Opportunities on the horizon for the management of early colon cancer

• Published in: Critical reviews in oncology/hematology Vol. 183; p. 103918
• Main Authors: Knapen, Daan G., de Haan, Jacco J., Fehrmann, Rudolf S.N., de Vries, Elisabeth G.E., de Groot, Derk Jan A.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.03.2023
• Subjects: (Neo)adjuvant; Chemotherapy, Adjuvant; Colonic Neoplasms - genetics; CtDNA; Early colon cancer; Humans; Immunoscore; Immunotherapy; Microsatellite Instability; Rectal Neoplasms; CtDNA; (Neo)adjuvant; Immunotherapy; Immunoscore; Early colon cancer
• ISSN: 1040-8428; 1879-0461
• DOI: 10.1016/j.critrevonc.2023.103918

There is a clear unmet need to improve early colon cancer management. This review encompasses the current systemic treatment landscape and summarises novel and pivotal trials. The Immunoscore and circulating tumour DNA (ctDNA) are studied to evaluate which patients should receive no, 3, or 6 months of adjuvant treatment. Several trials also test escalating treatment strategies for non-cleared ctDNA following standard adjuvant chemotherapy. Advances made in treating patients with metastatic colon cancer are now being translated to the early colon cancer setting. Two ongoing RCTs study immune checkpoint inhibitors (ICI) in patients with microsatellite instable high (MSI-H) early colon cancer as adjuvant treatment. Neo-adjuvant treatment is being studied in several ongoing RCTs as well. The complete response rate in patients with MSI-H tumours following ICI in neoadjuvant trials has potential organ-sparing implications. [Display omitted] •There are many ongoing ctDNA trials with (de)escalating systemic treatment implications.•Treatment advances in mCRC are translated to patients with early colon cancer.•Neoadjuvant ICI in patients with MSI-H tumours may become an organ-sparing treatment.