Real-world adoption of 3 months of adjuvant oxaliplatin chemotherapy in patients with stage III colorectal cancer (CRC).

Authors

null

Tharani Krishnan

BC Cancer - Vancouver, Vancouver, BC, Canada

Tharani Krishnan , Joao Paulo Solar Vasconcelos , Howard J Lim , Jonathan M. Loree , Janine Marie Davies , Karamjit Gill , Sharlene Gill

Organizations

BC Cancer - Vancouver, Vancouver, BC, Canada, BC Cancer - Vancouver, University of British Columbia, Vancouver, BC, Canada

Research Funding

No funding sources reported

Background: Based on the IDEA analysis, 3 months (mos) of adjuvant chemotherapy (ACT) with CAPOX has emerged as an option for both low-risk and high-risk stage III CRC. This has resource utilization, cost and toxicity benefits (particularly less neurotoxicity) without compromising efficacy. This study examines the patterns of uptake of CAPOX vs FOLFOX and duration of ACT in a contemporary post-COVID real-world cohort of patients (pts) in the province of British Columbia (BC), Canada. Methods: The provincial pharmacy database was used to identify pts with resected stage III CRC who received adjuvant CAPOX or FOLFOX between January 2021 and December 2022. Pts with rectal cancer requiring neoadjuvant chemotherapy or radiotherapy were excluded. Demographic, tumor, and treatment information was collected. “High-risk features” were defined as pT4 or pN2 tumors. “Urban” setting was defined based on the population size of the regional health authority. Descriptive statistical analyses were performed to examine baseline characteristics and Fisher’s exact test was used to examine univariate associations. Results: 452 pts were included, of which 234 (52%) and 218 (48%) were planned to receive 3 and 6 mos of ACT respectively (see table). Within the 3 mos group, 226 (97%) received CAPOX. Within the 6 mos group, there was a 51%/49% split between CAPOX/FOLFOX. By univariate analysis, factors associated with 3 mos of CAPOX vs 6 mos of ACT were age >70y (P=0.039), low/intermediate grade (P=0.005) and low-risk stage III disease (P<0.0001). 29% of pts planned for 6 mos of oxaliplatin ACT had low-risk disease, with 52% of these receiving CAPOX. Conclusions: 3 mos of adjuvant CAPOX is an accepted option for nearly all pts with stage III disease with consequent less neurotoxicity and fewer treatment visits. Yet, in this contemporary cohort, use of 3 mos of adjuvant CAPOX remains low and is associated with older age and low-risk disease. 6 mos of oxaliplatin is still being offered to pts with low-risk disease. Exploration of patient preferences, real-world treatment and time toxicities, and resource costs may improve more widespread adoption of 3 mos of adjuvant CAPOX in stage III CRC.

Characteristic n (%)Total Cohort (n=452)3 Months CAPOX Planned (n=226)6 Months FOLFOX or CAPOX Planned (n=218)
Male254 (56.2)119 (52.7)132 (60.6)
Age (years):
≤70
>70

314 (69.5)
138 (30.5)

147 (65.0)
79 (35.0)

162 (74.3)
56 (25.7)
Urban setting228 (50.4)106 (46.9)119 (54.6)
Tumor location:
Right colon
Left colon
Rectal

214 (47.3)
207 (45.8)
31 (6.9)

108 (47.8)
102 (45.1)
16 (7.1)

102 (46.8)
101 (46.3)
15 (6.9)
Grade:
Low/intermediate
High

384 (86.1)
62 (13.9)

202 (91.0)
20 (9.0)

177 (81.6)
40 (18.4)
High-risk stage III:
pT4
pN2
198 (43.8)
131 (29.0)
122 (27.0)
47 (26.3)
33 (14.6)
23 (10.2)
154 (70.6)
95 (43.6)
98 (44.9)

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Abstract Details

Meeting

2024 ASCO Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Cancers of the Colon, Rectum, and Anus

Track

Colorectal Cancer,Anal Cancer

Sub Track

Quality of Care/Quality Improvement

Citation

J Clin Oncol 42, 2024 (suppl 3; abstr 83)

DOI

10.1200/JCO.2024.42.3_suppl.83

Abstract #

83

Poster Bd #

F6

Abstract Disclosures