Colon cancer. Cancer attacking cell. Colon disease concept
Credit: Mohammed Haneefa Nizamudeen/Getty Images

Administering chemotherapy to colon cancer patients before surgery reduces the risk of the cancer returning according to a clinical trial of patients in the UK, Denmark, Sweden. The FOxTROT trial, funded by Cancer Research UK, demonstrated a 28% reduce risk of colon cancer returning when chemotherapy was given before, instead of after, surgically removing the patient’s tumor.

“Up to one-in-three colon cancer patients can see their cancer come back after surgery, said Dr Laura Magill, professor at the Birmingham Clinical Trials Unit, University of Birmingham. “That figure is far too high and we need new treatment strategies to stop colon cancer coming back.”

The study, whose results were published recently in the Journal of Clinical Oncology, was led by researchers at the University of Birmingham and University of Leeds and enrolled 1,053 cancer patients. The colon cancer patients were divided into two groups on the study. The first group (n=699) received a six-week chemotherapy regimen in advance of their surgery followed by another 18 weeks of chemo. The second group received the current standard for colon cancer treatment—surgery followed by 24 of chemotherapy. Follow-up assessment of the patients showed patients who had chemotherapy before surgery were significantly less like to experience recurrence of the disease.

“Six weeks of preoperative oxaliplatin-fluoropyrimidine chemotherapy for operable colon cancer can be delivered safely, without increasing perioperative morbidity,” wrote the researchers. “This chemotherapy regimen, when given preoperatively, produces marked histopathologic down-staging, fewer incomplete resections, and better 2-year disease control.”

The investigators in the trial have concluded that providing chemotherapy before surgery in colon cancer could be easily adopted by oncologists and health systems around the world. The researchers noted that preoperative chemotherapy shrinks tumors and may reduce the risk of incomplete resection, while also reducing cell shedding during surgery.

“Timing is everything when it comes to treating colon cancer. The simple act of bringing forward chemotherapy, giving it before instead of after surgery, delivers some remarkable results,” said Matthew Seymour, professor of gastrointestinal cancer research, University of Leeds. “Delivering chemotherapy before surgery could prevent recurrences of cancer without the need for expensive new drugs or technologies.”

“It was especially encouraging to find that patients who had chemotherapy before their surgery suffered fewer surgical complications,” Seymour added.

Based on the encouraging results for this trial, the research teams are now launching two additional clinical trials, FOXTROT-2 and FOXTROT-3 focused on whether older patients can also benefit from this approach and investigate if adding more chemotherapy drugs before surgery can provide greater reductions in 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 how likely they are to benefit from it,” the researchers noted.

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