22 March 2023

Treatments for bowel cancer, also known as colon cancer, cure around half of affected patients, but over 10,000 patients per year in the UK unfortunately still die from the disease. For many years the traditional treatment, providing the cancer has not spread elsewhere in the body, has been surgery to remove the visible tumour and, where advised, for the patient to receive a course of chemotherapy with the intent to kill off any remaining invisible cancer cells. In short, surgery comes first followed afterwards by chemotherapy (‘chemo’).

However, there is some new research that potentially turns this standard approach on its head. International research conducted as the FOxTROT 1 study involved over 2,700 patients across the UK, Denmark & Sweden.

The results of the study showed that another approach, already used for other types of cancer including for breast, prostate and bladder, could also be successfully applied to bowel cancer treatment. Here, a short course of chemo (using the same chemotherapy drugs) is undertaken before surgery and a reduced course of chemo may or may not then be recommended after surgery. The research demonstrated the following patient benefits compared with the traditional approach as:

  1. Having chemotherapy before surgery was safe for patients
  2. For most patients the chemotherapy shrank their tumour making surgery less complex
  3. Fewer serious complications arose after the surgery
  4. The cancer came back in a reduced number of patients (as measured after two years)

This new approach to treating bowel cancer (called ‘neoadjuvant chemotherapy) has now become a standard treatment option under NICE (the National Institute for Clinical Excellence) guidelines.

The FOxTROT Programme wants to build on the success of FOxTROT1, thanks to a multi-million pound research grant from Yorkshire Cancer Research, by finding out if there is also benefit to specific groups of patients:

  • Patients around or over 70 or those patients with additional significant medical problems (FOxTROT 2) to see if changing the chemotherapy drugs given before surgery leads to fewer side effects
  • Younger & medically fitter patientsto see if intensifying the chemo before surgery provides further benefits (FOxTROT 3)

Both the FOxTROT2 and FOxTROT3 research is now open to newly-diagnosed patients in many hospitals across with more wanting to join soon. Both studies will become international projects as there is keen interest in joining this research from hospitals in France, Scandinavia, Netherlands, Australia and India. Patient recruitment for both FOxTROT 2 and FOxTROT3 is already into double figures.

Pete Wheatstone, a bowel cancer survivor and patient advocate who has been working with the FOxTROT programme, says: “This is an exciting opportunity for improved bowel cancer treatment compared with the treatment that I underwent just a few years ago. Some six years after completion of my treatment I still have to cope with the longer-term impacts of the complications from cancer-removing surgery and chemotherapy side effects. This newer treatment approach, already in normal use for other types of cancer, should be suitable for up to 3 in 5 new Stage 2 and 3 bowel cancer patients.”

Cathy Gladwin, a bowel cancer survivor and patient advocate, says: “Changing the order of treatment has led to a greater, positive impact on recovery from bowel cancer and is an amazing discovery.”

Bowel Research UK trustee Prof Dion Morton says:

“Introducing neoadjuvant therapy in bowel cancer is the biggest treatment advance in the last 15 years for this common cancer.

For the first time, we can start personalising therapy for bowel cancer. Neoadjuvant therapy is starting to help us select the right treatment for the right patient.”

The FOxTROT website for both patients and clinical staff provides further information on FOxTROT 1, 2 and 3 and can be found at https://ctru.leeds.ac.uk/foxtrot/. It features a dedicated section for patients and the public, including interactive maps where patients can find their nearest collaborating hospital.