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Is fluoropyrimidindes without oxaliplatin optimal for the adjuvant treatment of mainstream stage III colon cancer?

We have read the large ACTS-CC trial by Yoshida published in September 9 issue of Annals of Oncology [1]. They have randomized 1518 stage III colon cancer patients either S-1 or UFT after curative surgery and demonstrated that S-1 was noninferior to UFT (1). We have several comments: They stated that oxaliplatin plus 5-fluorouracil or capecitabine are recommended for the adjuvant treatment of colon cancer in the western guidelines, but fluoropyrimidine alone remains one of the options. NCCN recommends oxaliplatin plus fluoropyrimidines in the order of category 1 [2] and ESMO recommends it as standard and fluoropyrimidines alone are recommended only if oxaplatin is contraindicated [3]. However, the patients in both arms received oral fluorpyrimidine without oxaliplatin in the current trial where two thirds of the participants are below 70 years of age and about 85% had stage IIIB or IIIC disease. We have the feeling that the patients in this trial may not have received the best standard of the time. Given the fact that superiority of oxaliplatin plus fluoropyrimidines were known when the trial was designed, we think that the authors should answer the question of why they designed the arms without oxaliplatin.