“Although not a direct comparison with FOLFOX from MOSAIC, the results are quite comparable, in the primary endpoint (3-year disease-free survival) as well as the endpoint of the current report of overall survival with long-term follow-up. These data permit the conclusion that either regimen is acceptable for stage 3 colon cancer,” Dr. Haller said.

National Comprehensive Cancer Network guidelines for colon cancer already acknowledge that XELOX is superior to bolus 5-FU/FA, while capecitabine alone seems to be equivalent to bolus 5-FU/FA in patients with stage 3 colon cancer. The guidelines recommend FOLFOX (5-FU, leucovorin, oxaliplatin) or XELOX as the preferred adjuvant treatment options for these patients.3

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Specifically, the current guidelines recommend oxaliplatin 130 mg/m2 administered intravenously over 2 hours on day 1 with capecitabine 1,000 mg/m2 administered orally twice daily on days 1-14 every 21 days for 24 weeks. This is the same regimen used in the XELOXA trial.1,3

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Although XELOX is already an accepted regimen for stage 3 colon cancer, there are some patients that would benefit more from this particular regimen.

“The most obvious [patients] are in areas of the United States or the rest of the world where the availability of infusion pumps, distance, etc, would favor a shorter regimen with an oral component,” Dr. Haller explained. “The combination of capecitabine plus oxaliplatin is also an accepted regimen for gastric cancer, and these additional data will help physicians and patients to get comfortable with the regimen.”

References

  1. Schmoll H-J, Tabernero J, Maroun J, et al. Capecitabine plus oxaliplatin compared with fluorouracil/folinic acid as adjuvant therapy for stage III colon cancer: final results of the NO16968 randomized controlled phase III trial [published online ahead of print August 31, 2015]. J Clin Oncol. doi: 10.1200/JCO.2015.60.9107.
  2. What are the survival rates for colorectal cancer by stage? American Cancer Society website. http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorecolo-cancer-survival-rates. Updated August 13, 2015. Accessed September 11, 2015.
  3. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Colon Cancer Version 3.2015. Available at http://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. Accessed September 11, 2015.

Topics:

Colon Cancer Colorectal Cancer Gastrointestinal Cancer