A recent study has raised concerns over the tolerability of the CAPOX chemotherapy regimen, a combination of capecitabine and oxaliplatin, in patients with colorectal cancer (CRC). Conducted at a single institution from June 2017 to June 2023, the study examined 153 patients with stage II or III CRC undergoing either neoadjuvant or adjuvant CAPOX treatment. The findings indicate that only 44.4% (95% CI, 36%-52%) of patients completed their intended CAPOX cycles, highlighting significant challenges in chemotherapy completion due to toxicity.
The study revealed that female patients experienced particularly poor tolerability, with a completion rate of just 34.6% (95% CI, 23%-45%). This was significantly lower than their male counterparts. Furthermore, nearly a third of all patients, 30.7% (95% CI, 23%-38%), encountered grade ≥ 3 adverse events during treatment, emphasizing the severe side effects associated with CAPOX.
“This study highlights that a substantial number of patients with localized CRC undergoing curative-intent treatment with CAPOX do not complete the planned cycles of chemotherapy because of toxicity…. These findings underscore the need for careful patient selection and appropriate supportive care to optimize the therapeutic benefit of CAPOX in this setting,”
Veronica Mears, PharmD, University Hospitals Cleveland Medical Center in Cleveland, Ohio.
Key Predictors of Early Discontinuation
Multivariable analysis identified several independent predictors for early discontinuation of CAPOX. Female sex emerged as a significant factor, with an odds ratio of 0.408 (95% CI, 0.197-0.845; P = .016), indicating higher odds of early discontinuation compared to males. White race also surfaced as a predictor, with an odds ratio of 0.38 (95% CI, 0.14-0.99; P = .047). Additionally, patients who had six or more planned cycles faced an increased likelihood of discontinuation, reflected by an odds ratio of 0.379 (95% CI, 0.181-0.793; P = .010).
These findings suggest that demographic and treatment-related factors significantly influence the ability to complete CAPOX therapy. As such, these factors should be carefully considered when planning treatment regimens to enhance patient outcomes and reduce adverse effects.
Addressing Hospitalization and Supportive Care
The study also highlighted the impact of CAPOX-related toxicity on hospitalization rates. Approximately 17.6% (95% CI, 11%-23%) of patients required hospital admission due to adverse effects from the treatment. This underlines the necessity for robust supportive care systems to manage and mitigate the risks of chemotherapy-related complications.
Secondary outcomes from the study included not only hospitalization rates but also dose reductions, which are critical in managing toxicity without compromising the treatment's effectiveness. The findings advocate for tailored treatment approaches that prioritize patient safety while striving for optimal therapeutic benefits.
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