Vol 17, No 1 (2021)
Research paper
Published online: 2020-12-01

open access

Page views 603
Article views/downloads 679
Get Citation

Connect on Social Media

Connect on Social Media

Evaluation of the efficacy of chemotherapy with capecitabine and oxaliplatin in patients with disseminated colorectal cancer. The impact of primary cancer focus on treatment efficacy

Ewa Anna Kosakowska12, Andrzej Rutkowski2, Piotr T. Wysocki2, Wojciech Michalski3, Anna Cencelewicz-Lesikow2, Michał Kunkiel4, Agnieszka Jagiello-Gruszfeld4
Oncol Clin Pract 2021;17(1):1-5.


Introduction. Colorectal cancer is an increasingly common cancer, and due to the possibility of using many drugs nd combination therapy, it bears the hallmarks of a chronic disease. Improving the quality of life is important. 

Material and methods. The following analysis applies to the oxaliplatin and capecitabine (CAPOX) regimen in a group of 305 patients. This chemotherapy was used as part of palliative treatment lines I, II or III. 

Results. The work proved the effectiveness of the scheme despite the reduction of drug doses in about 50% of patients, and toxicity grade 3 was only present in 5% (grade 4 complications were not observed). The group of patients in which CAPOX was used as the first treatment line was considered representative, and the effectiveness of the treatment depending on the location of the primary tumour was evaluated. 

Conclusion. Differences in overall survival of patients after stratification were observed relative to the location of the primary tumour. Survival was longer in patients with left-sided primary tumour compared to right-sided localisation and was, respectively, 20.4 (95% CI, 17.5–23.4) and 12.1 months (95% CI, 10.5–13.8) (P = 0.014).

Article available in PDF format

View PDF Download PDF file


  1. Lidia Sc, Meyerhardt J, Winkfield KI, et al. Winkfield K. Colorectal cancer: symptoms and signs cancer.net. Editorial Board. 2018; 11.
  2. Seufferlein T, Ahn J, Krndija D, et al. Tumor biology and cancer therapy - an evolving relationship. Cell Commun Signal. 2009; 7: 19.
  3. Arkenau HT, Arnold D, Cassidy J, et al. Efficacy of oxaliplatin plus capecitabine or infusional fluorouracil/leucovorin in patients with metastatic colorectal cancer: a pooled analysis of randomized trials. J Clin Oncol. 2008; 26(36): 5910–5917.
  4. Guo Yu, Xiong BH, Zhang T, et al. XELOX vs. FOLFOX in metastatic colorectal cancer: An updated meta-analysis. Cancer Invest. 2016; 34(2): 94–104.
  5. Rothenberg ML, Cox JV, Butts C, et al. Capecitabine plus oxaliplatin (XELOX) versus 5-fluorouracil/folinic acid plus oxaliplatin (FOLFOX-4) as second-line therapy in metastatic colorectal cancer: a randomized phase III noninferiority study. Ann Oncol. 2008; 19(10): 1720–1726.
  6. Shida D, Tanabe T, Boku N, et al. Prognostic Value of Primary Tumor Sidedness for Unresectable Stage IV Colorectal Cancer: A Retrospective Study. Ann Surg Oncol. 2019; 26(5): 1358–1365.
  7. Shen H, Yang J, Huang Q, et al. Different treatment strategies and molecular features between right-sided and left-sided colon cancers. World J Gastroenterol. 2015; 21(21): 6470–6478.
  8. Lee MS, Menter DG, Kopetz S. Right versus left colon cancer biology: integrating the consensus molecular subtypes. J Natl Compr Canc Netw. 2017; 15(3): 411–419.
  9. Petrelli F, Tomasello G, Borgonovo K, et al. Prognostic survival associated with left-sided vs right-sided colon cancer: a systematic review and meta-analysis. JAMA Oncol. 2017; 3(2): 211–219.
  10. Loupakis F, Yang D, Yau L, et al. Primary tumor location as a prognostic factor in metastatic colorectal cancer. J Natl Cancer Inst. 2015; 107(3).
  11. Holch JW, Ricard I, Stintzing S, et al. The relevance of primary tumour location in patients with metastatic colorectal cancer: A meta-analysis of first-line clinical trials. Eur J Cancer. 2017; 70: 87–98.
  12. Gallois C, Pernot S, Zaanan A, et al. Colorectal cancer: why does side matter? Drugs. 2018; 78(8): 789–798.
  13. Meropol NJ, Gold PJ, Diasio RB, et al. Thymidine phosphorylase expression is associated with response to capecitabine plus irinotecan in patients with metastatic colorectal cancer. J Clin Oncol. 2006; 24(25): 4069–4077.
  14. Sadahiro S, Suzuki T, Tanaka A, et al. Association of right-sided tumors with high thymidine phosphorylase gene expression levels and the response to oral uracil and tegafur/leucovorin chemotherapy among patients with colorectal cancer. Cancer Chemother Pharmacol. 2012; 70(2): 285–291.
  15. Elsaleh H, Joseph D, Grieu F, et al. Association of tumour site and sex with survival benefit from adjuvant chemotherapy in colorectal cancer. Lancet. 2000; 355(9217): 1745–1750.
  16. Peng J, Li C, Wang F, et al. Right- and left-sided stage III colon cancers present different prognostic outcomes of oxaliplatin-based adjuvant chemotherapy after curative resection. Cancer Manag Res. 2018; 10: 2095–2103.
  17. Negri FV, Wotherspoon A, Cunningham D, et al. Mucinous histology predicts for reduced fluorouracil responsiveness and survival in advanced colorectal cancer. Ann Oncol. 2005; 16(8): 1305–1310.
  18. Modest DP, Schulz C, von Weikersthal LF, et al. Outcome of patients with metastatic colorectal cancer depends on the primary tumor site (midgut vs. hindgut): analysis of the FIRE1-trial (FuFIRI or mIROX as first-line treatment). Anticancer Drugs. 2014; 25(2): 212–218.
  19. Morris V, Overman MJ, Jiang ZQ, et al. Progression-free survival remains poor over sequential lines of systemic therapy in patients with BRAF-mutated colorectal cancer. Clin Colorectal Cancer. 2014; 13(3): 164–171.
  20. Murcia O, Juárez M, Rodríguez-Soler M, et al. Colorectal cancer molecular classification using BRAF, KRAS, microsatellite instability and CIMP status: Prognostic implications and response to chemotherapy. PLoS One. 2018; 13(9): e0203051.
  21. Goldstein J, Tran B, Ensor J, et al. Multicenter retrospective analysis of metastatic colorectal cancer (CRC) with high-level microsatellite instability (MSI-H). Ann Oncol. 2014; 25(5): 1032–1038.
  22. Carethers JM, Chauhan DP, Fink D, et al. Mismatch repair proficiency and in vitro response to 5-fluorouracil. Gastroenterology. 1999; 117(1): 123–131.