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CRC: Deciding on Duration of Adjuvant Therapy

Insights From: Andrea Cercek, MD, Memorial Sloan Kettering Cancer Center; Tanios Bekaii-Saab, MD, Mayo Clinic
Published: Thursday, Feb 08, 2018



Transcript: 

Tanios Bekaii-Saab, MD: We are hoping that the paper of 3 versus 6 months of adjuvant therapy will be published soon. The data haven’t changed much since it was last presented, which is good. Our understanding right now of how we should treat patients in the adjuvant setting with stage 3 colon cancer is as follows: If the patient has a low-risk tumor, stage 1 or less or T3 or less, those patients seem to benefit from no more than 3 months of chemotherapy. This is the 3-month advantage. Patients would either go on FOLFOX or CAPOX chemotherapy and would have about the same benefit, with much less toxicity, than 6 months. For patients with stage T3N1 or less, so lower-risk patients, 3 months of chemotherapy is probably as good as 6. In my clinic, that’s what I do with my patients.

For stage T4N2, the more aggressive tumors, 6 months of chemotherapy is probably a little bit better. Not much better, but a little bit better. Interestingly, when we look at the data with CAPOX versus FOLFOX, the data with CAPOX for 3 months versus CAPOX for 6 months seem to essentially be at the same level, meaning 3 months and 6 months of CAPOX seemed to do equally well. So, for patients with more aggressive tumors, stage T4N2 or higher, I think the discussion would become very important about the 3 versus 6 months.

For low-risk patients, I think, frankly, 3 months is relatively settled and there’s very little discussion. But I think with 3 versus 6 months for high-risk patients, the discussion should continue with the implications of toxicities, cost, etc, of the 3 versus 6 months. The differences between CAPOX and FOLFOX seem to favor, a little bit, CAPOX for 3 months then FOLFOX. And the toxicities that come from oxaliplatin are important.
So, I think the happy medium for many patients is where they choose to go for the 6 months or the physician considers 6 months, with 3 months of oxaliplatin-based therapy plus fluoropyrimidine followed by 3 months of fluoropyrimidine to complete the 6 months. I think it’s a little bit more of a complex discussion, but at the same time I think we have clues that we’re really not going to be a detriment by exposing patients with high-risk tumors to 3 months of CAPOX, with a consideration to continue to the 6 months. But as I said, for the low-risk patients, 3 months is sufficient.

Transcript Edited for Clarity 
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Transcript: 

Tanios Bekaii-Saab, MD: We are hoping that the paper of 3 versus 6 months of adjuvant therapy will be published soon. The data haven’t changed much since it was last presented, which is good. Our understanding right now of how we should treat patients in the adjuvant setting with stage 3 colon cancer is as follows: If the patient has a low-risk tumor, stage 1 or less or T3 or less, those patients seem to benefit from no more than 3 months of chemotherapy. This is the 3-month advantage. Patients would either go on FOLFOX or CAPOX chemotherapy and would have about the same benefit, with much less toxicity, than 6 months. For patients with stage T3N1 or less, so lower-risk patients, 3 months of chemotherapy is probably as good as 6. In my clinic, that’s what I do with my patients.

For stage T4N2, the more aggressive tumors, 6 months of chemotherapy is probably a little bit better. Not much better, but a little bit better. Interestingly, when we look at the data with CAPOX versus FOLFOX, the data with CAPOX for 3 months versus CAPOX for 6 months seem to essentially be at the same level, meaning 3 months and 6 months of CAPOX seemed to do equally well. So, for patients with more aggressive tumors, stage T4N2 or higher, I think the discussion would become very important about the 3 versus 6 months.

For low-risk patients, I think, frankly, 3 months is relatively settled and there’s very little discussion. But I think with 3 versus 6 months for high-risk patients, the discussion should continue with the implications of toxicities, cost, etc, of the 3 versus 6 months. The differences between CAPOX and FOLFOX seem to favor, a little bit, CAPOX for 3 months then FOLFOX. And the toxicities that come from oxaliplatin are important.
So, I think the happy medium for many patients is where they choose to go for the 6 months or the physician considers 6 months, with 3 months of oxaliplatin-based therapy plus fluoropyrimidine followed by 3 months of fluoropyrimidine to complete the 6 months. I think it’s a little bit more of a complex discussion, but at the same time I think we have clues that we’re really not going to be a detriment by exposing patients with high-risk tumors to 3 months of CAPOX, with a consideration to continue to the 6 months. But as I said, for the low-risk patients, 3 months is sufficient.

Transcript Edited for Clarity 
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