J Clin Oncol: Effect of early discontinuation of oxaliplatin on prognosis in patients with stage III colon cancer

Oxaliplatin-based adjuvant chemotherapy for stage III colon cancer (CC) remains the standard of
care for patients with high-risk stage III colon cancer for 6 months.
There is a lack of data on
whether early discontinuation of all treatments (ETD) or early discontinuation of oxaliplatin (EOD) has adverse prognostic effects.

The study evaluated the effects of
ETD and EOD on the prognosis of patients with stage III colon cancer.
The patient data source is the ACCENT/IDEA database, and the subjects are scheduled to receive fluorouracil, folic acid, and oxaliplatin or capecitabine + oxaliplatin for
6 months.
ETD is defined as stopping treatment and EOD is defined as stopping oxaliplatin therapy
only before the patient has received up to 75% of the planned course of treatment.
The correlation between ETD/EOD and overall and disease-free survival (DFS) was evaluated using the Cox model, adjusted
for identified prognostic factors.

Survival prognosis in both groups

The ETD and EOD analyses included 10,447 (20.
9% ETD) and 7,243 (18.
8% EOD) patients
, respectively.
People with ETD or EOD are statistically more likely to be female than those without ETD or EOD, with an ≥1-point increase in ECOG performance status, and people with ETD tend to be older and have a lower
body mass index.
In multivariate analyses, ETD was associated with disease-free survival and reduced overall survival (HR 1.
61, p<0.
001; HR 1.
73, p<0.
001）； EOD had no such correlation (HR 1.
07, p=0.
3; HR 1.
13, p=0.
1）
。 In addition, patients treated with oxaliplatin with a shorter than usual planned course had a poorer
prognosis.

In summary, in patients with stage III colon cancer who received 6 months of oxaliplatin basic chemotherapy, premature discontinuation of all treatments was associated with
a poorer tumor prognosis.
However, early discontinuation of oxaliplatin has no adverse prognostic effects
.
The results of this study support the discontinuation of oxaliplatin and continued fluoropyrimidine in more than half of patients who received more than 6 months of scheduled chemotherapy in severe neurotoxicity
.

Original source:

Claire Gallois, et al.
Prognostic Impact of Early Treatment and Oxaliplatin Discontinuation in Patients With Stage III Colon Cancer: An ACCENT/IDEA Pooled Analysis of 11 Adjuvant Trials.
Journal of Clinical Oncology.
October 28, 2022.
https://ascopubs.
org/doi/full/10.
1200/JCO.
21.
02726