Comparison of the Efficacy of S-1 Plus Oxaliplatin or Capecitabine Plus Oxaliplatin for Six and Eight Chemotherapy Cycles as Adjuvant Chemotherapy in Patients With Stage II-III Gastric Cancer After D2 Resection

ObjectiveTo compare the efficacy of adjuvant chemotherapy with six or eight cycles of S-1 plus oxaliplatin (SOX) or Capecitabine plus oxaliplatin (XELOX) after D2 resection of GC.Design and participantsWe collected 470 cases of patients with TNM stage II and III GC who underwent D2 gastrectomy in the Harbin Medical University Cancer Hospital from January 2007 to December 2017 and received six or eight cycles of SOX or XELOX regimen. This study was designed to evaluate the prognosis of patients receiving six or eight cycles of SOX or XELOX chemotherapy and identify the appropriate number of chemotherapy cycles.ResultsAmong the 470 study participants [340 (72.3%) males; median age, 50 years (range, 24-76 years)], 355 and 115 received XELOX or SOX regimen chemotherapy, respectively. The number of 152 patients included in this study who received 6 and 8 cycles of chemotherapy in stage II and stage III without considering chemotherapy regimens were 125 and 27. The median DFS was, respectively, 14.9 months and 26.8 months (P = 0.08), the median OS was, respectively, 30.2 months and 30.8 months (P = 0.5), the difference was not statistically significant. Comprehensive survival analysis of XELOX and SOX group showed no significant difference for DFS (P = 0.29) and OS (P = 0.61). The total number of stage III GC patients who received six and eight cycles of chemotherapy was 92 and 19, respectively. The median DFS of patients who received six and eight cycles of chemotherapy was 14.6 and 23.2 months (P = 0.3), respectively. The median OS of patients who received six and eight cycles of chemotherapy was 26 and 30.6 months (P = 0.9), respectively. Comprehensive analysis of DFS (P=0.73) and OS (P=0.6) shows no difference between the XELOX group SOX groups. Subgroup analysis revealed significant differences in the gender (P = 0.05) and histological classification (P < 0.05) distribution.ConclusionRegardless of the XELOX regimen or the SOX regimen, similar survival benefits are observed in patients receiving six or eight chemotherapy cycles irrespective of the regimen used. The XELOX and SOX regimens are well tolerated in patients undergoing D2 resection of GC.

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Postoperative Adjuvant Chemotherapy Cancel Out the Negative Survival Impact on Stage II/III Gastric Cancer Patients With Postoperative Complications

10.21203/rs.3.rs-1228368/v1 ◽

2022 ◽

Author(s):

Li-li Shen ◽

Jun Lu ◽

Jia Lin ◽

Bin-bin Xu ◽

Zhen Xue ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Stage Ii ◽

Stage Iii ◽

Time Interval ◽

Term Survival ◽

Significant Difference ◽

Negative Effect ◽

Gastric Cancer Patients ◽

Stratified Analysis

Abstract Purpose The potential additive influence of adjuvant chemotherapy (AC) on prognosis of patients with stage II/III gastric cancer (GC) who experienced complications after radical surgery is unclear.Methods The whole group was divided into a postoperative complication (PC) group and a postoperative non-complication (NPC) group, and the overall survival (OS) rate, recurrence-free survival (RFS) rate and recurrence rate were compared between the two groups of patients. Results A total of 1563 patients between January 2010 and December 2015 in our center were included in this analysis. There were 268 patients (17.14%) in the PC group and 1295 patients (82.86%) in the NPC group. The 5-year OS rate of the PC group was 55.2%, the NPC group was 63.3%; and the 5-year RFS rate of the PC group was 53.7%, the non-PC group was 58.8%. Recurrence patterns showed no significant difference between the two group (all p>0.05). Adjuvant chemotherapy (AC) significantly improved the OS and RFS rates of patients with and without PCs (both p<0.05), and it showed no significant difference between the PC group and the NPC group who received AC (both p> 0.05). Stratified analysis showed that AC only improve the OS or RFS rates of stage III patients (both p<0.05). Further stratified analysis of the time interval (TI) from operation to initiation of AC in the PC group showed that a TI after 6 weeks (≥6eeks) improved only the OS and RFS rates of stage III patients, while when a TI within 6 weeks (＜6weeks), a benefit was observed in stage II and III patients (both p<0.05).Conclusion AC can abolish the negative effect of PCs on the long-term survival of patients with stage III GC; for stage II patients, the above offset effect is affected by the TI. Delaying AC initiation after 6 weeks may not improve the survival of patients experienced stage II GC with complications.

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Predictive factors for the underutilization of adjuvant chemotherapy in colon cancer in Southwestern Sydney

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.6070 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 6070-6070

Author(s):

W. L. Ng ◽

G. Gabriel ◽

E. Moylan

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Predictive Factors ◽

Predictive Factor ◽

Treatment Guidelines ◽

Stage Ii ◽

Stage Iii ◽

Utilization Rate ◽

Co Morbidity ◽

Significant Difference

6070 Background: Adjuvant chemotherapy improves survival in stage III and high risk stage II colon cancers and is therefore recommended in current treatment guidelines. Despite this, retrospective studies demonstrate that utilization rates remain suboptimal in Australia and other countries. In this study we aimed to identify predictive factors for adjuvant chemotherapy underutilization in the Southwestern Sydney Area Health Service (SWSAHS). Methods: We examined data collected on all patients with a diagnosis of stage II or III colon and rectosigmoid cancers from SWSAHS colorectal database between 1997 and 2003. Follow-up and survival were calculated until October 2005. SPSS was used for statistical analysis and Kaplan-Meier for survival analysis. Results: 704 patients were identified. The overall adjuvant chemotherapy utilization rate was 48% (68% for stage III and 26% for stage II). Overall 5 year survival was 69% for patients who received adjuvant chemotherapy compared with 39% for those who did not receive chemotherapy (p<0.001). The main predictive factor identified for not receiving chemotherapy in both stages was increasing age. Rates of utilization of adjuvant chemotherapy for stage III colon cancer were 90% (<50 yrs), 81% (50–69 yrs) and 50% (70+ yrs). The trend was similar for stage II patients with corresponding utilization rates of 69%, 37% and 10%, respectively. The difference in chemotherapy utilization by age groups is highly significant (p<0.001). Other factors including sex, health insurance status, site of primary colon cancer and index of relative socioeconomic disadvantage did not show significant difference in chemotherapy usage. We were unable to evaluate the effect of co-morbidity on chemotherapy use from our database. Conclusions: Increasing age is the single most important predictive factor in the underutilization of adjuvant chemotherapy in colon cancer despite evidence that the elderly can accrue the same benefit from adjuvant chemotherapy as their younger counterparts. No significant financial relationships to disclose.

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Inferring the effects of concurrent chemotherapy with or without adjuvant chemotherapy versus radiotherapy alone in stage II-IVB nasopharyngeal carcinoma: Comparison of results from meta-analysis of observational studies and randomized trials.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e17573 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e17573-e17573

Author(s):

Teng Hwee Tan ◽

Yu Yang Soon ◽

Timothy Cheo ◽

Jeremy Chee Seong Tey ◽

Ivan Weng Keong Tham

Keyword(s):

Adjuvant Chemotherapy ◽

Nasopharyngeal Carcinoma ◽

Observational Studies ◽

Randomized Trials ◽

Meta Analysis ◽

Concurrent Chemotherapy ◽

Stage Ii ◽

Stage Iii ◽

Routine Practice ◽

Significant Difference

e17573 Background: Multiple randomized trials (RCTs) reported that concurrent chemotherapy (CCT) with or without adjuvant chemotherapy (AC) improves survival in stage II-IVB nasopharyngeal carcinoma (NPC) compared to radiation therapy alone. However, it is unclear if similar benefits can be observed in routine practice as patients included in RCTs could be very different from patients in routine practice. The aim of this study is to compare the effects of CCT with or without AC as estimated from observational studies (OBS) with findings from RCTs. Methods: We searched MEDLINE for eligible studies determining the effect of addition of CCT with or without AC in stage II-IVB NPC. Outcome of interest was overall survival (OS). We performed the meta-analysis with random effects model to estimate the pooled hazard ratios (HR), confidence intervals (CI), and I squared statistic (I2) for both RCTs and OBS and compared them using Altman interaction test. Results: We found nine RCTs and 19 OBS including 6523 patients. Eight RCTs and 14 OBS had at least 75% of its patients with stage III-IVB NPC while only one RCT and five OBS had at least 75% of its patients with stage II NPC. The survival benefit associated with chemotherapy was similar in both RCTs and OBS focusing on stage III-IVB NPC (RCTs HR 0.67, 95% CI 0.56 – 0.81, I2 = 48% vs OBS HR 0.71 95% CI 0.62 – 0.82, I2 = 4%, interaction P (IP) = 0.67). Similarly, there was no significant difference in OS for RCT and OBS focusing on stage II NPC (RCTs HR 0.34, 95% CI 0.17 to 0.66, I2 = non-applicable due to single study vs OBS HR 0.61, 95% CI 0.37 to 1.02, I2 = 0%, IP = 0.17). Conclusions: Patients with stage II and stage III-IVB nasopharyngeal carcinoma treated in routine practice received similar survival benefits associated with concurrent chemotherapy with or without adjuvant chemotherapy as patients treated in randomized trials.

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Cardiac transthyretin wild-type amyloidosis (ATTRwt): a prospective study of 400 patients followed at the Italian referral center

European Heart Journal ◽

10.1093/ehjci/ehaa946.2144 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Milani ◽

L Obici ◽

R Mussinelli ◽

M Basset ◽

G Manfrinato ◽

...

Keyword(s):

Natural History ◽

Median Survival ◽

Troponin I ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Wild Type ◽

Staging Systems ◽

Significant Difference ◽

History Of

Abstract Background Cardiac wild type transthyretin (ATTRwt) amyloidosis, formerly known as senile systemic amyloidosis, is an increasingly recognized, progressive, and fatal cardiomyopathy. Two biomarkers staging systems were proposed based on NT-proBNP (in both cases) and troponin or estimated glomerular filtration rate, that are able to predict survival in this population. The availability of novel effective treatments requires large studies to describe the natural history of the disease in different populations. Objective To describe the natural history of the disease in a large, prospective, national series. Methods Starting in 2007, we protocolized data collection in all the patients diagnosed at our center (n=400 up to 7/2019). Results The referrals to our center increased over time: 5 cases (1%) between 2007–2009, 33 (9%) in 2010–2012, 90 (22%) in 2013–2015 and 272 (68%) in 2016–2019. Median age was 76 years [interquartile range (IQR): 71–80 years] and 372 patients (93%) were males. One hundred and seventy-three (43%) had atrial fibrillation, 63 (15%) had a history of ischemic cardiomyopathy and 64 (15%) underwent pacemaker or ICD implantation. NYHA class was I in 58 subjects (16%), II in 225 (63%) and III in 74 (21%). Median NT-proBNP was 3064 ng/L (IQR: 1817–5579 ng/L), troponin I 0.096 ng/mL (IQR: 0.063–0.158 ng/mL), eGFR 62 mL/min (IQR: 50–78 mL/min). Median IVS was 17 mm (IQR: 15–19 mm), PW 16 mm (IQR: 14–18 mm) and EF 53% (IQR: 45–57%). One-hundred and forty-eight subjects (37%) had a concomitant monoclonal component in serum and/or urine and/or an abnormal free light chain ratio. In these patients, the diagnosis was confirmed by immunoelectron microscopy or mass spectrometry. In 252 (63%) the diagnosis was based on bone scintigraphy. DNA analysis for amyloidogenic mutations in transthyretin and apolipoprotein A-I genes was negative in all subjects. The median survival of the whole cohort was 59 months. The Mayo Clinic staging based on NT-proBNP (cutoff: 3000 ng/L) and troponin I (cutoff: 0.1 ng/mL) discriminated 3 different groups [stage I: 131 (35%), stage II: 123 (32%) and stage III: 127 (33%)] with different survival between stage I and II (median 86 vs. 81 months, P=0.04) and between stage II and III (median 81 vs. 62 months, P<0.001). The UK staging system (NT-proBNP 3000 ng/L and eGFR 45 mL/min), discriminated three groups [stage I: 170 (45%), stage II: 165 (43%) and stage III: 45 (12%)] with a significant difference in survival: between stage I and stage II (86 vs. 52 months, P<0.001) and between stage II and stage III (median survival 52 vs. 33 months, P=0.045). Conclusions This is one of the largest series of patients with cardiac ATTRwt reported so far. Referrals and diagnoses increased exponentially in recent years, One-third of patients has a concomitant monoclonal gammopathy and needed tissue typing. Both the current staging systems offered good discrimination of staging and were validated in our independent cohort. Funding Acknowledgement Type of funding source: None

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The efficacy of adjuvant chemotherapy for resected high-risk stage II and stage III colorectal cancer in frail patients

International Journal of Clinical Oncology ◽

10.1007/s10147-021-01876-1 ◽

2021 ◽

Author(s):

Kosuke Mima ◽

Nobutomo Miyanari ◽

Keisuke Kosumi ◽

Takuya Tajiri ◽

Kosuke Kanemitsu ◽

...

Keyword(s):

Colorectal Cancer ◽

High Risk ◽

Adjuvant Chemotherapy ◽

Stage Ii ◽

Stage Iii ◽

Frail Patients

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CXCR6-CXCL16 Axis Promotes Breast Cancer by Inducing Oncogenic Signaling

Cancers ◽

10.3390/cancers13143568 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3568

Author(s):

Hina Mir ◽

Neeraj Kapur ◽

Dominique N. Gales ◽

Praveen K. Sharma ◽

Gabriela Oprea-Ilies ◽

...

Keyword(s):

Breast Cancer ◽

Actin Polymerization ◽

Biological Significance ◽

Stage Ii ◽

Stage Iii ◽

Soluble Form ◽

Migration And Invasion ◽

Antibody Microarray ◽

Terminal Fragment ◽

Significant Difference

Precise mechanisms underlying breast cancer (BrCa) metastasis are undefined, which becomes a challenge for effective treatments. Chemokine signaling instigates the trafficking of cancer cells in addition to leukocytes. This study aimed to ascertain the clinical and biological significance of the CXCR6/CXCL16 signaling axis in the pathobiology of BrCa. Our data show a higher expression of CXCR6 in BrCa cell lines and tissues. Stage-III BrCa tissues express significantly higher CXCR6 compared to stage-II tissues. The ligand, CXCL16, could remain tethered to the cell surface, and, after proteolytic shedding of the ectodomain, the N-terminal fragment is released, converting it to its oncogenic, soluble form. Like CXCR6, N-terminal CXCL16 and ADAM-10 were significantly higher in stage-III than stage-II, but no significant difference was observed in the C-terminal fragment of CXCL16. Further, stimulation of the CXCR6/CXCL16 axis activated Src, FAK, ERK1/2, and PI3K signaling pathways, as per antibody microarray analysis, which also underlie CXCL16-induced F-actin polymerization. The CXCR6/CXCL16 axis induces cytoskeleton rearrangement facilitating migration and invasion and supports BrCa cell survival by activating the PI3K/Akt pathway. This study highlights the significance of the CXCR6/CXCL16 axis and ADAM10 as potential therapeutic targets for advanced-stage BrCa.

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Clinical and Socioeconomic Factors that Predict Non-completion of Adjuvant Chemotherapy for Colorectal Cancer in a Rural Cancer Center

The American Surgeon ◽

10.1177/00031348211054708 ◽

2022 ◽

pp. 000313482110547

Author(s):

Chelsea Knotts ◽

Alexandra Van Horn ◽

Krysta Orminski ◽

Stephanie Thompson ◽

Jacob Minor ◽

...

Keyword(s):

Colorectal Cancer ◽

Adjuvant Chemotherapy ◽

Socioeconomic Factors ◽

Cancer Patients ◽

Private Insurance ◽

Stage Ii ◽

Stage Iii ◽

Insurance Status ◽

Complete Treatment ◽

Colorectal Cancer Patients

Background Previous literature demonstrates correlations between comorbidities and failure to complete adjuvant chemotherapy. Frailty and socioeconomic disparities have also been implicated in affecting cancer treatment outcomes. This study examines the effect of demographics, comorbidities, frailty, and socioeconomic status on chemotherapy completion rates in colorectal cancer patients. Methods This was an observational case-control study using retrospective data from Stage II and III colorectal cancer patients offered chemotherapy between January 01, 2013 and January 01, 2018. Data was obtained using the cancer registry, supplemented with chart review. Patients were divided based on treatment completion and compared with respect to comorbidities, age, Eastern Cooperative Oncology Group (ECOG) score, and insurance status using univariate and multivariate analyses. Results 228 patients were identified: 53 Stage II and 175 Stage III. Of these, 24.5% of Stage II and 30.3% of Stage III patients did not complete chemotherapy. Neither ECOG status nor any comorbidity predicted failure to complete treatment. Those failing to complete chemotherapy were older (64.4 vs 60.8 years, P = .043). Additionally, those with public assistance or self-pay were less likely to complete chemotherapy than those with private insurance ( P = .049). Both factors (older age/insurance status) remained significant on multivariate analysis (increasing age at diagnosis: OR 1.03, P =.034; public insurance: OR 1.84, P = .07; and self-pay status: OR 4.49, P = .03). Conclusions No comorbidity was associated with failure to complete therapy, nor was frailty, as assessed by ECOG score. Though frailty was not significant, increasing age was, possibly reflecting negative attitudes toward chemotherapy in older populations. Insurance status also predicted failure to complete treatment, suggesting disparities in access to treatment, affected by socioeconomic factors.

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Q-TWiST analysis of tivozanib (T) versus sorafenib (S) in patients with advanced renal cell carcinoma (RCC) in the TIVO-3 study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.298 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 298-298

Author(s):

Michael Szarek ◽

Michael N. Needle ◽

Brian I. Rini ◽

Sumanta K. Pal ◽

David F. McDermott ◽

...

Keyword(s):

Progression Free Survival ◽

Phase Iii ◽

P Value ◽

Patient Centered ◽

Health States ◽

Significant Difference ◽

Phase Iii Study ◽

The Difference ◽

Similar Survival ◽

Mean Differences

298 Background: In the randomized phase III study TIVO-3, the VEGFR-TKI tivozanib (TIVO) increased progression-free survival with better tolerability but no difference in overall survival (OS) relative to sorafenib (SORA) as third- or fourth-line therapy in patients with metastatic RCC. These results provide motivation to apply quality-adjusted time without symptoms of disease and toxicity (Q-TWiST) methods to quantify the net health benefits of TIVO, in the presence of similar survival, when compared to SORA. Methods: In application of Q-TWiST, patient-level OS was subdivided into three mutually exclusive states: time with toxicity (TOX), time without symptoms and toxicity (TWiST), and time after progression/relapse (REL). Mean Q-TWiST was calculated by applying utility coefficients of 0.5, 1.0, and 0.5 to the restricted mean (max 36 months follow-up) health states of TOX, TWiST, and REL, respectively; 95% CIs for the means and mean differences were estimated by bootstrap distributions. Relative Q-TWiST gain was defined as the mean absolute Q-TWiST difference divided by the SORA mean OS. Results: Mean TWiST was significantly longer for TIVO than for SORA (10.30 months v.5.35 months; Table). Mean REL time was significantly shorter for TIVO, with no difference in mean TOX time. Mean Q-TWiST was 15.04 and 12.78 months for TIVO and SORA, respectively, a statistically significant difference (p=0.0493). The relative gain for TIVO was 11.2%. Clinical trial information: NCT02627963 . Values in table are mean (95% CI) in months or p-value for difference in treatment group means. Conclusions: The difference in Q-TWiST in TIVO-3 was primarily driven by benefits of TIVO in TWiST, partially offset by superiority of SORA in REL time. As a third- or fourth-line treatment for RCC, TIVO significantly increased Q-TWiST relative to SORA, primarily through an increase in TWiST, which is generally considered to be the state with highest utility to patients. Consequently, Q-TWiST may be considered an alternative patient-centered measure of benefit of TIVO in these settings. [Table: see text]

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Invasive thymoma: the role of mediastinal irradiation following complete or incomplete surgical resection.

Journal of Clinical Oncology ◽

10.1200/jco.1988.6.11.1722 ◽

1988 ◽

Vol 6 (11) ◽

pp. 1722-1727 ◽

Cited By ~ 225

Author(s):

W J Curran ◽

M J Kornstein ◽

J J Brooks ◽

A T Turrisi

Keyword(s):

Relapse Rate ◽

Salvage Therapy ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Subtotal Resection ◽

Total Resection ◽

Mediastinal Irradiation ◽

Significant Difference

To evaluate the role of mediastinal irradiation (RT) following surgery for invasive thymomas, a clinical and pathologic review of 117 patients with the diagnosis of thymoma was completed. Fourteen cases were excluded because of the lack of histologic criteria for a thymic tumor, and the remaining 103 were classified according to a staging system as follows: stage I, completely encapsulated (43); stage II, extension through the capsule or pericapsular fat invasion (21); stage III, invasion of adjacent structures (36); and stage IV, thoracic dissemination or metastases (3). The 5-year actuarial survival and relapse-free survival rates were 67% and 100% for stage I, 86% and 58% for stage II, and 69% and 53% for stage III. No recurrences occurred among stage I patients after total resection without RT. However, eight of 21 patients with invasive (stage II or III) thymomas had mediastinal recurrence as the first site of failure following total resection without RT. The 5-year actuarial mediastinal relapse rate of 53% in this group compares unfavorably with the mediastinal relapse rate seen among stage II or III cases following total resection with RT (0%) or following subtotal resection/biopsy with RT (21%). Despite attempted salvage therapy, five of eight patients with mediastinal relapse following total resection alone died of progressive disease. No significant difference was observed in the local relapse rate, overall relapse rate, or survival between those patients undergoing biopsy and RT v subtotal resection and RT for invasive thymomas (stages II and III). Total resection alone appears to be inadequate therapy resulting in an unacceptably high local failure rate with poor salvage therapy results.

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Duration of Oxaliplatin-Containing Adjuvant Therapy for Stage III Colon Cancer: ASCO Clinical Practice Guideline

Journal of Clinical Oncology ◽

10.1200/jco.19.00281 ◽

2019 ◽

Vol 37 (16) ◽

pp. 1436-1447 ◽

Cited By ~ 10

Author(s):

Christopher Lieu ◽

Erin B. Kennedy ◽

Emily Bergsland ◽

Jordan Berlin ◽

Thomas J. George ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Expert Panel ◽

Disease Free Survival ◽

Evidence Base ◽

Stage Iii ◽

Risk Of Recurrence ◽

Stage Iii Colon Cancer ◽

Significant Difference ◽

Resected Stage

PURPOSE To develop recommendations for duration of adjuvant chemotherapy with a fluoropyrimidine and oxaliplatin for patients with completely resected stage III colon cancer based on the results of trials of 3 months compared with 6 months of treatment. METHODS ASCO convened an Expert Panel and conducted a systematic review of relevant studies. The guideline recommendations were based on the review of evidence by the Expert Panel. RESULTS Pooled data from the six International Duration Evaluation of Adjuvant Chemotherapy (IDEA) Collaboration randomized controlled trials comprise the evidence base for these guideline recommendations. RECOMMENDATIONS The recommendations for therapy duration apply to patients with completely resected stage III colon cancer who are being offered adjuvant chemotherapy with oxaliplatin and a fluoropyrimidine. Recommendations are informed by the findings of a recent pooled analysis of clinical trials that compared 6 months versus 3 months of oxaliplatin-based chemotherapy. For patients at a high risk of recurrence (T4 and/or N2), adjuvant chemotherapy should be offered for a duration of 6 months. For patients at a low risk of recurrence (T1, T2, or T3 and N1), either 6 months of adjuvant chemotherapy or a shorter duration of 3 months may be offered on the basis of a potential reduction in adverse events and no significant difference in disease-free survival with the 3-month regimen. In determining duration of therapy, the Expert Panel recommends a shared decision-making approach, taking into account patient characteristics, values and preferences, and other factors and including a discussion of the potential for benefit and risks of harm associated with treatment duration. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines .

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