Effect of invitation to colonoscopy versus faecal immunochemical test screening on colorectal cancer mortality (COLONPREV): a pragmatic, randomised, controlled, non-inferiority trial
People prefer stool card over colonoscopy, and it is not inferior.
Oxaliplatin-Based Adjuvant Chemotherapy in Older Patients With Stage III Colon Cancer: An ACCENT/IDEA Pooled Analysis of 12 Trials
Author(s): Claire Gallois, MD1; Qian Shi, PhD2; Levi D. Pederson, PhD2; Thierry André, PhD3; Timothy J. Iveson, PhD4; Alberto F. Sobrero, PhD5; Steven Alberts, PhD6; Aimery de Gramont, PhD7; Jeffrey A. Meyerhardt, PhD8; Thomas George, PhD9; Hans-Joachim E. Schmoll, PhD10; Ioannis Souglakos, PhD11; Andrea Harkin, PhD12; Roberto Labianca, PhD13; Frank A. Sinicrope, PhD6; Eiji Oki, PhD14; Anthony F. Shields, PhD15; Ioannis Boukovinas, PhD16; Rachel Kerr, PhD17; Sara Lonardi, PhD18; Greg Yothers, PhD19; Takayuki Yoshino, PhD20; Richard M. Goldberg, PhD21; Julien Taieb, PhD1; Demetris Papamichael, MD22
Source: https://doi.org/10.1200/JCO.23.01326
Dr. Anjan Patel's Thoughts
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.
PURPOSE
A number of studies suggest that older patients may have reduced or no benefit from the addition of oxaliplatin to fluoropyrimidines as adjuvant chemotherapy for stage III colon cancer (CC).MATERIALS AND METHODS
We studied the prognostic impact of age, as well as treatment adherence/toxicity patterns according to age, in patients with stage III CC who received 3 or 6 months of infusional fluorouracil, leucovorin, and oxaliplatin/capecitabine and oxaliplatin (CAPOX) on the basis of data collected from trials from the ACCENT and IDEA databases. Associations between age and time to recurrence (TTR), disease-free survival (DFS), overall survival (OS), survival after recurrence (SAR), and cancer-specific survival (CSS) were assessed by a Cox model or a competing risk model, stratified by studies and adjusted for sex, performance status, T and N stage, and year of enrollment.RESULTS
A total of 17,909 patients were included; 24% of patients were age older than 70 years (n = 4,340). Patients age ≥70 years had higher rates of early treatment discontinuation. Rates of grade ≥3 adverse events were similar between those older and younger than 70 years, except for diarrhea and neutropenia that were more frequent in older patients treated with CAPOX (14.2% v 11.2%; P = .01 and 12.1% v 9.6%; P = .04, respectively). In multivariable analysis, TTR was not significantly different between patients <70 years and those ≥70 years, but DFS, OS, SAR, and CSS were significantly shorter in those patients ≥70 years.CONCLUSION
In patients ≥70 years with stage III CC fit enough to be enrolled in clinical trials, oxaliplatin-based adjuvant chemotherapy was well tolerated and led to similar TTR compared with younger patients, suggesting similar efficacy. TTR may be a more appropriate end point for efficacy in this patient population.Author Affiliations
1Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, SIRIC CARPEM, Paris-Cité University, Paris, France; 2Department of Quantitative Health Science, Mayo Clinic, Rochester, MN; 3Department of Medical Oncology, Hôpital Saint-Antoine, Sorbonne Université, Paris, France; 4Department of Medical Oncology, University of Southampton, Southampton, United Kingdom; 5Medical Oncology, IRCCS San Martino IST, Genoa, Italy; 6Department of Oncology, Mayo Clinic, Rochester, MN; 7Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France; 8Dana-Farber Cancer Institute, Boston, MA; 9University of Florida Health Cancer Center, Gainesville, FL; 10Department Internal Medicine, Clinic of Internal Medicine IV, University Clinic Halle, Martin-Luther University, Halle, Germany; 11Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Greece; 12Cancer Research UK Glasgow Clinical Trials Unit, Glasgow, United Kingdom; 13Cancer Center, Ospedale Papa Giovanni XXIII Bergamo, Bergamo, Italy; 14Department of Surgery and Science, Kyushu University, Fukuoka, Japan; 15Karmanos Cancer Institute, Wayne State University, Detroit, MI; 16Bioclinic Thessaloniki, Thessaloniki, Greece; 17Department of Oncology, Oxford University, Oxford, United Kingdom; 18Department of Oncology, Veneto Institute of Oncology IRCCS, Padua, Italy; 19Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA; 20Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan; 21West Virginia University Cancer Institute and the Mary Babb Randolph Cancer Center, Morgantown, WV; 22Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia, CyprusRelated Articles
Assessment of the Addition of Oxaliplatin to Fluoropyrimidine-Based Adjuvant Chemotherapy in Patients With High-Risk Stage II Colon Cancer: An ACCENT Pooled Analysis
No oxaliplatinum in stage 2 colon cancer, even high-risk patients, by the way, De Gramont is one of the authors (father of FOLOFX reigmens).
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.