'Remarkable' results in colon cancer trial

Giving colon cancer patients chemotherapy before surgery cuts the risk of the disease coming back, according to the results of a new clinical trial.

The FOxTROT trial, a collaborative study by scientists at Leeds and the University of Birmingham, showed that giving colon cancer patients chemotherapy before rather than after surgery reduced the chance of cancer returning within 2 years by 28%.

Matthew Seymour, Professor of Gastrointestinal Cancer Research in the School of Medicine, said: “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.

“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.

“Scaling up this treatment worldwide, including in low and middle income countries, could transform cancer care and save many thousands of lives.”

Worldwide benefit

Some 1,053 colon cancer patients from 85 hospitals in the UK, including the Leeds Cancer Centre, along with Denmark and Sweden, were involved in the Cancer Research UK-funded study.

Participants were divided into two groups. The first group received 6 weeks of chemotherapy, followed by surgery, then 18 weeks of chemotherapy. The second group had standard treatment for colon cancer, which was surgery first followed by 24 weeks of chemotherapy.

Through follow-up assessments, the scientists found that patients who had chemotherapy before surgery were significantly less likely to see their cancer come back, compared with those who got all their chemotherapy after surgery.

The scientists believe that giving chemotherapy to bowel cancer patients before surgery could be easily adopted by the NHS and other health systems across the world. At least 5,000 colon cancer patients in the UK, and hundreds of thousands of patients worldwide, could benefit from this treatment every year.

Patient story

Of the 1,053 patients who took part in the FOxTROT trial, the 699 patients who received chemotherapy before surgery included Geoff Hoggard from Leeds, who was diagnosed with colon cancer in 2016.

“I’d noticed blood in my poo a few times and initially I had felt quite embarrassed about it. But I ended up being diagnosed with colon cancer, which was a massive wake-up call. Doctors at the Leeds Cancer Centre saw the cancer very clearly with a colonoscopy and I was told that it needed urgent treatment, which came as a huge shock.

“I was willing to take any opportunity to get the most effective treatment. The FOxTROT trial felt like the best way to do that, and I was happy to sign up when my consultant offered to put me on it.

“I got six weeks of chemotherapy before surgery and 18 weeks after, which was hard going. Brain fog and severe tiredness took its toll on me. I kept going, thanks to the support of friends, family and my local church, who were a constant source of strength.

“Eventually, it was all worth it. I’ve had no complications since the surgery, and there were no signs of cancer in the months and years after. Six years on, I’m back living life to the full.

“I have no regrets at all about taking part in the FOxTROT trial and proud that Leeds played such a major part of it. I hope that many others will live longer, free from cancer, because of the developing science that underpins this new approach, and which worked so well in my case.”

Transforming cancer care

Dr Laura McGill, Associate Professor at the Birmingham Clinical Trials Unit at the University of Birmingham, said: “Up to 1 in 3 colon cancer patients can see their cancer come back after surgery. That figure is far too high and we need new treatment strategies to stop colon cancer coming back.

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

“A growing body of evidence is showing the value of pre-operative chemotherapy in several other cancers, and we believe that our results could transform how we approach colon cancer in the clinic.”

Tackling health inequalities

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, testing a treatment that could be used on the widest possible group of patients.

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

The scientists are now undertaking two further clinical trials, FOXTROT-2 and FOXTROT-3, to investigate whether older patients also benefit from chemotherapy before surgery and to investigate if adding in more chemotherapy drugs before surgery further reduces the chances of cancer coming back. 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 paper, titled “Preoperative chemotherapy for operable colon cancer: mature results of an international randomised controlled trial”, was published on 19 January 2023 in the Journal of Clinical Oncology.