Improving QOL and safety while reducing costs: Evidence-based adjuvant chemotherapy of colorectal cancer (CRC).

Abstract

e14646 Background: The addition of oxaliplatin in adjuvant chemotherapy for stage II CRC and for elderly (≥ 70) patients with stage II or III CRC requires careful consideration. Most patients with stage II or III CRC receive oxaliplatin-based adjuvant regimens (Abrams. J Clin Oncol 2011). Mature results of the adjuvant MOSAIC and C-07 trials, however, failed to show improvement in OS or DFS among the elderly (≥ 70 years) and those with stage II CRC (Tournigand. J Clin Oncol 2012). Oxaliplatin causes neuropathy, increases the incidence and severity of febrile neutropenia, and adds substantial cost for both oxaliplatin and WBC growth factors. Methods: All chemotherapy requests submitted to Oncology Analytics for stage II and III CRC from 2009 through 2012 were analyzed. Utilization of oxaliplatin was retrospectively analyzed, with special attention to its use in those who were elderly (≥ 70 years), and for those of any age with stage II. Results: Our review showed a total of 242 adjuvant chemotherapy requests in stage II/III CRC. The majority of them, 57% (138/242), were elderly (≥ 70 years) with Stage II/III, and 24% (58/242) of any age had stage II. Thirty-four (14%) were both elderly and stage II. Overall, more than two thirds, 71% (171/242), received oxaliplatin containing regimens. More than two thirds of the elderly, regardless of stage, and more than half of all stage II patients, regardless of age, were treated with oxaliplatin containing regimens. Conclusions: The historical predominance of oxaliplatin use in the adjuvant setting, among patients over seventy years of age and/or those with stage II CRC, needs to be addressed as a priority. With mature data from the MOSAIC and C-07 trials, oncologists need to change prescribing behavior to provide less toxic therapies, thereby diminishing the incidence of neuropathy and reducing the risk of febrile neutropenia. The elimination of oxaliplatin in these subsets will also diminish costs for the Medicare population by a quarter billion dollars each year, without an adverse impact on outcome. [Table: see text]