Abstract |
The benefit of adjuvant therapy, such as 5-fluorouracil (5-FU) combined with leucovorin, is a matter of debate for patients with Dukes' B colon cancer. Several approaches have been taken to address this issue. Initially, studies were conducted to assess treatment benefits in both Dukes' B and Dukes' C patients. These studies identified an overall benefit of adjuvant treatment and enrolled enough Dukes' C patients to determine a treatment benefit for adjuvant 5-FU/ leucovorin in this subpopulation. However, the individual studies were insufficiently powered to detect a treatment benefit in Dukes' B patients. An analysis of four separate studies (National Surgical Adjuvant Breast and Bowel project) compared the benefit of adjuvant treatment in Dukes' B patients with that in Dukes' C patients and showed similar relative reductions in mortality and disease-free survival in Dukes' B and in Dukes' C patients. The Liver Infusion Meta-Analysis Group also reported similar relative benefits from a portal vein infusion of 5-FU-based chemotherapy in Dukes' B and Dukes' C patients. The International Multicenter Pooled Analysis of Colon Cancer Trials B2 study, which combined data from patients with Dukes' B colon cancer in five separate trials, failed to show a statistically significant benefit of adjuvant 5-FU/ leucovorin compared with surgery alone. We review the advantages and limitations of different approaches to detect treatment benefits in patients with Dukes' B colon cancer, and we argue that there is a need for a meta-analysis of all adjuvant trials to reliably address this question.
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Authors | M Buyse, P Piedbois |
Journal | Seminars in oncology
(Semin Oncol)
Vol. 28
Issue 1 Suppl 1
Pg. 20-4
(Feb 2001)
ISSN: 0093-7754 [Print] United States |
PMID | 11273585
(Publication Type: Evaluation Study, Journal Article)
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Chemical References |
- Antimetabolites, Antineoplastic
- Leucovorin
- Fluorouracil
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Topics |
- Antimetabolites, Antineoplastic
(therapeutic use)
- Chemotherapy, Adjuvant
- Colonic Neoplasms
(drug therapy, mortality, pathology, surgery)
- Disease-Free Survival
- Fluorouracil
(therapeutic use)
- Humans
- Leucovorin
(therapeutic use)
- Meta-Analysis as Topic
- Multicenter Studies as Topic
- Neoplasm Staging
- Proportional Hazards Models
- Randomized Controlled Trials as Topic
- Statistics as Topic
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