Adjuvant chemotherapy for stage III colon cancer: relative dose intensity and survival among veterans

Aspinall, Sherrie L.; Good, Chester B.; Zhao, Xinhua; Cunningham, Francesca; Heron, Bernadette B.; Geraci, M.P.H. Jane M.; Passero, Vida; Stone, Roslyn A.; Smith, Kenneth J.; Rogers, Renee J.; Shields, Jenna; Sartore, Megan; Boyle, D Patrick; Giberti, Sherry; Szymanski, John M.; Smith, Doug; Ha, Allen; Sessions, Jolynn; Depcinski, Shawn; Fishco, Shane; Molina, Irvin; Lepir, Tanja; Jean, Carmela; Cruz-Diaz, Lymaris; Motta, Jessica; Calderon-Vargas, Rebeca; Maland, Janelle; Keefe, Sean; Tague, Marshall; Leone, Alice; Glovack, Brian; Kaplan, Barry; Cosgriff, Sean; Kaster, Lindsay; Tonnu-Mihara, Ivy; Nguyen, Kimmai; Carmichael, Jenna; Clifford, Linda; Lu, Kan V.; Chatta, Gurkamal S.

doi:10.1186/s12885-015-1038-y

Cited by 78 publications

(88 citation statements)

References 30 publications

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“…Yet, many patients still experience severe toxicity and are subsequently dose-reduced, delayed or discontinue treatment prematurely. Discontinuation, reductions and delays in chemotherapy can reduce overall and recurrence-free survival, 3 making individualized dosing a priority. Body composition, the amount and distribution of adipose and lean soft tissue (the main compartment of which is skeletal muscle mass) is one factor influencing the pharmacokinetics and metabolism of many chemotherapy agents.…”

Section: Introductionmentioning

confidence: 99%

Muscle mass at the time of diagnosis of nonmetastatic colon cancer and early discontinuation of chemotherapy, delays, and dose reductions on adjuvant FOLFOX: The C‐SCANS study

Feliciano

Lee

Prado

et al. 2017

Cancer

105

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Background For many chemotherapy regimens dosed on body surface area (BSA), patients are dose-reduced, delayed, or discontinue treatment, reducing survival. Consideration of body composition may be useful in individualizing chemotherapy dosing, but few studies examine the association of body composition with chemotherapy tolerance in colon cancer. Methods We identified non-metastatic colon cancer patients diagnosed from 2006–2011 at Kaiser Permanente who received FOLFOX as initial adjuvant chemotherapy (n=533). We quantified patients’ muscle mass using clinically-acquired computed tomography (CT) scans and quantified chemotherapy doses, treatment dates, and related toxicities using the electronic medical record. In logistic regression models adjusting for age, sex, and stage, we examined associations of muscle tertiles with early discontinuation (<6 cycles), treatment delay (≥3 days off-schedule ≥3 times), and/or dose reduction (relative dose intensity≤0.70, based on planned treatment). Results Average age at diagnosis was 58.7 years, body surface area (BSA) was 1.9 m2, and body mass index was 28.7 kg/m2. Compared to the highest sex-specific tertile of muscle, patients in the lowest tertile were more likely to experience toxicities had twice the risk of adverse outcomes on FOLFOX: odds ratios (OR) and 95% Confidence Intervals (95%CI) were OR=2.34 (95%CI: 1.04, 5.24; p-trend=0.03) for early discontinuation, OR=2.24 (95%CI: 1.37, 3.66; p-trend=0.002) for treatment delay and OR=2.28 (95%CI: 1.19, 4.36; p-trend=0.01) for dose reduction. Conclusions Lower muscle mass is associated with greater toxicity and poor chemotherapy adherence on FOLFOX. Many chemotherapy drugs are dosed on BSA: treatment may be better individualized if muscle mass is considered.

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Section: Introductionmentioning

confidence: 99%

Muscle mass at the time of diagnosis of nonmetastatic colon cancer and early discontinuation of chemotherapy, delays, and dose reductions on adjuvant FOLFOX: The C‐SCANS study

Feliciano

Lee

Prado

et al. 2017

Cancer

105

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“…Aspinall et al . reported that a relative dose intensity of 5‐FU/LV of less than 70% was associated with worse 5‐year OS for Stage III patients, and Neugut et al . reported that 5‐FU‐based chemotherapy for Stage III patients over 5–7 months was associated with better 5‐year OS than the same regimen for 1–4 months .…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of interhospital variation in adjuvant chemotherapy for patients with Stage II/III colorectal cancer: a nationwide study

et al. 2018

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“…It is generally considered that keeping the relative dose intensity (RDI) high is important in adjuvant chemotherapy [11][12]. For instance, in adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil for breast cancer, maintaining RDI ≥85% is recommended to prolong the relapse-free survival and overall survival [11].…”

Section: Ivyspringmentioning

confidence: 99%

“…For instance, in adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil for breast cancer, maintaining RDI ≥85% is recommended to prolong the relapse-free survival and overall survival [11]. Likewise, in colon cancer, RDI of adjuvant chemotherapy is known to affect the prognosis [12]. As with breast and colon cancer, keeping high RDI is expected to improve the prognosis in NSCLC patients treated with adjuvant CV therapy.…”

Section: Ivyspringmentioning

confidence: 99%

The Factors Reducing Relative Dose Intensity of Cisplatin and Vinorelbine as Adjuvant Chemotherapy in Patients with Non-Small Cell Lung Cancer

Inose¹,

Takahashi²,

Yoshimura³

et al. 2018

Oncomedicine

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Purpose Adjuvant therapy with cisplatin and vinorelbine (CV therapy) is recommended for patients after complete surgical resection of stage II and IIIA non-small cell lung cancer (NSCLC). However, a dose reduction or early discontinuation of a subsequent course of treatment is a frequent clinical problem. The aim of this study was to investigate the factors reducing the relative dose intensity (RDI) of adjuvant CV therapy in patients with NSCLC. Methods Patients who had received CV as an adjuvant chemotherapy for NSCLC at the Osaka City University Hospital between July 2007 and March 2016 were identified from medical records. The patients were classified into two groups (RDI <50% and RDI ≥50%, respectively), and patients' characteristics, laboratory values, adverse reactions, and RDI of CV therapy were analyzed. The two groups were compared using the Fisher's exact test. Results The study population consisted of 25 patients. There were six patients (24.0%) with RDI <50% and 19 patients (76.0%) with RDI ≥50%. Univariate analysis showed that the use of calcium channel blockers [crude odd ratio (OR): 10.70; 95% confidence interval (CI): 1.31-86.94; p=0.032] and renal dysfunction (creatinine clearance <60 mL/min) (crude OR: 18.00; 95% CI: 1.37-235.70; p=0.031) were associated with the reduced RDI. Conclusion This study indicated that the renal dysfunction and concomitant use of calcium channel blockers might be predictive factors for reduced RDI of adjuvant CV therapy in patients with NSCLC. Patients with these factors may be able to avoid extreme reduction in RDI if the dose is reduced or the dosing interval is prolonged.

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Adjuvant chemotherapy for stage III colon cancer: relative dose intensity and survival among veterans

Abstract: Background: Given the paucity of information on dose intensity, the objective of this study is to describe the use of adjuvant chemotherapy for stage III colon cancer, focusing on relative dose intensity (RDI), overall survival (OS) and disease-free survival (DFS).

Cited by 78 publications

References 30 publications

Muscle mass at the time of diagnosis of nonmetastatic colon cancer and early discontinuation of chemotherapy, delays, and dose reductions on adjuvant FOLFOX: The C‐SCANS study

Muscle mass at the time of diagnosis of nonmetastatic colon cancer and early discontinuation of chemotherapy, delays, and dose reductions on adjuvant FOLFOX: The C‐SCANS study

Prognostic impact of interhospital variation in adjuvant chemotherapy for patients with Stage II/III colorectal cancer: a nationwide study

The Factors Reducing Relative Dose Intensity of Cisplatin and Vinorelbine as Adjuvant Chemotherapy in Patients with Non-Small Cell Lung Cancer

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