Risk factor of severe diarrhea and enterocolitis induced by CAPOX: a retrospective multicenter study

Area of Science:

• Oncology
• Gastroenterology
• Pharmacology

Background:

• Previous studies suggested a link between capecitabine plus oxaliplatin (CAPOX) and angiotensin receptor blockers (ARBs) increasing severe diarrhea risk.
• A larger multicenter study was conducted to validate these findings, accounting for other potential risk factors.

Purpose of the Study:

• To validate the association between concurrent CAPOX and ARB/ACE inhibitor use and severe diarrhea/enterocolitis.
• To identify independent risk factors for severe gastrointestinal toxicity in patients treated with CAPOX.

Main Methods:

• Retrospective multicenter study of 362 colorectal cancer patients treated with CAPOX.
• Primary endpoint: Grade ≥3 diarrhea and/or enterocolitis.
• Logistic regression models (unadjusted and adjusted) were used to assess risk factors.

Main Results:

• In multivariable analysis, age ≥65 years (OR 2.71) and estimated glomerular filtration rate (eGFR) <60 ml/min (OR 5.4) were significant independent risk factors for severe diarrhea/enterocolitis.
• Concurrent use of ARBs or ACE inhibitors was not found to be significantly associated with increased risk.

Conclusions:

• Age and impaired kidney function are critical independent risk factors for severe CAPOX-induced diarrhea/enterocolitis.
• The previously suggested association between ARBs/ACE inhibitors and severe gastrointestinal toxicity with CAPOX was not confirmed in this larger study.