ABSTRACT
Results from the pivotal IDEA trial, which evaluated 3 versus 6 months of adjuvant oxaliplatin-based chemotherapy, are incorporated into the NCCN Guidelines for Colon Cancer. The guidelines recommend that for patients with low-risk stage III disease, the preferred regimen is CAPEOX for 3 months or FOLFOX for 3 to 6 months. For patients with high-risk stage III disease, the preferred regimen is CAPEOX for 3 to 6 months or FOLFOX for 6 months. In metastatic disease, tumor sidedness should be a consideration when choosing a biologic. For BRAF-mutated disease, several triplets are now recommended options. Importantly, for a subset of patients with metastatic disease, new to the NCCN Guidelines is the incorporation of nivolumab and pembrolizumab as subsequent therapy for those with microsatellite instability-high or mismatch repair-deficient tumors.
Subject(s)
Antineoplastic Agents, Immunological/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biomarkers, Tumor/genetics , Colorectal Neoplasms/therapy , Practice Guidelines as Topic , Antineoplastic Agents, Immunological/standards , Antineoplastic Combined Chemotherapy Protocols/standards , Chemotherapy, Adjuvant/methods , Chemotherapy, Adjuvant/standards , Colectomy/standards , Colorectal Neoplasms/genetics , Colorectal Neoplasms/mortality , Colorectal Neoplasms/pathology , DNA Mismatch Repair/genetics , Disease-Free Survival , Fluorouracil/standards , Fluorouracil/therapeutic use , Humans , Leucovorin/standards , Leucovorin/therapeutic use , Medical Oncology/standards , Microsatellite Instability , Mutation , Neoplasm Staging , Organoplatinum Compounds/standards , Organoplatinum Compounds/therapeutic use , Oxaliplatin/therapeutic use , Proctectomy/standards , Proto-Oncogene Proteins B-raf/genetics , Randomized Controlled Trials as Topic , Societies, Medical/standards , United States/epidemiologyABSTRACT
The NCCN Guidelines for Rectal Cancer are now more closely aligned with those for colon cancer. A new MRI-based definition of the rectum has been included and the use of MRI in staging has been elevated in importance. There is a new emphasis on neoadjuvant therapy, especially the concurrent use of chemotherapy and radiotherapy. One of the biggest changes is more acceptance of an observational approach-"watch and wait, nonoperative management"-for select patients experiencing a complete clinical response with no evidence of residual disease after neoadjuvant therapy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Practice Guidelines as Topic , Proctectomy/standards , Rectal Neoplasms/therapy , Watchful Waiting/standards , Antineoplastic Combined Chemotherapy Protocols/standards , Chemoradiotherapy/methods , Chemoradiotherapy/standards , Disease-Free Survival , Fluorouracil/standards , Fluorouracil/therapeutic use , Humans , Leucovorin/standards , Leucovorin/therapeutic use , Medical Oncology/standards , Neoadjuvant Therapy/methods , Neoadjuvant Therapy/standards , Neoplasm Staging , Organoplatinum Compounds/standards , Organoplatinum Compounds/therapeutic use , Proctectomy/methods , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/mortality , Rectal Neoplasms/pathology , Rectum/diagnostic imaging , Rectum/pathology , Rectum/surgery , Societies, Medical/standards , United States/epidemiologySubject(s)
Antimetabolites, Antineoplastic/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Colorectal Neoplasms/drug therapy , Deoxycytidine/analogs & derivatives , Fluorouracil/administration & dosage , Antimetabolites, Antineoplastic/economics , Antimetabolites, Antineoplastic/standards , Antineoplastic Combined Chemotherapy Protocols/economics , Antineoplastic Combined Chemotherapy Protocols/standards , Capecitabine , Colorectal Neoplasms/economics , Deoxycytidine/administration & dosage , Deoxycytidine/economics , Deoxycytidine/standards , Deoxycytidine/toxicity , Fluorouracil/economics , Fluorouracil/standards , Humans , Leucovorin/administration & dosage , Leucovorin/economics , Leucovorin/standards , Organoplatinum Compounds/administration & dosage , Organoplatinum Compounds/economics , Organoplatinum Compounds/standards , Oxaliplatin , Randomized Controlled Trials as TopicABSTRACT
The complex, 2-amino-2-methyl-3-butanoneoximedichloroplatinum(II), [Pt(ambo)Cl2], was chosen because of its potential to bind to GpA sequences of duplex DNA. Crystals of [Pt(ambo)Cl2] are monoclinic, space group, P2(1)/n, a = 6.799(4), b = 17.642(5), c = 8.193(2) A, beta = 102.10(3) degrees, Z = 4, R = 0.033 (1864 F). The binding of [Pt(ambo)Cl2] to salmon-sperm DNA was studied using enzymatic digestion and HPLC analysis. [Pt(ambo)Cl2] was found to form fewer GpG and ApG intrastrand adducts and more monofunctional adducts than [Pt(en)Cl2]. Binding to GpA sequences could not be established, but [Pt(ambo)Cl2] forms substantially more adducts with adenine than does [Pt(en)Cl2].
