Jonathan M Loree1, Aaron Sha1, Maryam Soleimani1, Hagen F Kennecke2, Maria Y Ho1, Winson Y Cheung3, Karen E Mulder4, Shirin Abadi1, Jennifer L Spratlin4, Sharlene Gill5. 1. Division of Medical Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada. 2. Department of Oncology, Virginia Mason Medical Center, Seattle, WA. 3. Department of Oncology, University of Calgary, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada. 4. Department of Oncology and Faculty of Medicine and Dentistry, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada. 5. Division of Medical Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: sgill@bccancer.bc.ca.
Abstract
BACKGROUND: Capecitabine and oxaliplatin (CAPOX) and folinic acid, fluorouracil, and oxaliplatin (FOLFOX) are both used in the adjuvant treatment of colon cancer, and while their efficacy is assumed to be similar, they have not been directly compared. We reviewed the toxicity profiles, relative dose intensity (RDI), and survival associated with these regimens across a multi-institutional cohort. PATIENTS AND METHODS: We identified 394 consecutively treated patients with stage III colon cancer who received an oxaliplatin-containing regimen. RDI was defined as the total dose received divided by the intended total dose if all cycles were received. RESULTS: FOLFOX was associated with increased mucositis (6.2% vs. 0.7%, P = .0069) and neutropenia (25.9% vs. 8.6%, P < .0001), while CAPOX was associated with increased dose-limiting toxicities (DLTs) (90.7% vs. 80.2%, P = .0055), diarrhea (31.8% vs. 9.0%, P < .0001), and hand-foot syndrome (19.9% vs. 2.1%, P < .0001). Higher median RDI of fluoropyrimidine (93.7% vs. 80.0%, P < .0001) and oxaliplatin (87.2% vs. 76.3%, P < .0001) was noted for patients receiving FOLFOX. Reducing the duration from 6 to 3 months would have prevented 28.7% of FOLFOX and 20.5% of CAPOX patients from ever experiencing a DLT (P = .0008). Overall survival did not differ by regimen (hazard ratio = 0.73; 95% confidence interval 0.45-1.22; P = .24). However, CAPOX was associated with improved disease-free survival (3-year disease-free survival 83.8% vs. 73.4%, P = .022), which remained significant in high-risk (T4 or N2) (P = .039) but not low-risk patients (P = .19). CONCLUSION: CAPOX may be associated with improved disease-free survival despite greater toxicities and lower RDI. Reducing adjuvant chemotherapy duration to 3 months would prevent 26% of patients from ever experiencing a DLT.
BACKGROUND:Capecitabine and oxaliplatin (CAPOX) and folinic acid, fluorouracil, and oxaliplatin (FOLFOX) are both used in the adjuvant treatment of colon cancer, and while their efficacy is assumed to be similar, they have not been directly compared. We reviewed the toxicity profiles, relative dose intensity (RDI), and survival associated with these regimens across a multi-institutional cohort. PATIENTS AND METHODS: We identified 394 consecutively treated patients with stage III colon cancer who received an oxaliplatin-containing regimen. RDI was defined as the total dose received divided by the intended total dose if all cycles were received. RESULTS:FOLFOX was associated with increased mucositis (6.2% vs. 0.7%, P = .0069) and neutropenia (25.9% vs. 8.6%, P < .0001), while CAPOX was associated with increased dose-limiting toxicities (DLTs) (90.7% vs. 80.2%, P = .0055), diarrhea (31.8% vs. 9.0%, P < .0001), and hand-foot syndrome (19.9% vs. 2.1%, P < .0001). Higher median RDI of fluoropyrimidine (93.7% vs. 80.0%, P < .0001) and oxaliplatin (87.2% vs. 76.3%, P < .0001) was noted for patients receiving FOLFOX. Reducing the duration from 6 to 3 months would have prevented 28.7% of FOLFOX and 20.5% of CAPOXpatients from ever experiencing a DLT (P = .0008). Overall survival did not differ by regimen (hazard ratio = 0.73; 95% confidence interval 0.45-1.22; P = .24). However, CAPOX was associated with improved disease-free survival (3-year disease-free survival 83.8% vs. 73.4%, P = .022), which remained significant in high-risk (T4 or N2) (P = .039) but not low-risk patients (P = .19). CONCLUSION:CAPOX may be associated with improved disease-free survival despite greater toxicities and lower RDI. Reducing adjuvant chemotherapy duration to 3 months would prevent 26% of patients from ever experiencing a DLT.
Authors: Yi Zhong; Tao Su; Qiuxiao Shi; Yanru Feng; Ze Tao; Qiuxia Huang; Lan Li; Liqiang Hu; Shengfu Li; Hong Tan; Shan Liu; Hao Yang Journal: Int J Nanomedicine Date: 2019-11-01
Authors: Lennard Y W Lee; Thomas Starkey; Shivan Sivakumar; Susan Fotheringham; Guy Mozolowski; Vanessa Shearwood; Claire Palles; Philip Camilleri; David Church; Rachel Kerr; David Kerr Journal: Cancer Med Date: 2019-09-04 Impact factor: 4.452
Authors: Tiago Cordeiro Felismino; Victor Hugo Fonseca de Jesus; Bruno Cezar de Mendonça Uchóa Junior; Francisca Giselle Rocha Moura; Rachel P Riechelmann; Samuel Aguiar Junior; Celso Abdon Lopes de Mello Journal: Ecancermedicalscience Date: 2020-02-24