Date de révision : 10 octobre 2008

Cancer non métastatique

Conduite à tenir initiale

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Attitude postchirurgicale

En présence d'un résidu tumoral

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En l'absence de résidu tumoral

 

Options de chimiothérapie adjuvante

Stade II : validation de l'indication en RCP
Les options ci-dessous sont décrites par ordre de préférence :

   
  LV5FU2 (Acide folinique / 5-FU, 12 cures)
  FUFOL (5-FU / acide folinique, 6 cures)
  5-FU continu, 3 mois
  Si nombreux facteurs de mauvais pronostic :
FOLFOX (Acide folinique / 5-FU / oxaliplatine, 12 cures)
Surveillance attentive des complications neurologiques éventuelles : si paresthésies permanentes, arrêt FOLFOX et poursuite avec LV5FU2 sans oxaliplatine
 

 

Références :
Benson AB 3nd et al.
American Society of Clinical Oncology recommandations on adjuvant chemotherapy for stage II colon cancer.
J Clin Oncol 2004; 22: 3408-19.

International Multicenter Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) investigators- Efficacy of adjuvant Fluorouracil and folinic Acid in B2 colon Cancer.
J Clin Oncol 1999; 17: 1356-63.

Figueredo A et al.
Adjuvant therapy for stage II colon cancer : a systematic review from the cancer care Ontario program in evidence-based care's gastrointestinal cancer disease site group.
J Clin Oncol 2004; 22 : 3395-407.

De Gramont A, et al.
Oxaliplatin/5FU/LV in adjuvant colon cancer : updated efficacy results of the MOSAIC trial, including survival, with a median follow up of six years.
J Clin Oncol 2007; 25(18S) : 4007A

QUASAR Collaborative group
Adjuvant chemotherapy versus observation in patients with colorectal cancer : a randomised study.
Lancet 2007; 370 : 2020-29

Ribic CM, et al.
Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer.
N Engl J Med 2003; 349: 247-57

Sargent DJ, et al.
Confirmation of deficient mismatch repair (dMMR) as apredictive marker for lack of benefit from 5-FU based chemotherapy in stage II and III colon cancer (cc) : a pooled molecular reanalyses of randomized chemotherapy trials.
J Clin Oncol 2008; 26(S) = 4008A

 

Stade III : options citées par ordre de préférence
   
 

FOLFOX (Acide folinique / 5-FU / oxaliplatine, 12 cures)
Surveillance attentive des complications neurologiques éventuelles : si paresthésies permanentes, arrêt FOLFOX et poursuite avec LV5FU2 sans oxaliplatine

  Capécitabine, 8 cycles
  LV5FU2 (Acide folinique / 5-FU, 12 cures)
 

5-FU continu, 3 mois

  FUFOL (5-FU / acide folinique, 6 cures)

 

 

Références :

André T. et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer.
N Engl J Med 2004; 350 : 2343-51.

André T. et al.
Semimonthly versus monthly regimen of fluorouracil and leucovorin administrated for 24 or 36 weeks as adjuvant therapy in stage II and III colon cancer : results of randomized trial.
J Clin Oncol 2003; 21 : 2896-903.

Chau I et al.
Longitudinal quality of life and quality adjusted survival in a randomised controlled trial comparing six months of bolus fluorouracil/leucovorin vs. twelve weeks of protracted venous infusion fluorouracil as adjuvant chemotherapy for colorectal cancer.
Eur J Cancer 2005; 41 : 1551-9.

Saini A et al.
Twelve weeks of protracted venous infusion of fluorouracil (5-FU) is as effective as 6 months of bolus 5-FU and folinic acid as adjuvant treatment in colorectal cancer.
Br J Cancer 2003; 88 : 1859-65.

Twelves C. et al.
Capecitabine as adjuvant treatment for Stage III colon cancer.
N Eng J Med 2005; 352 : 2696-704.

 

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voie biliaire, cholangiocarcinome, Klatskin, biliary tract