Patient factors related to the real-world adoption of 3 months of adjuvant chemotherapy (ACT) in patients with stage III colorectal cancer (CRC).

e15609 Background: Based on the IDEA analysis, 3 months (mos) of ACT with CAPOX is an option for both low-risk and high-risk stage III CRC, with potential resource utilization, cost and toxicity benefits. This study examined the patterns of uptake of CAPOX vs FOLFOX and duration of ACT, focussing on patient factors, in a contemporary post-COVID real-world cohort of patients (pts) in British Columbia, Canada. Methods: The provincial pharmacy database was used to identify pts with resected stage III CRC who received adjuvant CAPOX or FOLFOX from January 2021 to December 2022. Demographic, tumor, and treatment information was collected. Descriptive statistical analyses were performed to examine baseline characteristics and Fisher’s exact test was used to examine univariate associations. Results: 452 pts were included, of which 234 (52%) and 218 (48%) were planned to receive 3 and 6 mos of ACT respectively (see table). Within the 3 mos group, 226 (97%) received CAPOX. Within the 6 mos group, there was a 51%/49% split between CAPOX/FOLFOX. By univariate analysis, age > 70y (P = 0.039), low/intermediate grade (P = 0.005) and low-risk disease (P < 0.0001) were significantly associated with 3 mos of CAPOX. There was no difference in ACT choice with regards to ECOG status, ileostomy or pre-existing neuropathy. 29% of pts planned for 6 mos of ACT had low-risk disease, with 52% of these receiving CAPOX. Patients who received 6mos of ACT were significantly more likely to report neuropathy (68 vs 36%, P < 0.0001) and to stop oxaliplatin early (54 vs 31%, P < 0.0001). The most likely reason for early discontinuation of ACT was neuropathy in the 6mos group and gastrointestinal toxicity in the 3mos group (P < 0.0001). Irrespective of duration, mean time from consult to ACT was longer for FOLFOX vs CAPOX (24 vs 19 days, P = 0.007). Conclusions: In this contemporary cohort, use of 3 mos of adjuvant CAPOX remains low. 6 mos of oxaliplatin is still being offered to pts with low-risk disease, and is associated with more neuropathy warranting early oxaliplatin cessation. Exploration of patient preferences and resource costs may improve more widespread adoption of 3 mos of adjuvant CAPOX in stage III CRC. Table: see text