What adjuvant chemotherapy would you recommend in a elderly patient with resected stage III colon cancer with MMR deficiency with MLH1 promoter hypermethlation?

Topics: Gastrointestinal Cancers • Medical Oncology • Colorectal Cancer

Answer from: Medical Oncologist at Academic Institution

This is a great question and actually a quite common situation we see in the clinic. Majority of the dMMR colorectal cancer is actually due to MLH1 promotor hypermethylation (about 75% of all dMMR colorectal cancer) while a small portion of dMMR colorectal cancer is due to Lynch syndrome. These pati...

Comments

Medical Oncologist at Cancer and Blood Spclsts of Louisville
Thanks, that’s very helpful.

Medical Oncologist at Pinehurst Medical Clinic
No data yet on immunotherapy in stage 3 colon canc...

Medical Oncologist at NYU Winthrop Hospital
Elderly patient. I will use 5 FU, Leucovorin only;...

Answer from: Medical Oncologist at Academic Institution

One could also argue, that in an elderly frail patient with a low absolute benefit of adjuvant chemotherapy and its attendant side effects consider surveillance and if there is systemic recurrence (25%) palliate with immune therapy.

Answer from: Medical Oncologist at Academic Institution

Great answers. We also have a study that allows any chemo duration for stage 3 and if ctDNA is positive, could get PD1.

Answer from: Medical Oncologist at Community Practice

Approximately 60% of the stage III dMMR colon cancer patients are cured after surgical resection and at most, only 10–15% benefit from oxaliplatin-based adjuvant treatment (André et al., PMID 26527776, Tougeron et al., PMID 26839356). There is considerable prognostic heterogeneity depen...

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