Three months of oxaliplation-containing chemo as effective as six months
"3 months of oxaliplatin-containing adjuvant chemotherapy was non-inferior to 6 months of the same therapy for patients with high-risk stage II and stage III colorectal cancer and was associated with reduced toxicity and improved quality of life. Despite the fact the study was underpowered, these data suggest that a shorter duration leads to similar survival outcomes with better quality of life and thus might represent a new standard of care."
"In view of the results of the SCOT study and the meta-analysis of all six worldwide studies conducted by the IDEA collaboration, 3 months of adjuvant chemotherapy will become the new global standard of adjuvant treatment for most patients who are suitable for treatment with CAPOX, particularly those patients with T1–3, N1 disease."
Full text: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(18)30093-7/fulltext
But consider: https://www.ncbi.nlm.nih.gov/pubmed/29620995 IDEA France, in which 90% of patients received mFOLFOX6, shows superiority of 6 months of adjuvant chemotherapy compared with 3 months, especially in the T4 and/or N2 subgroups.
https://www.ncbi.nlm.nih.gov/pubmed/29620994 The Three or Six Colon Adjuvant trial failed to formally show noninferiority of 3 versus 6 months of treatment to the predefined margin of 20% relative increase. The results depended on the adjuvant regimen and risk. For CAPOX, 3 months were as good as 6 months; for FOLFOX, 6 months added extra benefit. Counter-intuitively, the low-risk patients benefitted more than the high-risk population from the 6-month duration. The choice of regimen and duration should depend on patient characteristics and be balanced against the extra toxicity of longer therapy.
Comments
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I had 5 1/2 treatments before
I had 5 1/2 treatments before I had a reaction that landed me in emergency dept. So that was almost 3 months. But I was diagnosed at stage 4. I started a different drug this week since I can no longer take the oxaliplatin. I was kind of glad to not have the oxaliplatin side effects anymore. Good to hear it is effective at shorter time.
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Great news. Thanks for
Great news. Thanks for posting.
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Interesting
Interesting article. Seems like not all doctors agree though which can be harmful to some patients that they push it on. That Oxy is a nasty drug and the more you take the more it harms you physically. Can't believe some people can go 12 rounds of that. After 5 it was terrible for me. Thanks for the article.
Kim
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My 6th round landed me in theAnnabelle41415 said:Interesting
Interesting article. Seems like not all doctors agree though which can be harmful to some patients that they push it on. That Oxy is a nasty drug and the more you take the more it harms you physically. Can't believe some people can go 12 rounds of that. After 5 it was terrible for me. Thanks for the article.
Kim
My 6th round landed me in the emergency room for 9 hours
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the less pain, more gain dept
I think stage 2, and some 3A-3B patients will welcome the reduced pain and disability on oxi-, not so sure about oncologists.
Personally, I see the chemo issue primarily through the lens of targeting and initial care. I think that many patients would have even better OS and less disability if the current system did enough support work to choose amongst oral chemo (capecitabine, UFT) added to targeted cimetidine, aspirin, PSK etc instead of oxi.
There are identifiable stage 2 and 3 patients that perform more like stage IV patients with a slightly longer fuse that need to be treated better for known targets with mild adjuncts. The vast majority of those patients get screwed on this, starting on the day of diagnosis. (e,g No CA199, LDH, vitamin D3 test and tx, or cimetidine as well as several more chem panels)
Second, the follow up blood testing would be less distorted by chemo damage and can be more sensitive and accurate to catch early deviations that imply recurrence or risk if done well. I don't think NCCN followup guidelines are adequate for the discerning patients.
Also mild targeted adjuncts and better monitoring would better serve misclassified patients who are occult stage 4 and micrometastatic CRC that get a nasty surprise on recurs that were preventable or better treatable.
My perspective concerns a stage 4b patient treated more like such a targetable stage 2-3 patient, merely extended.
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Just to add to the original post. In June 2017 a large study was presented at the ASCO conference about 3 vs. 6 months Oxaliplatin regimen.
The results were clear. 3 months treatment has the same effect as 6 months. I barely made it through 6 treatments(3 months) anyway, as the Oxaliplatin is hard on the bonemarrow and the production of white blood cells.
Video interview from the ASCO conference:
Rgds, Bjorn
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Terribleabita said:My 6th round landed me in the
My 6th round landed me in the emergency room for 9 hours
So sorry to hear that. I'm hoping that they did something for your future treatment and either quit it or reduced it.
Kim
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Saw that
Yes, came across that study several weeks ago. My husband, Stage 3, having had 4 treatments by then, jumped on it and decided that was good enough for him. His Oncologist didn't like it though. When we showed him the study, he said he needed to see the background data. He left the room for close to 10 minutes and came back. With nothing. No data to argue with, other than there's no long-term data, i.e., 10 years +. Yeah, okay. But my husband's point is: is it worth it to get those last 6 treatments, just because that's the Cancer Center's current protocol, and risk having a poor quality of life, for barely negligible possible benefit?
The side effects he's most concerned with are neuropathy and chemo brain, which increase in intensity with each treatment and are likely permanent. My husband is very active physically and mentally and wants to stay that way. He reckons the next 10 years will be the best 10 years of the rest of his life and doesn't want them ruined. He's just finished his 6th treatment and will likely stop there but his Oncologist is trying to convince him to get another 2 treatments at least. We'll see how it goes over the next week or so but he is leaning more towards stopping at this point.
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My experienceShiraz61 said:Saw that
Yes, came across that study several weeks ago. My husband, Stage 3, having had 4 treatments by then, jumped on it and decided that was good enough for him. His Oncologist didn't like it though. When we showed him the study, he said he needed to see the background data. He left the room for close to 10 minutes and came back. With nothing. No data to argue with, other than there's no long-term data, i.e., 10 years +. Yeah, okay. But my husband's point is: is it worth it to get those last 6 treatments, just because that's the Cancer Center's current protocol, and risk having a poor quality of life, for barely negligible possible benefit?
The side effects he's most concerned with are neuropathy and chemo brain, which increase in intensity with each treatment and are likely permanent. My husband is very active physically and mentally and wants to stay that way. He reckons the next 10 years will be the best 10 years of the rest of his life and doesn't want them ruined. He's just finished his 6th treatment and will likely stop there but his Oncologist is trying to convince him to get another 2 treatments at least. We'll see how it goes over the next week or so but he is leaning more towards stopping at this point.
My oncologist talked me into two more treatments as well. On the last one, I had a heart-attack like reaction to the medication. It looks like there is no permanent damage, but I wish I had stopped earlier. Of course, if I have a recurrence, I might feel differently. These are very hard decisions. Sometimes intuition is a good guide.
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Ending chemo
My dad has had four treatments (supposed to go 8) and has decided he is done with chemo. The neuropathy has been the most difficult side effect. We meet with doc on Monday. Sure he will be encouraged to proceed. I completely support his decision to stop.
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I went the full course...
I went the full course CAPOX (Oxaliplatin and Xeloda) and reduced to 80% for the last two. I was not feeling the effects of the Oxaliplatin until I kicked the shower frame and didn’t notice it Until much later in the day. I didn‘t notice the full effects of the Neuropathy until two months later. I’m still dealing with Neuropathy 18 months later. It’s down to the ankle on my right legs and mid-calf on my left. I feel improvement every day.
If 3 months does it, I say go for it.
Best of Luck
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We did a test round to see.Annabelle41415 said:Terrible
So sorry to hear that. I'm hoping that they did something for your future treatment and either quit it or reduced it.
Kim
We did a test round to see. Nurses staring at me at soon as it started. 25 minutes in had to stop it. I am now on a different drug, plus still with the 5fu and leucoverin
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Just two more?SandiaBuddy said:My experience
My oncologist talked me into two more treatments as well. On the last one, I had a heart-attack like reaction to the medication. It looks like there is no permanent damage, but I wish I had stopped earlier. Of course, if I have a recurrence, I might feel differently. These are very hard decisions. Sometimes intuition is a good guide.
So your Onc bargained you into two more, just like my husband's Onc is trying to do? I wonder if this study is well known throughout the oncology field and they've all decided on this "just two more" bargaining chip? I know they have their tried and tested treatment protocols and that the cancer centers have to be very standardized, but it seems to us that it's too "one size fits all" and doesn't look at the entire picture or the whole person. Their goal is to try to cure cancer but if side-effects cause problems or disabilities, they refer you to a specialist for that, it's not their problem. My husband was told there's some medication for neuropathy, to "help with it". Not good enough. We'd prefer to avoid it in the first place. And the best way that we can see, is to not get the last 6 treatments, which seem to be mostly, if not entirely, useless, according to this study, for his cancer. And as far as "chemo brain", the Oncologist waffled a bit on that, saying there's not been much study done on it yet. That's not encouraging.
Yes, it's a very hard decision. But it's a personal one and based on what is most important to the individual at the time. My husband will be turning 70 this year. He might feel differently if he was younger but his main concern is the next 10 years of his life, which he says will be best of what's left. There's lots more he'd like to do, places to travel to, etc. After 80, he says there will be the natural decline, where he'll have to slow down and take it much easier, but he's not wanting that sped up by 10 years. He's also accepting of cancer recurrence at any time, whether he got the whole whack of 12 treatments, 8 or 6, as they (cancer docs) can't guarantee anything. If it were me, I'd stop at 6, as this study is very clear. Lots of participants, several countries, no industry funding to sway the stats, and a lot of confidence from the doctors involved. But that's my husband's decision, so I can only support him in whatever he decides.
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SupportShiraz61 said:Just two more?
So your Onc bargained you into two more, just like my husband's Onc is trying to do? I wonder if this study is well known throughout the oncology field and they've all decided on this "just two more" bargaining chip? I know they have their tried and tested treatment protocols and that the cancer centers have to be very standardized, but it seems to us that it's too "one size fits all" and doesn't look at the entire picture or the whole person. Their goal is to try to cure cancer but if side-effects cause problems or disabilities, they refer you to a specialist for that, it's not their problem. My husband was told there's some medication for neuropathy, to "help with it". Not good enough. We'd prefer to avoid it in the first place. And the best way that we can see, is to not get the last 6 treatments, which seem to be mostly, if not entirely, useless, according to this study, for his cancer. And as far as "chemo brain", the Oncologist waffled a bit on that, saying there's not been much study done on it yet. That's not encouraging.
Yes, it's a very hard decision. But it's a personal one and based on what is most important to the individual at the time. My husband will be turning 70 this year. He might feel differently if he was younger but his main concern is the next 10 years of his life, which he says will be best of what's left. There's lots more he'd like to do, places to travel to, etc. After 80, he says there will be the natural decline, where he'll have to slow down and take it much easier, but he's not wanting that sped up by 10 years. He's also accepting of cancer recurrence at any time, whether he got the whole whack of 12 treatments, 8 or 6, as they (cancer docs) can't guarantee anything. If it were me, I'd stop at 6, as this study is very clear. Lots of participants, several countries, no industry funding to sway the stats, and a lot of confidence from the doctors involved. But that's my husband's decision, so I can only support him in whatever he decides.
Exactly. The best thing you can do is support him in whatever decision he reaches.
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Goodabita said:We did a test round to see.
We did a test round to see. Nurses staring at me at soon as it started. 25 minutes in had to stop it. I am now on a different drug, plus still with the 5fu and leucoverin
I'm glad that you and nurses are staying vigilant about it and watching it. Don't let it go. Hoping this new drug will be better for you and you can tolerate it.
Kim
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Luckily there are more
Luckily there are more options than Folfox. I had to stop after 6 because it almost killed me so I'll never be on it again. It was horrible to go through, anyway. I'd been really undecided as to whether even to do it as a follow up after my surgery because I'd had an infection and couldn't start on it within the prescribed amount of time after surgery which greatly lessens the chance of it working. So I did it and almost died from it but now that I have mets, if I hadn't tried it, I'd be kicking myself for not doing it and blaming myself for being the reason it spread.
Mikenh, the best explanation I've had is to compare it to dendelions in your lawn. You use different treatments to try to get rid of all of them and your yard looks perfect for a while and you think you won the battle and then suddenly another one pops up.
Jan
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