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These studies suggest that colon cancer treatment options include surgery, chemotherapy, targeted therapy, immunotherapy, and the use of medicinal plants, with personalized strategies based on molecular profiling and disease stage.
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Perioperative chemotherapy, involving treatment before and after surgery, has been explored as a potential strategy to improve outcomes in patients with locally advanced colon cancer. A multicenter, randomized phase 3 trial assessed the efficacy of perioperative chemotherapy with mFOLFOX6 or CAPOX compared to standard care. The study found that while perioperative chemotherapy increased the chance of pathological downstaging, it did not significantly improve disease-free survival compared to immediate surgery followed by optional adjuvant chemotherapy. However, the experimental group showed a higher 3-year overall survival rate (94.9%) compared to the standard care group (88.6%).
Adjuvant chemotherapy, administered after surgical resection, is a standard treatment for stage III colon cancer and is considered for high-risk stage II patients. The combination of fluorouracil, leucovorin, and oxaliplatin (FOLFOX) has been shown to improve disease-free survival in patients with stage II or III colon cancer. A systematic review highlighted that while adjuvant therapy did not significantly improve overall survival in stage II patients, it did enhance disease-free survival, particularly in those with high-risk features.
For metastatic colorectal cancer (mCRC), systemic therapy options have expanded significantly. The NCCN Guidelines recommend the use of checkpoint inhibitors for mCRC with deficient mismatch repair/microsatellite instability-high (dMMR/MSI-H) status, and targeted therapies for tumors with HER2 amplification or BRAF V600E mutations. Additionally, the management of unresectable metastatic disease involves a combination of chemotherapy, anti-angiogenic agents, and anti-epidermal growth factor agents, tailored based on biomarkers such as KRAS/NRAS/BRAF mutations.
The emergence of precision medicine has led to more personalized adjuvant treatment strategies for colon cancer. Factors such as gender, age, tumor stage, molecular profile, and patient preferences are increasingly considered in treatment decisions. Future approaches may involve molecular profiling through liquid biopsies to further personalize adjuvant therapy.
In addition to conventional treatments, medicinal plants have shown potential in the prevention and treatment of colon cancer. Bioactive components from plants like grape, soybean, green tea, garlic, olive, and pomegranate have demonstrated various anti-cancer mechanisms, including induction of apoptosis, reduction of DNA oxidation, and inhibition of cell proliferation. These findings suggest that purified herbal compounds could complement existing therapies and offer alternative treatment options.
The treatment landscape for colon cancer includes a range of options from perioperative and adjuvant chemotherapy to systemic therapies for metastatic disease. Personalized treatment strategies and the potential use of medicinal plants are promising areas of ongoing research. As our understanding of tumor biology and molecular profiling advances, more tailored and effective treatment regimens are likely to emerge, improving outcomes for colon cancer patients.
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