Receipt of chemotherapy among Medicaid-enrolled patients diagnosed with regional colon cancer

e15016 Background: Although overall improvements in colon cancer mortality have been observed, persistent disparities marked by socioeconomic inequality remain. Inadequate treatment received by the poor leads to disparities in overall and disease-free survival. This paper evaluates the patient, health services, and community characteristics associated with receipt of chemotherapy among poor Medicaid beneficiaries diagnosed with SEER-staged regional colon cancer. Methods: A dataset was constructed from Medicaid-enrolled patients diagnosed with colon cancer from 1999 to 2002 (n=692). Using claims data, North Carolina Central Cancer Registry data, and U.S. Census data, multivariable models were constructed to evaluate the association between patient, health services, and community characteristics and adjuvant chemotherapy. Results: Characteristics of the study population include: 66% female; 25% ages 65–74 and 46% ages 75+; and 42% African American. 1 in 4 of individuals with regional stage colon cancer had a Medicaid or Medicare claim for chemotherapy within 12 months of diagnosis. Individuals under age 65 (OR 6.4, CI 3.6–11.1) and ages 65- 74 (OR 4.4, CI 2.6–7.7) were significantly more likely to receive chemotherapy than individuals 75 and older in the multivariable model. Although non-cancer related comorbidity, class of case, and poverty were significantly associated with received chemotherapy in unadjusted models, their effects were no longer significant after controlling for age. Conclusions: A substantial percentage of Medicaid enrollees do not receive recommended adjuvant chemotherapy. The poor elderly may be especially at risk for under treatment. No significant financial relationships to disclose.

Download Full-text

Differences in the outcomes of adjuvant chemotherapy for colon cancer prescribed by physicians in different disciplines: a population-based study in Taiwan

BMJ Open ◽

10.1136/bmjopen-2017-021341 ◽

2018 ◽

Vol 8 (12) ◽

pp. e021341

Author(s):

Cheng-I Hsieh ◽

Raymond Nien-Chen Kuo ◽

Chun-Chieh Liang ◽

Hsin-Yun Tsai ◽

Kuo-Piao Chung

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Cox Regression ◽

Surgical Margin ◽

Disease Free Survival ◽

Disease Stage ◽

Multiple Primary Cancers ◽

Positive Surgical Margin ◽

Recurrence Rates ◽

Significant Difference

ObjectivesOne feature unique to the Taiwanese healthcare system is the ability of physicians other than oncologists to prescribe systemic chemotherapy. This study investigated whether the care paths implemented by oncologists and non-oncologists differ with regard to patient outcomes.SettingData from the Taiwan Cancer Registry and National Health Insurance Database were linked to identify patients with colon cancer who underwent colectomy as first treatment within 3 months of diagnosis and adjuvant chemotherapy between 2005 and 2009.Participants and methodsPostoperative patients who underwent adjuvant chemotherapy were included in this study. The exclusion criteria included patients with stage IV disease, a positive surgical margin and early disease recurrence. Among the patients presenting with multiple primary cancers, we also excluded patients who were diagnosed with colon cancer but for whom this was not the first primary cancer. The variables included sex, age, comorbidities, disease stage, chemotherapy cycle and changes in treatment regimen as well as the specialty of treatment providers and their case volume. Cox regression models and Kaplan-Meier analysis were used to examine differences in outcomes in the matched cohorts.ResultsWe examined 3534 patients who were prescribed adjuvant chemotherapy by physicians from different disciplines. In terms of 5-year disease-free survival, no significant difference was observed between the groups of oncologists or surgeons among patients with stage II (90.02%vs88.99%) or stage III (77.64%vs79.99%) diseases. Patients who were subjected to changes in their chemotherapy regimens presented recurrence rates higher than those who were not.ConclusionsThe discipline of practitioners is seldom taken into account in most series. This is the first study to provide empirical evidence demonstrating that the outcomes of patients with colon cancer do not depend on the treatment path, as long as the selection criteria for adjuvant chemotherapy is appropriate. Further study will be required before making any further conclusions.

Download Full-text

Clinicopathological characteristics and impact on efficacy of three versus six months of adjuvant chemotherapy in early-onset colon cancer: ACHIEVE and ACHIEVE-2 trials.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.3_suppl.60 ◽

2021 ◽

Vol 39 (3_suppl) ◽

pp. 60-60

Author(s):

Eiji Oki ◽

Masahito Kotaka ◽

Dai Manaka ◽

Manabu Shiozawa ◽

Yasuhiro Sakamoto ◽

...

Keyword(s):

Colon Cancer ◽

High Risk ◽

Adjuvant Chemotherapy ◽

Early Onset ◽

Lung Metastases ◽

Age Groups ◽

Disease Free Survival ◽

Clinicopathological Characteristics ◽

Related Data ◽

Incidence And Mortality

60 Background: Colorectal cancer (CRC) incidence and mortality have decreased since the 1970s but several data such as the SEER CRC registry show that the incidence of early onset colon cancer (eoCC, age 20-49) and RC keep increasing. There is limited results suggesting eoCC may have different behaviors compared to traditional CC (tCC, age ≥ 50). Methods: Individual patient data of 1,805 high-risk stage II/III colon cancer (CC) patients (pts) as the modified ITT population in ACHIEVE and ACHIEVE-2 trials were investigated. Clinicopathological features and treatment-related data were assessed by age group. Disease-free survival (DFS) was assessed by Kaplan-Meier curves and Cox multivariable models adjusted by trials, regimen, T and N. Results: Of the 1,805 pts, eoCC were 155 pts (8.6%). Using 5% difference between age groups as clinically meaningful cutoff, eoCC had similar gender (female, 52 vs 48%), PS (PS = 1, 1 vs 4%), risk group (high-risk, 43 vs 42%) and T stage (T4, 30 vs 30%) as tCC, while eoCC were less likely right-sided colon primary (32 vs 39%), had N1 disease (48 vs 54%), and treated by FOLFOX (16 vs 23%). Overall, eoCC significantly had a worse DFS than tCC (3y-DFS, 75 vs 82%; Adjusted Hazard Ratio = 1.40: 95% Confidence Interval, 1.00-1.95: p= 0.0478); in addition, similar DFS were observed among tCC pts (age 50-69 vs >70). eoCC experienced less neutropenia, thrombocytopenia and stomatitis, but had more diarrhea, nausea and/or vomiting. There were 38 and 297 pts with an initial relapse in eoCC and tCC, respectively. Of those, peritoneal metastases were more frequently seen in eoCC (n = 13, 34%) than in tCC (n = 63, 21%) (p = 0.097), whereas liver and lung metastases were similar between the two groups. Impact on DFS of 3 versus 6 months of adjuvant chemotherapy in eoCC (3y-DFS, 75% vs 76%) is similar to that in tCC (83% vs 81%). Conclusions: eoCC had unique characteristics; the difference in DFS between eoCC and tCC were potentially due to a different metastatic spread. eoCC had a different adverse event profile compared to tCC. No impact on DFS of treatment duration in eoCC was suggested. Clinical trial information: UMIN000013036.

Download Full-text

Three Versus 6 Months of Oxaliplatin-Based Adjuvant Chemotherapy for Patients With Stage III Colon Cancer: Disease-Free Survival Results From a Randomized, Open-Label, International Duration Evaluation of Adjuvant (IDEA) France, Phase III Trial

Journal of Clinical Oncology ◽

10.1200/jco.2017.76.0355 ◽

2018 ◽

Vol 36 (15) ◽

pp. 1469-1477 ◽

Cited By ~ 54

Author(s):

Thierry André ◽

Dewi Vernerey ◽

Laurent Mineur ◽

Jaafar Bennouna ◽

Jérôme Desrame ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Health Care Providers ◽

Disease Free Survival ◽

Phase Iii ◽

Stage Iii ◽

Care Providers ◽

Free Survival ◽

Stage Iii Colon Cancer ◽

Disease Free

Purpose Reduction of adjuvant treatment duration may decrease toxicities without loss of efficacy in stage III colon cancer. This could offer clear advantages to patients and health care providers. Methods In International Duration Evaluation of Adjuvant Chemotherapy (IDEA) France, as part of the IDEA international collaboration, patient with colon cancer patients were randomly assigned to 3 and 6 months of modified FOLFOX6 (mFOLFOX6: infusional fluorouracil, leucovorin, and oxaliplatin) or capecitabine plus oxaliplatin (CAPOX) by physician choice. The primary end point was disease-free survival (DFS), and analyses were descriptive. Results A total of 2,010 eligible patients received either 3 or 6 months of chemotherapy (modified intention-to-treat population); 2,000 (99%) had stage III colon cancer (N1: 75%, N2: 25%); 1,809 (90%) received mFOLFOX6, and 201 (10%) received CAPOX. The median age was 64 years, and the median follow-up time was 4.3 years. Overall, 94% (3 months) and 78% (6 months) of patients completed treatment (fluoropyrimidines ± oxaliplatin). Maximal grade 2 and 3 neuropathy rates were 28% and 8% in the 3-month arm and 41% and 25% in the 6-month arm ( P < .001). Final rates of residual neuropathy greater than grade 1 were 3% in the 3-month arm and 7% in the 6-month arm ( P < .001). There were 578 DFS events: 314 and 264 in the 3- and 6-month arms, respectively. The 3-year DFS rates were 72% and 76% in the 3- and 6-month arms, respectively (hazard ratio [HR], 1.24; 95% CI, 1.05 to 1.46; P = .0112). In the 3 and 6-month arms, respectively, for patients who received mFOLFOX6, the 3-year DFS rates were 72% and 76% (HR, 1.27; 95% CI, 1.07 to 1.51); for the T4 and/or N2 population, they were 58% and 66% (HR, 1.44; 95% CI, 1.14 to 1.82); and for the T1-3N1 population, they were 81% and 83% (HR, 1.15; 95% CI, 0.89 to 1.49). Conclusion IDEA France, in which 90% of patients received mFOLFOX6, shows superiority of 6 months of adjuvant chemotherapy compared with 3 months, especially in the T4 and/or N2 subgroups. These results should be considered alongside the international IDEA collaboration data.

Download Full-text

Duration of Oxaliplatin-Containing Adjuvant Therapy for Stage III Colon Cancer: ASCO Clinical Practice Guideline

Journal of Clinical Oncology ◽

10.1200/jco.19.00281 ◽

2019 ◽

Vol 37 (16) ◽

pp. 1436-1447 ◽

Cited By ~ 10

Author(s):

Christopher Lieu ◽

Erin B. Kennedy ◽

Emily Bergsland ◽

Jordan Berlin ◽

Thomas J. George ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Expert Panel ◽

Disease Free Survival ◽

Evidence Base ◽

Stage Iii ◽

Risk Of Recurrence ◽

Stage Iii Colon Cancer ◽

Significant Difference ◽

Resected Stage

PURPOSE To develop recommendations for duration of adjuvant chemotherapy with a fluoropyrimidine and oxaliplatin for patients with completely resected stage III colon cancer based on the results of trials of 3 months compared with 6 months of treatment. METHODS ASCO convened an Expert Panel and conducted a systematic review of relevant studies. The guideline recommendations were based on the review of evidence by the Expert Panel. RESULTS Pooled data from the six International Duration Evaluation of Adjuvant Chemotherapy (IDEA) Collaboration randomized controlled trials comprise the evidence base for these guideline recommendations. RECOMMENDATIONS The recommendations for therapy duration apply to patients with completely resected stage III colon cancer who are being offered adjuvant chemotherapy with oxaliplatin and a fluoropyrimidine. Recommendations are informed by the findings of a recent pooled analysis of clinical trials that compared 6 months versus 3 months of oxaliplatin-based chemotherapy. For patients at a high risk of recurrence (T4 and/or N2), adjuvant chemotherapy should be offered for a duration of 6 months. For patients at a low risk of recurrence (T1, T2, or T3 and N1), either 6 months of adjuvant chemotherapy or a shorter duration of 3 months may be offered on the basis of a potential reduction in adverse events and no significant difference in disease-free survival with the 3-month regimen. In determining duration of therapy, the Expert Panel recommends a shared decision-making approach, taking into account patient characteristics, values and preferences, and other factors and including a discussion of the potential for benefit and risks of harm associated with treatment duration. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines .

Download Full-text

The Optimal Duration of Adjuvant Chemotherapy in Colon Cancer

Cancers ◽

10.3390/cancers12092509 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2509

Author(s):

Maike Collienne ◽

Dirk Arnold

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Treatment Duration ◽

Disease Free Survival ◽

Patient Characteristics ◽

Risk Groups ◽

Prognostic Information ◽

Free Survival ◽

Clinical Risk Groups ◽

Peripheral Sensory

Adjuvant chemotherapy for colon cancer (UICC stage II and III) has been under investigation over the last 30 years, regarding treatment duration and regimens. In this review, choice of regimen, its duration, possible limitations and future perspectives are discussed. Monotherapy with 5-fluorouracil was followed by addition of oxaliplatin, resulting in improved 3-yr disease free survival (DFS) and overall survival (OS) rates, but also increased peripheral sensory neurotoxicity (PSN). The International Duration Evaluation of Adjuvant therapy (IDEA) collaboration demonstrated less toxicity, especially PSN, when shortening treatment duration to 3 months. However, formally, the anticipated non-inferiority of 3 months with fluoropyrimidine (FP)/oxaliplatin over 6 months (at 3-yr DFS) was not met for all patients groups, although subgroup analyses showed non-inferiority with capecitabine/oxaliplatin (CAPOX) rather than with FOLFOX, and also in relation to the prognostic information (e.g., clinical low-risk group, pT1-3 N0). In addition, first data of newer parameters like Immunoscore® and ctDNA show promising results as stratification parameters. Further investigations to better define clinical risk groups and prognostic factors are mandatory. Besides this, individual decision-making of treatment intensity (FP or FP/oxaliplatin) and duration should always consider patient characteristics and preferences, also given the absolute relatively small differences and their clinical relevance.

Download Full-text

Six months versus twelve months of capecitabine as adjuvant chemotherapy for stage III (Dukes' C) colon cancer: Initial safety report for the open-label randomized phase III study (JFMC37-0801).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.3607 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 3607-3607 ◽

Cited By ~ 2

Author(s):

Katsuyuki Kunieda ◽

Sotaro Sadahiro ◽

Hideyuki Mishima ◽

Chikuma Hamada ◽

Shigetoyo Saji ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Treatment Duration ◽

Disease Free Survival ◽

Chemotherapeutic Agents ◽

Phase Iii ◽

Stage Iii ◽

Serious Adverse Events ◽

Phase Iii Trial ◽

Stage Iii Colon Cancer

3607 Background: The standard treatment duration of adjuvant chemotherapy (CT) in patients (pts) with stage III colon cancer is 6 months. On the other hand, no clinical trial showed the optimal treatment duration of oral chemotherapeutic agents in adjuvant setting for colon cancer. Sargent et al have reported that 83% of recurrences in stage II and III pts have occurred within the first 3 years after surgery and peak was observed around one year after surgery. Therefore, to clarify the benefit of 12 months administration of Capecitabine, we designed randomized phase III trial for a comparison of 6 months treatment and 12 months treatment of capecitabine as adjuvant CT for stage III colon cancer. Methods: JFMC37 is a multicenter, randomized Phase III trial. Patients with fully resected Stage III colon or recto sigmoid cancer were eligible. Capecitabine was administered orally as tablets, 2,500 mg/m²/day for 14 days followed by a 7-days rest. Treatment is continued to 8 cycles (6 months) in arm A (A) or 16 cycles (12 months) in arm B (B). Patients were randomized 1:1 to A or B. Data size was estimated by disease free survival as primary endpoint. The statistical design is based on superiority hypothesis; 5-yrs DFS is 60% in arm A, 67% in arm B ;unilateral α=0.05, 1-β=0.8;and planed accrual is 1200 pts. Results: Between September 2008 to December 2009, 1304 patients were enrolled and then randomized. Both arms were well balanced for mean age: (A) 64.1, (B) 63.8; ECOG PS (%0/1): (A) 95.0/5.0, (B) 97.1/2.9; involvement of lymph nodes (%N0/N1/N2): (A) 77.1/19.9/3.1, (B) 76.6/19.7/3.7. Treatment completion rate for A and B were 68.2% and 43.4%. Incidences of serious adverse events (SAEs) over 1% were neutropenia: (A) 2.6%, (B) 3.8%, diarrhea: (A) 2.9%, (B) 2.1%, loss of appetite: (A) 1.3%, (B) 1.0%, fatigue: (A) 1.8%, (B) 1.2%, hand-hoot syndrome: (A) 16.4%, (B) 22.1%. Conclusions: There were no obvious differences in SAEs between arm A and arm B. Although twelve months of capecitabine showed a tendency to increase G3/4 hand-foot syndrome, we concluded that incidence of SAEs were acceptable and comparable to previously report.

Download Full-text

Cochrane systematic review and meta-analysis of adjuvant chemotherapy for stage II colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.3548 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 3548-3548

Author(s):

Brandon Matthew Meyers ◽

Humaid Obaid Al-Shamsi ◽

Alvaro Tell Figueredo

Keyword(s):

Colon Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Meta Analysis ◽

Disease Free Survival ◽

Stage Ii ◽

Cochrane Systematic Review ◽

Free Survival ◽

Stage Ii Colon Cancer ◽

Disease Free

3548 Background: Colon cancer is potentially curable by surgery in the early stages of the disease. Adjuvant chemotherapy improves disease-free and overall survival in patients with stage III disease, but the magnitude of benefit in stage II colon cancer is less clear. A previous Cochrane systematic review and meta-analysis (SR/MA) found improved disease-free, but not overall survival (Figueredo et al., 2008). An updated SR/MA was performed to determine the effects of adjuvant chemotherapy on disease-free and overall survival in patients with stage II colon cancer. Methods: Relevant databases (MEDLINE, EMBASE, and Cochrane) were independently searched by all authors, using the same search strategy employed in the original study (1/1988 to 9/2012). Randomized trials containing data on stage II colon cancer patients undergoing adjuvant 5-fluorouracil (5FU) chemotherapy versus observation were included. Pooled results were expressed as hazard ratios (HR) whenever possible, or risk ratios (RR), with 95% confidence intervals (95%CI) using a random effects model. Results: Seven studies were identified, and included in the final SR/MA. Six of the 7 studies were included in the disease-free survival analysis (n=4587). Adjuvant 5FU was associated with better disease-free survival (RR 0.84 (95%CI 0.75-0.94)). All 7 studies (n=5353) were included in the overall survival analysis showing an improvement with adjuvant 5FU (HR 0.87 (95%CI 0.78-0.97)). There was no evidence of heterogeneity across the studies (I2 = 0% for all analyses). Conclusions: In stage II colon cancer, adjuvant 5FU chemotherapy statistically improves both disease-free and overall survival. Our SR/MA demonstrates, for the first time, an overall survival advantage with adjuvant chemotherapy in stage II colon cancer.

Download Full-text

A randomized phase III trial of S-1/oxaliplatin (SOX) versus UFT/leucovorin as adjuvant chemotherapy for high-risk stage III colon cancer: The ACTS-CC 02 trial.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.484 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 484-484 ◽

Cited By ~ 1

Author(s):

Takao Takahashi ◽

Eiji Sunami ◽

Tetsuya Kusumoto ◽

Mitsuyoshi Ota ◽

Yoshiyuki Sakamoto ◽

...

Keyword(s):

Colon Cancer ◽

High Risk ◽

Adjuvant Chemotherapy ◽

Primary Endpoint ◽

Disease Free Survival ◽

Phase Iii ◽

Stage Iii ◽

Disease Stage ◽

Stage Iiic ◽

Stage Iii Colon Cancer

484 Background: The ACTS-CC 02 trial was designed to verify the superiority of postoperative adjuvant chemotherapy with S-1/oxaliplatin (SOX) over UFT/leucovorin (LV), one of the standard oral fluoropyrimidine regimens in Japan, in terms of disease-free survival (DFS) in patients (pts) with high-risk stage III colon cancer (any T, N2, or positive nodes around the origin of the feeding arteries). The results of the safety analysis have been reported previously (Clin Colorectal Cancer, 2018). We now present the 3-year DFS results as the primary endpoint. Methods: Pts who underwent curative resection for pathologically confirmed high-risk stage III colon cancer were randomly assigned to receive either UFT/LV (300–600 mg/day of UFT according to body surface area [BSA] and 75 mg/day of LV on days 1-28, every 35 days, 5 courses) or SOX (100 mg/m2 of oxaliplatin on day 1 and 80–120 mg/day of S-1 according to BSA on days 1-14, every 21 days, 8 courses). The primary endpoint was DFS. Results: From April 2010 through October 2014, a total of 966 pts were enrolled at 260 institutions. The full analysis set, excluding pts who withdrew informed consent before protocol treatment, comprised 478 and 477 pts in the UFT/LV group and SOX group, respectively. The median age was 65.0 years. The ECOG PS was 0 in 94.0%, and the disease stage was IIIA/IIIB/IIIC in 1.3%/50.2%/48.6%. The 3-year DFS rate was 60.6% in the UFT/LV group and 62.7% in the SOX group (HR: 0.90; 95% CI: 0.74-1.09; p = 0.28); the superiority of SOX was not demonstrated. In stage IIIB, the 3-year DFS rate was 69.3% and 68.5% in the UFT/LV group and SOX group, respectively (HR: 1.01; 95% CI: 0.74-1.37; p = 0.95). In Stage IIIC, the 3-year DFS rate was 50.6% and 55.8% in the UFT/LV group and SOX group, respectively (HR: 0.82, 95% CI: 0.63-1.06; p = 0.12). Notably, in the N2b subgroup, the 3-year DFS rate was 46.0% and 54.7% in the UFT/LV group and SOX group, respectively (HR: 0.76, 95% CI: 0.55-1.05; p = 0.10). Conclusions: SOX was not shown to be superior to UFT/LV in pts with high-risk stage III colon cancer. However, the oxaliplatin-based regimen was suggested to be more effective in advanced disease, such as stage IIIC and N2b. Clinical trial information: JapicCTI-101073.

Download Full-text

Preoperative Sarcopenia is Associated with Poorer Compliance Rate of Adjuvant Chemotherapy and Worse Disease-free Survival of Patients with Stage Ⅲ Colon Cancer

10.21203/rs.3.rs-1034158/v1 ◽

2021 ◽

Author(s):

Liang Yu ◽

Guangliang Chen ◽

Zongbin Xu ◽

Pan Chi ◽

Zhifen Chen

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Perioperative Complications ◽

Compliance Rate ◽

Disease Free Survival ◽

Perioperative Outcomes ◽

Significant Prognostic Factor ◽

Important Indicator

Abstract Purpose: Preoperative sarcopenia has been proved to be associated with worse postoperative outcomes in cancer patients. This study aimed to evaluate whether preoperative sarcopenia affects the perioperative outcomes, adjuvant chemotherapy, and long-term outcomes of patients with stage Ⅲ colon cancer.Methods: Total 218 patients who underwent curative resection for stage Ⅲ colon cancer in our department from January, 2015 and December, 2018 were retrospectively analyzed. Sarcopenia was assessed by total psoas index, which measured the total area the level of L3 vertebral body and normalized according to patients’ height. Perioperative complications, postoperative adjuvant chemotherapy, and long-term prognosis were retrospectively analyzed.Results: Of 218 patients, 100(45.9%) patients were diagnosed with sarcopenia. Sarcopenia did not add the risk of perioperative complications (20.0% vs 15.3%, P=0.357), but it increased hospital stays (7.6±3.9 vs 6.7±2.2 days, P=0.042). Patients with sarcopenia had a lower rate of receiving adjuvant chemotherapy (70.0% vs 82.2%, p=0.033) and less likely to receive adequate adjuvant chemotherapy (58.6% vs 70.1, P=0.08). Patients with adequate adjuvant chemotherapy had significantly better 3-year OS (89.8% vs 79.5, P=0.005) and a tendency of better 3-year DFS (76.4% vs 63.6%, P=0.055) than those with inadequate adjuvant chemotherapy and Non-adjuvant chemotherapy. Compared with the patients without sarcopenia, patients with sarcopenia had significantly worse 3-year DFS (76.9% vs 62.8%, P=0.026).Conclusion: Preoperative sarcopenia was an important indicator to predict the compliance of AC in stage Ⅲ colon cancer patients, and it is also a significant prognostic factor of worse 3-year DFS.

Download Full-text

Fluorouracil Plus Leucovorin as Effective Adjuvant Chemotherapy in Curatively Resected Stage III Colon Cancer: Results of the Trial adjCCA-01

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.6.1787 ◽

2001 ◽

Vol 19 (6) ◽

pp. 1787-1794 ◽

Cited By ~ 82

Author(s):

Rainer Porschen ◽

Andreas Bermann ◽

Thomas Löffler ◽

Gregor Haack ◽

Klaus Rettig ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Adjuvant Treatment ◽

Disease Free Survival ◽

Stage Iii ◽

Postoperative Treatment ◽

Free Survival ◽

Stage Iii Colon Cancer ◽

Resected Stage ◽

Disease Free

PURPOSE: Adjuvant postoperative treatment with fluorouracil (5-FU) and levamisole in curatively resected stage III colon cancer significantly reduces the risk of cancer recurrence and improves survival. Biochemical modulation of 5-FU with leucovorin has resulted in increased remission rates in metastatic colorectal cancer, thus reflecting an increased tumor-cell kill. The impact of 5-FU plus leucovorin on survival and tumor recurrence was analyzed in comparison with the effects of 5-FU plus levamisole in the prospective multicentric trial adjCCA-01. PATIENTS AND METHODS: Patients with a curatively resected International Union Against Cancer stage III colon cancer were stratified according to T, N, and G category and randomly assigned to receive one of the two adjuvant treatment schemes: 5-FU 400 mg/m2 body-surface area intravenously in the first chemotherapy course, then 450 mg/m2 × 5 days; 12 cycles, plus leucovorin 100 mg/m2 (arm A), or 5-FU plus levamisole (Moertel scheme; arm B). RESULTS: Six hundred eighty (96.9%) of 702 patients enrolled onto this study were eligible. After a median follow-up time of 46.5 months, the 5-FU plus leucovorin combination significantly improved disease-free survival (P = .037) and significantly decreased overall mortality (P = .0089) in comparison with 5-FU plus levamisole. In a multivariate proportional hazards model, adjuvant chemotherapy emerged as a significant prognostic factor for survival (P = .0059) and disease-free survival (P = .03). Adjuvant treatment with 5-FU plus levamisole as well as with 5-FU plus leucovorin was generally well tolerated; only a minority of patients experienced grade 3 and 4 toxicities. CONCLUSION: After a curative resection of a stage III colon cancer, adjuvant treatment with 5-FU plus leucovorin is generally well tolerated and significantly more effective than 5-FU plus levamisole in reducing tumor relapse and improving survival.

Download Full-text