Duration of Adjuvant Doublet Chemotherapy (3 or 6 months) in Patients With High-Risk Stage II Colorectal Cancer

Timothy J Iveson, Alberto F Sobrero, Takayuki Yoshino, Ioannis Souglakos, Fang-Shu Ou, Jeffrey P Meyers, Qian Shi, Axel Grothey, Mark P Saunders, Roberto Labianca, Takeharu Yamanaka, Ioannis Boukovinas, Niels H Hollander, Fabio Galli, Kentaro Yamazaki, Vassilis Georgoulias, Rachel Kerr, Eiji Oki, Sara Lonardi, Andrea HarkinGerardo Rosati, James Paul

Publikation: Bidrag til tidsskriftArtikelForskningpeer review

Abstrakt

PURPOSE: As oxaliplatin results in cumulative neurotoxicity, reducing treatment duration without loss of efficacy would benefit patients and healthcare providers.

PATIENTS AND METHODS: Four of the six studies in the International Duration of Adjuvant Chemotherapy (IDEA) collaboration included patients with high-risk stage II colon and rectal cancers. Patients were treated (clinician and/or patient choice) with either fluorouracil, leucovorin, and oxaliplatin (FOLFOX) or capecitabine and oxaliplatin (CAPOX) and randomly assigned to receive 3- or 6-month treatment. The primary end point is disease-free survival (DFS), and noninferiority of 3-month treatment was defined as a hazard ratio (HR) of < 1.2- v 6-month arm. To detect this with 80% power at a one-sided type one error rate of 0.10, a total of 542 DFS events were required.

RESULTS: 3,273 eligible patients were randomly assigned to either 3- or 6-month treatment with 62% receiving CAPOX and 38% FOLFOX. There were 553 DFS events. Five-year DFS was 80.7% and 83.9% for 3-month and 6-month treatment, respectively (HR, 1.17; 80% CI, 1.05 to 1.31; P [for noninferiority] .39). This crossed the noninferiority limit of 1.2. As in the IDEA stage III analysis, the duration effect appeared dependent on the chemotherapy regimen although a test of interaction was negative. HR for CAPOX was 1.02 (80% CI, 0.88 to 1.17), and HR for FOLFOX was 1.41 (80% CI, 1.18 to 1.68).

CONCLUSION: Although noninferiority has not been demonstrated in the overall population, the convenience, reduced toxicity, and cost of 3-month adjuvant CAPOX suggest it as a potential option for high-risk stage II colon cancer if oxaliplatin-based chemotherapy is suitable. The relative contribution of the factors used to define high-risk stage II disease needs better understanding.

OriginalsprogEngelsk
Sider (fra-til)631-641
Antal sider11
TidsskriftJournal of Clinical Oncology
Vol/bind39
Udgave nummer6
DOI
StatusUdgivet - 20 feb. 2021

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Udforsk hvilke forskningsemner 'Duration of Adjuvant Doublet Chemotherapy (3 or 6 months) in Patients With High-Risk Stage II Colorectal Cancer' indeholder.

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