Nav: Home

Debate on duration of colon cancer adjuvant chemotherapy takes centre stage at ESMO 2017

September 10, 2017

LUGANO-MADRID, 11 September, 2017 - The debate on whether to shorten adjuvant chemotherapy for colon cancer from six to three months takes centre stage today in a special session at the ESMO 2017 Congress in Madrid. (1)

Is three months of chemotherapy enough in the adjuvant treatment of colon cancer? This is the main controversy in this debate, according to ESMO spokesperson Professor Alberto Sobrero, Head of the Medical Oncology Unit at Ospedale San Martino in Genova, Italy, co-chair of the Special Session and Scientific Co-Chair of the Congress. He said: "This debate is a practice changing one and the session will give much more clarity on how clinicians should now treat their patients."

Six months of oxaliplatin-based chemotherapy has been the standard adjuvant therapy for stage III colon cancer since 2004. However, the neurotoxicity of oxaliplatin sparked research into whether three months of therapy provided the same benefit but with reduced side effects.

Six randomised phase III trials have been conducted worldwide comparing three versus six months of chemotherapy with FOLFOX or CAPOX. The IDEA study was a pooled analysis of the 12,834 patients enrolled in the six trials. It showed that six months gave less than 1% added benefit over three months when all patients and both types of chemotherapy were included in the analysis.

Investigators of the four most mature trials (SCOT, TOSCA, ACHIEVE, IDEA-FRANCE) will present their results during the congress session. Expert interpretation will be given by a clinician and a statistician. Gastrointestinal cancer specialist Professor Andrés Cervantes, Chair of the ESMO Educational Committee, member of the ESMO Guidelines Committee and session co-chair, will discuss how the latest data in this debate will practically impact the ESMO Clinical Practice Guidelines on Early Colon Cancer, which are set to be updated in 2018. Members of the panel will be asked to vote for three or six months of treatment in a variety of clinical scenarios.

Distinguished panel for the Special Session:
  • Andrés Cervantes, session co-chair and Chair of ESMO Educational Committee. Medical Oncology Department, INCLIVA University of Valencia, Valencia, Spain.+*
  • Alberto Sobrero, session and ESMO 2017 congress co-chair. Medical Oncology Unit, IRCCS San Martino, Genova, Italy.*
  • Marc Buyse, Associate Professor of Biostatistics, Universiteit Hasselt, Belgium and Associate Editor, Annals of Oncology (Statistics).
  • Axel Grothey, Division of Medical Oncology, Mayo Clinic, Rochester, MN, US.*
  • Timothy Iveson, Department of Medical Oncology, University Hospital Southampton, Southampton, UK.
  • Roberto Labianca, Cancer Centre, Ospedale Giovanni XXIII, Bergamo, Italy.+*
  • Tim Maughan, Oxford Institute for Radiation Oncology, Professor of Clinical Oncology, University of Oxford, Oxford, UK.*
  • Jeffrey A. Meyerhardt, Clinical Director, Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, US.
  • Anthony F. Shields, Professor of Medicine and Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, US.
  • Ioannis Souglakos, Assistant Professor of Medical Oncology, Medical School, University of Crete, Medical Oncologist, University Hospital of Heraklion, Greece.
  • Julien Taieb, Head of the Gastroenterology and GI Oncology Department, Georges Pompidou European Hospital, Paris Descartes University, France.*
  • Takayuki Yoshino, National Cancer Centre Hospital East in Chiba, Japan.*
"The common sense conclusion from the IDEA study is that it's not worth going through the toxicity and inconvenience of six months to gain less than 1% efficacy," said Sobrero. "Especially considering that the toxicity is cut by at least 50% with the three month regimen."

"Statistically, three months of treatment was slightly inferior to six months in the overall study population of stage III patients," added ESMO spokesperson Professor Eric Van Cutsem, main author of the ESMO consensus guidelines for the management of patients with metastatic colorectal cancer, Head of Digestive Oncology, University Hospitals Leuven, Belgium. "However, the clinical conclusion, given the reduction in neurotoxicity with a shorter duration of treatment, was that three months is almost identical to six months."

Two additional analyses revealed unexpected findings. First, for high risk stage III patients (N2 or T4) the difference in efficacy widens in favour of six months. Second, the results differ according to the type of chemotherapy. CAPOX is equally effective at three or six months, independently of the patient's level of risk. Six months of FOLFOX is more effective than three months.

Sobrero said: "While overall there are minor differences in efficacy between three and six months, high risk patients should receive six months of chemotherapy and CAPOX should be preferred over FOLFOX."

"In low risk patients the difference was so minor that the clinical conclusion is that three months of oxaliplatin-based chemotherapy is as good as six months," said Van Cutsem. "Although statistically the difference is small, this makes a huge clinical difference to patients with the reduction in neurotoxicity."

Regarding the standard of care for adjuvant chemotherapy in stage III colon cancer, Van Cutsem said: "In high risk patients six months remains the standard, but in low risk patients three months should become the new standard duration of treatment."

Van Cutsem confirmed that this is the strategy he uses with his stage III colon cancer patients. He said: "In high risk stage III patients we give six months of FOLFOX - unless the patient has neurotoxicity, in which case we stop oxaliplatin but continue with 5FU for a total duration of six months. In patients with low risk tumours, we give three months of FOLFOX."

Sobrero said most patients prefer the three month option which gives much lower toxicity for very little loss in efficacy. He said: "Every now and then I see a patient who does not want to lose even 1% of efficacy and wants six months of chemotherapy. This is just one of the fascinating aspects of implementing the data from the IDEA study. We will thoroughly debate the issues and give clear conclusions during this session, which is set to be packed with health professionals who face patients with this serious disease everyday and desperately want better treatments."
-end-
Notes to Editors

Please make sure to use the official name of the meeting in your reports: ESMO 2017 Congress

+Co-author of ESMO Clinical Practice Guidelines on Early Colon Cancer.

*Co-author of ESMO Consensus Guidelines for the Management of Patients with Metastatic Colorectal Cancer.

References

1 The following abstracts will be presented during Special Session 'When clinical practice demands to go beyond statistics: Adjuvant chemotherapy of colon cancer. The 3 vs 6 month story' on Monday, 11 September 2017, 14:45 to 16:15 (CEST) in Madrid Auditorium.

LBA21_PR 'Prospective pooled analysis of six phase III trials investigating duration of adjuvant (adjuv) oxaliplatin-based therapy (3 vs 6 months) for patients (pts) with stage III colon cancer (CC): Updated results of IDEA (International Duration Evaluation of Adjuvant chemotherapy)' will be presented by Axel Grothey.

LBA22 'Updated results of the SCOT study: An International Phase III Randomised (1:1) Non-inferiority Trial Comparing 3 versus 6 months of oxaliplatin based adjuvant chemotherapy for colorectal cancer' will be presented by Timothy Iveson.

LBA23 'FOLFOX4/XELOX in stage II-III colon cancer: efficacy and safety results of the Italian Three Or Six Colon Adjuvant (TOSCA) trial' will be presented by Roberto Labianca.

LBA24 'Efficacy of 3 versus 6 months of oxaliplatin-based adjuvant chemotherapy for Stage III colon cancer (CC): Results from phase III ACHIEVE trial as part of the International Duration Evaluation of Adjuvant therapy (IDEA) Collaboration' will be presented by Takayuki Yoshino.

473O 'Three versus six months adjuvant oxaliplatin-based chemotherapy for patients with stage III colon cancer: per-protocol, subgroups and long-lasting neuropathy results' will be presented by Julien Taieb.

Disclaimer

Commentators quoted in the press release are required to comply with the ESMO Declaration of Interests policy and the ESMO Code of Conduct .

About the European Society for Medical Oncology (ESMO)

ESMO is the leading professional organisation for medical oncology. With 16,000 members representing oncology professionals from over 130 countries worldwide, ESMO is the society of reference for oncology education and information. We are committed to supporting our members to develop and advance in a fast-evolving professional environment. http://www.esmo.org

European Society for Medical Oncology

Related Chemotherapy Articles:

Chemotherapy is used to treat less than 25% of people with localized sarcoma
UCLA researchers have found that chemotherapy is not commonly used when treating adults with localized sarcoma, a rare type of cancer of the soft tissues or bone.
Starved cancer cells became more sensitive to chemotherapy
By preventing sugar uptake, researchers succeeded in increasing the cancer cells' sensitivity to chemotherapeutic treatment.
Vitamin D could help mitigate chemotherapy side effects
New findings by University of South Australia researchers reveal that Vitamin D could potentially mitigate chemotherapy-induced gastrointestinal mucositis and provide relief to cancer patients.
Less chemotherapy may have more benefit in rectal cancer
GI Cancers Symposium: Colorado study of 48 patients with locally advanced rectal cancer receiving neoadjuvant chemotherapy, found that patients receiving lower-than-recommended doses in fact saw their tumors shrink more than patients receiving the full dose.
Male fertility after chemotherapy: New questions raised
Professor Delbès, who specializes in reproductive toxicology, conducted a pilot study in collaboration with oncologists and fertility specialists from the McGill University Health Centre (MUHC) on a cohort of 13 patients, all survivors of pediatric leukemia and lymphoma.
'Combo' nanoplatforms for chemotherapy
In a paper to be published in the forthcoming issue in NANO, researchers from Harbin Institute of Technology, China have systematically discussed the recent progresses, current challenges and future perspectives of smart graphene-based nanoplatforms for synergistic tumor therapy and bio-imaging.
Nanotechnology improves chemotherapy delivery
Michigan State University scientists have invented a new way to monitor chemotherapy concentrations, which is more effective in keeping patients' treatments within the crucial therapeutic window.
Novel anti-cancer nanomedicine for efficient chemotherapy
Researchers have developed a new anti-cancer nanomedicine for targeted cancer chemotherapy.
Ending needless chemotherapy for breast cancer
A diagnostic test developed at The University of Queensland might soon determine if a breast cancer patient requires chemotherapy or would receive no benefit from this gruelling treatment.
A homing beacon for chemotherapy drugs
Killing tumor cells while sparing their normal counterparts is a central challenge of cancer chemotherapy.
More Chemotherapy News and Chemotherapy Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Debbie Millman: Designing Our Lives
From prehistoric cave art to today's social media feeds, to design is to be human. This hour, designer Debbie Millman guides us through a world made and remade–and helps us design our own paths.
Now Playing: Science for the People

#574 State of the Heart
This week we focus on heart disease, heart failure, what blood pressure is and why it's bad when it's high. Host Rachelle Saunders talks with physician, clinical researcher, and writer Haider Warraich about his book "State of the Heart: Exploring the History, Science, and Future of Cardiac Disease" and the ails of our hearts.
Now Playing: Radiolab

Insomnia Line
Coronasomnia is a not-so-surprising side-effect of the global pandemic. More and more of us are having trouble falling asleep. We wanted to find a way to get inside that nighttime world, to see why people are awake and what they are thinking about. So what'd Radiolab decide to do?  Open up the phone lines and talk to you. We created an insomnia hotline and on this week's experimental episode, we stayed up all night, taking hundreds of calls, spilling secrets, and at long last, watching the sunrise peek through.   This episode was produced by Lulu Miller with Rachael Cusick, Tracie Hunte, Tobin Low, Sarah Qari, Molly Webster, Pat Walters, Shima Oliaee, and Jonny Moens. Want more Radiolab in your life? Sign up for our newsletter! We share our latest favorites: articles, tv shows, funny Youtube videos, chocolate chip cookie recipes, and more. Support Radiolab by becoming a member today at Radiolab.org/donate.