The Colon Club

Hello all,
I start my first of six cycles of folfox on 12/1. I will ask my oncologist about this as well but everything I’m seeing online is a minimum of 8 cycles. Has anyone else only had 6 and was it successful?

I have stage IIIb CC, G2, 2/29 + LN.

Thank you

I ended up having 8, though Oxi was pulled or limited for two. I had a lot of conversations with my team that suggested 6 was enough. I think I also saw studies indicating that 6 wasn’t different from 8 on many important measures, though I have only a vague memory there at this point (might be worth a look). I would add, though, that unless you have serious neuropathy issues or dangerous complications, my two cents is that you will feel better in the future if you finish the 8. I got a very big benefit from it, but I think most of the measurable benefit occurred in the first 4. It’s hard to say about “success.” That’s the reason for a conservative approach.

I think that the reference is: Adjuvant FOLFOX treatment for stage III colon cancer: how many cycles are enough?

The 5-year overall survival rate of patients was 77.9 %, and the 3-year disease-free survival was 76.7 %. For overall survival, a significant benefit was noted for treatment of at least 8 cycles, for disease-free survival, significant differences were apparent from patient data of those who underwent from 7 to 12 treatment cycles. Multivariate survival analysis of that patient data at cycle 8 for overall survival and cycle 7 for disease free survival revealed cycle number as the only independent prognostic factor (p = 0.04, 0.048).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980863/

I was on Xeloda + oxaliplatin which has two-thirds the number of cycles compared to FOLFOX. My oncologist said 4 is minimal, 6 is the sweet spot and 8 is the maximum. So that would map to 6, 9 and 12 for FOLFOX though I'm doing the ratio; my oncologist didn't say that. I had 8 cycles of Xeloda but skipped oxaliplatin for two rounds.

The paper is from 2016.

I found another article, Effect of Adjuvant FOLFOX Chemotherapy Duration on Outcomes of Patients With Stage III Colon Cancer, from 2015 with the conclusion:

Conclusion: Early discontinuation of FOLFOX was not associated with differences in survival outcomes, lending support to clinical trials that are under way to evaluate the efficacy of shorter durations of therapy.

https://pubmed.ncbi.nlm.nih.gov/26123496/

Another paper, Impact of Relative Dose Intensity of FOLFOX Adjuvant Chemotherapy on Risk of Death Among Stage III Colon Cancer Patients, indicates that NCCN guidelines recommended tailored chemo for stage II colon cancer patients based on risk level. So it appears that there was research on this that came out in 2018 in guidelines form. The conclusion of this particular paper is:

Conclusions: There is no significant harm on the risk of death when reducing RDI by <30% for high-risk patients. For the low-risk patients, we found that RDI as low as 45% did not significantly affect the risk of death.


https://pubmed.ncbi.nlm.nih.gov/34756680/

Thank you NHMike! Sounds like I got the right amount (6 cycles for low risk).