METHODS: Records of patients treated with FOLFOX or CAPOX in the adjuvant setting for stage III colon cancer across four institutions in Sydney during 2006-2016 were reviewed. The relative dose intensity (RDI) of fluoropyrimidine and oxaliplatin of each regimen, disease-free survival (DFS), overall survival (OS), and incidence of grade ≥2 toxicities were compared.
RESULTS: Characteristics of patients receiving FOLFOX (n = 195) and CAPOX (n = 62) were evenly matched. FOLFOX patients had a higher mean RDI for both fluoropyrimidine (85% vs. 78%, p < 0.01) and oxaliplatin (72% vs. 66%, p = 0.06). In spite of a lower RDI, CAPOX patients trended toward a better 5-year DFS (84% vs. 78%, HR = 0.53, p = 0.068) and similar OS (89% vs. 89%, HR = 0.53, p = 0.21) compared to the FOLFOX group. This difference was most pronounced in the high-risk (T4 or N2) group where 5-year DFS was 78% versus 67% (HR = 0.41, p = 0.042). Patients receiving CAPOX experienced more grade ≥2 diarrhea (p = 0.017) and hand-foot syndrome (p < 0.001) but not peripheral neuropathy or myelosuppression.
CONCLUSIONS: In a real-world setting, patients who received CAPOX had similar OS rates when compared to those receiving FOLFOX in the adjuvant setting in spite of lower RDI. In the high-risk population, CAPOX appears to demonstrate a superior 5-year DFS over FOLFOX.
方法:回顾了2006-2016年悉尼四家机构在III期结肠癌辅助治疗中接受FOLFOX或CAPOX治疗的患者记录。氟嘧啶和奥沙利铂各方案的相对剂量强度(RDI),无病生存率(DFS),总生存期(OS),并比较了≥2级毒性的发生率。
结果:接受FOLFOX(n=195)和CAPOX(n=62)的患者的特征均匀匹配。FOLFOX患者的两种氟嘧啶的平均RDI均较高(85%vs.78%,p<0.01)和奥沙利铂(72%vs.66%,p=0.06)。尽管RDI较低,CAPOX患者倾向于更好的5年DFS(84%与78%,HR=0.53,p=0.068)和类似的OS(89%与89%,HR=0.53,p=0.21)与FOLFOX组相比。这种差异在高风险(T4或N2)组中最为明显,其中5年DFS为78%对67%(HR=0.41,p=0.042)。接受CAPOX的患者出现了更多的≥2级腹泻(p=0.017)和手足综合征(p<0.001),但没有周围神经病变或骨髓抑制。
结论:在现实世界中,尽管RDI较低,但接受CAPOX的患者与接受FOLFOX辅助治疗的患者的OS率相似.在高危人群中,CAPOX似乎表现出优于FOLFOX的5年DFS。