Proposed Pathway & Evidence for Colorectal Profiler UPDATE IN PROGRESS – Adjuvant Stage III Colon Cancer NCCN: Category 1: mFOLFOX & mFLOX Category 2a: simp 5FU/Leu, 5FU/Leu, Capecitabine alone, CapeOx Adjuvant Stage III Colon Cancer Pathway Regimen Evidence Cost Preference Clinic Margin 1 mFOLFOX MOSAIC trial showed superiority over simp $X 5FU/Leu in DFS, in overall survival showed slight $X superiority with HR of 0.8 2 Simp 5FU/Leu For patients who cannot tolerate oxaliplatin $X $X 3 5FU/Leu Not studied against mFOLFOX $X Equivalent but less expensive than Capecitabine $X alone 3 Capecitabine Twelves 2005 study showed equivalency to $X alone bolus 5FU/Leu in DFS, overall survival and $X relapse free survival 3 CapeOx No study showing equivalency or superiority to $X a 5FU/Leu regimen or mFOLFOX, does have a $X study showing similar safety profile as Cape NP+ trial NSABP C-07 Trial showed superiority over bolus $X 5FU/Leu in disease free survival, but $X equivalency in overall survival. Also, if patients recur then their overall survival is worse with mFLOX over 5FU/Leu Worse diarrhea over mFOLFOX +NP = non-preferred Adjuvant Stage II III Rectal Cancer – NCCN: Category 2a: all regimens Category 2b: Capecitabine/RT Adjuvant Rectal Cancer Concurrent Chemo/RT 6 weeks – – Pathway Regimen Evidence Cost Preference Clinic Margin
Proposed Pathway & Evidence for Colorectal Profiler – UPDATE IN PROGRESS Adjuvant Stage III Colon Cancer NCCN: Category 1: mFOLFOX & mFLOX Category 2a: simp 5FU/Leu, 5FU/Leu, Capecitabine alone, CapeOx Adjuvant Stage III Colon Cancer Pathway Preference Regimen Evidence Cost Clinic Margin 1 mFOLFOX MOSAIC trial showed superiority over simp 5FU/Leu in DFS, in overall survival showed slight superiority with HR of 0.8 $X $X 2 Simp 5FU/Leu For patients who cannot tolerate oxaliplatin $X $X 3 5FU/Leu Not studied against mFOLFOX Equivalent but less expensive than Capecitabine alone $X $X 3 Capecitabine alone Twelves 2005 study showed equivalency to bolus 5FU/Leu in DFS, overall survival and relapse free survival $X $X 3 CapeOx No study showing equivalency or superiority to a 5FU/Leu regimen or mFOLFOX, does have a study showing similar safety profile as Cape $X $X NP+ NSABP C-07 Trial showed superiority over bolus 5FU/Leu in disease free survival, but equivalency in overall survival. Also, if patients recur then their overall survival is worse with mFLOX over 5FU/Leu Worse diarrhea over mFOLFOX $X $X +NP = non-preferred Adjuvant Stage II – III Rectal Cancer NCCN: Category 2a: all regimens Category 2b: Capecitabine/RT Adjuvant Rectal Cancer – Concurrent Chemo/RT – 6 weeks Pathway Preference Regimen Evidence Cost Clinic Margin trial
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