Supported by data from randomized clinical trials, the use of neoadjuvant chemotherapy (NAC) in the management of many gastrointestinal cancers has increased dramatically. Neoadjuvant chemotherapy is used to treat patients with potentially resectable (gastro)esophageal, gastric, rectal, and pancreatic cancers. Colon cancer may soon be added to that list—the recent Fluorouracil, Oxaliplatin and Targeted Receptor pre-Operative Therapy (FOxTROT) trial demonstrated promise for the role of NAC in the management of patients with clinically (i.e., radiologically) staged T3-4 N0-2 disease.
1 Specifically, patients who were randomized to six weeks of NAC demonstrated higher rates of complete resection and tumor down-staging as well as a significantly lower disease recurrence rate at 2 years compared with standard management with upfront resection followed by adjuvant therapy. Notably, patients treated with NAC did not have a higher rate of serious perioperative complications. However, a key point to consider is that appropriate utilization of NAC in the management of patients with locally advanced colon cancer presumes that these patients can be accurately identified by contemporary staging modalities. …
