Role of Leucovorin in Colon Cancer Management

Adjuvant Therapy

The National Comprehensive Cancer Network recommends 5-FU/leucovin as standard adjuvant treatment for all stage III colon cancer patients, demonstrating significant improvement in disease-free and overall survival 1, 2
The addition of oxaliplatin to 5-FU/LV (FOLFOX regimen) further improves disease-free survival in stage III colon cancer and is now considered the standard of care 3
For stage II colon cancer, adjuvant chemotherapy with 5-FU/leucovorin may be considered for patients with high-risk features, such as T4 tumors, poorly differentiated histology, and vascular invasion 1, 4

Standard adjuvant treatment regimens incorporating leucovorin include 5-FU plus leucovorin (LV5FU2) and FOLFOX (5-FU/leucovorin plus oxaliplatin) 2, 3
The recommended duration of adjuvant chemotherapy is typically 6 months, though 3-month CAPEOX may be considered for high-risk stage II and low-risk stage III patients based on the IDEA study 2

Patients receiving bolus 5-FU/leucovorin/irinotecan should be carefully monitored due to potential increased 60-day mortality from gastrointestinal toxicity 1
MMR status testing is essential for all stage II patients, as dMMR patients have better prognosis and may not benefit from adjuvant 5-FU/LV therapy 2