{"entity":{"id":"paper-mosaic-oxaliplatin-adjuvant-colon-nejm-2004","kind":"paper","name":"Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer (MOSAIC)","aka":[],"tldr":"Adding oxaliplatin to chemotherapy after a colon cancer operation cut recurrences by 23 percent. It made FOLFOX the standard, and gave a generation of patients the numb fingers that go with it.","summary":"The Multicenter International Study of Oxaliplatin, Fluorouracil and Leucovorin in the Adjuvant Treatment of Colon Cancer randomly assigned 2,246 patients who had undergone curative resection for stage II or III colon cancer to fluorouracil and leucovorin alone or with oxaliplatin for six months, with disease-free survival as the primary end point; 1,123 patients were assigned to each group.\n\nGrade 3 sensory neuropathy occurred in 12.4 percent during treatment and fell to 1.1 percent at one year, the trade-off that the IDEA collaboration later tried to reduce by shortening treatment.","asOf":"2026-09-24","links":[{"label":"N Engl J Med 2004","url":"https://doi.org/10.1056/NEJMoa032709"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/15175436/"}],"tags":["colorectal-evidence"],"related":["paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018","paper-quasar-adjuvant-chemotherapy-vs-observation-lancet-2007"],"cancers":["colorectal","colon-cancer"],"sections":["chemotherapy"],"technologies":["cytotoxic-chemotherapy"],"targets":[],"drugs":["folfox","oxaliplatin","fluorouracil","leucovorin"],"companies":[],"institutions":[],"pathways":[],"terms":["neoadjuvant-adjuvant"],"trials":[],"people":["thierry-andre","josep-tabernero","aimery-de-gramont"],"bottlenecks":["b-toxicity-qol"],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2004,"doi":"10.1056/NEJMoa032709","pmid":"15175436","authors":"André T, Boni C, Mounedji-Boudiaf L, et al.","paperType":"rct","findings":["After a median 37.9 months, 237 cancer-related events with oxaliplatin against 293 without (21.1 against 26.1 percent; hazard ratio for recurrence 0.77, p=0.002).","Three-year disease-free survival 78.2 percent (95 percent CI 75.6 to 80.7) against 72.9 percent (70.2 to 75.7), p=0.002.","Febrile neutropenia 1.8 percent; grade 3 sensory neuropathy 12.4 percent during treatment, 1.1 percent at one year.","Six patients in each group died during treatment (death rate 0.5 percent)."],"whatItMeans":"FOLFOX after surgery for stage III colon cancer, still the standard 22 years later, and the reason every later adjuvant trial in this disease is an oxaliplatin trial.","caveats":["The stage II subgroup did not show a clear benefit, and later analyses confined any benefit to high-risk stage II disease.","Persistent neuropathy is the dominant long-term harm and was the motivation for the duration trials.","Predates mismatch repair testing, ctDNA and the knowledge that mismatch repair-deficient stage II disease does not benefit from fluoropyrimidines."],"changedPractice":true,"participants":2246},"route":"/key-papers/paper-mosaic-oxaliplatin-adjuvant-colon-nejm-2004/","neighbours":{"paper":[{"id":"paper-quasar-adjuvant-chemotherapy-vs-observation-lancet-2007","kind":"paper","name":"Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study (QUASAR)","route":"/key-papers/paper-quasar-adjuvant-chemotherapy-vs-observation-lancet-2007/"},{"id":"paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018","kind":"paper","name":"Duration of adjuvant chemotherapy for stage III colon cancer (the IDEA collaboration)","route":"/key-papers/paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018/"},{"id":"paper-moertel-levamisole-fluorouracil-adjuvant-colon-nejm-1990","kind":"paper","name":"Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma","route":"/key-papers/paper-moertel-levamisole-fluorouracil-adjuvant-colon-nejm-1990/"},{"id":"paper-foxtrot-preoperative-chemotherapy-colon-jco-2023","kind":"paper","name":"Preoperative chemotherapy for operable colon cancer: mature results of an international randomized controlled trial (FOxTROT)","route":"/key-papers/paper-foxtrot-preoperative-chemotherapy-colon-jco-2023/"}],"cancer":[{"id":"colon-cancer","kind":"cancer","name":"Colon cancer (adenocarcinoma of the colon)","route":"/cancers/colon-cancer/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"}],"drug":[{"id":"fluorouracil","kind":"drug","name":"Fluorouracil (5-FU)","route":"/drugs/fluorouracil/"},{"id":"folfox","kind":"drug","name":"FOLFOX (5-FU, leucovorin, oxaliplatin)","route":"/drugs/folfox/"},{"id":"leucovorin","kind":"drug","name":"Leucovorin (folinic acid)","route":"/drugs/leucovorin/"},{"id":"oxaliplatin","kind":"drug","name":"Oxaliplatin","route":"/drugs/oxaliplatin/"}],"term":[{"id":"neoadjuvant-adjuvant","kind":"term","name":"Neoadjuvant / adjuvant / perioperative","route":"/terms/neoadjuvant-adjuvant/"}],"person":[{"id":"aimery-de-gramont","kind":"person","name":"Aimery de Gramont","route":"/people/aimery-de-gramont/"},{"id":"josep-tabernero","kind":"person","name":"Josep Tabernero","route":"/people/josep-tabernero/"},{"id":"thierry-andre","kind":"person","name":"Thierry André","route":"/people/thierry-andre/"}],"bottleneck":[{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}],"roadmap":[{"id":"colorectal-roadmap","kind":"roadmap","name":"Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation","route":"/roadmaps/colorectal-roadmap/"}]}}