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Postoperative chemotherapy relative dose intensity and overall survival in patients with colon cancer

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Abstract

Purpose

Quantifying the association of chemotherapy relative dose intensity (RDI) with overall survival may enable supportive care interventions that improve chemotherapy RDI to estimate their magnitude of potential clinical benefit.

Methods

This cohort study included 533 patients with stage II–III colon cancer who initiated a planned regimen of 12 cycles of 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) chemotherapy. The primary exposure was chemotherapy RDI. The primary outcome was overall survival. Restricted cubic splines estimated hazard ratios (HR).

Results

Chemotherapy regimen RDI was associated with overall survival in an L-shaped pattern (linear P = 0.006; nonlinear P = 0.057); the risk of death was flat above 85% but increased linearly below 85%. For example, a decrease in RDI from 85 to 75% was associated with an increased risk of death [HR: 1.20 (95% CI: 1.08, 1.52)], whereas an increase in RDI from 85 to 95% was not associated with the risk of death [HR: 1.06 (95% CI: 0.82, 1.38)].

Conclusion

If chemotherapy RDI is considered a potential surrogate of overall survival, supportive care interventions that improve chemotherapy RDI might confer a potential clinical benefit in this population.

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Data availability

Data described in the manuscript, code book, and analytic code will not be made available because this was a retrospective cohort study using electronic medical records. The institutional review board waived the requirement for informed consent. Consequently, study subjects did not explicitly consent for their data to be shared publicly. Moreover, study subjects were treated within a single health system for an uncommon disease, and our ability to preserve subject anonymity cannot be guaranteed.

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Author information

Authors and Affiliations

  1. Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA

    Justin C. Brown & Shengping Yang

  2. LSU Health Sciences Center New Orleans School of Medicine, 1901 Perdido St, New Orleans, LA, 70112, USA

    Justin C. Brown

  3. Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 533 Bolivar St, New Orleans, LA, 70112, USA

    Justin C. Brown

  4. Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA

    Jeffrey A. Meyerhardt

  5. Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, USA

    Bette J. Caan

Authors
  1. Justin C. Brown
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  2. Jeffrey A. Meyerhardt
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  3. Shengping Yang
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  4. Bette J. Caan
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Corresponding author

Correspondence to Justin C. Brown.

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Conflict of interest

Dr. Brown reports receiving grants from the National Cancer Institute, Cancer Research UK, and the American Institute for Cancer Research during the study. Dr. Meyerhardt reports receiving grants from the National Cancer Institute during the study and consulting fees from Merck Pharmaceutical during the 36 months before publication (all fees  < $5000). Dr. Caan reports receiving grants from the National Cancer Institute during the study. All other authors report no disclosures.

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Brown, J.C., Meyerhardt, J.A., Yang, S. et al. Postoperative chemotherapy relative dose intensity and overall survival in patients with colon cancer. Cancer Chemother Pharmacol (2024). https://doi.org/10.1007/s00280-024-04665-5

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