Nabil Ismaili, Director of Medical Oncology and Radiotherapy Department at Mohammed VI University of Sciences and Health, shared a post on LinkedIn:
“New publication – Cancer Investigation
I am pleased to share the publication of my systematic review ‘Biomarker‑Guided Adjuvant Therapy in Stage II/III Colon Cancer: A Systematic Review of Current Evidence and Clinical Implications’ in Cancer Investigation (Taylor & Francis).
Why this matters: Adjuvant therapy for stage II/III colon cancer is shifting from a one‑size‑fits‑all approach to biomarker‑driven precision oncology.
Key takeaways from 52 included studies:
- Universal MMR testing is mandatory – dMMR/MSI‑H tumors (~15%) should receive immunotherapy (ATOMIC trial: 3‑year DFS 86.4% vs 76.6%; HR 0.50; NICHE‑2: pCR 68%, 3‑year DFS 100%).
- Perioperative CEA – remains a valuable, low‑cost biomarker for initial risk stratification.
- ctDNA – enables dynamic MRD detection and safe de‑escalation of oxaliplatin (DYNAMIC‑III: ~60% reduction in oxaliplatin use; 3‑year RFS 85.3% vs 88.1%).
- KRAS/BRAF mutations + tumor laterality – refine prognosis in MSS tumors (KRAS codon 12 mutations portend worse outcomes, especially in left‑sided tumors).
- Toxicity biomarkers (DPYD, UGT1A1) – should be assessed before treatment to personalize dosing.
A stepwise framework is proposed: MMR testing → CEA → mutational profiling + laterality → ctDNA (when available) → DPYD/UGT1A1 genotyping
Remaining challenges: assay standardization, accessibility in LMICs, and validation in under‑represented populations (elderly, organ impairment, ethnic minorities).
Grateful to my colleagues at Mohammed VI University of Sciences and Health (Casablanca).”
Title: Biomarker‑Guided Adjuvant Therapy in Stage II/III Colon Cancer: A Systematic Review of Current Evidence and Clinical Implications
Author: Nabil Ismaili
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