Optimal duration of oxaliplatin-based adjuvant chemotherapy in patients with different risk factors for stage II-III colon cancer: a meta-analysis.

ABSTRACT

BACKGROUND: The duration of oxaliplatin-based chemotherapy in high-risk stage II, low-risk stage III, and high-risk stage III colon cancer (CC) patients is controversial. To reduce the risk of adverse events (AEs) without compromising efficacy while improving chemotherapy compliance is crucial. METHODS: The authors searched Cochrane, Embase, Pubmed, and Web of Science databases for articles from inception to August 8, 2023, the main outcomes were disease-free survival, overall survival, chemotherapy completion rates, and AE frequency. RESULTS: Six randomized controlled trials (RCTs) involving 10 332 patients were included. Disease-free survival analysis revealed that only the high-risk stage III CC patients experienced better results with the 6-month FOLFOX regimen when compared with the 3-month regimen [Hazard ratio (HR) 1.32, 95% CI 1.15-1.51, P <0.0001). Overall survival (OS) analysis revealed that extending the use of FOLFOX and CAPEOX regimens did not provide survival benefits for stage III CC patients (HR 1.16, 95% CI 0.9-1.49, and HR 0.89, 95% CI 0.67-1.18, P =0.40). The completion rate of the 3-month oxaliplatin-based adjuvant chemotherapy regimen was significantly higher than that of the 6-month regimen [Relative risk (RR) 1.16, 95% CI 1.06-1.27, P =0.002]. Moreover, the 3-month regimen had significantly lower AE rates than the 6-month regimen (RR 0.62, 95% CI 0.57-0.68, P <0.00001), with differences mainly concentrated in grade 3/4 neutropenia (RR 0.70, 95% CI 0.59-0.85, P =0.0002), peripheral sensory neuropathy at ≥grade 2 (RR 0.45, 95% CI 0.38-0.53, P <0.00001), and hand-foot syndrome at ≥grade 2 (RR 0.36, 95% CI 0.17-0.77, P =0.009). CONCLUSION: The 6-month FOLFOX regimen should only be recommended for high-risk stage III CC, while the 3-month regimen can be recommended for other stages. A 3-month CAPEOX regimen can be recommended for stage II-III CC.