Biomarker-Guided Adjuvant Therapy in Stage II/III Colon Cancer: A Systematic Review of Current Evidence and Clinical Implications.
Nabil Ismaili
✦ AI-curated · Sources linked
In 30 seconds
This systematic review synthesised evidence on biomarker-guided adjuvant treatment for resectable stage II/III colon cancer, drawing on 52 studies identified from 1,245 records. It reviewed randomised trials, prospective cohorts and retrospective analyses, with narrative synthesis because of heterogeneity. In stage III disease, ATOMIC found that adding atezolizumab to mFOLFOX improved 3-year disease-free survival compared with chemotherapy alone (86.4% vs. 76.6%; HR 0.50; 95% CI 0.34-0.72). The review also describes MMR, ctDNA, CEA and mutation profiling as tools for refining prognosis or treatment decisions, while noting the need for prospective validation.
Key findings
- ATOMIC reported 3-year disease-free survival of 86.4% vs. 76.6% with atezolizumab plus mFOLFOX versus chemotherapy alone (HR 0.50; 95% CI 0.34-0.72).
- DYNAMIC-III reduced oxaliplatin use by approximately 60%, with 3-year recurrence-free survival of 85.3% vs. 88.1%; the accompanying text notes it did not meet its primary non-inferiority endpoint.
- dMMR/MSI-H tumors account for approximately 15% of stage II/III cases; the review identifies universal MMR testing as a key step in treatment stratification.
- Postoperative ctDNA had strong prognostic value in observational studies, with hazard ratios for recurrence >5.
Why it matters
The review highlights how tumour biology and residual-disease markers may help distinguish prognosis and treatment response beyond clinicopathological features alone. This is relevant because adjuvant therapy can entail toxicity and may be unnecessary for some patients, while others may benefit from treatment intensification. The evidence also underscores that biomarker-informed decisions require validation and careful interpretation rather than reliance on a single test.
What to keep in mind
The evidence was heterogeneous in interventions, settings and biomarker assays, requiring narrative rather than quantitative synthesis. The review also notes under-representation of elderly people, patients with organ impairment and ethnic minorities, and calls for prospective validation of integrated models.