Incidence and Risk Factors of Non-neutropenic Enterocolitis With Adjuvant Capecitabine and Oxaliplatin Chemotherapy...

Following the IDEA collaboration, the use of capecitabine and oxaliplatin (CAPOX regimen) for adjuvant colorectal cancer treatment has increased. While CAPOX is associated with higher rates of diarrhea, non-neutropenic enterocolitis (NNE) and related hospitalizations have not been well described.

We performed a retrospective cohort study of patients treated with adjuvant CAPOX, mFOLFOX6 (infusional 5-fluorouracil, leucovorin, and oxaliplatin), and capecitabine between 2015 and 2023 at 2 hospitals in Quebec, Canada. Data on demographics, oncologic treatments, and complications, including NNE (defined as grade ≥ 2 diarrhea with radiologic ileocolitis) were extracted.

A total of 223 patients were included, 82.9% of patients had stage III colorectal cancer, 54.3% received CAPOX, and 40.8% mFOLFOX6. NNE occurred in 12.4% of patients treated with CAPOX versus 1.1% with mFOLFOX6 (odds ratio [OR] 12.736, P = .002). All NNE were grade 3 to 4 events and required hospitalization. The median time to CAPOX-induced NNE onset was 36 days after the first chemotherapy dose. Risk factors for NNE included CAPOX use (OR [vs. mFOLFOX6] OR 12.736, P = .002) and age over 65 years (OR 4.214, P = .006). No difference in relapse-free survival was observed for stage III patients with versus without NNE (hazard ratio 0.247, P = .167).

NNE is a significant complication of CAPOX, particularly in patients over 65 years. It occurs early in the treatment course, leads to a high rate of hospitalization, and necessitates careful patient selection and close monitoring during early cycles.