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Survival and patient-reported outcomes of real-world high-risk stage II and stage III colon cancer patients after reduction of adjuvant CAPOX duration from 6 to 3 months.
- Source :
-
European journal of cancer (Oxford, England : 1990) [Eur J Cancer] 2024 Sep; Vol. 208, pp. 114207. Date of Electronic Publication: 2024 Jul 10. - Publication Year :
- 2024
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Abstract
- Aim: Adjuvant chemotherapy has been advised for high-risk stage II and III colon cancer since 2004. After the IDEA study showed no clinically relevant difference in outcome, reduction of adjuvant CAPOX duration from 6 to 3 months was rapidly adopted in the Dutch treatment guideline in 2017. This study investigates the real-world impact of the guideline change on overall survival (OS) and patient-reported outcomes (PROs).<br />Methods: Patients with high-risk stage II (pT4 +) and III (pN+) colon cancer were selected from the Netherlands Cancer Registry, based on surgical resection and adjuvant CAPOX before (2015-2016) versus after (2018-2019) the guideline change. Both groups were compared on OS, using multivariable Cox regression, and on PROs.<br />Results: Patients treated before (n = 2330) and after (n = 2108) the guideline change showed similar OS (HR 1.02; 95 %CI [0.89-1.16]), also in high-risk stage III (pT4/N2, HR 1.06 [0.89-1.26]). After the guideline change, 90 % of patients were treated for 3 months with no inferior OS to those still receiving 6 months (HR 0.89 [0.66-1.20]). PROs 2 years after CAPOX completion, available for a subset of patients, suggest a lower neuropathy (n = 366; 26.2 [21.3-31.1] to 16.5 [14.4-18.6]) and better quality of life (n = 396; 80.9 [78.6-83.2] to 83.9 [82.8-84.9]), but no significant difference in workability (n = 120; 31.5 [27.9-35.1]) to 35.3 [33.8-36.7]), with reduction from 6 to 3 months of CAPOX.<br />Conclusion: This real-world study confirmed that shorter adjuvant CAPOX did not compromise OS and may improve PROs, complementing the IDEA study and supporting 3 months of adjuvant CAPOX in daily clinical practice.<br />Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: I.A.F: Grant to institution: DoMore Diagnostics. F.H.B: Payment to institution from Personal Genome Diagnostics. G.R.V: Grants to institution and/or nonfinancial support: BMS, Merck, Servier, Personal Genome Diagnostics, Bayer, Sirtex, Pierre Fabre, Lilly, Delfi Diagnostics, Nordic all financial supports transferred to the institute. A.M.M and W.M.U.G: declare no potential conflicts of interests. M.K: advisory role: Eisai, Nordic Farma, Merck-Serono, Pierre Fabre, Servier. Institutional scientific grants: Bayer, Bristol Myers Squibb, Merck, Personal Genome Diagnostics (PGDx), Pierre Fabre, Roche, Sirtex, Servier. Non-financial interests: chair of the ESMO RWD-DH working group, co- chair: DCCG, PI PLCRC (national observational cohort study), involved in several clinical trials as PI or co-investigator in CRC. J.M.L.R: institutional financial interests: Bayer, BMS, Merck-Serono, Pierre Fabre, Servier, HUB 4 organoids, Cleara Biotech.<br /> (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Subjects :
- Humans
Male
Female
Chemotherapy, Adjuvant
Aged
Middle Aged
Netherlands
Oxaliplatin therapeutic use
Oxaliplatin administration & dosage
Capecitabine administration & dosage
Capecitabine therapeutic use
Time Factors
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Aged, 80 and over
Registries
Colonic Neoplasms mortality
Colonic Neoplasms pathology
Colonic Neoplasms drug therapy
Patient Reported Outcome Measures
Neoplasm Staging
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0852
- Volume :
- 208
- Database :
- MEDLINE
- Journal :
- European journal of cancer (Oxford, England : 1990)
- Publication Type :
- Academic Journal
- Accession number :
- 39024724
- Full Text :
- https://doi.org/10.1016/j.ejca.2024.114207