Feasibility of Capecitabine and Oxaliplatin Combination Chemotherapy Without Central Venous Access Device in Patients With Stage III Colorectal Cancer

Published:November 29, 2015DOI:



      5-Fluorouracil and leucovorin plus oxaliplatin (FOLFOX) or capecitabine plus oxaliplatin (XELOX) is a standard adjuvant treatment for patients with stage III colon cancer (CC). Capecitabine is an oral fluoropyrimidine, and administration of oxaliplatin does not necessarily require the insertion of a central venous access device (CVAD). We evaluated the feasibility of XELOX without a CVAD as adjuvant treatment in patients with stage III CC.

      Patients and Methods

      We retrospectively studied prospectively collected data from patients with stage III CC treated with XELOX in the International Duration Evaluation of Adjuvant Chemotherapy French trial. Patients were divided into 2 groups: those with a CVAD and those with peripheral venous access (PVA), including patients who had and had not had a CVAD at the first cycle of chemotherapy. Chemotherapy without a CVAD was considered feasible if the patient received all cycles of adjuvant therapy without it.


      A total of 203 patients were included: 86 (43%) in the PVA group and 116 (57%) in the CVAD group. Of the 85 patients in the PVA group (1 patient was not treated), 69 (81.2%) did not require the insertion of a CVAD. However, 16 (18.8%) required CVAD insertion owing to systematic delay of the initially planned CVAD before the second cycle of chemotherapy in 7, complications related to PVA usage in 5, a switch to the modified FOLFOX6 regimen in 2, and other reasons in 2. The oxaliplatin dose was similar in both groups regardless of the chemotherapy duration. XELOX without a CVAD was feasible for 81.2% of the patients for whom a CVAD had not been planned before chemotherapy and for 88.4% of patients for whom chemotherapy was planned without the use of a CVAD.


      XELOX chemotherapy without a CVAD is a feasible approach for treating patients with stage III CC in the adjuvant setting.


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        • Ferlay J.
        • Soerjomataram I.
        • Ervik M.
        • et al.
        GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11.
        ([Internet]) International Agency for Research on Cancer, Lyon, France2013 (Available at:) (Accessed April 24, 2015)
        • Moertel C.G.
        • Fleming T.R.
        • Macdonald J.S.
        • et al.
        Levamisole and fluorouracil as adjuvant therapy of resected colon carcinoma.
        N Engl J Med. 1990; 322: 352-358
        • International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) Investigators
        Efficacy of adjuvant fluorouracil and folinic acid in colon cancer.
        Lancet. 1995; 345: 939-944
        • André T.
        • Boni C.
        • Navarro M.
        • et al.
        Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial.
        J Clin Oncol. 2009; 27: 3109-3116
        • Kuebler J.P.
        • Wieand H.S.
        • O'Connell M.J.
        • et al.
        Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: results from NSABP C-07.
        J Clin Oncol. 2007; 25: 2198-2204
        • Yothers G.
        • O'Connell M.J.
        • Allegra C.J.
        • et al.
        Oxaliplatin as adjuvant therapy for colon cancer: updated results of NSABP C-07 trial, including survival and subset analyses.
        J Clin Oncol. 2011; 29: 3768-3774
        • André T.
        • Boni C.
        • Mounedji-Boudiaf L.
        • et al.
        Multicenter international study of oxaliplatin/5-fluorouracil/leucovorin in the adjuvant treatment of colon cancer (MOSAIC) investigators: oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer.
        N Engl J Med. 2004; 350: 2343-2351
        • Twelves C.
        • Wong A.
        • Nowacki M.P.
        • et al.
        Capecitabine as adjuvant treatment for stage III colon cancer.
        N Engl J Med. 2005; 352: 2696-2704
        • Haller D.G.
        • Tabernero J.
        • Maroun J.
        • et al.
        Capecitabine plus oxaliplatin compared with fluorouracil and folinic acid as adjuvant therapy for stage III colon cancer.
        J Clin Oncol. 2011; 29: 1465-1471
        • Schmoll H.J.
        • Tabernero J.
        • Maroun J.A.
        • et al.
        Capecitabine plus oxaliplatin compared with fluorouracil/folinic acid as adjuvant therapy for stage III colon cancer: final results of the NO16968 randomized controlled phase III trial.
        J Clin Oncol. 2015; 33: 3733-3740
        • André T.
        • Iveson T.
        • Labianca R.
        • et al.
        The IDEA (International Duration Evaluation of Adjuvant Chemotherapy) collaboration: prospective combined analysis of phase III trials investigating duration of adjuvant therapy with the FOLFOX (FOLFOX4 or modified FOLFOX6) or XELOX (3 versus 6 months) regimen for patients with stage III colon cancer: trial design and current status.
        Curr Colorectal Cancer Rep. 2013; 9: 261-269
      1. Bouchoud L, Rochon F, Decosterd S, et al. Extravasation de cytostatiques: procédure de prise en charge approuvée par la COMED, version 6, 2012. Available at: Accessed April 24, 2015.

        • Yoshida Y.
        • Hoshino S.
        • Aisu N.
        • et al.
        Administration of chemotherapy via the median cubital vein without implantable central venous access ports: port-free chemotherapy for metastatic colorectal cancer patients.
        Int J Clin Oncol. 2015; 20: 332-337
        • Maurizio G.
        • Pittiruti M.
        • Biffi R.
        Vascular access in oncology patients.
        CA Cancer J Clin. 2008; 58: 323-346
      2. Registered Nurses' Association of Ontario. Nursing Best Practice Guidelines. Project: Assessment and Device Selection for Vascular Access. Available at: Accessed April 24, 2015.

        • Barbetakis N.
        • Asteriou C.
        • Kleontas A.
        • et al.
        Totally implantable central venous access ports: analysis of 700 cases.
        J Surg Oncol. 2011; 104: 654-656
        • Kim J.T.
        • Oh T.Y.
        • Chang W.H.
        • et al.
        Clinical review and analysis of complications of totally implantable venous access devices for chemotherapy.
        Med Oncol. 2012; 29: 1361-1364
        • Sawayama H.
        • Hayashi N.
        • Watanabe M.
        • et al.
        The central vein access port and catheter in outpatient chemotherapy for colorectal cancer: a retrospective study of 101 patients.
        Surg Today. 2012; 42: 29-34
        • Twelves C.
        • Gollins S.
        • Grieve R.
        • et al.
        A randomised cross-over trial comparing patient preference for oral capecitabine and 5-fluorouracil/leucovorin regimens in patients with advanced colorectal cancer.
        Ann Oncol. 2006; 17: 239-245
        • Liu G.
        • Franssen E.
        • Fitch M.
        • et al.
        Patient preferences for oral versus intravenous palliative chemotherapy.
        J Clin Oncol. 1997; 15: 110-115
        • Borner M.M.
        • Schoffski P.
        • de wit R.
        • et al.
        Patient preference and pharmacokinetics of oral modulated uFT versus intravenous fluorouracil and leucovorin: a randomised crossover trial in advanced colorectal cancer.
        Eur J Cancer. 2002; 38: 349-358
        • Biffi R.
        • de Braud F.
        • Orsi F.
        • et al.
        Totally implantable central venous access ports for long-term chemotherapy a prospective study analyzing complications and costs of 333 devices with a minimum follow-up of 180 days.
        Ann Oncol. 1998; 9: 767-773