The Adjuvant Treatment of Stage III Colon Cancer: Might Less Be More?
The Adjuvant Treatment of Stage III Colon Cancer: Might Less Be More?
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作者：
James J. Lee;E. Chu
基于奥沙利铂的化疗（FOLFOX [亚叶酸、氟尿嘧啶、奥沙利铂]或XALIX [奥沙利铂、卡培他滨;也称为CAPOX]）持续6个月是目前体能状态良好的III期结肠癌患者辅助治疗的标准。然而，这些方案与显著毒性相关，包括骨髓抑制、腹泻和奥沙利铂诱导的累积剂量依赖性神经毒性。缩短辅助治疗的持续时间将是最佳的，这将降低总体毒性，同时保持总体临床疗效。国际辅助治疗持续时间评价（IDEA）研究的目的是使用6项同时进行的III期随机试验的前瞻性设计汇总分析，评价3个月奥沙利铂辅助治疗相比6个月奥沙利铂辅助治疗在III期结肠癌中的非劣效性。在此，我们回顾了IDEA研究的结果，并使用基于患者的风险因素讨论了基于奥沙利铂的辅助化疗的最佳持续时间。
Oxaliplatin-based chemotherapy (FOLFOX [folinic acid, fluorouracil, oxaliplatin] or XELOX [oxaliplatin, capecitabine; also called CAPOX]) for 6 months is the current standard for adjuvant therapy of stage III colon cancer patients with good performance status. However, these regimens are associated with significant toxicities, including myelosuppression, diarrhea, and oxaliplatin-induced, cumulative, dose-dependent neurotoxicity. A reduced duration of adjuvant therapy, which would reduce overall toxicity while maintaining overall clinical efficacy, would be optimal. The goal of the International Duration Evaluation of Adjuvant (IDEA) study was to evaluate the noninferiority of 3-month compared with 6-month adjuvant oxaliplatin-based treatment in stage III colon cancer using a prospectively designed pooled analysis of 6 concurrently conducted phase III randomized trials. Herein, we review the findings of the IDEA study and discuss the optimal duration of oxaliplatin-based adjuvant chemotherapy using patient-based risk factors.