Absolute benefit in risk reduction needed to use...


Absolute benefit in risk reduction needed to use...

How much absolute benefit in terms of reduction in the risk of relapse do you believe is necessary to justify using a fluoropyrimidine alone (without the inclusion of oxaliplatin)?

How much absolute benefit in terms of reduction in the risk of relapse do you believe is necessary to justify using an oxaliplatin regimen (in addition to fluoropyrimidine)?

Steven R Alberts, MD, MPH
Chair, Division of Medical Oncology
Professor of Oncology
Mayo Clinic
Rochester, Minnesota
Answer: 5%; ≥5%

I believe that a 5% absolute reduction in the risk of relapse is sufficient for me to initiate treatment with a fluoropyrimidine alone.

Because of the potential side effects of oxaliplatin, I would like to see at least a 5% absolute benefit in relapse risk.

Al B Benson III, MD
Professor of Medicine
Associate Director for
Clinical Investigations
Robert H Lurie Comprehensive
Cancer Center of
Northwestern University
Chicago, Illinois
Answer: Approx 5%; ≥5%

In order to initiate treatment with a fluoropyrimidine alone I would like to see an approximately 5% absolute reduction from baseline relapse risk without treatment.

At least a 5% absolute reduction in relapse risk would be necessary for me to use an oxaliplatin-based regimen.

Charles S Fuchs, MD, MPH
Director
Center for Gastrointestinal Cancer
Dana-Farber/Harvard Cancer Center
Professor of Medicine
Harvard Medical School
Boston, Massachusetts
Answer: 3%; 3%-4%

A 3% absolute benefit in risk of relapse would be necessary for me to begin treatment with a fluoropyrimidine.

I would say 3% to 4% in an absolute setting would be enough to justify adding oxaliplatin to a fluoropyrimidine-based regimen.

Richard M Goldberg, MD
Professor of Medicine
Physician-in-Chief, OSUCCC -
James Cancer Hospital and
Richard J Solove Research Institute
Klotz Family Chair in Cancer Research
The Ohio State University
Columbus, Ohio
Answer: 3%; 3%-4%

A 3% absolute benefit in the reduction of the risk of relapse would be sufficient to initiate treatment if the patient felt that that amount of benefit was worthwhile.

I believe that determination of the necessary benefit to justify using oxaliplatin would be up to the patient, but for me it would be 3% to 4%.

Axel Grothey, MD
Professor of Oncology
Department of Medical Oncology
Mayo Clinic
Rochester, Minnesota
Answer: 5%-10%; 5%

I would need a 5% to 10% absolute benefit in the risk of relapse to begin treatment with a fluoropyrimidine alone.

A 5% absolute benefit in the relapse risk would justify the addition of oxaliplatin to a fluoropyrimidine for me.

Howard S Hochster, MD
Associate Director (Clinical Research)
Yale Cancer Center
Professor of Medicine
Yale School of Medicine
New Haven, Connecticut
Answer: 3%; 3%-4%

I would need a 3% absolute benefit in the risk of relapse to start treatment with a fluoropyrimidine alone.

To start treatment with an oxaliplatin-based regimen, I would like to see a 3% to 4% absolute decrease in the risk of relapse.

Herbert I Hurwitz, MD
Associate Professor of Medicine
Division of Hematology/Oncology
Clinical Director, Phase I Program
Co-leader, GI Oncology Program
Duke University Medical Center
Durham, North Carolina
Answer: 5%; 6%-10%

I would need approximately a 5% absolute benefit in relapse-free survival to initiate treatment with a fluoropyrimidine alone. These are typically long discussions with the patient regarding what this means to them with regard to relapse-free survival versus overall survival benefit.

I would require a 6% to 10% absolute reduction in relapse risk in order for me to add oxaliplatin to a fluoropyrimidine-based regimen.

Wells A Messersmith, MD
Professor and Director
GI Medical Oncology Program
Co-Leader
Developmental Therapeutics Program
University of Colorado Cancer Center
Aurora, Colorado
Answer: >5%; Approx 5%

I believe that I would need a greater than 5% absolute reduction in relapse risk to initiate treatment with a fluoropyrimidine.

For me, the minimum value that I would like to see is around a 5% absolute benefit in the risk of relapse in order to add oxaliplatin to a fluoropyrimidine regimen. This is the benefit that was seen in the MOSAIC trial.