Abstract：
BACKGROUND: Fluoropyrimidine and oxaliplatin-based adjuvant chemotherapy delivered as 5-fluorouracil, leucovorin and oxaliplatin (FOLFOX), or capecitabine and oxaliplatin (CAPOX) is the standard of care for resected stage III colon cancer. Without randomized trial data, we compared real-world dose intensity, survival outcomes, and tolerability of these regimens.
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.
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.
摘要：
背景：以5-氟尿嘧啶为基础的氟嘧啶和奥沙利铂辅助化疗，亚叶酸和奥沙利铂（FOLFOX），卡培他滨和奥沙利铂（CAPOX）是切除的III期结肠癌的标准治疗方法。没有随机试验数据,我们比较了真实世界的剂量强度，生存结果，和这些方案的耐受性。
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。
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。
