Changes in Prescribing Patterns in Stage III Colon Cancer

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Fang-Shu Ou Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota

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Daniel J. Walden Division of Medical Oncology, Mayo Clinic, Phoenix, Arizona

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Joseph J. Larson Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota

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Sandra Kang Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia

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Cassia R. Griswold Division of Medical Oncology, Mayo Clinic, Phoenix, Arizona

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Benjamin E. Ueberroth Division of Medical Oncology, Mayo Clinic, Phoenix, Arizona

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Bhamini Patel Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia

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Amber Draper Emory University Hospital Midtown, Emory University, Atlanta, Georgia

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Puneet Raman Division of Medical Oncology, Mayo Clinic, Phoenix, Arizona

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Olatunji B. Alese Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia

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Mohamad B. Sonbol Division of Medical Oncology, Mayo Clinic, Phoenix, Arizona

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Tanios S. Bekaii-Saab Division of Medical Oncology, Mayo Clinic, Phoenix, Arizona

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Christina S. Wu Division of Medical Oncology, Mayo Clinic, Phoenix, Arizona

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Daniel H. Ahn Division of Medical Oncology, Mayo Clinic, Phoenix, Arizona

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Background: For patients with resected stage III colon cancer, 6 months of adjuvant fluoropyrimidine-based chemotherapy has been the standard of care. The IDEA collaboration aimed to evaluate whether 3 months of adjuvant chemotherapy was noninferior to 6 months. Despite failing to meet its primary endpoint, the subgroup analyses demonstrated noninferiority based on regimen and treatment duration when a risk-stratified approach was used. Patients and Methods: To evaluate the impact of the results of the IDEA collaboration, we evaluated adjuvant chemotherapy prescribing practice patterns, including planned adjuvant treatment regimen and duration from January 1, 2016, to January 31, 2021. The time period was selected to evaluate chemotherapy prescribing patterns prior to the abstract presentation of the IDEA collaboration in June 2017 and after full manuscript publication in March 2018. Results: A total of 399 patients with stage III colon cancer who received adjuvant chemotherapy were included in the analysis. A significant increasing trend for use of 3 months of adjuvant chemotherapy was observed after presentation of the IDEA abstract (P<.001). A significant change in CAPOX (capecitabine/oxaliplatin) prescribing was also observed, increasing from 14% of patients prior to presentation of the IDEA abstract to 48% after presentation (P<.001). Comparing 3 months of CAPOX with 6 months of FOLFOX (fluorouracil/leucovorin/oxaliplatin), 3 months of CAPOX use also steadily increased over time (adjusted odds ratio [aOR], 1.28; 95% CI, 1.20–1.37; P<.001). Among subgroups of interest, no differences in adoption of CAPOX were observed. The adoption of 3 months of CAPOX was similar in patients with low-risk cancer (aOR, 1.27; 95% CI, 1.17–1.37) and those with high-risk cancer (aOR, 1.31; 95% CI, 1.16–1.47). Conclusions: Despite the IDEA collaboration failing to demonstrate noninferiority of 3 months’ duration of adjuvant therapy compared with 6 months, the findings have influenced practice prescribing patterns, favoring CAPOX and a shorter duration of planned adjuvant treatment.

Submitted January 23, 2023; final revision received April 10, 2023; accepted for publication April 11, 2023.

Author contributions: Study design: Ou, Ahn. Data collection: Walden, Kang, Griswold, Ueberroth, Patel, Draper, Raman, Alese. Data analysis: Ou, Larson, Sonbol, Bekaii-Saab, Wu, Ahn. Manuscript preparation: All authors.

Disclosures: Dr. Alese has disclosed receiving grant/research support from Taiho Oncology, Ipsen Pharmaceuticals, GlaxoSmithKline, Bristol Myers Squibb, PCI Biotech AS, Calithera Biosciences, Inc., SynCore Biotechnology Co. Ltd., and Suzhou Transcenta Therapeutics. The remaining authors have disclosed that they have not received any financial considerations from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by the National Institutes of Health under award number UL1TR00237 (J.L. Larson) and by Daniel Sargent Career Development Award ID0EL5BG7316 (F.S. Ou).

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Correspondence: Daniel H. Ahn, DO, Division of Medical Oncology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054. Email: ahn.daniel@mayo.edu

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