Boakye Daniel, Jansen Lina, Halama Niels, Chang-Claude Jenny, Hoffmeister Michael, Brenner Hermann
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Division of Translational Immunotherapy, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.
Ther Adv Med Oncol. 2021 Apr 22;13:17588359211006348. doi: 10.1177/17588359211006348. eCollection 2021.
The benefit of chemotherapy in colon cancer patients is well documented but depends largely on whether patients complete the planned treatment regimen. We evaluated predictors of early discontinuation (EDChemo) and dose reduction of chemotherapy, especially the role of adverse treatment effects, in stage III patients who received adjuvant chemotherapy.
Stage III colon cancer patients who were diagnosed in 2003-2014 and recruited into a population-based study in Germany and received FOLFOX [5-fluorouracil (5-FU), leucovorin (LV), and oxaliplatin], capecitabine monotherapy (CapMono), or 5-FU/LV were included. We assessed determinants of EDChemo and dose reduction using multivariable logistic regression. Also, we estimated proportions of EDChemo and dose reduction that are attributable to adverse effects using attributable fractions.
EDChemo and dose reduction rates were 52% and 17% for FOLFOX, 28% and 9% for CapMono, and 45% and 6% for 5-FU/LV, respectively. Predictors of EDChemo were low-grade tumor and treatment in a medium-volume hospital (for FOLFOX), obesity (for CapMono), and increasing age, T4 stage, and treatment in a medium-volume hospital (for 5-FU/LV). Adverse effects were particularly strongly associated with EDChemo and contributed to about 63%, 51%, and 32% of EDChemo of FOLFOX, CapMono, and 5-FU/LV, respectively. Of the various adverse effects, gastrointestinal events showed the strongest associations with EDChemo and accounted for about 7%, 26%, and 20% of EDChemo of FOLFOX, CapMono, and 5-FU/LV, respectively. Adverse effects were, moreover, a strong determinant of dose reduction and accounted for about 82% of all cases.
EDChemo is common in stage III colon cancer patients receiving chemotherapy and more than half of the cases of EDChemo and dose reduction are due to adverse treatment effects. Further research should address the potential for reducing EDChemo and dose reduction rates by close monitoring of patients for early signs and enhanced management of adverse effects, especially gastrointestinal events.
化疗对结肠癌患者的益处已有充分记录，但很大程度上取决于患者是否完成计划的治疗方案。我们评估了接受辅助化疗的III期患者早期终止化疗（EDChemo）和化疗剂量减少的预测因素，尤其是不良治疗效应的作用。
纳入2003年至2014年诊断为III期结肠癌、在德国一项基于人群的研究中入组并接受FOLFOX方案[5-氟尿嘧啶（5-FU）、亚叶酸钙（LV）和奥沙利铂]、卡培他滨单药治疗（CapMono）或5-FU/LV方案的患者。我们使用多变量逻辑回归评估EDChemo和剂量减少的决定因素。此外，我们使用归因分数估计可归因于不良反应的EDChemo和剂量减少的比例。
FOLFOX方案的EDChemo率和剂量减少率分别为52%和17%，CapMono方案为28%和9%，5-FU/LV方案为45%和6%。EDChemo的预测因素为低级别肿瘤以及在中等规模医院接受治疗（对于FOLFOX方案）、肥胖（对于CapMono方案）、年龄增加、T4期以及在中等规模医院接受治疗（对于5-FU/LV方案）。不良反应与EDChemo的关联尤为强烈，分别占FOLFOX方案、CapMono方案和5-FU/LV方案EDChemo的约63%、51%和32%。在各种不良反应中，胃肠道事件与EDChemo的关联最为强烈，分别占FOLFOX方案、CapMono方案和5-FU/LV方案EDChemo的约7%、26%和20%。此外，不良反应是剂量减少的一个重要决定因素，约占所有病例的82%。
在接受化疗的III期结肠癌患者中，EDChemo很常见，超过一半的EDChemo和剂量减少病例是由不良治疗效应导致的。进一步的研究应探讨通过密切监测患者的早期症状以及加强对不良反应（尤其是胃肠道事件）的管理来降低EDChemo和剂量减少率的可能性。
