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The 1990 trial that first showed chemotherapy after a colon cancer operation stops the cancer coming back. It cut recurrences by 41 percent and deaths by a third in node-positive disease.
Moertel, Fleming, Macdonald and colleagues randomly assigned 1,296 patients with resected colon cancer that was either locally invasive (stage B2) or node-positive (stage C) to observation or to one year of levamisole combined with fluorouracil; stage C patients could also be assigned to levamisole alone. Median follow-up at the time of writing was three years.
Toxic effects of levamisole plus fluorouracil were essentially those of fluorouracil alone: nausea, vomiting, stomatitis, diarrhoea, dermatitis and leukopenia, usually not severe. Because most patients were treated by community oncologists, the authors argued the approach would be readily adaptable to conventional practice, and it became the first adjuvant standard in colon cancer.
The start of adjuvant treatment for colon cancer. Levamisole was later dropped, but fluorouracil with folinic acid remained the backbone that oxaliplatin was added to in MOSAIC fourteen years later.
Shares Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer (MOSAIC), Neoadjuvant / adjuvant / perioperative, 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, Colon cancer (adenocarcinoma of the colon) and the tag colorectal-evidence.
Shares Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer (MOSAIC), Neoadjuvant / adjuvant / perioperative, 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, New England Journal of Medicine and the tag colorectal-evidence.
Shares Leucovorin (folinic acid), 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, Fluorouracil (5-FU), Colorectal cancer and the tag colorectal-evidence.
Shares Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study (QUASAR), Neoadjuvant / adjuvant / perioperative, 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, New England Journal of Medicine and the tag colorectal-evidence.
Shares Leucovorin (folinic acid), 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, Fluorouracil (5-FU), Colorectal cancer and the tag colorectal-evidence.
Shares Neoadjuvant / adjuvant / perioperative, 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, New England Journal of Medicine, Colorectal cancer and the tag colorectal-evidence.
Shares 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, New England Journal of Medicine, Cytotoxic chemotherapy, Colorectal cancer and the tag colorectal-evidence.
Shares 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, Colon cancer (adenocarcinoma of the colon), Colorectal cancer and the tag colorectal-evidence.