Physical Activity in Stage III Colon Cancer: CALGB/SWOG 80702 (Alliance)

Author(s): Justin C. Brown, PhD^1,2,3;Chao Ma, MS⁴;Qian Shi, PhD⁵;Charles S. Fuchs, MD, MPH⁶;Jeffrey Meyer, BS⁴;Donna Niedzwiecki, PhD⁷;Tyler Zemla, MS⁵;Felix Couture, MD⁸;Philip Kuebler, MD⁹;Pankaj Kumar, MD¹⁰;DeQuincy Lewis, MD¹¹;Benjamin Tan, MD¹²;Smitha Krishnamurthi, MD¹³;Eileen M. O’Reilly, MD¹⁴;Anthony F. Shields, MD¹⁵;and Jeffrey A. Meyerhardt, MD, MPH⁴

Source: DOI: 10.1200/JCO.22.00171 Journal of Clinical Oncology 41, no. 2 (January 10, 2023) 243-254.

Dr. Anjan Patel's Thoughts

Get your patients moving, even in the adjuvant setting! Of course, a lot of bias is possible here, but there was nearly a 10% difference in cure at three years.

PURPOSE

To determine the specific types, durations, and intensities of recreational physical activity associated with the greatest improvements in disease-free survival (DFS) of patients with colon cancer.

METHODS

We conducted a prospective cohort study nested within a randomized multicenter trial of stage III colon cancer that compared 3 versus 6 months of fluorouracil, leucovorin, and oxaliplatin with or without celecoxib. We measured recreational physical activity in the first 3 months of chemotherapy and again 6 months after completion of chemotherapy. The primary end point was DFS.

RESULTS

During a median follow-up of 5.9 years, 457 of 1,696 patients experienced disease recurrence or death. For total recreational physical activity volume, the 3-year DFS was 76.5% with < 3.0 metabolic equivalent task hours per week (MET-h/wk) and 87.1% with ≥ 18.0 MET-h/wk (risk difference [RD], 10.6%; 95% CI, 4.7 to 19.4; P < .001). For light-intensity to moderate-intensity activities, the 3-year DFS was 65.7% with 0.0 h/wk and 87.1% with ≥ 1.5 h/wk (RD, 21.4%; 95% CI, 9.2 to 37.1; P < .001). For vigorous-intensity activity, the 3-year DFS was 76.0% with 0.0 h/wk and 86.0% with ≥ 1.0 h/wk (RD, 10.0%; 95% CI, 4.5 to 18.9; P < .001). For brisk walking, the 3-year DFS was 81.7% with < 1.0 h/wk and 88.4% with ≥ 3.0 h/wk (RD, 6.7%; 95% CI, 3.0 to 13.8; P < .001). For muscle strengthening activity, the 3-year DFS was 81.8% with 0.0 h/wk and 88.8% for ≥ 0.5 h/wk (RD, 7.0%; 95% CI, 3.1 to 14.2; P = .003).

CONCLUSION

Among patients with stage III colon cancer enrolled in a trial of postoperative treatment, larger volumes of recreational physical activity, longer durations of light- to moderate-intensity aerobic physical activity, or any vigorous-intensity aerobic physical activity were associated with the greatest improvements in DFS.

Author Affiliations

¹Pennington Biomedical Research Center, Baton Rouge, LA;²LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA;³Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA;⁴Dana-Farber/Partners CancerCare, Boston, MA;⁵Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN;⁶Genentech, Inc, South San Francisco, CA;⁷Duke University Medical Center, Durham, NC;⁸Hôtel-Dieu de Québec, Québec, QC, Canada;⁹Columbus NCI Community Oncology Research Program, Columbus, OH;¹⁰Illinois CancerCare PC, Peoria, IL;¹¹Cone Health Medical Group, Asheboro, NC;¹²Siteman Cancer Center, Washington University School of Medicine in St Louis, Saint Louis, MO;¹³Cleveland Clinic, Cleveland, OH;¹⁴Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, NY;¹⁵Karmanos Cancer Institute, Wayne State University, Detroit, MI

Oxaliplatin-Based Adjuvant Chemotherapy in Older Patients With Stage III Colon Cancer: An ACCENT/IDEA Pooled Analysis of 12 Trials

There is more movement towards using time to relapse as an endpoint for adjuvant studies. This report highlights that there is still a role for oxaliplatin in older patients with Stage III CRC. The time to relapse was not significantly different in patients who are younger vs older. TTR is suggested as a more informative endpoint as older patients uniformly have a lower DFS and OS in most trials.

Neoadjuvant Immunotherapy in Locally Advanced Mismatch Repair–Deficient Colon Cancer

Epi and nivo for mismatch repair-deficient (dMMR) colon cancer had 98% response rate with 68% complete response, non-recurred with a median of follow up of 26 months. Does this mean bye-bye surgery??? Probably. We will need to assess those who have complete response and have a close follow up. CtDNA may play big role here, along with a need for randomized trials.

Machine Learning Predicts Oxaliplatin Benefit in Early Colon Cancer

COLOXIS is an interesting computer-based learning model that seems to be able to predict which patients are likely to benefit from adjuvant chemotherapy in colorectal cancer. This, along with ctDNA tests, may change whom we choose to offer adjuvant chemotherapy.

Adjuvant Hyperthermic Intraperitoneal Chemotherapy in Patients With Locally Advanced Colon Cancer (COLOPEC): 5-Year Results of a Randomized Multicenter Trial

Negative study for the use of HIPEC in the adjuvant setting of high-risk or locally advanced colorectal cancers, including those with perforation and peritoneal invasion. HIPEC doesn’t seem to reduce the risk of peritoneal recurrence after potentially curative resection.

Prognostic Impact of Early Treatment and Oxaliplatin Discontinuation in Patients With Stage III Colon Cancer: An ACCENT/IDEA Pooled Analysis of 11 Adjuvant Trials

Stopping oxaliplatinum and cont. of 5FU is better than stopping all chemotherapy. An option for patients with worsening neuropathy or other oxaliplatinum toxicity.