Would you recommend 3 or 6 months adjuvant chemo for low risk Stage III sigmoid cancer (T3/N1), but with positive LVI and PNI?

I would recommend 3 months of CAPOX in this case. For a patient with stage III colon cancer, the presence of LVI and PNI should not influence the treatment plan.

I agree overall with my colleagues from MD Anderson and USC, but would be more emphatic that 3 months of Cape-OX is sufficient. LVI and PNI differentiation are inconsistent pathologic "markers" which generally are not of consistent significance in multi-variate analyses across trials. We should recall that the difference for all 12,000 enrolled patients in IDEA was approximately 0.9% difference in 3 yr-DFS (and that 3 months of chemo was "non-inferior" because the 95% confidence interval for the...