Treatment
Recommendation 4.1
➤ In patients who are candidates for adjuvant doublet chemotherapy,
adjuvant oxaliplatin-containing chemotherapy may be offered for
a duration of 3 months or 6 months, after a discussion with the
patient of the potential benefits and risks of harm associated with
the options for treatment duration. (Weak recommendation; EB-
B-L)
Note: Recommendation 4.1 is based on a subgroup analysis of four
randomized trials from the IDEA collaboration. Choice of therapy with
CAPOX or FOLFOX was non-randomized, and made by treating clinicians
prior to randomization to 3- or 6-months duration of treatment. In high-risk
stage II patients, five-year DFS, the primary study outcome, was 81.7% vs.
82.0% (p = .09) with 3 vs. 6 months of CAPOX, respectively (hazard ratio
[HR], 1.02; 80% confidence interval [CI], 0.88 to 1.17). Five-year DFS
was 79.2% vs. 86.5% (p = .88) with 3 months vs. 6 months of FOLFOX,
respectively (HR, 1.41; 80% CI, 1.18 to 1.68). Among all patients, the
prevalence of peripheral neuropathy of grade 2 or higher during treatment
was 13% vs. 36% with 3 months vs. 6 months of treatment, respectively. These
findings should be considered during the shared decision-making process.
Recommendation Grading
Type Benefit/harm Evidence Quality
Strength of
Recommendation
EB Evidence-
based
B Benefits
outweigh
harms
H High Strong
CB
Consensus-
based
H Harms
outweigh
benefits
M Moderate
IC Informal
consensus
B/H Relative
balance of
benefits and
harms
L Low Weak
VL Very Low
Brozek JL, Akl EA, Compalati E, et al: Grading quality of evidence and strength of recommendations
in clinical practice guidelines part 3 of 3. e GRADE approach to developing recommendations.
Allerg y 66:588-95, 2011
