A newer alternative treatment approach for newly-diagnosed bowel cancer patients

17 November 2021

Bowel cancer (also known as colon cancer) treatment cures half of affected patients, but over 10,000 patients per year in the UK still die from the disease. For many years the standard treatment, providing the cancer has not spread elsewhere, has been to undergo surgery to remove the visible tumour and, where advised, to then undergo a course of chemotherapy with the intent to kill off any cancer cells remaining in the body. In short, surgery first followed afterwards by chemotherapy (also called ‘chemo’).

The FOxTROT 1 research project, involving over 2,700 patient across the UK, Denmark & Sweden, showed that another treatment approach, already used for other types of cancer (including breast, prostate and bladder cancers), could successfully be used for bowel cancer. In this alternative treatment approach a short course of ‘chemo’ is undertaken before surgery and a reduced course of ‘chemo’ may or may not then be recommended after surgery. The research findings and benefits of this approach for those patients included:

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

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

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

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

FOxTROT2 research is opening to newly diagnosed patients in October this year with FOxTROT 3 opening to patients shortly thereafter. Both are international research with over 66 hospitals across the UK wishing to take part. There is also interest from hospitals in France, Sweden, Netherlands and Australia wanting to joining this research.

Pete Wheatstone, a bowel cancer survivor, patient advocate and member of Bowel Research UK’s People and Research Together network, has been working with the FOxTROT programme:

“This seems to be an exciting opportunity for improved bowel cancer treatment compared with the treatment that I underwent just a few years ago. Some 6 years after completion of my treatment I still have to cope with the longer-term impacts of the 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 cancer patients.”

Bowel Research UK trustee Prof Dion Morton says:

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

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

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