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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.
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.
Non-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.
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.
An effect size comparable to adjuvant chemotherapy, from a behavioural intervention with no drug cost, which makes the delivery problem (who funds the trainers) the binding constraint rather than the evidence.
The European rulebook for what happens after a colon cancer operation, and the reason a patient with a T3 N1 tumour is now offered three months of chemotherapy rather than six.
FOLFOX after surgery for stage III colon cancer, still the standard 22 years later, and the reason every later adjuvant trial in this disease is an oxaliplatin trial.
Shares Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer (MOSAIC), CAPOX (capecitabine, oxaliplatin), Neoadjuvant / adjuvant / perioperative, Oxaliplatin and the tag colorectal-evidence.
Shares Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer (MOSAIC), Neoadjuvant / adjuvant / perioperative, 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, New England Journal of Medicine and the tag colorectal-evidence.
Shares Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer (MOSAIC), Neoadjuvant / adjuvant / perioperative, 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, Toxicity and quality of life are undervalued and the tag colorectal-evidence.
Shares Takayuki Yoshino, 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, Toxicity and quality of life are undervalued, New England Journal of Medicine and the tag colorectal-evidence.
Shares Thierry André, Takayuki Yoshino, 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, New England Journal of Medicine and the tag colorectal-evidence.
Shares Take ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helps, Neoadjuvant / adjuvant / perioperative, 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, Toxicity and quality of life are undervalued and the tag colorectal-evidence.
Shares Structured exercise after adjuvant chemotherapy for colon cancer (CHALLENGE), 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, Colon cancer (adenocarcinoma of the colon), Colorectal cancer and the tag colorectal-evidence.
Shares Takayuki Yoshino, Take ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helps, 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, Colon cancer (adenocarcinoma of the colon) and the tag colorectal-evidence.