Oxaliplatin associated neurotoxicity outcomes among older adults with colorectal cancer: a population-based study.
Bibliographic record
Abstract
e18034 Background: The addition of oxaliplatin to fluorouracil-based regimens in the adjuvant treatment of colorectal cancer (CRC) has been shown to improve overall survival at the expense of increased toxicity. Toxicity may be higher among older patients who may also derive less benefit from oxaliplatin. The true incidence of toxicity in the elderly is unknown. Methods: A cohort of patients ≥ 66 years old diagnosed with Stage II and III CRC between 2007 and 2011 in Ontario, Canada was identified using the Ontario Cancer Registry. Patients were stratified by age and oxaliplatin exposure. Linked administrative databases were then used to identify patients who were subsequently diagnosed with peripheral neuropathy (PN) or received a new prescription for a neuropathic pain medication. Cause-specific hazard models were used to estimate the effect of oxaliplatin exposure on the cause-specific hazard (CHR) of PN after accounting for the competing risk of death. Results: We identified 3,607 patients ≥ 66 years old with Stage II and III CRC, of whom 1,541 were treated with an oxaliplatin-based AC regimen. By the end of one year, the cumulative incidence of PN was 3.2% (95% CI, 2.0-4.8) for ages 66-69 and 5.5% (95% CI, 4.1-7.2) for age ≥ 70 among those treated with an oxaliplatin-based AC regimen. In an adjusted model, patients ≥ 70 years treated with oxaliplatin had a higher rate of PN (CHR, 2.07 [95% CI, 1.43-3.00; p < 0.001]) and new prescriptions for a neuropathic pain medication (CHR, 1.86 [95% CI, 1.43-2.42; p < 0.001]). In patients aged 66-69, oxaliplatin use was not associated with a new diagnosis of PN (p = 0.90). A formal test of interaction confirmed that the effect of oxaliplatin on the occurrence of PN differed between those aged 66-69 and those aged ≥ 70 years (p = 0.03). Conclusions: In this large, population-based cohort, CRC patients ≥ 70 years old treated with oxaliplatin had a significantly higher risk of developing PN and requiring treatment with neuropathic pain medications. Trials specifically designed to evaluate therapeutic options and identify toxicities in the elderly population with cancer are needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".