Results of Adjuvant FOLFOX Regimens in Stage III Colorectal Cancer Patients: Retrospective Analysis of 667 Patients

Abstract

Objective: The aim of this study was to assess the use of 5-fluorouracil (5-FU), leucovorin and oxaliplatin (FOLFOX) regimens in clinical practice according to their efficacy and toxicity. Methods: Patients who received oxaliplatin-containing regimens after curative resection for colorectal carcinoma from 10 different oncology centers between May 2004 and December 2009 were included in the study. All patients were treated with FOLFOX regimens. Patients with rectal carcinoma were also treated with chemoradiotherapy with 5-FU after 2 cycles of a FOLFOX regimen. Results: The median age of the patients was 56 years (range 17–78). Of the total 667 patients, 326 were given FOLFOX-4, 232 were given modified FOLFOX-4 and 109 were given FOLFOX-6. The distribution according to disease stage was 33 patients with stage IIIA colorectal cancer, 382 patients with stage IIIB and 252 patients with stage IIIC. The most common adverse events were neutropenia (54%), nausea (36.9%), neuropathy (38.2%) and anemia (33.1%) for all grades. The median follow-up time was 23 months (range 1–79). Three-year disease-free survival and overall survival were 65 and 85.7%, respectively. Conclusion: The different oxaliplatin-containing 5-FU-based adjuvant chemotherapy regimens in patients with stage III colorectal cancer seemed to be at least equal in terms of efficacy regardless of the method of 5-FU administration or oxaliplatin dose.

Risk of Febrile Neutropenia Associated With Select Myelosuppressive Chemotherapy Regimens in a Large Community-Based Oncology Practice

“…When intravenous antibiotic treatment and early patient censorship were not considered, the low FN incidence proportions (<10%) observed in this analysis for patients with CRC treated with XELOX or FOLFOX6, NHL treated with B±R, and MM treated with lenalidomide with or without dexamethasone seem to concur with previous findings from clinical trials and observational studies. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] However, the actual incidence proportions of FN for these regimens were observed to be >10% if the patterns of censoring inherent in the data are considered or if adjustments for misclassification of FN are made. These results help inform the use of prophylactic G-CSF for these regimens in clinical practice.…”

Gastrointestinal Adverse Effects in Advanced Colorectal Carcinoma Patients Treated with Different Schedules of FOLFOX

“…Oxaliplatin in combination with 5FU/LV has effectively increased the progression free survival in patients of colorectal carcinoma (Bano et al, 2013a). The severity of gastrointestinal adverse effects associated with 5FU/LV chemotherapy is increased with the incorporation of oxaliplatin in the regimen (Bano and Najam, 2013b;Bano et al, 2013c) FOLFOX4 is associated with grade 3 or 4 diarrhea (Uncu et al, 2013) and nausea/vomiting (Lee et al, 2013) protocol. Diarrhea is a frequent dose limiting toxicity of FOLFOX (Comeau and Mohundro, 2013) Lactobacillus spp containing probiotic treatment is recommended in chemotherapy or radiotherapy induced diarrhea (Gibson et al, 2013).…”

FOLFOX chemotherapy can safely be given to neutropenic patients with early-stage colorectal cancer for higher dose intensity and fewer visits

“…In the current study, 16 % (21/132) of patients experienced a cycle delay. This compares to 35.8 % for Uncu et al [16] and a calculated 47 % for Smoragiewicz et al [9] where dose reduction strategy was not specified. For the current study, a cumulative total of 170 cycles was given in the setting of neutropenia and 99 was given in the setting of thrombocytopenia for a total of 269 cycles (Table 3).…”

“…The rate of CIFN for this study, 4.5 %, is at the high end of the range published in the literature ( Table 2). The literature differed in the regimens used [16], the definition of CIFN [4], dosereduction strategies, ethnic populations, and the use of myeloid growth factors [9].…”