{"entity":{"id":"paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018","kind":"paper","name":"Duration of adjuvant chemotherapy for stage III colon cancer (the IDEA collaboration)","aka":[],"tldr":"Six trials pooled 12,834 patients to ask whether three months of chemotherapy is as good as six. For lower-risk tumours treated with CAPOX it is, and the nerve damage is far less.","summary":"Grothey, Sobrero, Shields and colleagues performed a prospective, preplanned, pooled analysis of six randomised phase 3 trials conducted concurrently to evaluate the non-inferiority of three months of FOLFOX or CAPOX against six months in stage III colon cancer. The primary end point was three-year disease-free survival, and non-inferiority could be claimed if the upper limit of the two-sided 95 percent confidence interval of the hazard ratio did not exceed 1.12.\n\nNon-inferiority was not confirmed overall, but the regimen-specific and risk-group results changed practice anyway: three months of CAPOX became standard for T1 to T3 N1 disease and six months of FOLFOX remained standard for T4 or N2 disease.","asOf":"2026-09-24","links":[{"label":"N Engl J Med 2018","url":"https://doi.org/10.1056/NEJMoa1713709"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/29590544/"},{"label":"Europe PMC full text (PMC6426127)","url":"https://europepmc.org/article/MED/29590544"}],"tags":["colorectal-evidence"],"related":["paper-mosaic-oxaliplatin-adjuvant-colon-nejm-2004","paper-esmo-localised-colon-cancer-guideline-ann-oncol-2020"],"cancers":["colorectal","colon-cancer"],"sections":["chemotherapy"],"technologies":["cytotoxic-chemotherapy"],"targets":[],"drugs":["folfox","capox","oxaliplatin","capecitabine"],"companies":[],"institutions":[],"pathways":[],"terms":["neoadjuvant-adjuvant"],"trials":[],"people":["thierry-andre","yoshino-takayuki"],"bottlenecks":["b-toxicity-qol","b-dose-optimisation"],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2018,"doi":"10.1056/NEJMoa1713709","pmid":"29590544","authors":"Grothey A, Sobrero AF, Shields AF, et al.","paperType":"meta-analysis","findings":["3,263 recurrence or death events among 12,834 patients; non-inferiority of three months not confirmed overall (hazard ratio 1.07, 95 percent CI 1.00 to 1.15).","Non-inferiority was seen for CAPOX (0.95, 0.85 to 1.06) but not for FOLFOX (1.16, 1.06 to 1.26).","In T1 to T3 N1 disease, three months was non-inferior: three-year disease-free survival 83.1 against 83.3 percent (1.01, 0.90 to 1.12).","In T4 or N2 disease, six months was superior: 64.4 against 62.7 percent (1.12, 1.03 to 1.23, p=0.01)."],"whatItMeans":"The largest de-escalation exercise in adjuvant oncology, and the reason a patient with a T3 N1 colon cancer is now offered four cycles of CAPOX rather than twelve of FOLFOX, with a fraction of the neuropathy.","caveats":["The formal non-inferiority question was answered no; practice follows the subgroup and regimen analyses, which were pre-specified but exploratory in combination.","Patients were not randomised between FOLFOX and CAPOX, so the regimen comparison is not randomised evidence.","Quality of life and neuropathy data are reported in the individual trials rather than in the pooled analysis."],"changedPractice":true,"participants":12834},"route":"/key-papers/paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018/","neighbours":{"paper":[{"id":"paper-esmo-localised-colon-cancer-guideline-ann-oncol-2020","kind":"paper","name":"Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","route":"/key-papers/paper-esmo-localised-colon-cancer-guideline-ann-oncol-2020/"},{"id":"paper-mosaic-oxaliplatin-adjuvant-colon-nejm-2004","kind":"paper","name":"Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer (MOSAIC)","route":"/key-papers/paper-mosaic-oxaliplatin-adjuvant-colon-nejm-2004/"},{"id":"paper-courneya-challenge-structured-exercise-colon-nejm-2025","kind":"paper","name":"Structured exercise after adjuvant chemotherapy for colon cancer (CHALLENGE)","route":"/key-papers/paper-courneya-challenge-structured-exercise-colon-nejm-2025/"}],"cancer":[{"id":"colon-cancer","kind":"cancer","name":"Colon cancer (adenocarcinoma of the colon)","route":"/cancers/colon-cancer/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"}],"drug":[{"id":"capecitabine","kind":"drug","name":"Capecitabine","route":"/drugs/capecitabine/"},{"id":"capox","kind":"drug","name":"CAPOX (capecitabine, oxaliplatin)","route":"/drugs/capox/"},{"id":"folfox","kind":"drug","name":"FOLFOX (5-FU, leucovorin, oxaliplatin)","route":"/drugs/folfox/"},{"id":"oxaliplatin","kind":"drug","name":"Oxaliplatin","route":"/drugs/oxaliplatin/"}],"term":[{"id":"neoadjuvant-adjuvant","kind":"term","name":"Neoadjuvant / adjuvant / perioperative","route":"/terms/neoadjuvant-adjuvant/"}],"person":[{"id":"yoshino-takayuki","kind":"person","name":"Takayuki Yoshino","route":"/people/yoshino-takayuki/"},{"id":"thierry-andre","kind":"person","name":"Thierry André","route":"/people/thierry-andre/"}],"bottleneck":[{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"},{"id":"b-dose-optimisation","kind":"bottleneck","name":"Wrong doses","route":"/bottlenecks/b-dose-optimisation/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}],"roadmap":[{"id":"colorectal-roadmap","kind":"roadmap","name":"Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation","route":"/roadmaps/colorectal-roadmap/"}],"idea":[{"id":"idea-crc-ctdna-de-escalation-beyond-stage-ii","kind":"idea","name":"Take ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helps","route":"/ideas/idea-crc-ctdna-de-escalation-beyond-stage-ii/"}]}}