Survival Impact of CAPOX vs FOLFOX in the Adjuvant Treatment of Stage III Colon Cancer
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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.
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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
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBackground
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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