Poster Presentation COSA-IPOS Joint Scientific Meeting 2012

A retrospective clinical audit comparing neuropathy associated with two different schedules of Oxaliplatin in the treatment of Metastatic Colorectal Carcinoma (#751)

Thomas Vien 1 , Desmond Yip 2
  1. Australian National University, Canberra, ACT, Australia
  2. Medical Oncology, The Canberra Hospital, Canberra, ACT, Australia

Aims: This study compares various aspects of peripheral neuropathy associated with two regimens for metastatic colorectal cancer: XELOX (oxaliplatin and capecitabine) and FOLFOX (oxaliplatin, fluorouracil and folinic acid). Methods: Patients on treatment between January 2009 and December 2011 were identified via the oncology pharmacy at three hospitals in the ACT: The Canberra Hospital, Calvary Hospital and National Capital Private Hospital. Initially, 80 patients were collected and 30 patients included after exclusion criteria were applied (13 XELOX and 17 FOLFOX). A retrospective chart review was conducted on oncology medical records at the three hospitals. XELOX was compared to FOLFOX in terms of neuropathy incidence and severity, seasonal variation in the onset of worst neuropathy, time to worst neuropathy, effectiveness of various neuropathy management methods, and arm pain incidence. Neuropathy severity was assessed using an Oxaliplatin Specific Neurotoxicity Scale (OSNS). Main results: Demographics were similar between the arms. Comparing XELOX to FOLFOX, no significant difference was found in neuropathy incidence (84.62% versus 82.35%, p=1.00), neuropathy severity (p=1.00 overall comparing all grades of severity) and season of worst neuropathy (p=0.999 overall comparing summer, autumn, winter and spring) between the arms. A non-significant trend towards an earlier time to worst neuropathy (11.73 weeks versus 15.00 weeks, p=0.240) was found.  A significant difference in arm pain incidence was found (42% versus 0%, p=0.003). For the management of neuropathy, non-significant trends towards a higher incidence of dose reduction to address neuropathy in the XELOX arm (36.4% versus 21.4%, p=0.656), and a larger decrease in neuropathy severity after dose reduction (-1.00 versus -0.33 in OSNS scores, p=0.440), was found.  Conclusion: This study provides preliminary evidence of XELOX non-inferiority to FOLFOX at the study location, which supports its use in the place of FOLFOX in metastatic colorectal cancer. The significant difference in arm pain incidence, and other non-significant trends, should be explored further with a larger sample size.