The Colon Club

News | June 04, 2017 | ASCO, Colorectal Cancer

CHICAGO—Patients may be able to simplify their course of chemotherapy after surgery for stage III lymph node–positive colon cancer, according to a new analysis of six clinical trials (abstract LBA1). The data, presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 2–6, suggest that some patients may only need half of the longstanding standard course of chemotherapy.

The researchers examined data on 12,834 patients and found that 3 months of chemotherapy was nearly as effective as 6 months in patients with relatively lower recurrence risk. The findings suggest that this new schedule results in fewer side effects, particularly nerve damage.

“The side effects were dramatically lower and so this will change the standard of care,” said senior study author Axel Grothey, MD, an oncologist at the Mayo Clinic Cancer Center in Rochester, Minnesota.

Since 2004, the standard adjuvant therapy after surgery has been a combination of chemotherapies (FOLFOX or XELOX) given over a period of 6 months. The goal of this study, which pooled data from 6 studies conducted in North America, Europe, and Asia, was to determine if 3 months of chemotherapy was as effective as 6 months.

The analysis showed that a 3-month course of chemotherapy was associated with a lower chance of being colon cancer free at 3 years compared with the standard 6-month course (74.6% vs 75.5%). In patients considered low risk for cancer recurrence (60% of patients in the study), the difference was even smaller (83.1% in patients receiving a 3-month course vs 83.3% in patients receiving a 6-month course).

“It is very good news. It will decrease long-term side effects that would affect quality of life,” said Grothey. He noted that patients with higher-risk colon cancer should discuss these results with their clinicians to tailor a course of therapy optimal for them, taking into account their preference, age, and ability to tolerate chemotherapy.

Nerve damage was substantially less common in patients receiving a 3-month course of chemotherapy compared with a 6-month course (15% vs 45% with FOLFOX and 17% vs 48% with XELOX). For all patients combined, the rate of disease-free survival at 3 years was slightly lower with 3 months of chemotherapy vs 6 months of chemotherapy (74.6% vs 75.5%). The type of chemotherapy regimen selected affected the difference in 3-year disease-free survival between the 3-month and 6-month treatment durations (75.9% vs 74.8% with XELOX and 73.6% vs 76.0% with FOLFOX). Patients were followed for a median time of 39 months.

TXLiz wrote:I am of 2 minds about this.

3 months sounds great! Easy!

However, I picture microscopic cancer cells slinking about my body and want them dead. I want their families dead. I want their pets dead.

Lee wrote:

TXLiz wrote:I am of 2 minds about this.

3 months sounds great! Easy!

However, I picture microscopic cancer cells slinking about my body and want them dead. I want their families dead. I want their pets dead.

I can not argue with this..., I want their pets dead. Makes sense to me . . .

Lee

TXLiz wrote:
Haha it's from Cheers. Since this place is our Cheers, I had to use it.

Tdubz wrote:This is very interesting. It sure would be awesome to say I'm half way done instead of a quarter done. Is a lifetime of neuropathy worth a 1% difference? Especially for those of us on the younger side? Tough call. I get my genetic test back in 4 weeks. Maybe that would be a good time to discuss this further with my onc.

Edit to add:

At the bottom of the article, it says for folfox users, the difference was slightly larger, 73.6 vs 76.0%. That a 2.4% difference instead of the one percent mentioned at the top of the article. (If I'm understanding the article correctly)

I saw an elderly man today while getting my infusion who couldn't walk because of the neuropathy in his feet. Is that the life I see for myself at 37? No. But at the same time I want to be alive for as long as this old man was.

Tdubz wrote:I saw an elderly man today while getting my infusion who couldn't walk because of the neuropathy in his feet. Is that the life I see for myself at 37? No. But at the same time I want to be alive for as long as this old man was.

benben wrote:I talked with my assistant ONC today. She is actually my ONC's assistant. He wasn't out of office.
I asked and she said "oh no, he's here - just in the other room with another patient. We trade off sometimes."
I was a bit peaved as I was discussing low blood count with his assistant rather than him. I also brought up this study.
She smiled and said that she had indeed heard of it and had just met with one of the authors of the study yesterday.
Supposedly she said the studies are good mostly for stage II and Stage III with no lymph involvement. She said
they would still push aggressively for 12 treatments with stage IIIb and C.