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Adjuvant chemotherapy for stage III colon cancer: relative dose intensity and survival among veterans.

Aspinall SL, Good CB, Zhao X, Cunningham FE, Heron BB, Geraci M, Passero V, Stone RA, Smith KJ, Rogers R, Shields J, Sartore M, Boyle DP, Giberti S, Szymanski J, Smith D, Ha A, Sessions J, Depcinski S, Fishco S, Molina I, Lepir T, Jean C, Cruz-Diaz L, Motta J, Calderon-Vargas R, Maland J, Keefe S, Tague M, Leone A, Glovack B, Kaplan B, Cosgriff S, Kaster L, Tonnu-Mihara I, Nguyen K, Carmichael J, Clifford L, Lu K, Chatta G - BMC Cancer (2015)

Bottom Line: Receipt of >70% RDI was associated with better 5-year OS (p < 0.001) and 3-year DFS (P = 0.009) than was receipt of ≤70% RDI, with 5-year OS rates of 66.3% and 50.5%, respectively and 3-year DFS rates of 66.1% and 52.7%, respectively.In the multivariable analysis of 5-year OS, oxaliplatin + 5-FU/LV (versus 5-FU/LV) (HR = 0.55; 95% CI = 0.34-0.91), >70% RDI at the first year (HR = 0.58; 95% CI = 0.37-0.89) and married status (HR = 0.66; 95% CI = 0.45-0.97) were associated with significantly decreased risk of death, while age ≥75 (versus 55-64) (HR = 2.06; 95% CI = 1.25-3.40), Charlson Comorbidity Index (HR = 1.17; 95% CI = 1.06-1.30), T4 tumor status (versus T1/T2) (HR = 5.88; 95% CI = 2.69-12.9), N2 node status (HR = 1.68; 95% CI = 1.12-2.50) and bowel obstruction (HR = 2.32, 95% CI = 1.36-3.95) were associated with significantly increased risk.Similar associations were observed for DFS.

View Article: PubMed Central - PubMed

Affiliation: VA Pharmacy Benefits Management Services, Hines, IL, USA. sherrie.aspinall@va.gov.

ABSTRACT

Background: Given the paucity of information on dose intensity, the objective of this study is to describe the use of adjuvant chemotherapy for stage III colon cancer, focusing on relative dose intensity (RDI), overall survival (OS) and disease-free survival (DFS).

Methods: Retrospective cohort of 367 patients diagnosed with stage III colon cancer in 2003-2008 and treated at 19 VA medical centers. Kaplan-Meier curves summarize 5-year OS and 3-year DFS by chemotherapy regimen and RDI, and multivariable Cox proportional hazards regression was used to model these associations.

Results: 5-fluorouracil/leucovorin (FU/LV) was the most commonly initiated regimen in 2003 (94.4%) and 2004 (62.7%); in 2005-2008, a majority of patients (60%-74%) was started on an oxaliplatin-based regimen. Median RDI was 82.3%. Receipt of >70% RDI was associated with better 5-year OS (p < 0.001) and 3-year DFS (P = 0.009) than was receipt of ≤70% RDI, with 5-year OS rates of 66.3% and 50.5%, respectively and 3-year DFS rates of 66.1% and 52.7%, respectively. In the multivariable analysis of 5-year OS, oxaliplatin + 5-FU/LV (versus 5-FU/LV) (HR = 0.55; 95% CI = 0.34-0.91), >70% RDI at the first year (HR = 0.58; 95% CI = 0.37-0.89) and married status (HR = 0.66; 95% CI = 0.45-0.97) were associated with significantly decreased risk of death, while age ≥75 (versus 55-64) (HR = 2.06; 95% CI = 1.25-3.40), Charlson Comorbidity Index (HR = 1.17; 95% CI = 1.06-1.30), T4 tumor status (versus T1/T2) (HR = 5.88; 95% CI = 2.69-12.9), N2 node status (HR = 1.68; 95% CI = 1.12-2.50) and bowel obstruction (HR = 2.32, 95% CI = 1.36-3.95) were associated with significantly increased risk. Similar associations were observed for DFS.

Conclusion: Patients with stage III colon cancer who received >70% RDI had improved 5-year OS. The association between RDI and survival needs to be examined in studies of adjuvant chemotherapy for colon cancer outside of the VA.

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Related in: MedlinePlus

Adjuvant chemotherapy regimen received in thefirst cycleby year of pathology confirmed diagnosis. “Other” includes 3 patients who received an oxaliplatin-based regimen plus bevacizumab; 6 patients who received an irinotecan-based regimen, and 2 patients who received a regimen not listed.
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Fig1: Adjuvant chemotherapy regimen received in thefirst cycleby year of pathology confirmed diagnosis. “Other” includes 3 patients who received an oxaliplatin-based regimen plus bevacizumab; 6 patients who received an irinotecan-based regimen, and 2 patients who received a regimen not listed.

Mentions: The most commonly initiated regimen was 5-FU/LV in 2003 (94.4%) and 2004 (62.7%), while a majority of patients (60%-74%) started an oxaliplatin-based regimen in 2005–2008 (50%-66% received oxaliplatin plus 5-FU/LV) (Figure 1). At some point after their first cycle, 57 (15.5%) patients were switched to different adjuvant chemotherapy regimens, including 26 who started oxaliplatin plus 5-FU/LV. Considering the entire course of adjuvant therapy, 30.8% received 5-FU/LV; 34.3% received oxaliplatin plus 5-FU/LV; 5.4% received oxaliplatin plus capecitabine; 12.5% received capecitabine monotherapy, and 16.9% received “mixed” (i.e., they switched between regimens) or “other” regimens.Figure 1


Adjuvant chemotherapy for stage III colon cancer: relative dose intensity and survival among veterans.

Aspinall SL, Good CB, Zhao X, Cunningham FE, Heron BB, Geraci M, Passero V, Stone RA, Smith KJ, Rogers R, Shields J, Sartore M, Boyle DP, Giberti S, Szymanski J, Smith D, Ha A, Sessions J, Depcinski S, Fishco S, Molina I, Lepir T, Jean C, Cruz-Diaz L, Motta J, Calderon-Vargas R, Maland J, Keefe S, Tague M, Leone A, Glovack B, Kaplan B, Cosgriff S, Kaster L, Tonnu-Mihara I, Nguyen K, Carmichael J, Clifford L, Lu K, Chatta G - BMC Cancer (2015)

Adjuvant chemotherapy regimen received in thefirst cycleby year of pathology confirmed diagnosis. “Other” includes 3 patients who received an oxaliplatin-based regimen plus bevacizumab; 6 patients who received an irinotecan-based regimen, and 2 patients who received a regimen not listed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4352567&req=5

Fig1: Adjuvant chemotherapy regimen received in thefirst cycleby year of pathology confirmed diagnosis. “Other” includes 3 patients who received an oxaliplatin-based regimen plus bevacizumab; 6 patients who received an irinotecan-based regimen, and 2 patients who received a regimen not listed.
Mentions: The most commonly initiated regimen was 5-FU/LV in 2003 (94.4%) and 2004 (62.7%), while a majority of patients (60%-74%) started an oxaliplatin-based regimen in 2005–2008 (50%-66% received oxaliplatin plus 5-FU/LV) (Figure 1). At some point after their first cycle, 57 (15.5%) patients were switched to different adjuvant chemotherapy regimens, including 26 who started oxaliplatin plus 5-FU/LV. Considering the entire course of adjuvant therapy, 30.8% received 5-FU/LV; 34.3% received oxaliplatin plus 5-FU/LV; 5.4% received oxaliplatin plus capecitabine; 12.5% received capecitabine monotherapy, and 16.9% received “mixed” (i.e., they switched between regimens) or “other” regimens.Figure 1

Bottom Line: Receipt of >70% RDI was associated with better 5-year OS (p < 0.001) and 3-year DFS (P = 0.009) than was receipt of ≤70% RDI, with 5-year OS rates of 66.3% and 50.5%, respectively and 3-year DFS rates of 66.1% and 52.7%, respectively.In the multivariable analysis of 5-year OS, oxaliplatin + 5-FU/LV (versus 5-FU/LV) (HR = 0.55; 95% CI = 0.34-0.91), >70% RDI at the first year (HR = 0.58; 95% CI = 0.37-0.89) and married status (HR = 0.66; 95% CI = 0.45-0.97) were associated with significantly decreased risk of death, while age ≥75 (versus 55-64) (HR = 2.06; 95% CI = 1.25-3.40), Charlson Comorbidity Index (HR = 1.17; 95% CI = 1.06-1.30), T4 tumor status (versus T1/T2) (HR = 5.88; 95% CI = 2.69-12.9), N2 node status (HR = 1.68; 95% CI = 1.12-2.50) and bowel obstruction (HR = 2.32, 95% CI = 1.36-3.95) were associated with significantly increased risk.Similar associations were observed for DFS.

View Article: PubMed Central - PubMed

Affiliation: VA Pharmacy Benefits Management Services, Hines, IL, USA. sherrie.aspinall@va.gov.

ABSTRACT

Background: Given the paucity of information on dose intensity, the objective of this study is to describe the use of adjuvant chemotherapy for stage III colon cancer, focusing on relative dose intensity (RDI), overall survival (OS) and disease-free survival (DFS).

Methods: Retrospective cohort of 367 patients diagnosed with stage III colon cancer in 2003-2008 and treated at 19 VA medical centers. Kaplan-Meier curves summarize 5-year OS and 3-year DFS by chemotherapy regimen and RDI, and multivariable Cox proportional hazards regression was used to model these associations.

Results: 5-fluorouracil/leucovorin (FU/LV) was the most commonly initiated regimen in 2003 (94.4%) and 2004 (62.7%); in 2005-2008, a majority of patients (60%-74%) was started on an oxaliplatin-based regimen. Median RDI was 82.3%. Receipt of >70% RDI was associated with better 5-year OS (p < 0.001) and 3-year DFS (P = 0.009) than was receipt of ≤70% RDI, with 5-year OS rates of 66.3% and 50.5%, respectively and 3-year DFS rates of 66.1% and 52.7%, respectively. In the multivariable analysis of 5-year OS, oxaliplatin + 5-FU/LV (versus 5-FU/LV) (HR = 0.55; 95% CI = 0.34-0.91), >70% RDI at the first year (HR = 0.58; 95% CI = 0.37-0.89) and married status (HR = 0.66; 95% CI = 0.45-0.97) were associated with significantly decreased risk of death, while age ≥75 (versus 55-64) (HR = 2.06; 95% CI = 1.25-3.40), Charlson Comorbidity Index (HR = 1.17; 95% CI = 1.06-1.30), T4 tumor status (versus T1/T2) (HR = 5.88; 95% CI = 2.69-12.9), N2 node status (HR = 1.68; 95% CI = 1.12-2.50) and bowel obstruction (HR = 2.32, 95% CI = 1.36-3.95) were associated with significantly increased risk. Similar associations were observed for DFS.

Conclusion: Patients with stage III colon cancer who received >70% RDI had improved 5-year OS. The association between RDI and survival needs to be examined in studies of adjuvant chemotherapy for colon cancer outside of the VA.

Show MeSH
Related in: MedlinePlus