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Estimating the Economic Value of CDX2 as a Predictive Biomarker to Guide Treatment Decisions in Stage II Colon Cancer

  • Piero Dalerba
    Correspondence
    Correspondence: Piero Dalerba, MD, Herbert Irving Comprehensive Cancer Center, Columbia University, 1130 St Nicholas Ave, ICRC Rm 924, New York, NY 10032, USA.
    Affiliations
    Department of Pathology and Cell Biology, Columbia University, New York, NY, USA

    Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, NY, USA

    Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA

    Columbia Stem Cell Initiative, Columbia University Medical Center, New York, NY, USA

    Digestive and Liver Diseases Research Center, Columbia University, New York, NY, USA
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Published:November 02, 2021DOI:https://doi.org/10.1016/j.jval.2021.09.006
      Colon cancer represents one of the most common and lethal forms of malignancy in the human population, accounting for approximately 10% of global cancer diagnoses and >570 000 annual deaths worldwide.
      • Sung H.
      • Ferlay J.
      • Siegel R.L.
      • et al.
      Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.
      Among patients diagnosed with colon cancer, approximately one-third (35%) are diagnosed with a tumor that is locally advanced (i.e., infiltrating beyond the full thickness of the muscular layer of the intestinal wall) but not yet overtly metastatic, a condition defined as stage II by the American Joint Committee on Cancer staging manual.
      • O’Connell J.B.
      • Maggard M.A.
      • Ko C.Y.
      Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging.
      ,
      • Amin M.B.
      • Edge S.
      • Greene F.
      • et al.
      AJCC Cancer Staging Manual.
      Most patients with stage II colon cancer are cured by surgical resection of the primary tumor, but a substantial percentage (10%-15%) are poised to relapse and eventually die of the disease.
      • O’Connell J.B.
      • Maggard M.A.
      • Ko C.Y.
      Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging.
      A common strategy implemented in medical oncology to improve the survival of patients with a locally advanced malignancy is to treat them with adjuvant chemotherapy (i.e., chemotherapy administered after surgical resection of all detectable tumor tissue) to prevent relapse from undetectable cancer cells. Adjuvant chemotherapy, however, can cause toxicity and is best reserved for patients who are both at high risk of relapse and affected by chemosensitive tumors. In the specific case of stage II colon cancer, several prognostic factors have been identified as capable of stratifying patients into “high-risk” versus “low-risk” categories with regard to the likelihood of relapse,
      • Compton C.
      • Fenoglio-Preiser C.M.
      • Pettigrew N.
      • Fielding L.P.
      American Joint Committee on Cancer Prognostic Factors Consensus conference: colorectal working group.
      ,
      • Rebuzzi S.E.
      • Pesola G.
      • Martelli V.
      • Sobrero A.F.
      Adjuvant chemotherapy for stage II colon cancer.
      but none have proven useful to identify patients who would indisputably benefit from adjuvant chemotherapy,
      • O’Connor E.S.
      • Greenblatt D.Y.
      • LoConte N.K.
      • et al.
      Adjuvant chemotherapy for stage II colon cancer with poor prognostic features.
      leaving clinicians uncertain with regard to the best treatment strategy.
      • Fang S.H.
      • Efron J.E.
      • Berho M.E.
      • Wexner S.D.
      Dilemma of stage II colon cancer and decision making for adjuvant chemotherapy.
      • Kannarkatt J.
      • Joseph J.
      • Kurniali P.C.
      • Al-Janadi A.
      • Hrinczenko B.
      Adjuvant chemotherapy for stage II colon cancer: a clinical dilemma.
      • Sobrero A.
      • Köhne C.H.
      Should adjuvant chemotherapy become standard treatment for patients with stage II colon cancer? For the proposal [published correction appears in Lancet Oncol. 2006;7(7):533].
      • Meropol N.J.
      Ongoing challenge of stage II colon cancer.
      • Tournigand C.
      • de Gramont A.
      Chemotherapy: is adjuvant chemotherapy an option for stage II colon cancer?.
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