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Impact of p53 expression and microsatellite instability on stage III colon cancer disease-free survival in patients treated by 5-fluorouracil and leucovorin with or without oxaliplatin
Annals of Oncology, 10/19/09

Zaanan A et al. – Our observations indicate that MSI status and p53 expression may influence the impact of oxaliplatin on adjuvant treatment of stage III colon cancer patients.

Methods

Retrospective study included 233 unselected patients with stage III colon cancer treated by FL (n = 124) or FOLFOX (n = 109)
Impact of p53 expression and MSI on disease-free survival (DFS) defined using univariate and multivariate analyses
Cox proportional hazards model specifically designed to evaluate interaction between chemotherapy and these genetic alterations

Results

In univariate analyses, addition of oxaliplatin significantly improved DFS provided that tumour overexpressed p53 or displayed MSI phenotype
In multivariate analyses, p53 confirmed as independent factor predictive of benefit from FOLFOX (P = 0.03), while interaction of MSI with chemotherapy could not be determined in the absence of relapse in the MSI group treated with FOLFOX

Exclusive Author Commentary
PRAZ Françoise, 10/20/09

Both p53 expression and MSI phenotype may have an impact on the efficacy of adjuvant treatment by FOLFOX in patients with stage III colon cancer. Yet, the clinical outcome of patients whose tumour lacks detectable expression of p53 and does not display MSI was not improved by adding oxaliplatin to FL regimen. Although such a retrospective study remains to be validated in future studies to translate into clinical practice, these observations are very promising since they may help personalizing therapy by identifying a subgroup of patients who are most likely to benefit from FOLFOX.

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