Safety and efficacy of a modified XELOX adjuvant regimen for patients with operated stage III colon cancer: a Chinese single‐center experience

Abstract

BackgroundA fixed 8-cycle oxaliplatin and capecitabine (XELOX) regimen has been the standard adjuvant therapy for patients with stage III colon cancer. However, completing the full-cycle of oxaliplatin is often associated with severe neurotoxicity. To spare patients from the toxic effects, without comprising the required efficacy, we evaluated the safety and efficacy of a modified XELOX (mXELOX) adjuvant chemotherapy regimen with 6 cycles of oxaliplatin and a full cycle of capecitabine.MethodsWe retrospectively analyzed 330 eligible patients with stage III colon cancer who underwent curative tumor resection followed by mXELOX, standard XELOX or unfinished XELOX adjuvant chemotherapy between December 2007 and April 2015. Associated prognostic factors were investigated and their disease-free survival (DFS) and overall survival (OS) rates were also determined and compared among the different regimen groups.ResultsCompared with the standard XELOX group, the mXELOX group had lower total incidence rates of neurotoxicity (39.3% vs. 76.2%, P < 0.001), leucopenia (53.6% vs. 69.8%, P = 0.017) and thrombocytopenia (38.1% vs. 56.3%, P = 0.011). The standard XELOX and mXELOX adjuvant chemotherapy regimens presented with comparable 3-year DFS rates (86.3% vs. 89.2%; P = 0.838) and 3-year OS rates (92.7% vs. 97.6%; P = 0.227). Compared to unfinished XELOX chemotherapy, the oncologic benefits of the mXELOX regimen were greater for patients with T4 tumors (3-year DFS: Hazard ratio [HR], 2.184; 95% confidence interval [CI], 1.051–4.540; P = 0.036; 3-year OS: HR, 4.529; 95% CI 1.245–16.479; P = 0.022) and for high-risk patients (3-year DFS: HR, 1.962; 95% CI 0.964–3.993; P = 0.044; 3-year OS: HR, 4.193; 95% CI 1.182–14.874; P = 0.026).ConclusionsThe mXELOX adjuvant chemotherapy presented a comparable survival benefit and lower incidence of toxicity than standard XELOX chemotherapy. It could be an alternative treatment for high-risk patients with operated stage III colon cancer.

Feasibility Study of a Modified XELOX Adjuvant Chemotherapy for High-Recurrence Risk Patients With Operated Stage III Colon Cancer

“…modified XELOX regimen was associated witha significantly lower incidence and severity of adverse events, especially neurotoxicity, without impairing survival (Peng et al, 2019). In the current study, 64.7% (44/68) of patients suffered severe adverse events, of which grade 2-3 neurotoxicity was the most common severe adverse event.…”

“…Another phase 2 Japanese study also reported that intermittent oxaliplatin treatment improved severe neuropathy in a modified FOLFOX6 plus bevacizumab regimen without reducing progression-free survival in patients with inoperable or metastatic colorectal cancer ( Kato et al., 2018 ). In fact, we previously found that a two-cycle shorter duration of oxaliplatin treatment in the modified XELOX regimen was associated witha significantly lower incidence and severity of adverse events, especially neurotoxicity, without impairing survival ( Peng et al., 2019 ). In the current study, 64.7% (44/68) of patients suffered severe adverse events, of which grade 2–3 neurotoxicity was the most common severe adverse event.…”

“…Recently, we reported that a modified XELOX (mXELOX) adjuvant chemotherapy with 8 cycles of capecitabine and 6 cycles of oxaliplatin presented a comparable survival outcome and lower incidence of neurotoxicity than a standard full cycle of XELOX chemotherapy for patients with stage III operated colon cancer (Peng et al, 2019). Although the previous study provided the first evidence supporting the administration of the mXELOX adjuvant chemotherapy regimen for stage III colon cancer patients, it did not assess the long-term oncologic efficacy of modified XELOX chemotherapy in those patients by performing a comparison with the standard full cycle of XELOX chemotherapy.…”

Colorectal Cancer Chemotherapy during COVID-19 Pandemic

“…Hence, in resource constrained situations, oral capecitabine is strongly recommended in these patients and resumption of oxaliplatin in subsequent cycles for a total of 4 cycles may be an optimum strategy in these circumstances despite lack of Level 1 evidence. [11]…”

Adjuvant chemotherapy improves survival in high-risk stage II colon cancer: a retrospective cohort study

“… 2 , 3 There is a consensus that chemotherapy, a common treatment choice for CC, can prolong the survival of stage III CC patients after radical surgery and reduce the likelihood of tumor recurrence. 4 , 5 The American Society of Clinical Oncology and the European Society of Medical Oncology guidelines also recommend postoperative chemotherapy for cases with stage II CC who are at high risk of recurrence. 6 , 7 However, there are currently no clear criteria for defining patients at high risk.…”