P-258 - Grade III-IV toxicities among elderly stage III colon cancer patients receiving CAPOX or capecitabine

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anticancer Agents
Complications/Toxicities of Treatment
Geriatric Oncology
Colon and Rectal Cancer
Biological Therapy
Presenter F. van Erning
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors F. van Erning1, M. Janssen-Heijnen2, G.-. Creemers3, V. Lemmens1, H. Pruijt4
  • 1Netherlands Comprehensive Cancer Organisation, Eindhoven/NL
  • 2VieCuri Medical Centre, Venlo/NL
  • 3Catharina Hospital, Eindhoven/NL
  • 4Jeroen Bosch Hospital, Den Bosch/NL



Little is known about the prevalence of toxicities among elderly stage III colon cancer patients receiving adjuvant chemotherapy (adjCT) and the influence of these toxicities on treatment intensity.


Stage III colon cancer patients aged ≥70 years diagnosed in southern-Netherlands between 2005-2012 who received adjCT, comprising of capecitabine and oxaliplatin (CAPOX, n = 193) or capecitabine monotherapy (CapMono, n = 164), were included. For toxicity grading, Common Terminology Criteria for Adverse Events version 4.0 were used. Grade III-IV toxicities that appeared in >5% of patients were reported and investigated whether these toxicities were related to patient, tumor and treatment characteristics using &KHgr;2-tests, Fisher's Exact tests and T-tests. Characteristics included were gender, age, comorbidity, ASA score, pT-pN, tumor subsite, differentiation grade, period of diagnosis, completion of planned cycles and mean total dosage (MTD).


The number of grade III-IV toxicities differed between CAPOX and CapMono (p < 0.0001). For CAPOX, 20% developed no toxicity; 32% developed 1 toxicity; 22% developed 2 toxicities; and 26% developed ≥3 toxicities. For CapMono, these proportions were 49%, 31%, 13% and 7% respectively.

For CAPOX, most common grade III-IV toxicities were diarrhea (n = 40, 21%); neurological complications (n = 21, 11%); vomiting/nausea (n = 21, 11%); thrombocytopenia (n = 16, 8%); and hypokalemia (n = 15, 8%). For CapMono, most common toxicities were dermatological complications (n = 28, 17%); diarrhea (n = 14, 9%); and fatigue (n = 11, 7%). 8% of reported toxicities was grade IV; the other toxicities were grade III.

Higher ASA score was associated with diarrhea and thrombocytopenia among patients receiving CAPOX (p = 0.015 and p = 0.048 respectively). Diagnosis in later periods was associated with dermatological complications and diarrhea among patients receiving CapMono (p = 0.0003 and p = 0.015 respectively). No other patient or tumor characteristics appeared related to toxicity.

For CAPOX, patients with diarrhea or vomiting/nausea less often completed all planned cycles as compared to patients without these toxicities (10% vs. 39%, p = 0.0006 and 10% vs. 35%, p = 0.017 respectively). Furthermore, MTD of capecitabine within the CAPOX regimen was lower for patients with diarrhea (85,576 vs. 157,890mg/m2, p < 0.0001), vomiting/nausea (80,573 vs. 151,284mg/m2, p < 0.0001), and hypokalemia (75,295 vs. 149,621mg/m2, p < 0.0001) but higher for patients with neurological complications (173,583 vs. 139,868mg/m2, p = 0.043) and thrombocytopenia (159,278 vs. 135,099mg/m2, p = 0.025). MTD of oxaliplatin was lower for patients with diarrhea (363 vs. 603mg/m2, p < 0.0001), vomiting/nausea (358 vs. 580m/m2, p = 0.0009) and hypokalemia (369 vs. 572mg/m2, p = 0.008) but higher for patients with thrombocytopenia (655 vs. 501mg/m2, p = 0.0005). For CapMono, MTD of capecitabine was lower for patients with diarrhea (114,373 vs. 175,548mg/m2, p = 0.005).


A large majority of elderly treated with CAPOX and half of elderly treated with CapMono developed grade III-IV toxicities, which had a pronounced impact on completion of all planned cycles and mean total dosage.