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Six national trials pooled their results to ask whether three months of chemotherapy after bowel cancer surgery is as good as six. For low-risk disease it is, and it causes far less nerve damage.
IDEA was a prospective, preplanned pooled analysis of six concurrent phase 3 non-inferiority trials in resected stage III colon cancer. Across 12,834 patients and 3,263 events the non-inferiority of three months was not confirmed overall (hazard ratio 1.07, 95% CI 1.00 to 1.15 against a margin of 1.12), but it held for CAPOX (0.95, 0.85 to 1.06) and not for FOLFOX (1.16, 1.06 to 1.26). In the exploratory low-risk group (T1 to T3 and N1) three-year disease-free survival was 83.1 against 83.3 percent (hazard ratio 1.01); in T4 or N2 disease six months was better. Grade 2 or worse neuropathy roughly halves with the shorter course. The result is the two-tier recommendation in every guideline: three months of CAPOX for low-risk stage III, six months of FOLFOX or CAPOX for T4 or N2 disease.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
12,834 analysed.
non-inferiority not confirmed
SourceShares QUASAR, SCOT, CAPOX (capecitabine, oxaliplatin), Oxaliplatin.
Shares CAPOX (capecitabine, oxaliplatin), Neoadjuvant / adjuvant / perioperative, Oxaliplatin, FOLFOX (5-FU, leucovorin, oxaliplatin).
Shares MOSAIC, Neoadjuvant / adjuvant / perioperative, Fluorouracil (5-FU), Colon cancer (adenocarcinoma of the colon).
Shares CAPOX (capecitabine, oxaliplatin), Neoadjuvant / adjuvant / perioperative, Oxaliplatin, FOLFOX (5-FU, leucovorin, oxaliplatin).
Shares ATOMIC (Alliance A021502), Oxaliplatin, FOLFOX (5-FU, leucovorin, oxaliplatin), Colon cancer (adenocarcinoma of the colon).
Shares Neoadjuvant / adjuvant / perioperative, Oxaliplatin, FOLFOX (5-FU, leucovorin, oxaliplatin), Fluorouracil (5-FU).
Shares FOLFOX (5-FU, leucovorin, oxaliplatin), Fluorouracil (5-FU), Capecitabine, Platinum agents.
Shares CAPOX (capecitabine, oxaliplatin), Neoadjuvant / adjuvant / perioperative, Oxaliplatin, FOLFOX (5-FU, leucovorin, oxaliplatin).