What is the typical number of cycles for the CAPOX (Capecitabine + Oxaliplatin) regimen?

CAPOX Cycle Duration

For adjuvant treatment of colorectal cancer, administer CAPOX for 8 cycles (24 weeks/6 months total duration), with each cycle repeated every 3 weeks. 1

Standard Dosing Schedule

The CAPOX regimen consists of:

• Oxaliplatin 130 mg/m² IV infusion over 2 hours on day 1 1, 2
• Capecitabine 1,000 mg/m² orally twice daily on days 1-14 1, 2
• Repeat every 3 weeks for 8 cycles 1

Duration Modifications Based on Risk Stratification

Shortened Duration (3 months/4 cycles)

High-risk stage II and low-risk stage III colon cancer patients (T1-3N1) may receive only 3 months (4 cycles) of CAPOX based on IDEA study results. 1

This shortened approach specifically applies to:

• Stage II patients with high-risk features 1
• Stage III patients with T1-3N1 disease (low-risk) 1

Standard Duration (6 months/8 cycles)

All other stage III patients should receive the full 6 months (8 cycles) of CAPOX. 1

Critical Timing Considerations

Adjuvant chemotherapy must start within 3 weeks after postoperative recovery and no later than 2 months postoperatively. 1

Oxaliplatin-Specific Modifications

Discontinue oxaliplatin after 3-4 months if significant neurotoxicity (≥ grade 2) develops, but continue capecitabine to complete the full 6-month treatment duration. 2, 3

• Oxaliplatin may be reintroduced if previously discontinued for neurotoxicity rather than disease progression 2
• The Chinese Society of Clinical Oncology guidelines emphasize that CAPOX is preferred over mFOLFOX6 based on IDEA study results 1

Metastatic/Advanced Disease Setting

For metastatic colorectal cancer, CAPOX is typically continued until disease progression or unacceptable toxicity, without a predetermined cycle limit. 1

• After initial CAPOX cycles (typically 4-6), maintenance therapy with capecitabine plus bevacizumab may be considered 4
• In elderly patients (>75 years), 4 cycles of CAPOX followed by maintenance capecitabine/bevacizumab has shown efficacy 4

Common Pitfalls to Avoid

Do not use CAPOX beyond 6 months in the adjuvant setting unless within a clinical trial. 1

Do not continue oxaliplatin if grade 2 or higher neurotoxicity develops; switch to capecitabine monotherapy to complete the 6-month duration. 2, 3

North American patients may require dose reduction of capecitabine to 850 mg/m² twice daily due to increased toxicity compared to European patients. 1, 2

Special Populations

Elderly Patients (≥70 years)

There is limited evidence for oxaliplatin benefit in patients aged ≥70 years without high-risk features. 3

• Consider reduced-dose CAPOX (capecitabine 1,500 mg/m² days 1-14; oxaliplatin 100 mg/m² day 1) 5
• Standard 8-cycle duration still applies if treatment is initiated 5

Patients with dMMR/MSI-H Stage II Disease

These patients may not benefit from fluoropyrimidine-based therapy and should be considered for alternative approaches. 3