BC Cancer, Vancouver, British Columbia, Canada.
Hospital Sirio-Libanes, Sao Paulo, Brazil.
Oncologist. 2020 Mar;25(3):229-234. doi: 10.1634/theoncologist.2019-0553. Epub 2019 Oct 22.
The International Duration Evaluation of Adjuvant Chemotherapy (IDEA) collaboration aimed to evaluate whether 3 months of adjuvant chemotherapy are noninferior to 6 months. Our study objectives were to characterize medical oncologists' perspectives toward the results of the IDEA collaboration and to evaluate how IDEA impacted prescribing patterns of adjuvant FOLFOX and CAPOX in colon cancer.
A list of questions developed by four medical oncologists regarding IDEA results were formulated and distributed online to gastrointestinal medical oncologists globally. Descriptive statistics and chi-square tests were used to summarize information.
Of 174 responses, 145 were complete and analyzed. Responses were obtained globally from South America (53%); the U.S. and Canada (28%); Europe, Australia, and New Zealand (12%); and Asia (7%). Most clinicians (98%) were aware of the IDEA study. Prior to IDEA, clinicians preferred FOLFOX over CAPOX (81% vs. 19%). Subsequent to IDEA, 55% of clinicians preferred CAPOX over FOLFOX (odds ratio, 5.0; 95% confidence interval, 3.0-8.5; p < .01 compared with pre-IDEA). Two thirds (68%) of responders tailored duration of adjuvant therapy based on risk stratification. Most oncologists (76%) were more willing to discontinue oxaliplatin early if toxicities develop after the results of IDEA. Half of responders (50%) found that IDEA increased their confidence in decision making for adjuvant treatment; 36% were unchanged, and 15% indicated decreased confidence. Less than half (48%) were comfortable communicating the study results and the concept of a noninferiority trial with patients.
IDEA appears to have shifted clinician preference from FOLFOX to CAPOX for adjuvant therapy, and most clinicians now use a risk-stratified approach in determining duration of adjuvant therapy. Patient education resources may facilitate better communication of IDEA results to patients.
This global survey illustrates that most gastrointestinal medical oncologists now use a risk-stratified approach for determining the duration of adjuvant chemotherapy for stage III colon cancer. Clinicians are five times more likely to choose CAPOX over FOLFOX after the International Duration Evaluation of Adjuvant Chemotherapy (IDEA) collaboration results.
国际辅助化疗持续时间评估（IDEA）合作旨在评估 3 个月的辅助化疗是否不劣于 6 个月。我们的研究目的是描述肿瘤内科医生对 IDEA 合作结果的看法，并评估 IDEA 如何影响结直肠癌辅助 FOLFOX 和 CAPOX 的处方模式。
由四位肿瘤内科医生制定的关于 IDEA 结果的问题清单，并在网上分发给全球胃肠道肿瘤内科医生。使用描述性统计和卡方检验来总结信息。
在 174 份回复中，有 145 份完整并进行了分析。来自全球的回复包括南美洲（53%）；美国和加拿大（28%）；欧洲、澳大利亚和新西兰（12%）；和亚洲（7%）。大多数医生（98%）都知道 IDEA 研究。在 IDEA 之前，医生更喜欢 FOLFOX 而不是 CAPOX（81%对 19%）。在 IDEA 之后，55%的医生更喜欢 CAPOX 而不是 FOLFOX（比值比，5.0；95%置信区间，3.0-8.5；p <.01 与 IDEA 前相比）。三分之二（68%）的应答者根据风险分层来调整辅助治疗的持续时间。大多数肿瘤医生（76%）如果在 IDEA 结果后出现毒性反应，更愿意早期停止使用奥沙利铂。一半的应答者（50%）发现 IDEA 增加了他们对辅助治疗决策的信心；36%保持不变，15%表示信心下降。不到一半（48%）的人能够与患者沟通研究结果和非劣效性试验的概念。
IDEA 似乎已经将临床医生对辅助治疗的偏好从 FOLFOX 转移到了 CAPOX，现在大多数医生在确定辅助治疗的持续时间时使用风险分层方法。患者教育资源可能有助于更好地与患者沟通 IDEA 结果。
这项全球调查表明，大多数胃肠道肿瘤内科医生现在使用风险分层方法来确定 III 期结肠癌辅助化疗的持续时间。在国际辅助化疗持续时间评估（IDEA）合作结果公布后，医生选择 CAPOX 的可能性是 FOLFOX 的五倍。
