The Early Impact of the IDEA Collaboration Results: How the Results Changed Prescribing Practice

JNCI Cancer Spectr. 2021 Jun 15;5(4):pkab043. doi: 10.1093/jncics/pkab043. eCollection 2021 Aug.

Abstract

Background: Traditionally, adjuvant treatment for colon cancer has been 6 months of combination chemotherapy. Six phase III trials tested the hypothesis that 3 months is noninferior in efficacy to 6 months and reduces long-term side effects for patients. The results were pooled in the International Duration Evaluation of Adjuvant therapy (IDEA) collaboration. Although this did not meet the noninferiority endpoint, a preplanned subgroup analysis by chemotherapy regimen did demonstrate noninferiority for capecitabine and oxaliplatin. Additionally, risk stratification by T and N stage was defined.

Methods: In an effort to understand the real-life impact of these results, 4 months after the IDEA results, an online survey was distributed to clinicians to ask their approach to the adjuvant treatment of patients with stage III colon cancer.

Results: The survey was completed by 458 clinicians from 12 countries. Assuming that 6 months of treatment was the pretrial standard of care, 89.5% of clinicians reported they had changed practice to prescribe 3 months of treatment for some patients. For patients with low-risk stage III disease, there was a preference for 3 months, and for patients with high-risk stage III disease, most clinicians still prescribed 6 months at that time. Overall, capecitabine and oxaliplatin regimen was the most popular. There were important differences in responses depending on the location of respondent and T and N stage of disease.

Conclusion: This survey shows that the IDEA collaboration has been practice changing but reveals important differences in the way results are interpreted by individual clinicians.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Capecitabine / administration & dosage
  • Chemotherapy, Adjuvant / statistics & numerical data*
  • Clinical Trials, Phase III as Topic
  • Colonic Neoplasms / drug therapy*
  • Colonic Neoplasms / pathology
  • Drug Administration Schedule
  • Equivalence Trials as Topic
  • Female
  • Fluorouracil / administration & dosage
  • Health Care Surveys / statistics & numerical data
  • Humans
  • Leucovorin / administration & dosage
  • Male
  • Neoplasm Staging
  • Organoplatinum Compounds / administration & dosage
  • Oxaliplatin / administration & dosage
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Risk

Substances

  • Organoplatinum Compounds
  • Oxaliplatin
  • Capecitabine
  • Leucovorin
  • Fluorouracil

Supplementary concepts

  • Folfox protocol