Good IDEA: Drop Adjuvant Chemo From 6 to 3 Months in CRC

John Marshall from Medscape, here on the floor at ASCO. I've got my badge and everything; I'm a faculty guy—the whole thing.

Big news yesterday at the plenary session. We were anticipating this. A big piling up of different studies in the stage III colon cancer setting, looking at 6 months versus 3 months [of adjuvant oxaliplatin-based chemotherapy] in a bunch of patients and looking for noninferiority.^[1] It is a little bit controversial because, statistically, this compilation of studies didn't meet the noninferiority bar. You saw these curves being presented and you could not put a piece of paper between the 3-month and the 6-month curve. Even though the biostatisticians were suggesting that this might not have met this very high bar statistically, every clinician in that room said that 3 months was as good as 6 months. A standard practice-changing moment.

If you've got patients out there right now who are getting 6 months of adjuvant chemotherapy for colon cancer, you can tell them that all they need is 3 months. No more oxaliplatin nerve toxicity. If you look at the difference between 6 months of nerve toxicity versus 3 months, there's a dramatic difference. In point of fact, most of those patients who went on to 6 months in the clinical trials didn't get all of that oxaliplatin. It is much better to give most of the drug in the 3 months and be done.

Now the subset analysis. T4 N2 cancers had a higher risk overall. Even in that group, there was very little difference between 3 months and 6 months. Many of my colleagues are arguing that in that higher-risk group, you should give patients 3 months of oxaliplatin-based therapy and then maybe 3 months of just fluoropyrimidine. Finally—and I knew this all along and I told you—capecitabine performed better. When they did a subset analysis of those patients who got CAPOX versus FOLFOX, there was an even better outcome.

New standard of care: 3 months of CAPOX chemotherapy for most of your stage III patients. Only in those at higher risk should you consider going to 6 months. In those, I would say use only fluoropyrimidine.

This study changes your practice today. Here at ASCO, John Marshall for Medscape.

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Good IDEA: Drop Adjuvant Chemo From 6 to 3 Months in CRC - Medscape - Jun 12, 2017.

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