Colorectal cancer treatment considerations after the IDEA collaboration analysis

Transcription:

Dr. Thanios S. Bekai-Saab: Dan, you recently published data from 3 and 6 months of hands-on experience. Tell us a little more about this and how you can incorporate this into your practice.

Daniel H. Ann, DO: We presented data that observed changes in prescribing patterns after IDEA formulation. [international duration evaluation of adjuvant therapy] Collaborate has been published. To better understand the IDEA collaboration, he investigated whether 3 months of chemotherapy was non-inferior to his 6 months of chemotherapy in patients with stage III colon cancer. The IDEA collaboration studies patients with low-risk disease and possibly with high-risk disease with specific caveats such as 3 months of chemotherapy, specifically capecitabine oxaliplatin chemotherapy. was shown to be no worse than 6 months of chemotherapy in some patients.

It’s a bit more nuanced in terms of how it integrates with the complex nature of the data in stage II colon cancer, especially the DYNAMIC trial. The DYNAMIC trial examined non-inferiority to see if patients could behave in the same way as non-inferiority patients. A challenge of this study is that the non-inferiority margin was very large compared to the potential benefit from the addition of oxaliplatin chemotherapy. Risk of recurrence is much higher in ctDNA-positive people [circulating tumor DNA], is likely to recur. Looking at the actual number of patients who relapsed, the total number of ctDNA-negative patients was much higher. Although the incidence or percentage was much higher than positives, not all people who are ctDNA-negative can receive chemotherapy to achieve curative intent. These are some of the challenges we face. Much of the data we have is not clear. Ultimately, prospective trials that randomize negative and positive patients to receive chemotherapy are expected to address some of these questions.

Dr. Thanios S. Bekai-Saab: Thank you Dan. Jolene, let’s adjust this a bit. Suppose this is a stage IIIA patient. Low risk, but still stage III, 1 node positive, MRD negative.It is a stage IIIA patient [disease]MRD-negative patient, 55 years old. They are still a little hesitant about chemo and would like to discuss it. Will MRD-negative minds be shaken even more? They ask, “Doctor, do you really need chemotherapy?” What do you think of the patient?

Dr. Jolene Hubbard: I would strongly consider adjuvant therapy with capecitabine/oxaliplatin for 3 months in these individuals. Did they say MRD negative?

Dr. Thanios S. Bekai-Saab: MRD negative, stage IIIA, 1 lymph node positive.

Dr. Jolene Hubbard: Not enough data at this time. For a number of reasons, I’m reluctant to treat stage III symptoms without treatment. The first is that false negatives can occur. Many patients who are ctDNA negative one month after surgery eventually develop metastatic disease. Second, if a patient goes from negative to positive, the prognosis is worse. By delaying chemotherapy until MRD positive, will I miss the opportunity to get the maximum benefit from adjuvant therapy? . [disease]but I omit it and do capecitabine-oxaliplatin for 3 months.

Aparna Palik, MD, MS: Taking a step back, I also agree. I recommend my patients take capecitabine/oxaliplatin for 3 months. For her MRD-negative patients in Stage IIIA, I would not withhold treatment. I still recommend capecitabine/oxaliplatin. But for a patient who is adamantly opposed to oxaliplatin, he might try capecitabine or her 5-FU infusion for six months. [5-fluorouracil] 1 person. I don’t know if anyone would disagree, but I think so.

Dr. Thanios S. Bekai-Saab: Dan, how are you doing?

Daniel H. Ann, DO: Note that the data are not clear, but the benefits of oxaliplatin are highly additive, even for those who complete all oxaliplatin treatment. Survival gains are only a few percent. I would probably do adjuvant capecitabine for 3 months or fluoropyrimidine monotherapy for 3 months.

I edited the transcript for clarity.