Impact of Relative Dose Intensity of FOLFOX Adjuvant Chemotherapy on Risk of Death Among Stage III Colon Cancer Patients

Details

• Alternative Title:
  Clin Colorectal Cancer
• Personal Author:
  Zhou, Meijiao ; Thompson, Trevor D. ; Lin, Hui-Yi ; Chen, Vivien W. ; Karlitz, Jordan J. ; Fontham, Elizabeth T.H. ; Theall, Katherine P. ; Zhang, Lu ; Hsieh, Mei-Chin ; Pollack, Lori A. ; Wu, Xiao-Cheng
• Description:
  Background:
  
  The National Comprehensive Cancer Network (NCCN) guidelines have recommended tailored chemotherapy for stage III high-risk (T4 and/or N2) and low-risk (T1-T3 and N1) colon cancer since 2018. Studies have investigated the effect of relative dose intensity (RDI) of FOLFOX on stage III colon cancer survival, however, none has performed a stratified analysis by risk profiles. This study aims to identify the FOLFOX optimal RDI for high-risk and low-risk stage III colon cancer patients.
  
  Methods:
  
  Data on 407 eligible patients, diagnosed with stage III colon cancer in 2011 who received FOLFOX, were collected by 8 population-based cancer registries. Multivariable Cox model and Fine-Gray competing risks model were employed to explore Optimal RDI defined as the lowest RDI administered without significant differences in either overall or cause-specific death.
  
  Results:
  
  Among the 168 high-risk patients, the optimal RDI cut-off was 70% (HR = 1.59 with 95% CI: 0.69-3.66 in overall mortality; HR = 1.24 with 95% CI: 0.42-3.64 in cause-specific mortality when RDI < 70% vs. RDI ≥ 70%). Among the 239 low-risk patients, none of the evaluated cut-offs were associated with significant differences in risk of death between comparison groups. The lowest assessed RDI was 45%, HR = 0.80; 95% CI: 0.24 to 2.73 for overall mortality and HR = 0.53; 95% CI: 0.06 to 4.95 for cause-specific mortality, when RDI <45% versus RDI ≥45%.
  
  Conclusions:
  
  There is no significant harm on the risk of death when reducing RDI by <30% for high-risk patients. For the low-risk patients, we found that RDI as low as 45% did not significantly affect the risk of death.
  
  
• Subjects:
  Antineoplastic Combined Chemotherapy Protocols Chemotherapy, Adjuvant Colonic Neoplasms Humans Neoplasm Staging Proportional Hazards Models Retrospective Studies
• Keywords:
  Buprenorphine Chemotherapy Toxicity High-risk Stage III Low-risk Stage III Methadone Mortality Naltrexone Tailored Chemotherapy Treatment
• Source:
  Clin Colorectal Cancer. 21(2):e62-e75
• Pubmed ID:
  34756680
• Pubmed Central ID:
  PMC8971135
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  21
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:7132352d8c86d59702708ac5784a273852d307e74be70189b63139467b47a65bce3eb330ceed5c858e0d1974e250303ae973bbddb3497156b3e8fad7e9e77209
• Download URL:
  https://stacks.cdc.gov/view/cdc/115870/cdc_115870_DS1.pdf
• File Type:
  [PDF - 758.05 KB ]