Three-month course of chemotherapy as effective as six months following surgery for bowel cancer
Many patients receiving chemotherapy following surgery for bowel cancer may only need three months treatment rather than the six months currently given, new research published in Lancet Oncology has shown.
An international clinical trial, funded by an NIHR and MRC partnership, has evaluated the effectiveness of a three-month course of adjuvant oxaliplatin/fluoropyrimidine combination chemotherapy for colorectal cancer versus the standard six-month treatment regimen.
One of the main side effects of oxaliplatin chemotherapy is nerve damage affecting the hands and feet (peripheral neuropathy) which can be long-lasting and result in worse quality of life. The SCOT study also showed three months chemotherapy results in less peripheral neuropathy.
The SCOT study recruited 6,088 patients with high-risk stage II or stage III colorectal cancer from 244 centres across Europe, Australia and New Zealand. They received either a three or six month course of chemotherapy and were followed up for a minimum of three years.
After three years, 76.7 per cent of patients who received treatment over three months were disease free compared to 77.1 per cent of patients treated over six months. Patients treated over three months had fewer side effects and reported a better quality of life as well as reduced peripheral neuropathy.
Chief Investigator Dr Tim Iveson, Honorary Associate Professor at the University of Southampton and Consultant Medical Oncologist at University Hospital Southampton NHS Foundation Trust, said: “Bowel cancer is the fourth most common cancer in the UK with 41,000 new cases each year. Bowel cancer can be cured by surgery and chemotherapy. Approximately 2,500 patients per year currently receive up to six months of post-operative chemotherapy. Reducing chemotherapy duration to three months will save the NHS £5000 per patient – a total saving to the NHS of £12.5 million pounds per year.”
Dr Iveson added: “The impact on patients is important – having a shorter course of chemotherapy patients have fewer side effects. Following chemotherapy, irreversible nerve damage can a significant issue for some patients and reducing the duration of chemotherapy reduces peripheral neuropathy severity resulting in a better quality of life. Based on these results, three months of post-operative chemotherapy should be considered as the new standard care for many patients with bowel cancer.”
Mr Steven Pritchard from the three-month arm of the trial said: “I am delighted to say that nearly five years on from my treatment I am still in good health. I received three months of chemotherapy, which worked brilliantly and enabled me to get on with my life and return to work sooner than I had hoped. Being self-employed, this was extremely important to me. I am pleased that I was able to be part of this trial, I felt in safe hands throughout the trial and well supported by the trial team as well as my family. It’s great to think that this research could help other patients like me.”
Professor Tom Walley, Director of NIHR Evaluation, Trials and Studies, which funded the trial, said: “This study will have a direct benefit for individual patients, sparing them unnecessary adverse effects of drugs, and save costs for the NHS. It could lead to a major change in how bowel cancer patients are treated. I'm pleased the MRC/NIHR collaboration funded this study as bowel cancer effects so many people in the UK every year, and it's important that we continue to look at ways we can improve treatment.”
The SCOT study, led by the Cancer Research UK Clinical Trials Unit in Glasgow, has been included in a combined analysis of six concurrently conducted studies worldwide looking at the duration of adjuvant chemotherapy in a specific subgroup of SCOT patients. The IDEA analysis includes 12,834 patients and SCOT is the largest contributing study. IDEA, published in NEJM, supports the results reported by the SCOT study that for many patients three months of chemotherapy after curative resection of a colon cancer is just as good as 6 months, but with less inconvenience and long term toxicity.