Localised colon cancer: better outcomes with neoadjuvant chemotherapy
There was little data on whether neoadjuvant chemotherapy benefitted in advanced but localised colon cancer. This changed due to a recently published study.
Chemotherapy for colon cancer
- The study investigated the effects of different chemotherapy regimens on advanced but localised colon cancer.
- Study participants received either 6 preoperative and 18 postoperative cycles of oxaliplatin-fluoropyrimidine therapy or 24 cycles postoperatively.
- In the neoadjuvant group, there was more frequent histopathological downstaging, more resections with clean margins, and fewer recurrences.
Limited data on neoadjuvant therapy so far
Neoadjuvant chemotherapies have been used for some time in advanced, not yet metastasised colon cancer. However, there has been a lack of data to support the potentially improved outcomes. The randomised trial that has now been published has changed this.
Direct comparison of neoadjuvant and standard therapy
Participants were randomised 2:1:
- into the neoadjuvant group - in which 6 cycles of oxaliplatin/fluoropyrimidine are given before surgery and 18 cycles postoperatively.
- into the standard group - in which all 24 cycles are given after surgery.
Better outcomes with preoperative chemo
The data clearly show that splitting chemotherapy between pre- and postoperative is associated with better outcomes:
- Thus, there was a clearer histological tumour regression and better downstaging of T and N in the neoadjuvant group.
- At the same time, resection of the tumour was more often complete with clean margins.
- In addition, there were fewer recurrences after two years with the preoperative administration of chemotherapeutic agents.
These results were statistically significant. The authors also note that the neoadjuvant approach was not associated with higher intraoperative morbidity.
What are the benefits of neoadjuvant therapy?
In advanced non-metastatic and operable colon carcinomas, the administration of pre- and postoperative chemotherapy brings clear advantages. In the presented study, neoadjuvant therapy was associated with significantly better outcomes.
Morton D. et al: FOxTROT Collaborative Group. Preoperative Chemotherapy for Operable Colon Cancer: Mature Results of an International Randomized Controlled Trial. J Clin Oncol. 2023 Mar 10;41(8):1541-1552. Epub 2023 Jan 19. PMID: 36657089; PMCID: PMC10022855.