Capecitabine as Adjuvant Treatment for Stage III Colon Cancer

Twelves, Chris; Wong, Alfred; Nowacki, Marek P.; Abt, Markus; Burris, Howard A.; Carrato, Alfredo; Cassidy, Jim; Cervantes, Andrés; Fagerberg, Jan; Georgoulias, Vassilis; Husseini, Fares; Jodrell, Duncan I.; Koralewski, P.; Kröning, H.; Maroun, J.; Marschner, Norbert; McKendrick, Joseph; Pawlicki, Marek; Rosso, Riccardo; Schüller, J.; Seitz, Jean‐François; Štabuc, Borut; Tujakowski, Jerzy; Hazel, G. Van; Załuski, J.; Scheithauer, Werner

doi:10.1056/nejmoa043116

Cited by 1,109 publications

(669 citation statements)

References 23 publications

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“…Benefits of these agents include convenience, elimination of risks from indwelling central venous catheters and a different toxic profile. They are of comparable efficacy to the Mayo regime but with less toxicity (Carmichael et al, 2002;Douillard et al, 2002;Twelves et al, 2005). Toxicity profiles of FOLFOX and FOLFIRI (Andre et al, 2004;O'Connell, 2004;Allegra and Sargent, 2005) may reduce the completion of these treatments, but fewer cycles of these regimes may be as efficacious as the completed Mayo regime.…”

Section: Discussionmentioning

confidence: 99%

Failure to complete adjuvant chemotherapy is associated with adverse survival in stage III colon cancer patients

et al. 2007

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Two recent North American studies have shown that completion of 5-fluorouracil (5FU)-based adjuvant chemotherapy is a major prognostic factor for the survival of elderly stage III colon cancer patients. The aim of the present study was to confirm this finding in a population-based series from Australia. The study cohort comprised 851 stage III colon cancer patients treated by surgery alone and 461 who initiated the Mayo chemotherapy regime. One-third of patients who initiated chemotherapy failed to complete more than three cycles of treatment. Independent predictors for failure to complete were treatment in district or rural hospitals, low socioeconomic index and treatment by a low-volume surgeon. Patients who failed to complete chemotherapy showed worse cancer-specific survival compared not only to those who completed treatment (HR ¼ 2.24; 95% confidence interval (CI) (1.66 -3.03), Po0.001) but also to those treated by surgery alone (HR ¼ 1.37; 95% CI (1.09 -1.72), P ¼ 0.008). The current and previous studies demonstrate the importance of completing adjuvant 5-FU-based chemotherapy for colon cancer. Further prospective studies are required to identify better the physiological and socioeconomic factors responsible for failure to complete chemotherapy so that appropriate improvements in health service delivery can be made.

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Section: Discussionmentioning

confidence: 99%

Failure to complete adjuvant chemotherapy is associated with adverse survival in stage III colon cancer patients

et al. 2007

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“…Quellen: [ [934]. In einer Metaanalyse mit 8734 Patienten (NSABPC-08, XELOXA, X-ACT und AVANT Studien) unterschieden sich das DFS und das OS nicht in Abhängigkeit von dem verabreichten Fluoropyrimidin (5-FU/Leucovorin vs. Capecitabin) [924].…”

Section: Level Of Evidence 2bunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

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“…Two large randomised phase III trials have compared capecitabine against low-dose LV and 5FU (Mayo regimen) in patients with metastatic colorectal cancer with no difference in time to progression or overall survival (Van Cutsem et al, 2004). In addition, two randomised, controlled trials have shown at least equivalent disease-free survival with the use of an oral fluropyrimidine when compared with low-dose LV and 5FU as postoperative adjuvant therapy for stages II and III colon cancer (Wolmark et al, 2004;Twelves et al, 2005). Furthermore, the use of oral capecitabine has been supported by recent NICE guidance on the management of colon cancer in both the metastatic and adjuvant settings (NICE, 2003(NICE, , 2006.…”

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Preoperative radiotherapy combined with 5 days per week capecitabine chemotherapy in locally advanced rectal cancer

et al. 2007

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There is increasing evidence supporting the use of preoperative chemoradiotherapy in patients with locally advanced rectal cancer in an attempt to facilitate complete surgical resection with clear margins. We describe our experience of using a 5-day per week regime of preoperative capecitabine chemoradiotherapy. Between November 2004 and September 2006, 70 patients with MRI-defined locally advanced rectal cancer were selected for treatment. Capecitabine was given at a dose of 900 mg m À2 for 5 days per week combined with 45 Gy of radiotherapy in 25 doses. This regime was well tolerated with 89% of our patients receiving the full dose of chemotherapy and 96% receiving the full dose of radiotherapy. Ninety-three per cent proceeded to macroscopically complete surgical resection. The pathological complete response rate was 9.2% with a node-negative rate of 66%. A negative circumferential margin was achieved by 79% of the patients who underwent resection. Compared to studies using a 7-day per week capecitabine schedule, our results show increased compliance and less dose reductions with comparable pathological outcome. There is clear evidence from two systematic reviews that adjuvant radiotherapy reduces the risk of local recurrence in patients with resectable rectal cancer (Camma et al, 2000; Colorectal Cancer Collaborative, 2001). The greatest benefit is seen when preoperative radiotherapy is used with a biologically equivalent dose of 430 Gy. Further clinical trials were required to assess the benefit of adding concurrent chemotherapy to preoperative radiotherapy.The recent publication of two phase III trials confirms that preoperative concurrent chemoradiation (CRT) is superior to long-course radiotherapy alone in patients with T3/4 or nodepositive resectable rectal cancer. The EORTC 22921 (Bosset et al, 2005) and FFCD 9203 (Gerard et al, 2006) trials compared intravenous 5-fluorouracil (5FU) and leucovorin (LV) given during the first and fifth weeks of radiotherapy with radiotherapy alone (dose of RT was 45 Gy in 25 fractions in both arms of the studies). Both trials demonstrated a reduction in the rates of local recurrence at 5 years from 17% with radiotherapy alone to 8 -9% with preoperative CRT, but neither trial showed any difference in overall survival. A further recent phase III trial has demonstrated that preoperative 5FU CRT is superior to post-operative CRT with a significant reduction in local recurrence from 12 to 6% as well as a significant reduction in both acute and long-term toxicity (Sauer et al, 2004). This evidence will clearly result in an increasing use of fluoropyrimidine-based CRT.Intravenous 5FU-based chemoradiation presents many logistical challenges. Continuous infusion of 5FU requires the insertion of a central venous line with its attendant risks of thrombosis and infection as well as the inconvenience of a portable infusion pump. The use of the bolus 5FU/LV regimen used in the EORTC and FFCD trials requires 10 daily visits to the chemotherapy day unit, with associated waiting time, t...

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Capecitabine as Adjuvant Treatment for Stage III Colon Cancer

Abstract: Oral capecitabine is an effective alternative to intravenous fluorouracil plus leucovorin in the adjuvant treatment of colon cancer.

Cited by 1,109 publications

References 23 publications

Failure to complete adjuvant chemotherapy is associated with adverse survival in stage III colon cancer patients

Failure to complete adjuvant chemotherapy is associated with adverse survival in stage III colon cancer patients

S3-Leitlinie – Kolorektales Karzinom

Preoperative radiotherapy combined with 5 days per week capecitabine chemotherapy in locally advanced rectal cancer

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