Evaluation of Adjuvant Short CAPOX Followed by Capecitabine for Stage III Colon Cancer

Abstract

Background: Since 2004, 6 months of postsurgical adjuvant chemotherapy with combination of 5-FU/LV or oral Capecitabine and Oxaliplatin has been the standard of care worldwide for patients with stage III colon cancer. Objectives: to evaluate the efficacy of 3-months of Capecitabine and Oxaliplatin (CAPOX) followed by 3 months Capecitabine alone as adjuvant treatment in stage III colon cancer. Methods: This is a prospective study that included 50 patients with stage III colon cancer who presented to National Cancer Institute, Cairo University to receive adjuvant CAPOX for three months followed by three months Capecitabine alone where disease free survival (DFS) & overall survival (OS) and toxicity were evaluated. Results: The median age of patients was 43 years (range: 21-70) with male predominance. The majority of patients (70%) had right-sided lesions and N1 stage (64%). After a median follow up period of 36.8 months (range: 9.5-50.8); the 3-year cumulative DFS & OS were 57.2 & 86.3% respectively. Patients’ age, presence of comorbidity, higher grade, development of chemotherapy-related peripheral neuropathy (PN), N2 stage, perineural invasion (PNI) and lymph node ratio (LNR) > 0.25 were significantly associated with worse DFS whereas, the latter two were significantly related to worse OS. Diarrhea, vomiting, hand-foot syndrome and PN were the most common grade 3 toxicities. The latter was significantly higher in patients with preexisting diabetes. Conclusion: This small phase II study suggests that shorter duration of adjuvant oxaliplatin in stage III colon cancer might be associated with less toxicity especially peripheral neuropathy but still shows comparable survival to the six-months regimen. Further larger scale prospective randomized trial is mandatory to confirm these results.