CONTEXT
tumor, MMR-proficient colon cancer, cancers, toxicity, toxicities, colon cancer, Might chemoresistant cancers
TUMOR, RECURRENCE, CANCERS, DISEASE, COLON CANCER, PERIOPERATIVE COMPLICATION, REGRESSION


To determine whether giving the first 6 weeks of chemotherapy preoperatively might safely reduce recurrence risk in patients with locally advanced but operable colon cancer.
Neoadjuvant oxaliplatin-fluoropyrimidine chemotherapy for radiologically selected locally advanced operable colon cancer can be delivered safely and results in marked tumor down-staging, increased complete resection rates, and better disease control at 2 years than the same chemotherapy given postoperatively. Histologic tumor regression correlates strongly with freedom from recurrence. Less response was seen in mismatch repair (MMR)–deficient than in MMR-proficient cancers. Panitumumab did not enhance the benefit of neoadjuvant chemotherapy.
A short course of neoadjuvant chemotherapy represents a reasonable treatment option for patients with clinical stage T3+ operable, MMR-proficient colon cancer. However, further study and validation are required before adopting this as the preferred standard of care over up-front surgical resection.**Relevance section written by However, there are potential disadvantages of NAC that have delayed its evaluation in colon cancer. Might toxicity during NAC compromise fitness for surgery or increase perioperative complications? Might chemoresistant cancers progress during NAC reducing the chance of surgical cure? Given the imprecision of radiologic staging, might low-risk patients be exposed to the toxicities and inconvenience of chemotherapy when surgery alone might have been considered sufficient?By 2008, oxaliplatin-fluoropyrimidine combinations had demonstrated good efficacy and tolerability as both adjuvant and advanced disease treatment,