Management of chemotherapy dose intensity for metastatic colorectal cancer (Review)

Treatment Adherence to Adjuvant Chemotherapy According to the New Standard 3-month CAPOX Regimen in High-risk Stage II and Stage III Colon Cancer: A Population-based Evaluation in The Netherlands

BACKGROUND

A 3-month adjuvant treatment regimen with capecitabine and oxaliplatin (CAPOX) for high-risk stage II (T4N0) and stage III (node-positive) colon cancer was implemented in the Netherlands in 2017. The IDEA trial showed a clinically irrelevant difference in long-term outcomes in combination with a substantial decrease in toxicity in comparison with a 6-month regimen. A significantly increased dose intensity was observed in the 3-month arm, which might be essential to achieve optimal long-term outcomes. Hence, the aim of the present study was to evaluate if a similar dose intensity could be achieved in patients treated with adjuvant CAPOX for 3 months in daily practice.

MATERIALS AND METHODS

Patients scheduled for 3 months of adjuvant CAPOX for high-risk stage II or stage III colon cancer were selected from the Netherlands Cancer Registry. The number of administered cycles and the daily cumulative dose of capecitabine and oxaliplatin were extracted from the medical files. Relative dose intensity (RDI) was determined by comparing the administered dose intensity with the standard dose intensity.

RESULTS

In total, 802 (80.0%) of the 1002 patients completed 4 cycles of CAPOX. The overall mean RDI of adjuvant treatment was 82.9% for capecitabine, and 83.8% for oxaliplatin, based on the combination of dose reductions and omitting cycles.

CONCLUSION

One out of 5 patients did not complete 4 cycles of CAPOX. The administered dose of capecitabine and oxaliplatin in the first year after the update of the guideline was lower than the advised dose for the 3-month CAPOX regimen, and the administered dose in the IDEA study. The impact on long-term oncological outcomes should be awaited.

Efficacy and safety of fruquintinib plus capecitabine as first-line treatment in patients with metastatic colorectal cancer ineligible for intravenous chemotherapy: a two-stage, single-armed, phase II study

Fruquintinib has been recommended for treating refractory metastatic colorectal cancer. This single-arm, phase II study explored for the first time whether fruquintinib combined with capecitabine could be used as a first-line treatment for patients with metastatic colorectal cancer who are intolerant to intravenous chemotherapy. From December 8, 2021, to December 31, 2024, 17 patients were included in the effect analysis who respectively received capecitabine and fruquintinib at a starting dose of 825 mg/m2 twice a day and 4 mg every day (2 weeks followed by 1-week rest) and recorded changes in safety and quality of life; the dosage can be appropriately adjusted according to the protocol to make it tolerable for the patients. The median age was 76 years old; the study achieved a disease control rate of 88.2%, an overall response rate of 17.6%, and a median progression-free survival of 16.3 months (95% CI 9.7-22.9); the overall survival had not been reached. The median quality of life scores and self-assessment of health scores change, respectively, from 42 (IQR 34, 47) to 45 (IQR 41, 57) and from 5 (IQR 4.25, 6.75) to 4 (IQR 3.00, 6.00). There were only 3 events of grade ≥ 3 TRAEs, including one rare case of aortic dissection. Fruquintinib combined with capecitabine has initially shown ideal disease control, safety, and convenience, especially as a first-line treatment for elderly frail patients with metastatic colorectal cancer. Further phase III study is planned to refine this combination. Clinical Trial Number: NCT04866108.

Effect of Nutritional Intervention on Chemotherapy Tolerance and Quality of Life in Patients with Colorectal Cancer Undergoing Postoperative Chemotherapy: A Randomized Controlled Study

This study explored the effect of symptom-based individualized nutritional intervention on chemotherapy tolerance and quality of life (QOL) in patients with colorectal cancer (CRC) undergoing postoperative chemotherapy. Postoperative patients with CRC (n = 88) were randomly assigned to the control group (CG, n = 45) and intervention group (IG, n = 43) receiving conventional diet counseling and symptom-based individualized nutritional intervention, respectively, and chemotherapy tolerance, adverse effects, and QOL were compared. Participants in the IG exhibited better nutritional status at the last chemotherapy cycle, with lower Nutrition Risk Screening 2002 (2.37 ± 0.65 vs. 3.78 ± 0.65, p < 0.01) and Patient-Generated Subjective Global Assessment (6.26 ± 0.76 vs. 7.78 ± 0.70, p < 0.01) scores. Compared with CG, relative dose intensity reduction (9.3% vs. 25.89%, p = 0.02), chemotherapy regimen change (25.58% vs. 53.33%, p < 0.01), and chemotherapy delay (13.95% vs. 35.56%, p = 0.019) were lower in the IG. Nausea/vomiting (2.33% vs. 17.78%, p = 0.017), thrombocytopenia (2.33% vs. 28.89%, p < 0.01), and hand-foot syndrome (4.65% vs. 22.22%, p = 0.03) were less frequent in the IG. Participants in the IG had better QOL, with higher physical function scores at cycles 4 (67.91 ± 5.22 vs. 62.22 ± 4.02, p < 0.01) and 8 (72.71 ± 6.31 vs. 57.63 ± 4.75, p < 0.01). Individualized nutritional interventions improved chemotherapy tolerance and QOL and reduced adverse effects in this patient cohort.