The influence of adjuvant chemotherapy dose intensity on overall survival in resected colon cancer: a multicentered retrospective analysis

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dc.contributor.authorBreadner, Daniel
dc.contributor.authorLoree, Jonathan M.
dc.contributor.authorCheung, Winson Y.
dc.contributor.authorGipson, Meghan
dc.contributor.authorLakkunarajah, Suganija
dc.contributor.authorMulder, Karen E.
dc.contributor.authorSpartlin, Jennifer L.
dc.contributor.authorKong, Shiying
dc.contributor.authorDing, Philip Q.
dc.contributor.authorGill, Sharlene
dc.contributor.authorWelch, Stephen A.
dc.date.accessioned2022-11-06T01:02:21Z
dc.date.available2022-11-06T01:02:21Z
dc.date.issued2022-11-01
dc.date.updated2022-11-06T01:02:21Z
dc.description.abstractAbstract Background Colorectal cancer remains the second leading cause of cancer death in North America. Fluorouracil and oxaliplatin based adjuvant chemotherapy for resected colon cancer (CC) reduces cancer recurrence, but also causes significant toxicity requiring dose reductions. The effect of dose intensity on survival outcomes is not fully understood and strengthening the evidence supports informed decision making between patients and oncologists. Methods Patients treated with adjuvant chemotherapy, between 2006 and 2011, for resected colon cancer at four Canadian academic cancer centers were retrospectively analyzed. All patients must have received oxaliplatin with either capecitabine (CAPOX) or 5-FU (FOLFOX). Dose intensity (DI) was calculated as total delivered dose of an individual chemotherapy agent divided by the cumulative intended dose of that agent. The influence of DI on overall survival was examined. Results Five hundred thirty-one patients with high-risk stage II or stage III resected CC were eligible and included in the analysis. FOLFOX was the most common regimen (69.6%) with 29.7% of patients receiving CAPOX and 0.7% receiving both therapies. Median follow-up was 36.7 months. The median DI for 5-FU and capecitabine was 100% and 100% with 13.6% and 9.8% of patients receiving ≤ 80% DI, respectively. The median DI of oxaliplatin was 70% with 56.8% of patients receiving ≤ 80% DI. A DI of > 80% for each chemotherapy component was associated with a significant improvement in overall survival compared to those with a DI of ≤ 80% (5-FU HR = 0.23, 95% CI = 0.08–0.65, p = 0.006; capecitabine HR = 0.56, 95% CI = 0.33–0.94, p = 0.026; oxaliplatin HR = 0.52, 95% CI = 0.33–0.82, p = 0.005). Patients with T2 and/or N2 disease with an oxaliplatin DI > 80% had a trend towards improved survival (HR = 0.62, 95% CI = 0.38–1.02, p = 0.06). Conclusions In resected CC an adjuvant chemotherapy DI of > 80%, of each chemotherapy agent, is associated with improved overall survival.
dc.identifier.citationBMC Cancer. 2022 Nov 01;22(1):1119
dc.identifier.doihttps://doi.org/10.1186/s12885-022-10198-y
dc.identifier.urihttp://hdl.handle.net/1880/115422
dc.identifier.urihttps://doi.org/10.11575/PRISM/45226
dc.language.rfc3066en
dc.rights.holderThe Author(s)
dc.titleThe influence of adjuvant chemotherapy dose intensity on overall survival in resected colon cancer: a multicentered retrospective analysis
dc.typeJournal Article
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