Colon cancer

Paul F. Engstrom, Juan Pablo Arnoletti, Al B. Benson, Yi Jen Chen, Michael A. Choti, Harry S. Cooper, Raza A. Dilawari, Dayna S. Early, Marwan G. Fakih, Charles Fuchs, Jean L. Grem, Krystyna Kiel, James A. Knol, Lucille A. Leong, Kirk A. Ludwig, Edward W. Martin, Sujata Rao, Leonard Saltz, David Shibata, John M. Skibber & 1 others Alan P. Venook

Research output: Contribution to journalReview article

8 Citations (Scopus)

Abstract

The panel believes that a multidisciplinary approach is necessary for managing colorectal cancer. The panel endorses the concept that treating patients in a clinical trial has priority over standard or accepted therapy. The recommended surgical procedure for resectable colon cancer is an en bloc resection and adequate lymphadenectomy. Adequate pathologic assessment of the resected lymph nodes is important, with a goal of evaluating at least 12 nodes when possible. Adjuvant therapy with FOLFOX (category 1), 5-FU/LV (category 2A), or capecitabine (category 2A) is recommended for patients with stage III disease and as an option for patients with high-risk stage II disease (category 2A for all 3 treatment options). Patients with metastatic disease in the liver or lung should be considered for surgical resection if they are candidates for surgery and if complete resection (RO) or ablation can be achieved. Preoperative chemotherapy can be considered as initial therapy in patients with synchronous or metachronous resectable metastatic disease (neoadjuvant) or when a response to chemotherapy can convert a patient from an unresectable to a resectable state. Adjuvant chemotherapy should be considered after resection of liver or lung metastases. The recommended posttreatment surveillance program for patients with colon cancer includes serial CEA determinations; periodic chest, abdominal, and pelvic CT scans; and colonoscopic evaluations. Recommendations for patients with previously untreated disseminated metastatic disease represent a continuum of care in which lines of treatment are blurred rather than discrete. Principles to consider at initiation of therapy include preplanned strategies for altering therapy in both the presence and absence of disease progression, and plans for adjusting therapy for patients who experience certain toxicities. Recommended initial therapy for advanced or metastatic disease includes bevacizumab plus FOLFOX, FOLFIRI, CapeOX, or 5-FU/LV. Patients with progressive disease treated with a 5-FU-based or capecitabine-based regimen as initial therapy should be treated with second- or third-line chemotherapy consisting of FOLFIRI, CapeOX, FOLFOX, or irinotecan alone or, in the case of irinotecan and FOLFIRI, in combination with cetuximab. Monotherapy with either cetuximab or panitumumab is also an option after first or second progression.

Original languageEnglish (US)
Pages (from-to)884-925
Number of pages42
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume5
Issue number9
StatePublished - Oct 1 2007

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Colonic Neoplasms
irinotecan
Fluorouracil
Therapeutics
Drug Therapy
Continuity of Patient Care
Adjuvant Chemotherapy
Lymph Node Excision
Lung Diseases
Disease Progression
Liver Diseases
Colorectal Neoplasms
Thorax
Lymph Nodes
Clinical Trials
Neoplasm Metastasis
Lung
Liver

All Science Journal Classification (ASJC) codes

  • Oncology

Cite this

Engstrom, P. F., Arnoletti, J. P., Benson, A. B., Chen, Y. J., Choti, M. A., Cooper, H. S., ... Venook, A. P. (2007). Colon cancer. JNCCN Journal of the National Comprehensive Cancer Network, 5(9), 884-925.

Colon cancer. / Engstrom, Paul F.; Arnoletti, Juan Pablo; Benson, Al B.; Chen, Yi Jen; Choti, Michael A.; Cooper, Harry S.; Dilawari, Raza A.; Early, Dayna S.; Fakih, Marwan G.; Fuchs, Charles; Grem, Jean L.; Kiel, Krystyna; Knol, James A.; Leong, Lucille A.; Ludwig, Kirk A.; Martin, Edward W.; Rao, Sujata; Saltz, Leonard; Shibata, David; Skibber, John M.; Venook, Alan P.

In: JNCCN Journal of the National Comprehensive Cancer Network, Vol. 5, No. 9, 01.10.2007, p. 884-925.

Research output: Contribution to journalReview article

Engstrom, PF, Arnoletti, JP, Benson, AB, Chen, YJ, Choti, MA, Cooper, HS, Dilawari, RA, Early, DS, Fakih, MG, Fuchs, C, Grem, JL, Kiel, K, Knol, JA, Leong, LA, Ludwig, KA, Martin, EW, Rao, S, Saltz, L, Shibata, D, Skibber, JM & Venook, AP 2007, 'Colon cancer', JNCCN Journal of the National Comprehensive Cancer Network, vol. 5, no. 9, pp. 884-925.
Engstrom PF, Arnoletti JP, Benson AB, Chen YJ, Choti MA, Cooper HS et al. Colon cancer. JNCCN Journal of the National Comprehensive Cancer Network. 2007 Oct 1;5(9):884-925.
Engstrom, Paul F. ; Arnoletti, Juan Pablo ; Benson, Al B. ; Chen, Yi Jen ; Choti, Michael A. ; Cooper, Harry S. ; Dilawari, Raza A. ; Early, Dayna S. ; Fakih, Marwan G. ; Fuchs, Charles ; Grem, Jean L. ; Kiel, Krystyna ; Knol, James A. ; Leong, Lucille A. ; Ludwig, Kirk A. ; Martin, Edward W. ; Rao, Sujata ; Saltz, Leonard ; Shibata, David ; Skibber, John M. ; Venook, Alan P. / Colon cancer. In: JNCCN Journal of the National Comprehensive Cancer Network. 2007 ; Vol. 5, No. 9. pp. 884-925.
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abstract = "The panel believes that a multidisciplinary approach is necessary for managing colorectal cancer. The panel endorses the concept that treating patients in a clinical trial has priority over standard or accepted therapy. The recommended surgical procedure for resectable colon cancer is an en bloc resection and adequate lymphadenectomy. Adequate pathologic assessment of the resected lymph nodes is important, with a goal of evaluating at least 12 nodes when possible. Adjuvant therapy with FOLFOX (category 1), 5-FU/LV (category 2A), or capecitabine (category 2A) is recommended for patients with stage III disease and as an option for patients with high-risk stage II disease (category 2A for all 3 treatment options). Patients with metastatic disease in the liver or lung should be considered for surgical resection if they are candidates for surgery and if complete resection (RO) or ablation can be achieved. Preoperative chemotherapy can be considered as initial therapy in patients with synchronous or metachronous resectable metastatic disease (neoadjuvant) or when a response to chemotherapy can convert a patient from an unresectable to a resectable state. Adjuvant chemotherapy should be considered after resection of liver or lung metastases. The recommended posttreatment surveillance program for patients with colon cancer includes serial CEA determinations; periodic chest, abdominal, and pelvic CT scans; and colonoscopic evaluations. Recommendations for patients with previously untreated disseminated metastatic disease represent a continuum of care in which lines of treatment are blurred rather than discrete. Principles to consider at initiation of therapy include preplanned strategies for altering therapy in both the presence and absence of disease progression, and plans for adjusting therapy for patients who experience certain toxicities. Recommended initial therapy for advanced or metastatic disease includes bevacizumab plus FOLFOX, FOLFIRI, CapeOX, or 5-FU/LV. Patients with progressive disease treated with a 5-FU-based or capecitabine-based regimen as initial therapy should be treated with second- or third-line chemotherapy consisting of FOLFIRI, CapeOX, FOLFOX, or irinotecan alone or, in the case of irinotecan and FOLFIRI, in combination with cetuximab. Monotherapy with either cetuximab or panitumumab is also an option after first or second progression.",
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AU - Engstrom, Paul F.

AU - Arnoletti, Juan Pablo

AU - Benson, Al B.

AU - Chen, Yi Jen

AU - Choti, Michael A.

AU - Cooper, Harry S.

AU - Dilawari, Raza A.

AU - Early, Dayna S.

AU - Fakih, Marwan G.

AU - Fuchs, Charles

AU - Grem, Jean L.

AU - Kiel, Krystyna

AU - Knol, James A.

AU - Leong, Lucille A.

AU - Ludwig, Kirk A.

AU - Martin, Edward W.

AU - Rao, Sujata

AU - Saltz, Leonard

AU - Shibata, David

AU - Skibber, John M.

AU - Venook, Alan P.

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N2 - The panel believes that a multidisciplinary approach is necessary for managing colorectal cancer. The panel endorses the concept that treating patients in a clinical trial has priority over standard or accepted therapy. The recommended surgical procedure for resectable colon cancer is an en bloc resection and adequate lymphadenectomy. Adequate pathologic assessment of the resected lymph nodes is important, with a goal of evaluating at least 12 nodes when possible. Adjuvant therapy with FOLFOX (category 1), 5-FU/LV (category 2A), or capecitabine (category 2A) is recommended for patients with stage III disease and as an option for patients with high-risk stage II disease (category 2A for all 3 treatment options). Patients with metastatic disease in the liver or lung should be considered for surgical resection if they are candidates for surgery and if complete resection (RO) or ablation can be achieved. Preoperative chemotherapy can be considered as initial therapy in patients with synchronous or metachronous resectable metastatic disease (neoadjuvant) or when a response to chemotherapy can convert a patient from an unresectable to a resectable state. Adjuvant chemotherapy should be considered after resection of liver or lung metastases. The recommended posttreatment surveillance program for patients with colon cancer includes serial CEA determinations; periodic chest, abdominal, and pelvic CT scans; and colonoscopic evaluations. Recommendations for patients with previously untreated disseminated metastatic disease represent a continuum of care in which lines of treatment are blurred rather than discrete. Principles to consider at initiation of therapy include preplanned strategies for altering therapy in both the presence and absence of disease progression, and plans for adjusting therapy for patients who experience certain toxicities. Recommended initial therapy for advanced or metastatic disease includes bevacizumab plus FOLFOX, FOLFIRI, CapeOX, or 5-FU/LV. Patients with progressive disease treated with a 5-FU-based or capecitabine-based regimen as initial therapy should be treated with second- or third-line chemotherapy consisting of FOLFIRI, CapeOX, FOLFOX, or irinotecan alone or, in the case of irinotecan and FOLFIRI, in combination with cetuximab. Monotherapy with either cetuximab or panitumumab is also an option after first or second progression.

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