Real-World Toxicity Profile, Treatment Compliance, and Dose Intensity of CAPOX Chemotherapy in Gastric and Rectal Cancers: A Prospective Observational Study
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Abstract
Background: Capecitabine–oxaliplatin (CAPOX) is a commonly used chemotherapy regimen in gastric and colorectal malignancies. Although its efficacy has been well established in randomized trials, real-world evidence regarding toxicity patterns, treatment compliance, and dose intensity remains limited. Objectives: To evaluate the toxicity profile of CAPOX chemotherapy, assess treatment compliance and dose modifications, and identify early clinical predictors of significant adverse events in patients with gastric and rectal cancers. Methods: This prospective observational study included 60 patients with histologically confirmed gastric (n = 35) or rectal cancer (n = 25) treated with CAPOX chemotherapy. Treatment-related toxicities were graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Treatment compliance, dose delays, reductions, and relative dose intensity were systematically recorded. Results: The median age was 54 years, with male predominance. Overall, 46 patients (76.7%) completed all planned cycles of CAPOX, with higher completion rates observed in rectal cancer compared with gastric cancer (84% vs 71%). The most frequent toxicities were peripheral neuropathy (45%), nausea/vomiting (38.3%), diarrhea (30%), hand–foot syndrome (26.7%), and anemia (41.7%). Grade ≥2 peripheral neuropathy occurred in 18.3% of patients and correlated with cumulative oxaliplatin exposure. Early Grade 1 neuropathy within the first two cycles independently predicted subsequent dose reduction. Relative dose intensity ≥85% was maintained in 68% of patients, particularly among those receiving early, individualized dose adjustments. Conclusion: CAPOX chemotherapy demonstrates acceptable tolerability and good compliance in routine clinical practice. Early low-grade neuropathy, baseline nutritional status, and symptom clustering may serve as clinically useful markers for anticipating cumulative toxicity and optimizing individualized treatment delivery.
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Copyright (c) 2026 Dr Zahoor Ahmad Paul, Dr Tavseef Ahmad Tali, Dr Shumail Bashir, Dr Toufeeq Ahmed Teli
This work is licensed under a Creative Commons Attribution 4.0 International License.
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