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The trial that measured how small the benefit of chemotherapy is for node-negative bowel cancer: about 3.6 people in every 100 avoid dying, which is why the decision is a conversation rather than a rule.
QUASAR set out to determine the size and duration of any survival benefit from adjuvant chemotherapy in patients at low risk of recurrence, for whom the indication was unclear. After apparently curative resection, 3,239 patients from 150 centres in 19 countries were randomised to fluorouracil and folinic acid or to observation with chemotherapy considered on recurrence; 2,963 (91 percent) had stage II node-negative disease and 2,291 (71 percent) had colon rather than rectal cancer, with a median age of 63. Until 1997 levamisole or placebo was added; after 1997 the chemotherapy arm received fluorouracil and low-dose folinic acid only. The primary outcome was all-cause mortality, analysed by intention to treat.
Treatment efficacy did not differ significantly by tumour site, stage, sex, age or chemotherapy schedule.
The number every stage II conversation still uses. It is also the baseline against which ctDNA-guided de-escalation is judged: DYNAMIC halved chemotherapy use in exactly this group without losing recurrence-free survival.
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.
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), Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR), 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 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, Toxicity and quality of life are undervalued and the tag colorectal-evidence.
Shares Circulating tumor DNA analysis guiding adjuvant therapy in stage II colon cancer (DYNAMIC), 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, Toxicity and quality of life are undervalued 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 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 Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR), Neoadjuvant / adjuvant / perioperative, Colon cancer (adenocarcinoma of the colon), 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, Toxicity and quality of life are undervalued, Colorectal cancer and the tag colorectal-evidence.
Shares Circulating tumor DNA analysis guiding adjuvant therapy in stage II colon cancer (DYNAMIC), 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.