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New Study in JNCCN Highlights Rapid Adoption of Clinical Research Results into Chemotherapy Prescribing Patterns

Study sheds light on a rapid shift in practice evolution by oncologists treating people with colon cancer adjuvantly after primary surgery, following publications from the IDEA collaboration.

JNCCN Cover, August 2023PLYMOUTH MEETING, PA [August 7, 2023] — New research in the August 2023 issue of JNCCN—Journal of the National Comprehensive Cancer Network evaluates how an important analysis on local-regionally advanced colon cancer adjuvant chemotherapy impacted prescribing patterns. The IDEA collaboration included more than 12,000 patients with Stage III colon cancer across 6 randomized phase 3 trials in a planned pooled analysis, to determine how three or six months of post-surgery chemotherapy—either a combination of capecitabine/oxaliplatin (CAPOX) or fluorouracil/leucovorin/oxaliplatin (FOLFOX)—impacted outcomes.1 The current JNCCN study revealed that after the full publication of IDEA, the percentage of patients treated with CAPOX rose from 14% to 48%. Also, 45.2% of patients were prescribed adjuvant therapy for only three months after IDEA, compared to just 5.6% before.

Daniel H. Ahn, DO, Mayo Clinical Cancer Center“Our study results showed a significant increase in planning for three months of adjuvant chemotherapy after the presentation of IDEA. We also observed that more patients were prescribed CAPOX compared to FOLFOX, which had previously been more widely used as the preferred treatment regimen of choice,” said senior author Daniel H. Ahn, DO, Mayo Clinic Comprehensive Cancer Center. “The biggest concern with six months of chemotherapy are the toxicities from treatment—including low blood counts, kidney and liver dysfunction, and peripheral neuropathy (intolerable numbness and/or weakness). Patients that receive six months of adjuvant chemotherapy are greater than five times more likely to experience grade III or higher peripheral neuropathy. Of course, with three months of chemotherapy we have to be concerned about whether the shortened duration can potentially negatively affect cancer outcomes. Given these nuances, the choice of regimen and duration remains a shared decision.”

The researchers acknowledged that the study’s time period included the COVID-19 pandemic, which may also have played a part in encouraging a shorter duration for chemotherapy.

“At the height of the COVID-19 pandemic, prescribing treatments were influenced to incorporate more oral therapies and less infusion-based visits to minimize exposure to high-risk patients,” said Dr. Ahn.

The researchers studied 399 patients who had been diagnosed with stage III colon cancer and were treated with post-surgery chemotherapy at the Mayo Clinic or Emory University Heath System on or after January 1, 2016. Their findings examined the planned type of chemotherapy and duration before the IDEA abstract was presented, after the abstract, and after the full manuscript publication. In addition to seeing a shift toward shorter adjuvant treatment durations and toward the increased use of CAPOX, the results showed that the adoption of a shorter chemotherapy period was more prevalent for Black patients.

“The IDEA collaborative analysis in stage III colon cancer showing the fairly similar disease-free and overall survival with three months of adjuvant CAPOX compared to the prior standard of six months of chemotherapy in participants with T3N1 disease felt immediately practice changing at its presentation and publication in 2017-2018, and the data was incorporated into the NCCN Guidelines for Colon Cancer shortly thereafter,” explained Katrina S. Pedersen, MD, MS, Associate Professor of Medicine, GI Medical Oncologist, Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, who was not involved in this research. “This study provides the first long-term objective evidence that oncologists across several academic health systems agreed and rapidly shifted prescribing patterns from the majority getting FOLFOX for six months to receiving CAPOX or FOLFOX for three months.”

Dr. Pedersen, a member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Colon Cancer, continued: “Interestingly, the data presented raise the question of what role the COVID-19 pandemic had in accelerating the adoption of CAPOX and what motivated more rapid adoption of three-month regimens in African Americans. I would personally like to see further research to examine if community practice patterns have similarly shifted since IDEA, how prescribing changes have impacted outcomes in African Americans or in higher-risk (T4 or N2) patients, and whether our current era of significant chemotherapy supply chain restrictions have impacted treatment, to help inform future guidelines-based discussions.”

To read the entire study, visit Complimentary access to “Changes in Prescribing Patterns in Stage III Colon Cancer” is available until November 10, 2023.

JNCCN’s Growing Impact

The impact factor for JNCCN has continued to grow, hitting a new record high of 13.4, up from 12.693 last year. This index is calculated by Clarivate, based on the yearly average number of article citations published during the previous two years. With this new impact factor, JNCCN is now ranked in the top 92nd percentile.

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About JNCCN—Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside/BroadcastMed. Visit To inquire if you are eligible for a FREE subscription to JNCCN, visit Follow JNCCN on Twitter @JNCCN.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, equitable, and accessible cancer care so all patients can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) provide transparent, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit for more information.

[1] N Engl J Med 2018; 378:1177-1188, DOI: 10.1056/NEJMoa1713709