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Trial finds pre-surgery chemotherapy cuts risk of colon cancer recurrence

In a finding that has the potential of changing the cancer treatment protocols globally, researchers of a multi-country trial say that the risk of recurrence of cancers gets reduced by almost a third among patients undergoing chemotherapy before surgery.

The results of the randomised controlled clinical trial, published in the Journal of Clinical Oncology recently, showed that giving colon cancer patients chemotherapy before rather than after surgery, reduced the chance of cancer returning within two years by 28%.

For the trial, the researchers led by scientists at the University of Birmingham and the University of Leeds involved 1,053 colon cancer patients from 85 hospitals in the UK, Denmark and Sweden.

 The researchers divided the patients into two groups, the first composed of those who received six weeks of chemotherapy, followed by surgery, then 18 weeks of chemotherapy, while the second group had standard treatment for colon cancer, which was surgery first followed by 24 weeks of chemotherapy.

During follow-ups, the researchers discovered that patients who received chemotherapy before surgery were significantly less likely to have their cancer return than those who received all of their chemotherapy after surgery.

According to the researchers, the easy adaptability of their trial findings by physicians and oncologists has the potential to improve the lives of thousands of colon cancer patients worldwide.

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

“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,” she added.

Dr Magill went on to say that a growing body of evidence supports the use of pre-operative chemotherapy in many other cancers. “We believe that our results could transform how we approach colon cancer in the clinic.”

Leeds resident Geoff Hoggard, one of the 699 trial participants, who received chemotherapy before being operated upon said, “I had 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 saw 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,” he added.

“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,” Hoggard said while narrating his experience.

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

Pointing out that by simply giving chemotherapy before instead of after surgery, delivers some remarkable results professor of gastrointestinal cancer research at the University of Leeds, Professor Matthew Seymour, said, “Timing is everything when it comes to treating colon cancer.”

“Delivering chemotherapy before surgery could prevent recurrences of cancer without the need for expensive new drugs or technologies,” he added.

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

Stressing that cancer treatments can be prohibitively expensive in many parts of the world, professor of Surgery at the University of Birmingham, Professor Dion Morton, and one of the authors said, “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,” he added.

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

The researchers are investigating whether older patients benefit from chemotherapy before surgery and whether adding more chemotherapy drugs before surgery can reduce the chances of cancer returning.

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, they added.

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