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Summary:
1. J Clin Oncol: 6 months capecitabine plus 3 months oxaliplatin treatment can be used as an alternative to stage III CRC Adjuvant therapy
2.J Clin Oncol: Treatment with immune checkpoint inhibitors may increase the risk of cardiovascular events in patients
1
J Clin Oncol: 6 months of capecitabine plus 3 months of oxaliplatin therapy can be used as a treatment for stage III CRC Alternative Adjuvant Therapy
▎ Clinical Question:
Is 3 months of oxaliplatin combined with 6 months of fluorouracil inferior to 6 months of oxaliplatin in patients with high-risk stage II/III colorectal cancer (CRC)? Platinum plus 6 months of fluorouracil?
The combination of oxaliplatin and fluorouracil for 6 months is one of the standard options for adjuvant treatment of high-risk stage II and stage III CRC.
The optimal duration of oxaliplatin treatment to minimize neurotoxicity without compromising efficacy is unclear.
A randomized controlled trial from J Clin Oncol shows that 6 months of capecitabine plus 3 months of oxaliplatin can be used as an alternative adjuvant therapy for stage III CRC.
▎ research protocol:
(1) high-risk stage II and stage III CRC patients met the inclusion criteria, and a total of 1,788 people were included;
(2) patients were randomly assigned to the 3-month oxaliplatin combined with 6-month fluorouracil group and 6-month oxaliplatin combined with 6-month fluorouracil group (3-month treatment group and 6-month treatment group, respectively);
(3) The primary endpoint is disease-free survival (DFS), and the non-inferiority margin The value is a hazard ratio (HR) of 1.25.
▎ Main findings :
(1) The rate of neuropathy of any grade in the 6-month treatment group was higher than that in the 3-month treatment group (69.5% vs 58.3%; P <>
(2) 6 months The 3-year DFS rates of the treatment group and the 3-month treatment group were 83.7% and 84.7% respectively, and the HR was 0.953 (95% CI, 0.769-1.180; non-inferiority test, P=0.0065), which was within the non-inferiority boundary. Within value;
(3) In stage III CRC patients treated with capecitabine plus oxaliplatin, 3-year DFS in the 3-month treatment group was not inferior to that in the 6-month treatment group, with a HR of 0.713 (95% CI, 0.530-0.959; P=0.0009);
(4) In patients with high-risk stage II and stage III CRC treated with infusions of fluorouracil, leucovorin, and oxaliplatin, the 3-month treatment group was significantly Non-inferiority compared to treatment groups was not demonstrated.
▎ Outlook:
This study shows that in the treatment of stage III CRC, shortening the duration of oxaliplatin treatment from 6 months to 3 months can reduce neurotoxicity without affecting efficacy. Subsequent attempts can be made to further explore the optimal treatment time for oxaliplatin.
References:
[1] https://ascopubs.org/doi/full/10.1200/JCO.21.02962
2
J Clin Oncol: Treatment with immune checkpoint inhibitors may increase the risk of cardiovascular events in patients
▎ Clinical Issues :
What is the incidence of major adverse cardiovascular events (MACEs) in patients treated with immune checkpoint inhibitors (ICIs)?
In rare cases, ICIs can cause immune-mediated myocarditis. However, the true incidence of other MACEs after ICI therapy remains unclear because late-treatment side effects are rarely reported in prospective clinical trials.
A study from J Clin Oncol shows that ICIs treatment may have adverse effects on the occurrence of cardiovascular events in patients.
▎ Research protocol:
This study included a total of 672 patients who underwent ICI treatment. The primary endpoint of this study is MACE, which is a composite endpoint of acute coronary syndrome, heart failure (HF), stroke, and transient ischemic attack. Secondary outcomes were acute coronary syndrome and heart failure, respectively. Incidence rates were compared between groups after matching for age, sex, cardiovascular history, and cancer type.
▎ Key findings:
(1) The incidence of MACE was 10.3% during a median follow-up of 13 months (interquartile range, 6-22 months).
(2) In multivariable analysis, history of HF (HR, 2.27; 95% CI, 1.03-5.04; P=0.043) and valvular heart disease (HR, 3.01; 95% CI, 1.05-8.66; P=0.041 ) is significantly correlated with MACE.
(3) Cumulative incidence was significantly higher in the ICI-treated patient cohort compared with the non-ICI-treated cancer cohort and population controls, primarily driven by a shuffled higher risk of HF events.
▎ Outlook:
Cardiovascular events occurring during and after ICI treatment are more common than currently recognized by the academic community, and patients with a history of cardiovascular disease are often at higher risk. The incidence of MACE in cancer patients treated with ICI is significantly higher than that in other groups, indicating that in addition to the known potential risks, ICI treatment also has potential adverse effects.
References:
[1] https://ascopubs.org/doi/full/10.1200/JCO.21.01808
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