Adjuvant FOLFOX Treatment for Stage III Colorectal Cancer: Why Patients Quit FOLFOX?

第三期大腸直腸癌病人無法完成完整術後輔助性FOLFOX化學治療之原因分析

蔡易展(Yi-Jian Tsai) ； 林宏鑫(Hung-Hsin Lin) ； 林春吉(Chun-Chi Lin) ； 藍苑慈(Yuan-Tzu Lan) ； 張世慶(Shih-Ching Chang) ； 王煥昇(Huann-Sheng Wang) ； 姜正愷(Jeng-Kai Jiang) ； 陳維熊(Wei-Shone Chen) ； 林資琛(Tzu-Chen Lin) ； 林楨國(Jen-Kou Lin) ； 楊純豪(Shung-Haur Yang)

《中華民國大腸直腸外科醫學會雜誌》 28卷3期 (2017/09) Pp. 147-152

https://doi.org/10.6312/SCRSTW.2017.28(3).10612

摘要

Purpose. Adjuvant FOLFOX chemotherapy is the standard treatment for stage III colorectal cancer. However, most patient failed to complete full course. This study aimed to evaluate the completion rate and reasons for not fulfilling. Materials and Methods. This is a retrospective observation cohort study. Cases of stage III colorectal adenocarcinoma underwent curative resections and adjuvant FOLFOX chemotherapy between January 2009 and December 2015 were retrieved from the section of colorectal surgery database at Taipei Veterans General Hospital. Basic data of patient were collected including the reason of quitting FOLFOX, and the cumulative dose of oxaliplatin. Results. A total of 886 consecutive cases of stage III colorectal cancer were initially found. 110 cases were excluded due to refusing adjuvant chemotherapy, 199 receiving other regimen, 5 treating at other hospital. 572 patients were analyzed. 290 (50.6%) completed 12 cycles treatment with median Oxaliplatin cumulative dose of 984 mg/m^2 (644~1210 mg/ m^2). Among the 282 patients that failed to complete the treatment, 78 (27.7%) patients were due to physician's protectively early termination, 72 (25.5%) peripheral neuropathy, 30 (10.6%) disease progression, 18 (6.4%) allergic to oxaliplatin, 19 (6.7%) neutropenia, or deteriorated liver/kidney function, 17 (6.0%) severe nausea/vomiting, 12 (4.3%) deteriorated general condition, and 36 (12.8%) patient’s request. For those quitted due to neuropathy, the median cumulative dose of oxaliplatin is 746 mg/m^2, and 680.4 mg/m^2 for allergic reaction. Conclusions. Half of patients completed full course adjuvant FOLFOX. Preventive termination and peripheral neuropathy are the main reasons for quitting. Therapy to prevent or ameliorate Oxaliplatin-related neuropathy is needed to improve the completion rate.

關鍵字

Colorectal cancer ； Adjuvant chemotherapy ； FOLFOX

並列摘要

目的：FOLFOX 是第三期大腸直腸癌術後標準輔助性化學治療。但是許多病人無法完成完整療程。本研究欲探討完成完整FOLFOX 療程的比率及其無法完成的原因。方法：由台北榮總大腸直腸外科資料庫收集2009 年一月至2015 年十二月第三期大腸直腸癌術後接受FOLFOX 治療之病人之基本資料、接受Oxaliplatin 之劑量及無法完成之原因做分析。結果：研究期間內內共866 個第三期大腸直腸癌病人接受手術。其中110 人沒有接受後續輔助性化學藥物治療，199 人接受其他療法，5 人於其他他醫院治療。最後收集572人分析。290 人 (50.6%) 完成完整療程，其Oxaliplatin 累計計劑量之中位數為984 mg/m^2(644~1210 mg/m^2)。無法完成完整療程的病人中，78 人 (27.7%) 是因為主治醫師預防性停藥，72 人 (25.5%) 因週邊神經病變，30 人 (10.6%) 因疾病進展更換療法，18 人 (6.4%)因對Oxaliplatin 過敏，19 人 (6.7%) 因為白血球過低過肝腎功能惡化，17 人 (6.0%) 因嚴重噁心嘔吐，12 人 (4.3%) 因為整體身體狀況變差，36 人 (12.8%) 自行要求停藥。因週邊神經病變而中斷治療的患者，其Oxaliplatin 的累積劑量中位數為746 mg/m^2，而因對Oxaliplatin 過敏中斷治療的患者，其累積劑量中位數為680.4 mg/m^2。結論：半數病人能完成完整療程，週邊神經病變及及醫師預防性停藥是無法完成完整療程之主因。研發預防或減緩週邊神經經病變副作用之化學治療方法應能增加完整療程達成率。

並列關鍵字

大腸直腸癌 ； 化學治療 ； FOLFOX

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