Chemo before surgery helps stop colon cancer coming back

“Timing is everything when it comes to treating colon cancer,” says Matthew Seymour, Professor of Gastrointestinal Cancer Research at the University of Leeds. He knows that’s much more than just a phrase. Seymour helped run the FOxTROT trial, which showed that starting chemotherapy just a few weeks earlier can change outcomes for people with colon cancer. Beginning it before surgery, instead of after, significantly cuts the risk of the disease coming back.

It’s likely that the findings will change how doctors treat colon cancer (which is a type of bowel, or colorectal, cancer) in the NHS and around the world.

Changing how we treat colon cancer

FOxTROT, was led by scientists at the University of Birmingham and the University of Leeds.

They split 1,053 early-stage colon cancer patients from across the UK, Denmark and Sweden into two groups. The first group received 6 weeks of chemotherapy before surgery, and then 18 weeks of chemotherapy after. The second group had standard treatment for colon cancer: surgery followed by 24 weeks of chemotherapy.

“The standard approach has been to give chemotherapy after surgery to eradicate any cancer cells that might have spread,” explains Dr Laura Magill, an Associate Professor at the Birmingham Clinical Trials Unit, and another one of the FOxTROT trial leads. “But our research shows that giving some of that chemotherapy before surgery increases the chances that all cancer cells will be killed.”

Starting chemotherapy 6 weeks before surgery lowered the risk of colon cancer returning in the following 2 years by 28%. It also reduced the number of side effects from surgery, so patients were less likely to have problems like an infection, or to need another operation.

Saving lives around the world

Those results are especially impressive because they don’t rely on expensive new treatments or technologies. It’s quick and easy to start giving people chemotherapy 6 weeks earlier.

In fact, at least 5,000 people in the UK could benefit from the change every year – at no extra cost. Worldwide, the researchers behind the trial predict it could be used to treat hundreds of thousands more.

“In many parts of the world cancer treatments can be prohibitively expensive,” says lead investigator Dion Morton, Professor of Surgery at the University of Birmingham. “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.”