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Adjuvant fluorouracil, leucovorin and oxaliplatin in stage II–III colon cancer

One-paragraph summary

This 10-year follow-up of MOSAIC compared FOLFOX4 with fluorouracil/leucovorin after resection. In stage III, 10-year overall survival was 67.1% with FOLFOX4 versus 59.0% with fluorouracil/leucovorin. No overall-survival benefit was shown for stage II, and exploratory BRAF/MMR analyses were limited by subgroup size (PMID 26527776).

Key findings

  • Oxaliplatin produced durable stage III disease-control and survival benefit.
  • Stage III absolute 10-year OS difference was 8.1 percentage points.
  • Stage II did not show an OS advantage in the overall subgroup.
  • Long follow-up established chronic neuropathy as part of the benefit–harm calculation.

Limitations

  • Regimens and supportive care reflect an earlier era.
  • Biomarker subgroups were not powered for definitive treatment interactions.
  • Trial fitness and age distribution limit frail/older generalization.
  • Duration was six months; IDEA later tested shorter treatment.

Why it matters

MOSAIC established oxaliplatin-based adjuvant therapy as the stage III colon standard and created the toxicity problem that IDEA duration trials sought to reduce.

Cited by wiki pages

  • Overview
  • Localized colon cancer