Adjuvant CxT - Stage II

Question 1

NEJM, 1990

Moertel

Answer 1

5-FU + Levamisole for 1y for resected stage III

Question 2

6m FU + Leucovorin

Answer 2

1993 JCO - NSABP-C03
1994 Gastroenterology (Francini G)
1995 Lancet - IMPACT
1997 JCO                    (O'Connel M)
1998 JCO                    (O'Connel MJ)
1999 JCO - NSABP-C04
2000 Lancet - QUASAR
2005 JCO - Intergroup 0089

Question 3

QUASAR: QUick And Simple and Reliable

(design)

Answer 3

Lancet, 2007
150 centres in 19 countries
 Patients with uncertain indication for CxT (91% - stage II ; 29% - rectal cancer)
 CxT1: 5FU + LV (high or low dose) 
          5 days, every 4 weeks
          6 cycles
 CxT2: 30 week schedule of once weekly

Question 4

QUASAR: QUick And Simple and Reliable

(design)

Answer 4

( CxT
3239 R (
( Observation

Question 5

QUASAR: QUick And Simple and Reliable

(results)

Answer 5

RR of dying from colorectal cancer: 0,81
RR of recurrence: 0,78
The proportional reduction in recurrence with CxT x observation alone was much the same in stage II and III, and in colon and rectal cancers.

Question 6

QUASAR: QUick And Simple and Reliable

(clinical implications)

Answer 6

If 5y mortality without CxT is 20%, a reduction in the relative risk of death of 18% translates into an absolute improvement in survival of 3,5%.