Adjuvant Treatment Selection in Resected Stage I–III Colon Adenocarcinoma

Authored by Chinmay Jani, published on 2026-11-05 21:16:08.0

  1. Resected M0 Colon Adenocarcinoma
    • Confirm Staging And Fitness
      Confirm pT/pN stage, clear margins, MMR/MSI, pathology, and fitness.
      • Stage I | T1–2 N0
        • Observation
          No adjuvant chemotherapy.
      • Stage II | T3–4 N0
        • DMMR/MSI-H?
          • T4 Or Other Significant High-Risk Features?
            • Observation Preferred
            • Discuss Observation vs Selected Oxaliplatin-Containing Chemotherapy
              Discuss observation versus selected adjuvant treatment.
          • T4 Or Other High-Risk Factors?
            • Observation
            • Discuss Adjuvant Chemotherapy
              Consider 4 or 6 months based on risk, regimen, and patient factors.
      • Stage III | Any T, N+
        • DMMR/MSI-H?
          • Assess Atezolizumab And Oxaliplatin Eligibility
            • Atezolizumab Plus Fluoropyrimidine/Oxaliplatin Chemotherapy
              ATOMIC approach: MFOLFOX6 plus atezolizumab, followed by atezolizumab.
            • Give Standard Oxaliplatin-Based Adjuvant Chemotherapy
            • Individualized Adjuvant Treatment Discussion
              Individualize fluoropyrimidine-only option where appropriate. Before treatment: check DPYD, suitability for treatment, and relevant comorbidities. Evaluate PIK alteration/aspirin eligibility separately.
          • T4 And/Or N2?
            • CAPOX × 3 Months or FOLFOX × 3–6 Months
              CAPOX for 3 months or FOLFOX for 3–6 months.
            • FOLFOX × 6 Months or CAPOX × 3–6 Months (Individualized)
              FOLFOX for 6 months or CAPOX for 3–6 months.
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