When will you prescribe 3 v. 6 months of FOLFOX or XELOX for the adjuvant treatment of colon cancer?

This set of studies will do more to reduce toxicity for patients than any other studies presented at ASCO this year. Based on these results, I plan on treating stage III patients as follows:

1. For T4 and/or N2 patients, I will continue to recommend FOLFOX or CAPOX for 6 months, and continue to adjust oxaliplatin as needed for symptoms.

2. For T1-3 and N1 patients, I will discuss both 3 and 6 months of therapy but will recommend 3 months of FOLFOX or CAPOX. I'm not completely convinced of the 5FU/cape differences seen in these studies, but CAPOX is usually my default.

3. Keep an eye on these studies as there is likely more to come. The Alliance Celebrex study has not yet matured.

I agree for the most part with Yousuf for shortening to 3 months for those with T3N1 tumors, but I will have a low threshold for recommending 6 months of chemotherapy for any hint of a higher risk. Also for the occasional patient who does desire more aggressive treratment (there are such patients) I will be inclined to provide the full treatment.

As for the XELOX vs FOLFOX choice, since 2011, my default was also XELOX in about 75% of patients, but I have gradually been shifting to FOLFOX for a larger share of patients and am now probably 75% FOLFOX. I do not know what the experience of others is, but I all too frequently discover that patients are not taking the pills as prescribed. While we have studied medication adherence at length in ho...