Translation of IDEA trial results into clinical practice: Analysis of the implementation of a new guideline for colon cancer

• Published in: International journal of cancer 2022-10, Vol.151 (8), p.1270-1279
• Main Authors: Rooijen, Karlijn L., Derksen, Jeroen W. G., Verkooijen, Helena M., Vink, Geraldine R., Koopman, Miriam
• Format: Article
• Language: English
• Subjects: adjuvant chemotherapy; Cancer; cancer registry; Chemotherapy; Colon cancer; Colorectal cancer; Colorectal carcinoma; guideline; Medical research; Oxaliplatin; Patients; Toxicity; Tumors
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.34149

The IDEA trial showed no clinical relevant differences in efficacy between 3 and 6 months of oxaliplatin‐based adjuvant chemotherapy (ACT) in colon cancer (CC), while toxicity was substantially lower in the 3 months regimen. Therefore, in 2017 the Dutch colorectal cancer guideline was revised and currently recommends 3 months of oxaliplatin‐based ACT. Furthermore, the definition of high‐risk stage II CC was restricted to pT4 tumors. We analyzed changes in ACT between 2015 and 2019. From the Netherlands Cancer Registry all 16 721 patients ≥18 years with resected high‐risk stage II and stage III CC during 2015 to 2019 were selected. Differences in patient and treatment characteristics were analyzed per calendar year according to stage and age. Mean duration of oxaliplatin‐based ACT decreased from 18.6 (±8.0) to 9.5 (±3.8) weeks between 2015 and 2019. In patients receiving ACT (n = 8170), the proportion treated with oxaliplatin increased from 74% to 83%. The proportion of patients receiving ACT was stable, 61% to 69% in stage III and 26% to 29% in pT4 stage II. ACT in previous high‐risk pT3N0 disease decreased from 15% to 3%. Use of oxaliplatin increased from 27% to 49% in patients aged ≥75 years. The revised guideline was rapidly implemented and led to an increase in oxaliplatin‐based ACT in the elderly and increased guideline‐adherence in high‐risk stage II CC. What's new? Results from the 2017 International Duration Evaluation of Adjuvant Chemotherapy Collaboration (IDEA) trial support the use of adjuvant chemotherapy (ACT) for 3 months in stage II and III colon cancer patients. Our study examined the impact of the incorporation of IDEA trial results into colon cancer treatment guidelines in the Netherlands. Analyses of Netherlands Cancer Registry data show that rapid guideline implementation shortened ACT duration, increased oxaliplatin‐based ACT in elderly patients, and increased guideline‐adherence in stage II disease. Shorter treatment duration can reduce toxicity and costs. The findings highlight the value of rapid translation of scientific insights into clinical care.