A Postauthorization Survey to Document the Therapeutic Management of Oxaliplatin as a First-Line Chemotherapy Regimen in South Africa in Patients with Metastatic Colorectal Cancer
Oxaliplatin is a standard first-line treatment for metastatic colorectal cancer. The objectives were to document the therapeutic management of oxaliplatin in South Africa, determine the incidence and severity of sensory neuropathy, and record the 2-year survival rate. Meccelox was a prospective, noncontrolled, open label, multicentre, observational survey of adult patients with stage IV metastatic colorectal cancer treated with oxaliplatin-based chemotherapeutic regimens. The study was conducted from August 2007 to November 2011 in 29 sites in South Africa by 66 participating treating physicians. Among the 195 enrolled patients, 61% were treated with FOLFOX regimen (5-fluorouracil/folinic acid plus oxaliplatin) for an average of 12 cycles and 32% patients were treated with XELOX (capecitabine plus oxaliplatin) for an average of 6–8 cycles, with the main reason for discontinuation being completion of the preplanned prescribed regimen. In Meccelox survey, 80% of patients were treated with intent of palliation. Overall 64% of patients reported symptoms of sensory neuropathy. The 2-year survival rate was 30%. Conclusions. Patients received a specified preplanned number of chemotherapy cycles rather than being treated until disease progression or toxicity. Both the incidence of neuropathy and the 2-year survival rate were less than previous reports. 1. Introduction Colorectal cancer constitutes a major health problem worldwide representing the third most commonly diagnosed cancer in males and the second most common in females. Over 1.2 million new cancer cases and over 600,000 deaths occur globally each year [1]. Colorectal cancer can be considered as primarily a disease of the elderly, with more than 40% of cases occurring in patients over the age of 75 years [2]. In South Africa, incidence rates, after being standardized for age, are 8.6 per 100,000 males and 5.5 per 100,000 females, according to the country’s national cancer registry (NCR) [3]. Age-standardised mortality rates in South Africa are 7.7 per 100,000 males and 4.5 per 100,000 females [4]. The most common site for metastases is the liver; synchronous liver metastases occur in 15 to 25% of newly diagnosed patients [5, 6]. Treating with both chemotherapy and surgical resection, overall 5-year survival rates of about 30–40% can now be achieved for patients with metastatic colorectal cancer [5]. Chemotherapy remains the cornerstone therapy for the treatment of metastatic colorectal cancer. First-line therapy for patients with metastatic colorectal cancer is rapidly evolving. Treatment regimens are
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