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Impact of Relative Dose Intensity of FOLFOX Adjuvant Chemotherapy on Risk of Death Among Stage III Colon Cancer Patients

Research on optimal relative dose intensity (RDI) of FOLFOX in stage III colon cancer by risk profiles is scarce. Using cancer registries’ data, our study found when the risk of death remained the same, the minimum RDI of FOLFOX was as low as 70% for high-risk stage III colon cancer patients and as...

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Autores principales: Zhou, Meijiao, Thompson, Trevor D., Lin, Hui-Yi, Chen, Vivien W., Karlitz, Jordan J., Fontham, Elizabeth T.H., Theall, Katherine P., Zhang, Lu, Hsieh, Mei-Chin, Pollack, Lori A., Wu, Xiao-Cheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8971135/
https://www.ncbi.nlm.nih.gov/pubmed/34756680
http://dx.doi.org/10.1016/j.clcc.2021.09.008
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author Zhou, Meijiao
Thompson, Trevor D.
Lin, Hui-Yi
Chen, Vivien W.
Karlitz, Jordan J.
Fontham, Elizabeth T.H.
Theall, Katherine P.
Zhang, Lu
Hsieh, Mei-Chin
Pollack, Lori A.
Wu, Xiao-Cheng
author_facet Zhou, Meijiao
Thompson, Trevor D.
Lin, Hui-Yi
Chen, Vivien W.
Karlitz, Jordan J.
Fontham, Elizabeth T.H.
Theall, Katherine P.
Zhang, Lu
Hsieh, Mei-Chin
Pollack, Lori A.
Wu, Xiao-Cheng
author_sort Zhou, Meijiao
collection PubMed
description Research on optimal relative dose intensity (RDI) of FOLFOX in stage III colon cancer by risk profiles is scarce. Using cancer registries’ data, our study found when the risk of death remained the same, the minimum RDI of FOLFOX was as low as 70% for high-risk stage III colon cancer patients and as low as 45% for low-risk patients. BACKGROUND: The National Comprehensive Cancer Network (NCCN) guidelines have recommended tailored chemotherapy for stage III high-risk (T4 and/or N2) and low-risk (T1-T3 and N1) colon cancer since 2018. Studies have investigated the effect of relative dose intensity (RDI) of FOLFOX on stage III colon cancer survival, however, none has performed a stratified analysis by risk profiles. This study aims to identify the FOLFOX optimal RDI for high-risk and low-risk stage III colon cancer patients. METHODS: Data on 407 eligible patients, diagnosed with stage III colon cancer in 2011 who received FOLFOX, were collected by 8 population-based cancer registries. Multivariable Cox model and Fine-Gray competing risks model were employed to explore Optimal RDI defined as the lowest RDI administered without significant differences in either overall or cause-specific death. RESULTS: Among the 168 high-risk patients, the optimal RDI cut-off was 70% (HR = 1.59 with 95% CI: 0.69-3.66 in overall mortality; HR = 1.24 with 95% CI: 0.42-3.64 in cause-specific mortality when RDI < 70% vs. RDI ≥ 70%). Among the 239 low-risk patients, none of the evaluated cut-offs were associated with significant differences in risk of death between comparison groups. The lowest assessed RDI was 45%, HR = 0.80; 95% CI: 0.24 to 2.73 for overall mortality and HR = 0.53; 95% CI: 0.06 to 4.95 for cause-specific mortality, when RDI <45% versus RDI ≥45%. CONCLUSIONS: There is no significant harm on the risk of death when reducing RDI by <30% for high-risk patients. For the low-risk patients, we found that RDI as low as 45% did not significantly affect the risk of death.
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spelling pubmed-89711352022-06-01 Impact of Relative Dose Intensity of FOLFOX Adjuvant Chemotherapy on Risk of Death Among Stage III Colon Cancer Patients Zhou, Meijiao Thompson, Trevor D. Lin, Hui-Yi Chen, Vivien W. Karlitz, Jordan J. Fontham, Elizabeth T.H. Theall, Katherine P. Zhang, Lu Hsieh, Mei-Chin Pollack, Lori A. Wu, Xiao-Cheng Clin Colorectal Cancer Article Research on optimal relative dose intensity (RDI) of FOLFOX in stage III colon cancer by risk profiles is scarce. Using cancer registries’ data, our study found when the risk of death remained the same, the minimum RDI of FOLFOX was as low as 70% for high-risk stage III colon cancer patients and as low as 45% for low-risk patients. BACKGROUND: The National Comprehensive Cancer Network (NCCN) guidelines have recommended tailored chemotherapy for stage III high-risk (T4 and/or N2) and low-risk (T1-T3 and N1) colon cancer since 2018. Studies have investigated the effect of relative dose intensity (RDI) of FOLFOX on stage III colon cancer survival, however, none has performed a stratified analysis by risk profiles. This study aims to identify the FOLFOX optimal RDI for high-risk and low-risk stage III colon cancer patients. METHODS: Data on 407 eligible patients, diagnosed with stage III colon cancer in 2011 who received FOLFOX, were collected by 8 population-based cancer registries. Multivariable Cox model and Fine-Gray competing risks model were employed to explore Optimal RDI defined as the lowest RDI administered without significant differences in either overall or cause-specific death. RESULTS: Among the 168 high-risk patients, the optimal RDI cut-off was 70% (HR = 1.59 with 95% CI: 0.69-3.66 in overall mortality; HR = 1.24 with 95% CI: 0.42-3.64 in cause-specific mortality when RDI < 70% vs. RDI ≥ 70%). Among the 239 low-risk patients, none of the evaluated cut-offs were associated with significant differences in risk of death between comparison groups. The lowest assessed RDI was 45%, HR = 0.80; 95% CI: 0.24 to 2.73 for overall mortality and HR = 0.53; 95% CI: 0.06 to 4.95 for cause-specific mortality, when RDI <45% versus RDI ≥45%. CONCLUSIONS: There is no significant harm on the risk of death when reducing RDI by <30% for high-risk patients. For the low-risk patients, we found that RDI as low as 45% did not significantly affect the risk of death. 2022-06 2021-10-01 /pmc/articles/PMC8971135/ /pubmed/34756680 http://dx.doi.org/10.1016/j.clcc.2021.09.008 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Article
Zhou, Meijiao
Thompson, Trevor D.
Lin, Hui-Yi
Chen, Vivien W.
Karlitz, Jordan J.
Fontham, Elizabeth T.H.
Theall, Katherine P.
Zhang, Lu
Hsieh, Mei-Chin
Pollack, Lori A.
Wu, Xiao-Cheng
Impact of Relative Dose Intensity of FOLFOX Adjuvant Chemotherapy on Risk of Death Among Stage III Colon Cancer Patients
title Impact of Relative Dose Intensity of FOLFOX Adjuvant Chemotherapy on Risk of Death Among Stage III Colon Cancer Patients
title_full Impact of Relative Dose Intensity of FOLFOX Adjuvant Chemotherapy on Risk of Death Among Stage III Colon Cancer Patients
title_fullStr Impact of Relative Dose Intensity of FOLFOX Adjuvant Chemotherapy on Risk of Death Among Stage III Colon Cancer Patients
title_full_unstemmed Impact of Relative Dose Intensity of FOLFOX Adjuvant Chemotherapy on Risk of Death Among Stage III Colon Cancer Patients
title_short Impact of Relative Dose Intensity of FOLFOX Adjuvant Chemotherapy on Risk of Death Among Stage III Colon Cancer Patients
title_sort impact of relative dose intensity of folfox adjuvant chemotherapy on risk of death among stage iii colon cancer patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8971135/
https://www.ncbi.nlm.nih.gov/pubmed/34756680
http://dx.doi.org/10.1016/j.clcc.2021.09.008
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