Neoadjuvant and adjuvant chemotherapy in colorectal cancer

After surgery for stage II and III colon cancer (CC), adjuvant treatment depends on several factors: the patient's eligibility for chemotherapy, the risk of recurrence, potential toxicities, and life expectancy. For stage III, oxaliplatin-based chemotherapy (FOLFOX or CAPOX) is indicated for 3 to 6 months. For stage II, the indication for treatment depends on clinico-pathological risk factors. Neoadjuvant chemotherapy is an option that can be considered in the case of locally advanced tumor. Shared decision-making is important based on the benefit/risk balance and the patient's preferences. Many prognostic biomarkers, including the search for circulating tumor DNA, are under development for better risk stratification of recurrence to guide the (neo)-adjuvant therapeutic strategy, and certain molecular subgroups will likely be treated specifically in the future, starting with MSI/dMMR tumors using immunotherapy.