Adjuvant FOLFOX treatment for stage III colon cancer: how many cycles are enough?

Purpose: Adjuvant FOLFOX (5-fluorouracil and oxaliplatin) chemotherapy benefits stage III colon cancer patients. However, it still results in side effects and increased cost. Reducing cycles had been thought to decrease these problems. This retrospective study aimed to find the appropriate number of treatment cycles that are sufficient for treating these patients. Patients and methods: A total of 213 stage III colon cancer patients receiving adjuvant FOLFOX therapy were retrospectively recruited. Demographic data were collected for analysis. Survival analyses were performed between all cases of patients receiving above and below a certain cycle number. If a significant difference was reached at that cycle number, multivariate Cox Regression was performed with those factors resulting in p < 0.2 to assess the independent prognostic factors. Results: The 5-year overall survival rate of patients was 77.9 %, and the 3-year disease-free survival was 76.7 %. For overall survival, a significant benefit was noted for treatment of at least 8 cycles, for disease-free survival, significant differences were apparent from patient data of those who underwent from 7 to 12 treatment cycles. Multivariate survival analysis of that patient data at cycle 8 for overall survival and cycle 7 for disease free survival revealed cycle number as the only independent prognostic factor (p = 0.04, 0.048). Conclusion: Cycle number of adjuvant FOLFOX is a significant prognostic factor for stage III colon cancer patients. At least 8 cycles are needed to have an overall survival benefit, and 7 to disease-free survival.