Krishnan Tharani, Leung Emily, Solar Vasconcelos Joao Paulo, Lim Howard, Loree Jonathan M, Davies Janine, Gill Karamjit, Gill Sharlene
BC Cancer-Vancouver, University of British Columbia, Vancouver, BC.
Department of Medicine, University of British Columbia, Vancouver, BC.
JCO Oncol Pract. 2025 Mar;21(3):365-372. doi: 10.1200/OP-24-00492. Epub 2024 Oct 9.
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.
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.
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 ( = .039), well/moderately differentiated ( = .005), and low-risk disease ( < .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 36%, < .0001) and to stop oxaliplatin early (54 31%, < .0001). The most likely reason for early adjuvant discontinuation was neuropathy in the 6-month group and gastrointestinal toxicity in the 3-month group ( < .0001). Irrespective of duration, mean time from consult to starting chemotherapy was longer for FOLFOX versus CAPOX (24 19 days, = .007).
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.
基于国际辅助化疗持续时间评估分析，对于III期结直肠癌患者，采用卡培他滨和奥沙利铂（CAPOX）进行3个月的辅助化疗是一种选择，具有成本和毒性方面的优势。我们在加拿大一个当代真实世界患者队列中研究了CAPOX与氟尿嘧啶、亚叶酸钙和奥沙利铂（FOLFOX）的使用模式以及化疗持续时间。
利用省级药房数据库识别2021年1月至2022年12月期间接受辅助化疗的III期结直肠癌切除患者。收集并比较人口统计学、肿瘤和治疗信息。
在452例患者中，分别有234例（52%）和218例（48%）计划接受3个月和6个月的化疗。在3个月组中，226例（97%）接受了CAPOX。在6个月组中，CAPOX和FOLFOX的比例为51%对49%。年龄>70岁（P = 0.039）、高/中分化（P = 0.005）和低风险疾病（P < 0.0001）与3个月化疗显著相关。体能状态、回肠造口术或既往神经病变不影响治疗选择。在计划接受6个月化疗的患者中，29%患有低风险疾病，其中52%接受了CAPOX。接受6个月化疗的患者更有可能报告神经病变（68%对36%，P < 0.0001）并提前停用奥沙利铂（54%对31%，P < 0.0001）。6个月组辅助化疗提前停药的最可能原因是神经病变，3个月组是胃肠道毒性（P < 0.0001）。无论化疗持续时间如何，FOLFOX组从咨询到开始化疗的平均时间比CAPOX组长（24对19天，P = 0.007）。
在这个当代队列中，低风险疾病患者仍在接受6个月的化疗，且神经病变较多。探索患者偏好和资源成本可能会提高III期结直肠癌患者采用缩短疗程的辅助性CAPOX化疗的比例。
