Capecitabine Monotherapy for Elderly Patients With MRD-Negative High-Risk Colorectal Cancer
Key Clinical Takeaways
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Design/Population: This retrospective analysis included 117 patients aged 65 to 85 years with MRD-negative, high-risk stage II or III colorectal cancer who underwent curative surgery. Patients received either capecitabine monotherapy (n = 58) or capecitabine plus oxaliplatin (n = 59), with propensity score matching used to balance baseline characteristics.
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Key Outcomes: Median disease-free survival was comparable between capecitabine monotherapy (31 months) and combination therapy (40 months), with similar 3-year DFS rates (90% vs 81%). Survival outcomes remained consistent following propensity score matching, indicating no significant difference between regimens.
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Clinical Relevance: Capecitabine monotherapy resulted in substantially fewer adverse events, including neurotoxicity, leukopenia, and thrombocytopenia, compared with capecitabine plus oxaliplatin. These findings suggest that capecitabine alone may offer an effective and safer adjuvant option for elderly MRD-negative patients with high-risk colorectal cancer.
Findings from a retrospective analysis show that capecitabine monotherapy delivers survival outcomes comparable to capecitabine plus oxaliplatin while reducing the incidence of adverse events among elderly patients with minimal residual disease (MRD)-negative high-risk colorectal cancer (CRC).
“Postoperative adjuvant chemotherapy is a cornerstone of treatment,” stated Jiawei Zhai, MD, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China, and coauthors. “However, the optimal regimen for elderly MRD-negative patients remains controversial.”
In this study, researchers collected data from 117 patients aged 65 to 85 years with MRD-negative, high-risk CRC who received postoperative capecitabine either alone (n = 58) or in combination with oxaliplatin (n = 59). The primary end point was disease-free survival (DFS), and propensity score matching was used to balance baseline characteristics. A key secondary end point was safety.
At analysis, the median DFS was 31 months in the capecitabine monotherapy arm and 40 months in the capecitabine plus oxaliplatin arm (P = .26), with 3-year DFS rates of 90% and 81%, respectively (P = .26). Following propensity score matching, survival outcomes remained comparable (P = .73). Adverse events included neurotoxicity (7% vs 61%; P < .001), leukopenia (22% vs 49%; P = .002), and thrombocytopenia (10% vs 44%; P < .001) in the capecitabine monotherapy versus combination arms, respectively.
“Capecitabine monotherapy might provide comparable DFS to [capecitabine plus oxaliplatin] in elderly MRD-negative CRC patients, with better safety profile,” concluded Dr Zhai et al. “MRD status might guide personalized dose-reduction strategies for elderly patients with high-risk stage II and stage III CRC.”
Source:
Zhai J, Tan R, Ou W, et al. Prognostic and safety analysis of capecitabine monotherapy versus CapeOx (capecitabine plus oxaliplatin) in elderly patients with high-risk stage II and stage III MRD-negative colorectal cancer. J Gastrointest Oncol. Published online: October 29, 2025. doi: 10.21037/jgo-2025-504
