Adjuvant FOLFOX treatment for stage III colon cancer: how many cycles are enough?

Yi-Jian Tsai,Jen-Kou Lin,Hao-Wei Teng,Shung-Haur Yang,Chueh-Chuan Yen,Jeng-Kai Jiang,Tzu-Chen Lin,Wei-Shone Chen

doi:10.1186/s40064-016-2976-9

Yi-Jian Tsai, Jen-Kou Lin + Show 6 more

Open Access

https://doi.org/10.1186/s40064-016-2976-9

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Abstract

PurposeAdjuvant FOLFOX (5-fluorouracil and oxaliplatin) chemotherapy benefits stage III colon cancer patients. However, it still results in side effects and increased cost. Reducing cycles had been thought to decrease these problems. This retrospective study aimed to find the appropriate number of treatment cycles that are sufficient for treating these patients.Patients and methodsA total of 213 stage III colon cancer patients receiving adjuvant FOLFOX therapy were retrospectively recruited. Demographic data were collected for analysis. Survival analyses were performed between all cases of patients receiving above and below a certain cycle number. If a significant difference was reached at that cycle number, multivariate Cox Regression was performed with those factors resulting in p < 0.2 to assess the independent prognostic factors.ResultsThe 5-year overall survival rate of patients was 77.9 %, and the 3-year disease-free survival was 76.7 %. For overall survival, a significant benefit was noted for treatment of at least 8 cycles, for disease-free survival, significant differences were apparent from patient data of those who underwent from 7 to 12 treatment cycles. Multivariate survival analysis of that patient data at cycle 8 for overall survival and cycle 7 for disease free survival revealed cycle number as the only independent prognostic factor (p = 0.04, 0.048).ConclusionCycle number of adjuvant FOLFOX is a significant prognostic factor for stage III colon cancer patients. At least 8 cycles are needed to have an overall survival benefit, and 7 to disease-free survival.

Highlights

For patients with colon cancer, surgical resection offers the only potential cure
A significant benefit was noted for treatment of at least 8 cycles, for disease-free survival, significant differences were apparent from patient data of those who underwent from 7 to 12 treatment cycles
A total of 692 consecutive cases of stage III colorectal cancer were collected in the section of colorectal surgery database at Taipei Veterans General Hospital

Summary

Introduction

For patients with colon cancer, surgical resection offers the only potential cure. The results of the Multicenter International Study of oxaliplatin/5-fluorouracil/ leucovorin in the adjuvant treatment of colon cancer (MOSAIC) trial in 2004 (Andre et al 2004), along with the National Surgical Adjuvant Breast and Bowel Project (NSABP) C-07 report in 2007 (Kuebler et al 2007), Despite the efficacy of FOLFOX treatment for stage III colon cancer, this treatment leads to significant cost increase, toxicity, and inconvenience. Oxaliplatin-induced cumulative dose-dependent neurotoxicity is a clinically relevant issue. Peripheral neuropathy was reported for 92.1 % of patients receiving treatments, and the incidence of grade 3 neurotoxicity 1 year after completion was estimated to be 12 % in the MOSAIC trial.

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