Half the chemotherapy works as well as full course for bowel cancer
A major international trial shows colorectal cancer patients can safely cut their chemotherapy from 6 months to 3 months without sacrificing survival rates. The finding could reshape treatment protocols, reduce patient suffering from nerve damage, and lower healthcare costs across oncology clinics worldwide.
Originaltitel: Three Versus 6 Months of Adjuvant Oxaliplatin-Fluoropyrimidine Chemotherapy for Colorectal Cancer: Final Results of SCOT-An International, Randomized, Phase III, Noninferiority Trial
Tre månaders adjuvant kemoterapibehandling är lika effektiv som sex månaders behandling för kolorektalcancer, enligt SCOT-studien med över 6 000 patienter. Resultatet öppnar möjlighet att minska toxisk påverkan utan att offra överlevnadsprognos. Studien randomiserade högriskpatienter med stadium II och III kolorektalcancer till tre eller sex månaders behandling med antingen CAPOX eller FOLFOX. Efter medianuppföljning på 113 månader var femårsöverlevnaden 82,4 procent i båda grupperna (HR 0,96). Noninferioriteten visades även för rektalcancer, men effekten beror på behandlingstyp — CAPOX uppfyllde kriteriet, FOLFOX inte. Resultatet från Southampton University och samarbetande europeiska centra förändrar klinisk praxis. Inköpschefer kan förvänta minskade medicinkostnader, och patienter undviker långsiktig perifer neuropati. För regionvården innebär tremanadersprotokollet bättre kapacitetsutnyttjande utan prognostisk försämring.
<p>Adjuvant chemotherapy for colorectal cancer (CRC) with oxaliplatin and fluoropyrimidine was traditionally given for 6 months but is associated with cumulative peripheral neuropathy. The SCOT study (ISRCTN59757862) was an international, randomized, phase III, noninferiority trial investigating treatment reduction from 6 to 3 months. It originally reported noninferior disease-free survival with reduced toxicity and improved quality of life for 3 months of treatment in 6,088 patients. Here, we report overall survival (OS) with 38 months of additional follow-up. Patients with high-risk stage II and stage III CRC were assigned (1:1) to receive 3 or 6 months of either capecitabine and oxaliplatin (CAPOX) or infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX; bolus and infused fluorouracil with oxaliplatin) that were selected before random assignment. With a median of 113 months follow-up and 1,255 OS events, 5-year OS for 3 versus 6 months of treatment was 82.4% in both groups (hazard ratio, 0.96; 95% CI, 0.8 to 1.07), proving noninferiority of 3 months of treatment. Noninferiority of 3 months of treatment for OS was also shown in 1,087 patients with rectal cancer. The duration effect is regimen-dependent with noninferiority shown for CAPOX but not for FOLFOX. In summary, SCOT has shown noninferiority for OS with 3 months of adjuvant chemotherapy treatment, which should be recommended for most patients.</p>