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.
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.