16 februari 2018: Brons ASCO GU 2018

Wanneer darmkankerpatiënten met hoog risico op een recidief (stadium III) na een operatie een 6 maanden chemokuur krijgen met CAPOX = Capecitabine - Xeloda plus oxaliplatin dan hebben zij 10 procent meer kans om op 3 jaar nog steeds ziektevrij te zijn dan wanneer zij FOLFOX = 5-FU + Leucovarin + oxaliplatin krijgen als chemokuur. In mediane overall overleving zit weinig verschil tussen beide chemokuren. CAPOX geeft wel andere en ernstiger bijwerkingen dan FOLFOX en bij meer patiënten moest de dosering worden aangepast, zo blijkt uit een fase III studie en gepresenteerd op ASCO GU 2018.

Belangrijke conclusie: 

Als de chemokuren slechts drie maanden gegeven zouden worden i.p.v. 6 maanden dan zou 28.7% van de patiënten die FOLFOX kregen en 20.5% die CAPOX kregen nooit een recidief hebben gekregen (P=0.0008). Dus de ziektevrije tijd op 3 jaar was voor CAPOX beter bij 6 maanden chemo maar als de chemo slechts drie maanden gegeven zou worden zou de kans op een recidief op langere termijn voor FOLFOX minder zijn dan voor CAPOX.

Ik ga niet alles vertalen en zie ook in gerelateerde artikelen andere vormen van chemotherapie en lees ook onze literatuurlijsten niet-toxische stoffen bij darmkanker of chemo.

Hier de TAKE home message van de studie (abstract staat onderaan dit artikel plus referentielijst:

Survival impact of CAPOX versus FOLFOX in the adjuvant treatment of stage III colon cancer

TAKE-HOME MESSAGE

  • This retrospective study compared the efficacy and safety of CAPOX and FOLFOX for the adjuvant treatment of stage III colon cancer. CAPOX was associated with an improved disease-free survival at 3 years (83.8% vs 73.4%) among high-risk patients, although no difference in overall survival was noted between the two regimens. FOLFOX was associated with increased mucositis and neutropenia, while patients taking CAPOX had increased dose-limiting toxicities, diarrhea, and hand–foot syndrome. Patients receiving FOLFOX had a higher median relative dose intensity of both fluoropyrimidine and oxaliplatin. Reduction in the duration of both FOLFOX and CAPOX to 3 months would have prevented >20% of all dose-limiting toxicities.

  • Although CAPOX is associated with greater toxicity than FOLOFX, CAPOX is also associated with improved disease-free survival. Reducing the duration of either regimen may reduce toxicity.

    – Neil Majithia, MD

Het abstract:

CAPOX may be associated with improved DFS despite greater toxicities and lower RDI. Reducing adjuvant chemotherapy duration to 3 months would prevent 26% of patients from ever experiencing a DLT.

Survival impact of CAPOX versus FOLFOX in the adjuvant treatment of stage III colon cancer

Jonathan M. Loree
,
Aaron Sha
,
Maryam Soleimani
,
Hagen F. Kennecke
,
Maria Y. Ho
,
Winson Y. Cheung
,
Karen E. Mulder
,
Shirin Abadi
,
Jennifer L. Spratlin
,
Sharlene Gill'Correspondence information about the author Sharlene Gill
DOI: https://doi.org/10.1016/j.clcc.2018.01.010

Abstract (<250 words)

Background

CAPOX and FOLFOX are both used in the adjuvant treatment of colon cancer, and while their efficacy is assumed to be similar, they have not been directly compared. We reviewed the toxicity profiles, relative dose intensity (RDI) and survivals associated with these regimens across a multi-institutional cohort.

Methods

We identified 394 consecutively treated patients with stage III colon cancer who received an oxaliplatin containing regimen. RDI was defined as the total dose received divided by the intended total dose if all cycles were received.

Results

FOLFOX was associated with increased mucositis (6.2% vs 0.7%, P=0.0069) and neutropenia (25.9% vs 8.6%, P<0.0001), while CAPOX was associated with increased dose limiting toxicities (DLTs) (90.7% vs 80.2%, P=0.0055), diarrhea (31.8% vs 9.0%, P<0.0001) and hand-foot syndrome (19.9% vs 2.1%, P<0.0001). Higher median RDI of fluoropyrimidine (93.7% vs 80.0%, P<0.0001) and oxaliplatin (87.2% vs 76.3%, P<0.0001) was noted for patients receiving FOLFOX. Reducing the duration from 6 to 3 months would have prevented 28.7% of FOLFOX and 20.5% of CAPOX patients from ever experiencing a DLT (P=0.0008). Overall survival did not differ by regimen (HR 0.73, 95%CI 0.45-1.22; P=0.24), however CAPOX was associated with an improved disease-free survival (DFS) (3-year DFS 83.8% vs 73.4%, P=0.022), which remained significant in high risk (T4 or N2) (P=0.039) but not low risk patients (P=0.19).

Conclusions

CAPOX may be associated with improved DFS despite greater toxicities and lower RDI. Reducing adjuvant chemotherapy duration to 3 months would prevent 26% of patients from ever experiencing a DLT.

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Disclosures: None

Grant Support: JL is a member of the UBC Clinician Investigator program and was the recipient of the CAMO 2016 Research Fellowship, the J. Edward Mahoney Foundation ASCO YIA, and the RCPSC Detweiler Fellowship.

© 2018 Elsevier Inc. All rights reserved.

darmkanker, chemo, xeloda - capecitabine, overall overleving, ziektevrije tijd, progressie vrije tijd, complementair, CAPOX, FOLFOX


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