewer side effects. With over ten years of follow-up data, Dr. Schmoll considers these results very reliable. He concludes that oral capecitabine should be the standard of care for stage 3 colorectal cancer.

Full Transcript

Dr. Anton Titov, MD: Capecitabine (Xeloda) is a new oral chemotherapy for colorectal cancer treatment. How should Xeloda be used correctly? How is Xeloda combined with other chemotherapy medications in colon cancer treatment?

Stage three colon cancer is defined by known involvement of lymph nodes in colorectal cancer, but there are no identified colon cancer metastases in stage 3 colon cancer. What are the best current treatment methods for stage 3 colon cancer? What are the nuances or controversies in stage 3 colon cancer treatment?

Dr. Hans-Joachim Schmoll, MD: First of all, stage 3 colon cancer treatment must start with optimum surgery. The method and extent of surgery must be adapted to the local stage of the tumor. The surgical operation should be as minimal as possible.

In particular, the surgeon must remove more than twelve lymph nodes during primary tumor resection. This is often not done in many operations and in many hospitals around the world. We need to confirm the stage of colon cancer by examining enough lymph nodes.

Stage 2 colon cancer means no lymph node involvement. Stage 3 colorectal cancer means lymph node involvement. Establishing the stage of cancer with certainty is highly relevant for prognosis.

Sometimes we confirm lymph node involvement; it is stage 3 colon cancer. Then we give the patient prophylactic chemotherapy. Prophylactic chemotherapy for stage 3 colon cancer is not targeted treatment for now. It is classical "doublet" chemotherapy.

We use 5-Fluorouracil and oxaliplatin. We did clinical trials to test the addition of a third chemotherapy medication. This targeted chemotherapy is Bevacizumab, which targets blood vessels of the tumor, but Bevacizumab did not work well.

Two medications are used: 5-Fluorouracil and oxaliplatin. Stage 3 colon cancer patients receive a combination of 5-Fluorouracil and oxaliplatin for 4 to 6 months. The goal of therapy is to increase overall survival of patients.

Addition of oxaliplatin to 5-Fluorouracil cures an additional 5% of stage 3 colorectal cancer patients. This means 5 more out of 100 stage 3 colon cancer patients will be cured by oxaliplatin if it is added to 5-FU.

Stage 3 colon cancer patients take both oxaliplatin and 5-Fluorouracil. This increases the cure rate by 10% to 15% compared with no chemotherapy at all. Many stage 3 colon cancer patients are cured by this adjuvant combination chemotherapy after surgery.

How should 5-Fluorouracil be administered for maximum effect? One option is bolus injection. Another option is continuous infusion for 24 or 48 hours every 2 weeks. This means making a special IV infusion "port" in a patient.

A pump is used to administer the chemotherapy. It is very uncomfortable for the patient. It is also hard to control administration of chemotherapy if the patient experiences side effects.

Therefore, researchers started a program 10 or 15 years ago. Its goal was to substitute intravenous 5-Fluorouracil infusion with an oral route of administration. This orally-administered 5-Fluorouracil derivative medication is a pro-medication.

It is called Capecitabine. Another name for Capecitabine is UFT, but most oncologists use the name Capecitabine or Xeloda. We did an international clinical trial of Xeloda in 1,900 patients with stage 3 colon cancer.

We discovered that oral chemotherapy based on a combination of Capecitabine and oxaliplatin had similar efficacy to intravenous administration of 5-fluorouracil. Capecitabine was significantly better than single-agent chemotherapy with 5-fluorouracil in stage 3 colon cancer patients.

Capecitabine had fewer side effects. Oral administration of Capecitabine was easy. Capecitabine also worked well in elderly patients over the age of 70.

Capecitabine is an easy treatment. There is no need for infusions, intravenous ports, or pumps. Capecitabine chemotherapy results are replicable.

In my opinion, Capecitabine should be the standard of care for stage 3 colorectal cancer. Oral Capecitabine has the same efficacy as intravenous 5-fluorouracil. The clinical trial had 10 years of follow-up after treatment; results are very reliable.

Oral medication capecitabine (Xeloda) is equally effective as infusion of 5-fluorouracil. Prophylactic chemotherapy for stage 3 colon cancer is not targeted treatment. 5-Fluorouracil and oxaliplatin are often used in combination.

How should 5-Fluorouracil be administered for maximum effect? Maintenance treatment with capecitabine plus bevacizumab (Avastin) after induction treatment in stage 3 colon cancer can be very effective.

5-Fluorouracil cures an additional 5% of stage 3 colorectal cancer patients. Capecitabine (Xeloda) was significantly better than single-agent chemotherapy with 5-FU. Xeloda effectiveness has been proven in several clinical trials in stage 3 and stage 4 colorectal cancer.

Colon cancer stage 4 treatment involves multimodal chemotherapy and locoregional therapy of liver and lung metastases. A leading colorectal cancer expert discusses capecitabine (Xeloda) combination chemotherapy in colon cancer.