Adjuvant Chemotherapy Strategies in Colon Cancer

Adjuvant chemotherapy has transformed the management of colon cancer by reducing recurrence and improving long-term survival following surgical resection. Historically, single-agent fluoropyrimidines established a modest benefit for stage II and III disease. The addition of oxaliplatin gave rise to combination regimens such as FOLFOX (infusional fluorouracil, leucovorin and oxaliplatin) and CAPOX (capecitabine and oxaliplatin), which extended disease-free and overall survival but introduced cumulative neurotoxicity. Subsequent trials demonstrated that a three-month duration of oxaliplatin-based therapy may be non-inferior to six months in selected patients, balancing efficacy and quality of life. More recently, molecular stratification has refined risk assessment: circulating tumour DNA (ctDNA) offers dynamic monitoring of minimal residual disease to guide the need for therapy escalation or de-escalation, while the Immunoscore quantifies local immune response to predict recurrence risk. Microsatellite instability and mismatch-repair status now inform emerging strategies, including immune checkpoint inhibitors in high-risk or refractory cases. Together, these advances underscore a shift towards personalised adjuvant regimens that integrate clinicopathological staging with biomarker-driven decision making, aiming to spare low-risk patients unnecessary toxicity while intensifying treatment for those most likely to benefit.

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Adjuvant Chemotherapy Strategies in Colon Cancer publication trend

The graph below shows the total number of articles in adjuvant chemotherapy strategies in colon cancer across all publications each year (not limited to Nature Index journals).

Technical terms

Adjuvant chemotherapy: treatment given after surgical removal of a tumour to eliminate microscopic residual disease and reduce recurrence risk.

Oxaliplatin: a platinum-based cytotoxic agent that, when combined with fluoropyrimidines, enhances DNA damage in dividing cancer cells.

Fluoropyrimidine: an antimetabolite class including fluorouracil and capecitabine that interferes with DNA synthesis in rapidly proliferating cells.

Circulating tumour DNA (ctDNA): fragments of tumour-derived DNA detectable in blood, used to assess minimal residual disease and guide adjuvant therapy decisions.

Immunoscore: a quantitative measure of tumour-infiltrating immune cells that predicts recurrence risk and may inform therapy intensity.

References

1. Impact of tumor and node stages on the efficacy of adjuvant oxaliplatin-based chemotherapy in stage III colon cancer patients: an ACCENT pooled analysis ☆. ESMO Open (2025).
2. Opportunities on the horizon for the management of early colon cancer. Critical Reviews in Oncology/Hematology (2023).
3. 3 versus 6 months of adjuvant oxaliplatin-fluoropyrimidine combination therapy for colorectal cancer (SCOT): an international, randomised, phase 3, non-inferiority trial. The Lancet Oncology (2018).