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Impact of the IDEA collaboration results on the management of stage II-III colon cancer: 2 years of data from the medical oncology department in Marrakech, Morocco
Background
For many years, adjuvant fluoropyrimidine-based chemotherapy for 6 months has been the standard of care in stage II-III colon cancer with an improved overall survival for stage III and a risk of permanent peripheral neuropathy. However, the benefit of this adjuvant chemotherapy in stage II colon cancer and its duration in stage III were a subject of discussion in different studies. In 2020, the IDEA group collaboration final results were a cornerstone that changed the management of these 2 entities. The aim of this study is to report the impact of IDEA trial on the real-world clinical practice.
Methods
This is a retrospective study evaluating 44 patients diagnosed with stage II-III colon cancer between 2020 and 2021 at the medical oncology department of the Mohammed VI University Hospital-Marrakech. All patients underwent surgical treatment with curative intent.
Results
44 patients were included in this study, most of our patients were female (56.8%). The average age at diagnosis was 54 years. All patients had a PS of 0-1. All patients had an adenocarcinoma tumor of which (11%) are mucinous. 16 patients (36.3%) had a tumor of the right colon and 28 (63.6%) of the left. Half of the patients had a stage III and the other half a stage II disease. In the stage III group: 11 (50%) had a low-risk and 11(50%) had a high-risk disease. Among patients with a low-risk disease: 7 (70%) received CAPOX for 3 months, 2 (20%) for 6 months and 1 (10%) was lost to follow-up. Among patients with a high-risk disease: 10 (90%) received CAPOX and 1 (10%) FOLFOX for 6 months. In the stage II group: 10 (45,5%) had a low-risk, 4 (18%) had an intermediate-risk and 8 (36,3%) had a high-risk disease. Among patients with a high-risk disease: 6 (75%) received CAPOX, 1 (12%) received CAPECITABINE for 6 months and 1 was lost to follow-up. Among patients with an intermediate-risk disease: 50% received CAPOX and 50% received CAPECITABINE for 6 months. Among patients with low-risk disease: only 1 patient (10%) received adjuvant chemotherapy (CAPECITABINE) for 6 months and the other 90% were put under follow-up without adjuvant chemotherapy. For patients who received 3 months of treatment, 37% had G1 peripheral neuropathy versus 63% of G1-2 for those who received 6 months of treatment.
Conclusions
Based on the final results of the IDEA group collaboration, clinicians prefer the use of CAPOX over FOLFOX in the adjuvant sitting especially for the low-risk stage III disease, and they are more likely to use a risk stratification approach for decision making for stage II colon cancer. None of our patients had developed a disabling peripheral neuropathy.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
