[Skip to Content]
[Skip to Content Landing]
Views 268
Citations 0
Comment & Response
June 25, 2020

Risk-Benefit Comparisons Between Shorter and Longer Durations of Adjuvant Chemotherapy in High-Risk Stage II Colorectal Cancer—Reply

Author Affiliations
  • 1Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
  • 2Medical Oncology Unit, Medical Science Department, ASST Bergamo Ovest, Treviglio (BG), Italy
  • 3Cancer Center ASST Papa Giovanni XXIII, Bergamo, Italy
JAMA Oncol. Published online June 25, 2020. doi:10.1001/jamaoncol.2020.2262

In Reply We thank McCaw and colleagues for their observations and interesting suggestions about the end point of our Three or Six Colon Adjuvant (TOSCA) stage II subgroup analysis recently published in JAMA Oncology.1 We concluded that, despite not reaching the noninferiority significance, the clinical nonsignificance of the overall results (in particular the 1% difference in 5-year relapse-free survival) with 3-month capecitabine plus oxaliplatin (XELOX) treatment may reasonably lead to suggest that this schedule may be preferable in terms of efficacy and toxicity for these patients. We agree that future studies should look to composite end points (that couple efficacy and toxicity) and that these need to be prospectively evaluated in large randomized studies. McCaw and colleagues suggest a reanalysis of our data as a function of both outcome and toxicity outcomes for stratification purposes. This is a useful compromise coupling outcome and adverse events. Unfortunately, our trial did not include a quality-of-life evaluation. In a similar study, the Short Course Oncology Therapy (SCOT) trial,2 shorter chemotherapy duration showed similar survival with a better quality of life, and the authors identified the 3-month duration as the reference standard in these stages.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×