Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Oct 1;29(28):3768-74.
doi: 10.1200/JCO.2011.36.4539. Epub 2011 Aug 22.

Oxaliplatin as adjuvant therapy for colon cancer: updated results of NSABP C-07 trial, including survival and subset analyses

Greg Yothers  1 , Michael J O'Connell, Carmen J Allegra, J Philip Kuebler, Linda H Colangelo, Nicholas J Petrelli, Norman Wolmark
Affiliations
Randomized Controlled Trial

Oxaliplatin as adjuvant therapy for colon cancer: updated results of NSABP C-07 trial, including survival and subset analyses

Greg Yothers et al. J Clin Oncol. .

Abstract

Purpose: The National Surgical Adjuvant Breast and Bowel Project (NSABP) C-07 trial demonstrated that the addition of oxaliplatin to fluorouracil plus leucovorin (FULV) improved disease-free survival (DFS) in patients with stage II or III colon cancer. This analysis is the first publication of overall survival (OS) for the NSABP C-07 study. We updated DFS and examined both end points in clinically relevant patient subsets.

Patients and methods: Other studies have identified patients age 70 or older and those with stage II disease as patient subsets in which oxaliplatin may not be effective. We investigated toxicity as a driver of divergent outcomes in these subsets.

Results: In all, 2,409 eligible patients with follow-up were randomly assigned to either FULV (FU 500 mg/m(2) by intravenous [IV] bolus weekly for 6 weeks; leucovorin 500 mg/m(2) IV weekly for 6 weeks of each 8-week cycle for three cycles) or FLOX (FULV plus oxaliplatin 85 mg/m(2) IV on days 1, 15, and 29 of each cycle). With 8 years median follow-up, OS was similar between treatment groups (hazard ratio [HR], 0.88; 95% CI, 0.75 to 1.02; P = .08). FLOX remained superior for DFS (HR, 0.82; 95% CI, 0.72 to 0.93; P = .002). The effect of oxaliplatin on OS did not differ by stage of disease (interaction P = .38 for OS; interaction P = 0.37 for DFS) but did vary by age for OS (younger than age 70 v 70+ interaction P = .039). There was a similar trend for DFS (interaction P = .073). Oxaliplatin significantly improved OS in patients younger than age 70 (HR, 0.80; 95% CI, 0.68 to 0.95; P = .013), but no positive effect was evident in older patients.

Conclusion: Overall, the addition of oxaliplatin to FULV has not been proven to extend OS in this trial, but the DFS effect remained strong. Unplanned subset analyses suggest a significant OS effect of oxaliplatin in patients younger than age 70.

Trial registration: ClinicalTrials.gov NCT00004931.

PubMed Disclaimer

Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Overall survival (A) and disease-free survival (B) in the National Surgical Adjuvant Breast and Bowel Project C-07 trial. FLOX, fluorouracil plus leucovorin with the addition of oxaliplatin; FULV, fluorouracil plus leucovorin; HR, hazard ratio; Pts, patients.
Fig 2.
Fig 2.
Overall survival (A) and disease-free survival (B) by age in years (< 70, 70+) in the National Surgical Adjuvant Breast and Bowel Project C-07 trial. FLOX, fluorouracil plus leucovorin with the addition of oxaliplatin; FULV, fluorouracil plus leucovorin; HR, hazard ratio; Pts, patients.
Fig 3.
Fig 3.
Overall survival (A) and disease-free survival (B) by disease stage (II or III) in the National Surgical Adjuvant Breast and Bowel Project C-07 trial. FLOX, fluorouracil plus leucovorin with the addition of oxaliplatin; FULV, fluorouracil plus leucovorin; HR, hazard ratio; Pts, patients.
See this image and copyright information in PMC

References

    1. André T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med . 2004;350:2343–2351. - PubMed
    1. Kuebler JP, Wieand HS, O'Connell MJ, et al. Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: Results from NSABP C-07. J Clin Oncol . 2007;25:2198–2204. - PubMed
    1. André T, Boni C, Navarro M, et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC Trial. J Clin Oncol . 2009;27:3109–3116. - PubMed
    1. Jackson McCleary NA, Meyerhardt J, Green E, et al. Impact of older age on the efficacy of newer adjuvant therapies in >12,500 patients (pts) with stage II/III colon cancer: Findings from the ACCENT Database. J Clin Oncol. 2009;27(suppl; abstr 4010):170s. - PMC - PubMed
    1. Schoenfeld D. The asymptotic properties of nonparametric tests for comparing survival distributions. Biometrika . 1981;68:316–319.

Publication types

MeSH terms

Associated data