Adjuvant Treatment for pMMR/MSS Colon Cancer with Clinical T4b or Bulky Nodal Disease
This protocol applies to non-metastatic colon adenocarcinoma confirmed as proficient mismatch repair (pMMR) / microsatellite stable (MSS), where staging reveals clinical T4b disease or bulky nodal involvement.
Clinical scenario: pMMR/MSS colon adenocarcinoma, non-metastatic, with clinical T4b or bulky intra-abdominal nodal disease — a presentation that warrants perioperative systemic treatment planning.
Treatment Approach
Perioperative adjuvant chemotherapy — up to 6 months in duration — is the cornerstone of management in this setting. Several regimen options are recognised, including both combination and single-agent strategies, with certain regimens carrying a preferred designation. The complete regimen selection, sequencing, and criteria are detailed in the full protocol.
References
- Proficient MMR (pMMR)/microsatellite stable (MSS)
- Clinical T4b
- Bulky nodal disease
- FOLFOX (preferred)
- CAPEOX (preferred)
- Capecitabine
- Fluorouracil/leucovorin