Real-World Tolerability of Capecitabine and Oxaliplatin in Patients in the United States With Localized Colorectal Cancer Undergoing Curative-Intent Treatment

The combination of capecitabine and oxaliplatin (CAPOX) is commonly used in patients with localized colorectal cancer (CRC) receiving curative-intent treatment. Our study aimed to assess the real-world tolerability of CAPOX in a single-institution cohort of patients with localized CRC. This is a single-institution retrospective study that included patients with localized CRC receiving neoadjuvant or adjuvant CAPOX. The primary end point was completion rate of intended number (obtained by chart review) of CAPOX cycles irrespective of dose levels. Secondary outcome measures included the rate of grade ≥3 adverse events, hospital admission rate, and dose reductions. The study included 153 patients with a median age of 61 years; 49% were female and 78.4% had stage III CRC. The proportion of patients (95% CI) who completed all planned CAPOX cycles was 44.4% (36 to 52) in the entire cohort and 34.6% (23 to 45) among female patients. Independent variables associated with treatment completion in multivariable analysis were race, sex, and intended number of cycles. Notably, the therapy completion rates (95% CI) were 55% (43 to 66) and 33% (20 to 45) in patients intended to receive four and eight cycles of CAPOX, respectively. The rate of grade ≥3 adverse events and hospitalization because of CAPOX-related toxicity were 30.7% (95% CI, 23 to 38) and 17.6% (95% CI, 11 to 23), respectively. This study highlights that a substantial number of patients with localized CRC undergoing curative-intent treatment with CAPOX do not complete the planned cycles of chemotherapy because of toxicity. These findings underscore the need for careful patient selection and appropriate supportive care to optimize the therapeutic benefit of CAPOX in this setting.