Nicholas Hornstein, Gastrointestinal Medical Oncologist and Assistant Professor at Northwell Health Cancer Institute, shared on LinkedIn:
“IROCAS: PIII adjuvant mFOLFIRINOX vs mFOLFOX6 in high-risk stage III colon cancer, now in Annals of Oncology.
TLDR: Adding irinotecan did nothing (because it has never worked in the adjuvant setting)
Key Points
- Adjuvant colon, pT4 and/or pN2
- mFOLFIRINOX vs mFOLFOX6, 12 cycles, n=795
Results
- 3-yr DFS 65.6% vs 66.3%, HR 1.07
- 3-yr OS 91.2% vs 86.7%, HR 0.85
- Grade ≥3 AEs identical at 62% (little surprising, just more diarrhea and GCSF use)
Importantly, the DFS curves sit on top of each other.
Irinotecan doesn’t work in the adjuvant setting, which brings me to my next point, CIRCULATE-US
The escalation arm is cooked. I wonder if there is still equipoise to enroll there? After this and DYNAMIC-III failed, do we have enough data? I guess OS is still immature here so there is a minuscule glimmer of hope?
ctDNA keeps getting better at finding the patients who need better treatments, the problem is we didn’t have them until recently.
My pitch? Let’s use the new meds, G12Xs, anti-HER2, ADCs with non-irinotecan payloads. We have to do better for our patients. No one should be reaching for Irinotecan as adjuvant in 2026.”
Title: A randomised phase III trial of adjuvant treatment intensification with mFOLFIRINOX versus mFOLFOX6 in high-risk stage III colon cancer: Results of the international IROCAS study
Authors: J. Bennouna, T. André, E. Martin, C. Cremolini, S. Gill, T. Asmis, P. Kavan, E. Mitry, S. Hiret, L. Mineur, P. Artru, C. Perret, O. Bouché, Y. Touchefeu, B. Goldenberg, O. Dupuis, S. Lonardi, B. Chibaudel, H. Castanié, C. Coutzac, L. Bauguion, E. Guardiola, A. Benmaziane, J. Barrière, E. Chen, V. Simmet, G. Allegrini, F. Marmorino, V. Pezzella, L. Monard, L. Campion, C. O’Callaghan, and J. Taieb.
Read the Full Article
You may also be interested in: IROCAS at ESMO 2026: mFOLFIRINOX vs mFOLFOX6 in High-Risk Stage III Colon Cancer
