ArticleESMO open2026
Cost-effectiveness of switching to S-1 after fluoropyrimidine-induced hand-foot syndrome or cardiovascular toxicity in the treatment of metastatic colorectal cancer.
Article in ESMO open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe fluoropyrimidines 5-fluorouracil (5FU) and capecitabine are the backbone of systemic therapy for metastatic colorectal cancer (mCRC). Side effects include hand-foot syndrome (HFS) and cardiovascular toxicity (CVT), which may necessitate dose reductions or discontinuation of treatment. S-1 (Teysuno®) is an oral fluoropyrimidine that is licensed for use after fluoropyrimidine-induced HFS or CVT as it showed a lower incidence of those toxicities. It can be used as monotherapy or in combination with oxaliplatin or irinotecan. In this study, we assessed the cost-effectiveness of switching from 5FU or capecitabine-based treatment to S-1-based treatment after a patient with mCRC experiences HFS or CVT. PATIENTS AND
methodsWe developed a cohort-level decision analytic model to compare the costs and quality-adjusted life years (QALYs) when hypothetical patients would follow several different treatment strategies. We considered three different scenarios in which patients experienced toxicity on their initial first-line treatment of either CAPOX (1), FOLFOX (2) or capecitabine monotherapy (3), respectively. The step of first-line to second-line is denoted with an arrow (→). We used medication costs and administration costs, a lifelong time axis and compared strategies using incremental cost-effectiveness ratios (ICERs) and net benefit.
resultsCosts for treatment administration often exceeded costs for treatment medication. For scenario 1, the ICER of the strategy of switching to SOX → Irinotecan (which was identical to SOX → IRIS) was €60 303 compared with the next best strategy of discontinuation of CAPOX → Irinotecan. This is below the threshold of €80 000/QALY used by the Dutch government for high-impact health conditions. Results of scenario 2 were similar to scenario 1. For scenario 3, the ICER of S-1 → SOX was €92 551 compared with reduced dosage capecitabine monotherapy → CAPOX.
conclusionsS-1 based treatment strategies can be cost-effective when a treatment switch is required due to HFS or CVT during fluoropyrimidine-based treatment.
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