Stage III colon cancer: shorter oxaliplatin-based adjuvant therapy cuts neuropathy, not efficacy

  • Yoshino T & al.
  • JAMA Oncol
  • 12 Sep 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Shortening oxaliplatin-based adjuvant chemotherapy (ACT) from 6 to 3 months significantly reduced long-lasting peripheral sensory neuropathy (PSN) without compromising disease-free survival (DFS) in stage III colon cancer.

Why this matters

  • 3 months of therapy might be the better choice, especially in low-risk patients.

Study design

  • Open-label, randomized, phase 3 ACHIEVE trial at 244 centers in Japan (n=1291).
  • Patients received 3 or 6 months of ACT with capecitabine plus oxaliplatin (CAPOX) or modified fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6).
  • Funding: Japanese Foundation for Multidisciplinary Treatment of Cancer; Yakult Honsha.

Key results

  • Initial toxicity outcomes were reported previously.
  • 3-year DFS was similar in the 3- and 6-month groups (79.5% vs 77.9%; HR, 0.95; 95% CI, 0.76-1.20). There were no differences in DFS by disease risk or therapeutic regimen.
  • Rate of PSN lasting for 3 years; 3 vs 6 months:
    • Grade 2: 13% vs 30%.
    • Grade 3: 0.9% vs 6%.
  • Within-group frequency of any grade PSN lasting for 3 years was less in 3 vs 6 months:
    • CAPOX: 8% vs 21% (P<.001>
    • mFOLFOX6: 16% vs 34% (P<.001>
  • PSN lasting for 3 years was significantly lower with CAPOX vs mFOLFOX6:
    • 3 months: 8% vs 16% (P=.04).
    • 6 months: 21% vs 34% (P=.02).

Limitations

  • Japanese population.