Chemotherapy before surgery reduces risk of colon cancer recurring, trial finds

Giving chemotherapy to colon cancer patients before surgery reduces their risk of disease recurrence, according to the results of a clinical trial funded by Cancer Research UK.

The FOxTROT trial showed that giving colon cancer patients chemotherapy before rather than after surgery reduced the risk of cancer recurrence within 2 years by 28%.

1,053 colon cancer patients from 85 hospitals in the UK, Denmark and Sweden took part in the study, led by scientists from the University of Birmingham and the University of Leeds.

Through follow-up assessments, scientists found that patients who received chemotherapy before surgery were significantly less likely to have their cancer come back, compared to those who received all of their chemotherapy after surgery.

Scientists believe that giving bowel cancer patients chemotherapy before surgery could be easily adopted by the NHS and other healthcare systems around the world. At least 5,000 colon cancer patients in the UK and hundreds of thousands of patients worldwide could benefit from this treatment each year.

Dr Laura Magill, Associate Professor in the Birmingham Clinical Trials Unit at the University of Birmingham, said:

“Up to 1 in 3 patients with colon cancer may see their cancer come back after surgery. This figure is far too high and we need new treatment strategies to prevent colon cancer from coming back.

“The standard approach has been to give chemotherapy after surgery to eradicate any cancerous cells that may have spread before surgery. But our research shows that giving some of this chemotherapy before surgery increases the chances that all cancer cells are killed.

“A growing body of evidence shows the value of preoperative chemotherapy in several other cancers, and we believe our results could transform the way we approach colon cancer in the clinic.”

Dion Morton, professor of surgery at the University of Birmingham, said:

“In many parts of the world, cancer treatments can be prohibitively expensive. We wanted to go in the opposite direction, to test a usable treatment on the widest group of patients possible.

“Thanks to funding from Cancer Research UK, doctors around the world will now be able to put these discoveries into clinical practice, saving thousands of lives.”

Tailor-made cancer treatments

A total of 699 patients in the trial received chemotherapy before surgery. Geoff Hoggard from Leeds was diagnosed with colon cancer in 2016 and took part in the trial.

“I had noticed blood in my poo a few times and at first I felt quite embarrassed about it. But I ended up being diagnosed with colon cancer which was a huge warning signal. The doctors saw the cancer very clearly with a colonoscopy and I was told he needed urgent treatment, which was a huge shock.

“I was ready to take every opportunity to get the most effective treatment. The FOxTROT trial seemed like the best way to do it, and I was happy to sign up when my consultant suggested I do it.

“I had six weeks of chemotherapy before surgery and 18 weeks after, which was difficult. Brain fog and intense fatigue took their toll on me. I carried on, thanks to the support of friends, my family and my local church, which have been a constant source of strength.

“In the end, it was all worth it. I have had no complications since the operation, and there have been no signs of cancer in the months and years since. 6 years later, I am back live fully.

“I have no regrets about participating in the FOxTROT trial. I hope many more will live longer, cancer-free, thanks to the scientific development behind this new approach and which has worked so well in my case.

Matthew Seymour, Professor of Gastrointestinal Cancer Research at the University of Leeds, said:

“Timing is everything when it comes to treating colon cancer. The simple fact of advancing the chemotherapy, by administering it before rather than after the surgery, gives remarkable results.

“Giving chemotherapy before surgery could prevent cancer recurrences without the need for expensive new drugs or technologies. It was particularly encouraging to see that patients who had received chemotherapy before their surgery suffered fewer surgical complications.

“Expanding this treatment around the world, including in low- and middle-income countries, could transform cancer care and save thousands of lives.”

Scientists are currently undertaking two other clinical trials, FOXTROT-2 and FOXTROT-3, to determine whether older patients also benefit from chemotherapy before surgery and to determine whether adding more chemotherapy drugs before surgery reduces increased risk of cancer recurrence. If these trials are successful, patients could receive more tailored cancer treatments, with new types and combinations of chemotherapy offered to different patients based on their likelihood of benefiting.

The article, titled “Preoperative chemotherapy for operable colon cancer: mature results from an international randomized controlled trial”, was published today (19^e January) in the Journal of Clinical Oncology.