Advances in Early-Stage Colorectal Cancer Care: Integrating Emerging Evidence Into Practice

Early-stage colorectal cancer management is expanding beyond standard surgery, chemotherapy, and radiation, driven by molecular stratification and emerging data from landmark randomized trials. Daily aspirin for 3 years is now guideline-recommended for patients with stage II and III disease harboring somatic PIK3CA pathway alterations. This approach mandates molecular profiling of all stage II and III tumors at diagnosis. Immunotherapy for patients with mismatch repair–deficient (dMMR) tumors has changed the treatment paradigm. Neoadjuvant immunotherapy for locally advanced dMMR tumors—including dostarlimab and nivolumab/ipilimumab—has produced complete clinical and pathologic response rates that are enabling nonoperative management in select individuals. For the adjuvant treatment of stage III colon cancer, the addition of atezolizumab to FOLFOX is now recommended. Finally, structured exercise has taken its place in the adjuvant treatment guidelines, based on a randomized trial demonstrating a statistically significant improvement in disease-free and overall survival.