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Three-month chemo as 'effective as six after bowel cancer surgery'

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Many patients receiving chemotherapy following surgery for bowel cancer may only need three months treatment rather than the six months currently given, according to researchers.

Their study also showed that three months chemotherapy resulted in less peripheral neuropathy – nerve damage affecting the hands and feet – occurring as a result of chemotherapy.

“Three months of post-operative chemotherapy should be considered as the new standard care for many patients with bowel cancer”

Tom Iveson

They stated that, based on their findings, the shorter duration of treatment should be considered the “new standard of care”.

They evaluated the effectiveness of a three-month course of adjuvant oxaliplatin/fluoropyrimidine combination chemotherapy for colorectal cancer versus the standard six-month treatment regimen.

The SCOT study, led by the Cancer Research UK clinical trials unit in Glasgow, involved 6,088 patients with stage II or stage III colorectal cancer from 244 centres across Europe, Australia and New Zealand.

Patients 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% of patients who received treatment over three months were disease free, compared to 77.1% of patients treated over six months.

Patients treated over three months also had fewer side effects and reported a better quality of life as well as reduced peripheral neuropathy, noted the researchers.

“These data suggest that a shorter duration leads to similar survival outcomes with better quality of life and thus might represent a new standard of care,” they stated in the journal Lancet Oncology.

“It could lead to a major change in how bowel cancer patients are treated”

Tom Whalley

The study was funded through a partnership between the National Institute for Health Research and the Medical Research Council.

Lead study author Dr Tim Iveson, a consultant 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,” he said. “Reducing chemotherapy duration to three months will save the NHS £5000 per patient – a total saving to the NHS of £12.5m per year.”

Dr Iveson also highlighted that the impact on patients was important, because by having a shorter course of chemotherapy patients experienced fewer side effects.

“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,” he said.

“Based on these results, three months of post-operative chemotherapy should be considered as the new standard care for many patients with bowel cancer,” he stated.

National Institute for Health Research

Tom Walley

Tom Walley

Professor Tom Walley, director of evaluation, trials and studies at the National Institute for Health Research, said the trial “could lead to a major change in how bowel cancer patients are treated”.

Meanwhile, the SCOT study has been included in a combined analysis of six concurrently conducted studies globally looking at the duration of adjuvant chemotherapy in a specific subgroup of patients.

The IDEA analysis, published today in the New England Journal of Medicine, includes 12,834 patients of which SCOT is the largest contributing study.

It supported the SCOT study findings that for many patients three months of chemotherapy after curative resection of a colon cancer is just as good as six months, but with less inconvenience and long-term toxicity.

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