Modified FOLFOX6 tied to better tolerability, higher completion rates vs CAPOX
The combination of 5-fluorouracil and oxaliplatin (mFOLFOX6), the most commonly used adjuvant treatment option for stage IIB and stage III colon cancer in British Columbia, results in better tolerability and higher treatment completion rates relative to capecitabine plus oxaliplatin (CAPOX), according to a recent study.
Included in the analysis were patients (n=306) with resected stage IIB or stage III colon cancer from five British Columbia Cancer Agency centres treated with CAPOX or mFOLFOX6. The authors collected protocol utilization rates, patient characteristics and toxicities of the two regimens and compared these by descriptive statistics.
The most commonly used regimen was mFOLFOX6, with a utilization rate of 69 percent. Patients in the CAPOX arm were younger (57 vs 62 years; p<0.01), but there were no other significant differences between the two groups.
Compared to CAPOX, mFOLFOX6 was associated with less dose-limiting toxicities (82 percent vs 95 percent; p<0.01). In addition, more patients completed the intended 24-week course of mFOLFOX6 compared to CAPOX (82 percent vs 67 percent; p<0.01).
However, a study by Ho and colleagues found that replacing mFOLFOX6 with CAPOX in the adjuvant treatment of colon cancer was associated with potential cost savings from the payer and societal perspectives. [Clin Colorectal Cancer 2016;15:158-163]
From the payer perspective, CAPOX use led to cost savings of $5,339 CAD per patient vs use of mFOLFOX6. From a societal perspective, CAPOX use resulted in savings of $6,080 CAD per patient. The biggest cost savings with CAPOX were attributed to fewer visits for chemotherapy treatment and reduced usage of the central venous access device. [Clin Colorectal Cancer 2016;15:158-163]