Less peripheral sensory neuropathy with shorter-term oxaliplatin-based chemotherapy

By Reuters Staff

NEW YORK (Reuters Health) - 20/9/2019

Patients with advanced colon cancer face a lower risk of developing long-term peripheral sensory neuropathy (PSN) with a three-month rather than a six-month regimen of oxaliplatin-based adjuvant chemotherapy, according to results from the ACHIEVE phase 3 trial.

Adjuvant oxaliplatin-based fluorouracil, leucovorin and oxaliplatin (FOLFOX) or capecitabine plus oxaliplatin (CAPOX) chemotherapy, the standard of care for patients with stage-III colon cancer following surgery, can trigger PSN, leading to treatment modification or discontinuation.

Dr. Takayuki Yoshino from the National Cancer Center Hospital East, in Chiba, Japan, and colleagues compared the efficacy and PSN rates with three versus six months of FOLFOX or CAPOX adjuvant chemotherapy in an open-label, randomized noninferiority trial with 1,291 participants with stage-III colon cancer.

After a median follow-up of 39 months, the three-year disease-free survival did not differ significantly in the three-month and six-month arms among patients who received CAPOX (81.4% vs. 79.7%, respectively) or among patients who received FOLFOX (73.9% vs. 72.3%).

During treatment, 13% of patients in the three-month arm experienced grade-2 PSN and 0.9% experienced grade-3 PSN, compared to 30% and 6%, respectively, of patients in the six-month arm, the researchers report in JAMA Oncology, online September 12.

The rate of PSN of any grade lasting for three years in the three- and six-month arms was 8% versus 21%, respectively, for CAPOX and 16% versus 34%, respectively, for FOLFOX (both P<0.001). These rates were significantly lower for CAPOX than for FOLFOX for both treatment durations.

"Since the shortened therapy duration did not compromise outcomes, 3 months of CAPOX therapy might be the most appropriate treatment option, especially in patients with low-risk stage III colon cancer, although our results need to be interpreted within the IDEA (International Duration Evaluation of Adjuvant Chemotherapy) combined analysis as well as in terms of the reproducibility of results across all trials," the researchers conclude.

Dr. Yoshino did not respond to a request for comments.

SOURCE: https://bit.ly/2mnDMgl

JAMA Oncol 2019.

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