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 patients is controversial. To reduce the risk of adverse events (AEs) without compromising efficacy while improving chemotherapy compliance is crucial. Methods: We searched Cochrane, Embase, Pubmed, and Web of Science databases for articles from inception to 2023.8.8, the main outcomes were disease–free survival, overall survival, chemotherapy completion rates, and AE frequency. Results: Six randomized controlled trials involving 10,332 patients were included. Disease–free survival analysis revealed that only the high–risk stage III colon cancer patients experienced better results with the six–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 analysis revealed that extending the use of FOLFOX and CAPEOX regimens did not provide survival benefits for stage III colon cancer 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 three–month oxaliplatin–based adjuvant chemotherapy regimen was significantly higher than that of the six–month regimen (Relative risk [RR]: 1.16, 95% CI: 1.06–1.27, P=0.002). Moreover, the three–month regimen had significantly lower AE rates than the six–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). Conclusions: The six–month FOLFOX regimen should only be recommended for high–risk stage III colon cancer, while the three–month regimen can be recommended for other stages. A three–month CAPEOX regimen can be recommended for stage II–III colon cancer.