Three Versus Six Months of Adjuvant Oxaliplatin-Containing Chemotherapy for Patients With Stage III Colorectal Cancer: A Contemporary Real-World Analysis.

IF 4.7 3区 医学 Q1 ONCOLOGY JCO oncology practice Pub Date : 2024-10-09 DOI:10.1200/OP-24-00492
Tharani Krishnan, Emily Leung, Joao Paulo Solar Vasconcelos, Howard Lim, Jonathan M Loree, Janine Davies, Karamjit Gill, Sharlene Gill
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Abstract

Purpose: Based on the International Duration Evaluation of Adjuvant Chemotherapy analysis, 3 months of adjuvant chemotherapy with capecitabine and oxaliplatin (CAPOX) is an option for stage III colorectal cancer (colorectal cancer [CRC]), with cost and toxicity benefits. We examined the patterns of uptake of CAPOX versus fluorouracil, leucovorin, and oxaliplatin (FOLFOX) and chemotherapy duration in a contemporary real-world cohort of patients in Canada.

Methods: The provincial pharmacy database was used to identify patients with resected stage III CRC receiving adjuvant chemotherapy between January 2021 and December 2022. Demographic, tumor, and treatment information was collected and compared.

Results: Of 452 patients, 234 (52%) and 218 (48%) were planned to receive 3 and 6 months of chemotherapy, respectively. Within the 3-month group, 226 (97%) received CAPOX. Within the 6-month group, there was a 51%-49% split between CAPOX and FOLFOX. Age >70 years (P = .039), well/moderately differentiated (P = .005), and low-risk disease (P < .0001) were significantly associated with 3 months. Performance status, ileostomy, or preexisting neuropathy did not affect treatment choice. Of patients planned for 6 months, 29% had low-risk disease, with 52% of these receiving CAPOX. Patients receiving 6 months were more likely to report neuropathy (68 v 36%, P < .0001) and to stop oxaliplatin early (54 v 31%, P < .0001). The most likely reason for early adjuvant discontinuation was neuropathy in the 6-month group and gastrointestinal toxicity in the 3-month group (P < .0001). Irrespective of duration, mean time from consult to starting chemotherapy was longer for FOLFOX versus CAPOX (24 v 19 days, P = .007).

Conclusion: In this contemporary cohort, 6 months chemotherapy is still being offered to patients with low-risk disease and is associated with more neuropathy. Exploration of patient preferences and resource costs may improve adoption of reduced duration adjuvant CAPOX in stage III CRC.

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III 期结直肠癌患者接受含奥沙利铂辅助化疗三个月还是六个月?当代真实世界分析
目的:根据国际辅助化疗持续时间评估分析,3 个月的卡培他滨和奥沙利铂辅助化疗(CAPOX)是 III 期结直肠癌(colorectal cancer [CRC])的一种选择,具有成本和毒性优势。我们研究了加拿大当代真实世界患者队列中 CAPOX 与氟尿嘧啶、亮菌素和奥沙利铂(FOLFOX)的使用模式以及化疗持续时间:方法:利用省级药房数据库来识别2021年1月至2022年12月期间接受辅助化疗的切除III期CRC患者。收集并比较了人口统计学、肿瘤和治疗信息:在452名患者中,分别有234人(52%)和218人(48%)计划接受3个月和6个月的化疗。在 3 个月组中,226 人(97%)接受了 CAPOX 化疗。在 6 个月组中,CAPOX 和 FOLFOX 的比例为 51%-49%。年龄大于 70 岁(P = .039)、分化良好/中度(P = .005)和低风险疾病(P < .0001)与 3 个月的疗程显著相关。表现状态、回肠造口术或已有的神经病变并不影响治疗选择。在计划接受 6 个月治疗的患者中,29% 患有低风险疾病,其中 52% 接受了 CAPOX 治疗。接受 6 个月治疗的患者更有可能报告神经病变(68 对 36%,P < .0001)和提前停用奥沙利铂(54 对 31%,P < .0001)。6个月组患者最有可能提前停用辅助药物的原因是神经病变,3个月组患者最有可能提前停用辅助药物的原因是胃肠道毒性(P < .0001)。无论疗程长短,FOLFOX与CAPOX相比,从就诊到开始化疗的平均时间更长(24天对19天,P = .007):结论:在这一现代队列中,6 个月的化疗仍在提供给低风险疾病患者,并且与更多的神经病变相关。对患者偏好和资源成本的探讨可能会改善 CAPOX 辅助化疗在 III 期 CRC 中的应用。
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