Research into treating bowel cancer
This page tells you about research into bowel cancer treatment. You can find the following information
- A quick guide to what's on this page
- Why research?
- Chemotherapy research
- Radiotherapy research
- Surgery research
- Research into follow up after surgery
Research into treating bowel cancer
All treatments must be fully researched before they can be adopted as standard for everyone. This is so we can be sure they work better than treatments we already use. And so that we know they are safe.
New treatments are first developed and tested in the laboratory. If this shows that a treatment is safe, it is then tested in clinical trials for patients. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many clinical trials.
Research is going on all the time into improving the treatments for bowel cancer and reducing the side effects of treatment. There is research looking into giving chemotherapy before and after surgery, radiotherapy, surgical techniques and biological therapies.
You can view and print the quick guides for all the pages in the treating bowel cancer section.
Research goes on all the time into how best to treat bowel cancer. New treatments are first developed and tested in the laboratory. If this shows that a treatment is safe, it is then tested in clinical trials for patients. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many clinical trials.
Usually doctors test new drugs in people with advanced bowel cancer first. If a new treatment helps with advanced bowel cancer, it may work for early stage bowel cancer as well. It is then tested in clinical trials to see if it lowers the risk of an early stage cancer coming back.
Doctors would like to be able to identify who is most at risk of their bowel cancer coming back. People at lowest risk may not need such intensive treatment as people at higher risk. At the moment, we don't know for sure who is most at risk so some people have treatment they may not need. All treatments have side effects. So it is important that people don't have treatment that may not be helping them.
Here is a video on what it's like to take part in a clinical trial:
View a transcript of the video (Opens in a new window)
Many clinical trials are testing chemotherapy drugs, using different combinations, different doses, or different ways of giving them. The aim of this type of research is to find better ways of treating bowel cancer with chemotherapy. You can find information about individual trials on our clinical trials database. Researchers are looking at
Doctors call chemotherapy after surgery adjuvant therapy. This just means treatment alongside surgery. The SCOT trial is looking into whether having 12 weeks of adjuvant chemotherapy works as well as having 24 weeks of chemotherapy. Having less chemotherapy could mean fewer or milder side effects. The people who have taken part in this study have had surgery for stage 2 or 3 bowel cancer, followed by either OxMdG (oxaliplatin, fluorouracil, and folinic acid) or XELOX (oxaliplatin and capecitabine) chemotherapy. This trial has closed and we are waiting for the results.
Doctors call chemotherapy before surgery neo adjuvant treatment. Doctors think it may shrink tumours and make them easier to remove. It may also help to kill off cells that have already spread. The FOxTROT trial is looking at whether giving some chemotherapy before surgery (as well as after surgery) helps to stop the cancer coming back. Results from the pilot study show that having chemotherapy before surgery is safe. They also suggest that it can shrink tumours in some people. We will have to wait for the results from the large study before we know whether it can help to stop cancer coming back and improve survival.
This trial is also looking at whether adding a monoclonal antibody called panitumumab (Vectibix) to chemotherapy can help people with early bowel cancer. You can only have panitumumab if your cancer cells have normal RAS genes. Your doctor will check this before you have treatment. Trials have already shown that panitumumab can help some people with advanced bowel cancer to live longer and have a better quality of life.
The Copernicus trial is looking at the best time to give chemotherapy for cancer of the back passage (rectal cancer). Doctors usually treat rectal cancer with radiotherapy, followed by surgery and chemotherapy. But it may be helpful to give chemo before and after the surgery for some cancers. Researchers hope this will help lower the chances of the cancer coming back. In this trial you have the same amount of radiotherapy and chemotherapy as standard treatment, but you have some of the chemotherapy before surgery. This trial has now closed and we are waiting for the results.
The BACCHUS trial is looking at 2 different combinations of chemotherapy drugs with bevacizumab before surgery for rectal cancer. Bevacizumab is a type of biological therapy. Researchers think that having more drug treatment instead of radiotherapy may be better at stopping the cancer coming back to other parts of the body. This trial has now closed and we are waiting for the results.
The ARISTOTLE trial is for cancer of the rectum that has spread into surrounding tissues. The trial is looking at adding irinotecan to standard capecitabine chemotherapy with radiotherapy. You have this treatment before having surgery to remove the cancer. The researchers want to find out if adding irinotecan to standard treatment stops or helps to delay the cancer coming back after surgery. They also want to find out more about the side effects.
The EXCITE trial is looking at having cetuximab (Erbitux), capecitabine (Xeloda) and irinotecan (Campto) with radiotherapy before surgery for rectal cancer. Cetuximab is a biological therapy and capecitabine and irinotecan are chemotherapy drugs. Some chemotherapy drugs make cancer cells more sensitive to radiotherapy. Doctors want to see if this combination of treatments helps to shrink the cancer before surgery, and what the side effects are. This trial has now closed and we are waiting for the results.
The MESH trial is looking at whether the chemotherapy drug methotrexate can help people with a particular gene fault called MSH2 who have bowel cancer that has spread. This trial has now closed and we are waiting for the results.
There is a trial looking at a new type of chemotherapy called EZN-2208 with or without the biological therapy cetuximab. The trial is for people who have bowel cancer that has spread. EZN-2208 has been developed from the chemotherapy drug irinotecan. This trial has also closed and we are waiting for the results.
The FOCUS 4 trial is looking at different treatments, including chemotherapy, for different subtypes of bowel cancer. The people taking part have bowel cancer that cannot be removed with surgery or has spread to another part of the body. To work out the subtype of bowel cancer, the researchers will test a sample of the tumour to look for changes in certain genes and proteins.
One trial is comparing a new drug called HA-Irinotecan with standard irinotecan chemotherapy. Some people with bowel cancer that has spread have irinotecan with fluorouracil (also known as 5FU) and a vitamin called folinic acid. This combination of drugs is called FOLFIRI chemotherapy. HA-Irinotecan combines irinotecan with a substance called hyaluronic acid (HA). HA can help to get more irinotecan into cancer cells. The aims of the trial are to see if HA-Irinotecan works better than irinotecan and to learn more about the side effects.
Another trial is comparing etirinotecan pegol with standard irinotecan chemotherapy for advanced bowel cancer. The people taking part have bowel cancer cells that have a change in the KRAS gene. Etrinotecan pegol is irinotecan with a structure called polyethylene glycol (PEG) added to it. This technology may help the drug stay in the body for longer. You can find information about the etirinotecan pegol trial on our clinical trials database. This trial has closed and we are waiting for the results.
Doctors usually treat bowel cancer that has spread to the liver with chemotherapy followed by surgery to remove the cancer in the liver (liver metastases), then more chemotherapy. This is the standard treatment. Having chemotherapy before surgery can increase the risk of side effects of surgery, such as infection. But having chemotherapy is the best chance of keeping the cancer at bay. The EPOC B trial is a pilot study looking at whether giving all the chemotherapy after surgery is better than the standard treatment. This may reduce the risk of surgery side effects. This trial has also closed and we are waiting for the results.
Chemotherapy side effects
As with all treatments, chemotherapy causes side effects. The FOCCUS study is looking at the side effects of chemotherapy that affect the tummy (stomach) and bowel. The researchers want to find out more about how often these side effects happen, why they happen and how best to treat them.
Capecitabine is a form of the chemotherapy drug fluorouracil that you take as a tablet. One of the side effects of this and similar drugs is hand foot syndrome, or palmar plantar syndrome. The palms of your hands and the soles of your feet become red, sore or numb. This can be painful.
Doctors often prescribe a tablet called pyridoxine (vitamin B6) to help control hand foot syndrome. But studies have had mixed results on how well this works. A small Korean trial found that it did not help people taking capecitabine for bowel cancer. But recent results from the UK CAPP-IT trial found that pyridoxine did appear to reduce the rate of hand foot syndrome.
You can find more trials looking at chemotherapy on our clinical trials database.
There is a lot of research into radiotherapy for bowel cancer. There are trials looking at
We know that radiotherapy, along with surgery, can help to stop rectal cancer from coming back. We also know that having fluorouracil (5FU) or capecitabine chemotherapy can help radiotherapy to work better for rectal cancer. The chemotherapy makes the cancer cells more sensitive to radiation. Some trials are looking at giving chemotherapy with radiotherapy before or after surgery for rectal cancer.
A phase 1 trial in Dundee is looking at radiotherapy during surgery for cancer of the back passage (rectum). Radiotherapy during surgery is called intra operative radiotherapy (IORT). This trial is looking at a new type of intra operative radiotherapy called the photon radiosurgery system (PRS) that uses low energy X-rays. The trial aims to find out about the safety of PRS and see how well it works. The researchers also want to learn about the effects of PRS on cancer tissue and healthy tissue. This trial has now closed and we are waiting for the results.
Doctors know from laboratory research that radiotherapy might work better in people who are taking anti inflammatory drugs such as aspirin. The ASPIRE study is looking to find out more. The people taking part in this study are due to have radiotherapy before surgery for rectal cancer.
The National Institute for Health and Care Excellence (NICE) has approved a type of internal radiotherapy (sirspheres) for people with bowel cancer spread to the liver that cannot be surgically removed. During the treatment, millions of very tiny beads (microspheres) are injected into the liver. Each bead is coated with a radioactive substance. This gives a dose of radiotherapy to the liver tumours over a few days. The treatment is also called radio embolisation or SIRT.
NICE advised that SIRT is safe to use and can shrink liver tumours. But we need more research to see if SIRT can help people live longer and reduce symptoms. The large UK FOXFIRE trial is looking at whether SIRT can shrink bowel cancer tumours in the liver and make it possible to remove them with surgery. It is also looking at the side effects of this treatment. This trial has closed and we are waiting for the results.
Initial results from the international SIRFLOX study were recently presented at a large conference in America. The trial compared SIRT and FOLFOX chemotherapy (with or without bevacizumab) with chemotherapy alone for bowel cancer that had spread to the liver. Around 530 people took part. The researchers found that the combination of treatment was better at temporarily stopping the cancer from growing than chemotherapy alone. The average length of time it took for the cancer to start growing again was around 12 months with just chemotherapy, and around 20 months for those having both SIRT and chemotherapy. The researchers are still following up the people who took part in the trial and so it is too early to know if SIRT helps people to live longer overall.
Researchers are looking at ways of reducing side effects of bowel radiotherapy. A trial is looking at whether eating more or less fibre reduces radiotherapy side effects to the bowel. The people taking part have had treatment to the area between their hip bones (the pelvis). Pelvic radiotherapy can inflame the bowel lining and cause loose stool, diarrhoea and difficulty controlling your bowels. The researchers want to find out whether diets high or low in fibre are better for people having radiotherapy and whether they can reduce the side effects. This trial has now closed and we are waiting for the results.
You can look for radiotherapy trials for bowel cancer on our clinical trials database.
Surgery is one of the main treatments for bowel cancer. Researchers are looking at how surgery can be improved. There are trials looking at
The PARSC study is using a new test to help find the risk of stage 2 cancer of the large bowel (colon) coming back after surgery. The test looks at the actions of genes in the cancer cells. Doctors hope that this will help them to know who needs to have chemotherapy after surgery.
A newer type of surgery called keyhole (or laparoscopic) surgery is carried out by making small cuts in your abdomen, and putting surgical instruments and a camera through these holes to do the operation. We know that keyhole surgery is as good as standard 'open' surgery for removing and curing bowel cancer. The EnROL trial found that people who had keyhole surgery spent fewer days in hospital and recovered quicker than those having open surgery. The trial team found that there was no difference between the 2 groups when looking at the number of problems people had during and after surgery, such as infection. There was also no difference between the 2 groups in quality of life and how tired people felt a month after surgery.
The ROLARR trial is looking at using a robotic system for keyhole surgery to remove cancer of the back passage (rectal cancer). The trial wants to find out if robotic assisted keyhole surgery is as good as, or better than, standard keyhole surgery for removing rectal cancers. This trial has now closed and we are waiting for the results.
The GLISTEN study is looking at a substance called 5-ALA which can show if bowel cancer has spread to the lymph nodes. The 5-ALA makes cancer cells glow red under a blue light. The people taking part in this study are having keyhole surgery to remove the cancer. The aim of the study is to find the best dose of 5-ALA to use. This means the lowest dose that makes bowel cancer and any spread to the lymph nodes glow red under a blue light during surgery. This study has now closed and we are waiting for the results.
Another study is looking at finding which lymph nodes bowel cancer cells travel to first (the sentinel nodes). The researchers are using a dye and light to see if they can identify the sentinel nodes. In future, knowing which are sentinel nodes, and testing these during surgery would mean that people who do not have cancer in their lymph nodes could have a smaller operation. This study has now closed and we are waiting for the results.
A trial is comparing different ways of controlling pain after keyhole surgery to remove part of your bowel. To reduce pain after keyhole surgery, surgeons usually inject local anaesthetic around the small cuts in your abdomen at the end of the operation. In this study, using an ultrasound scan to help guide them, the surgeon will inject local anaesthetic between the muscle layers in the wall of your abdomen. This is called a TAP block. The aim is to see if giving local anaesthetic in this way reduces the amount of pain you get and the amount of painkillers you need after surgery. The researchers also want to see if this method of pain control helps people to eat and drink sooner and whether they get home earlier. This trial has closed and we are waiting for the results.
There is a trial looking at the timing of rectal cancer surgery. The researchers want to find out whether it is best to do surgery 6 to 8 weeks after chemoradiation treatment or whether it is safe to delay the surgery. The aim of the trial is to see if the cancer shrinks even further if surgery is delayed, so you can have a smaller operation.
There is another trial looking at the best time for surgery after radiotherapy or chemoradiation for rectal cancer. The trial is aiming to compare the size of the cancer 6 weeks and 12 weeks after finishing radiotherapy or chemoradiation. This will help surgeons to know how long they need to wait before operating, to get the best results from the radiotherapy or chemoradiation.
The ISAAC trial is looking at removing the original (primary) area of cancer in the bowel or back passage (rectum) before chemotherapy. It is for people with bowel cancer that has spread (advanced bowel cancer). The aim of the trial is to find out whether it is better to remove the original bowel cancer before having chemotherapy. Or whether it is better to wait to see if the cancer causes symptoms before removing it.
The above 3 trials have now closed and we are waiting for the results.
Recent results from the STARRCAT trial has shown that it is suitable and safe to operate at either 6 weeks or 12 weeks after chemoradiotherapy for rectal cancer. However only 31 people took part in the trial. The researchers found there was no difference between the 2 groups in how difficult the operation was, how long the people stayed in hospital and the problems people had after the operation.
You may hear your doctor call cancer that has spread to the liver secondary cancer or liver secondaries. There are specialised surgical treatments for liver secondaries, such as radiofrequency ablation and cryotherapy.
Surgeons have developed a new type of surgery for people with liver tumours in parts of the liver that are usually too dangerous or difficult to operate on. One example is when a tumour is very close to major liver blood vessels. This type of surgery is very new and experimental. Doctors only use it if a patient would die if they did not have it because there is a risk of dying from the surgery itself. The operation involves removing the liver from the body, cutting away the diseased tissue, and then putting back the healthy liver tissue. Doctors call this ex vivo hepatic resection and reimplantation for liver cancer.
The National Institute for Health and Care Evidence (NICE) has guidelines about this. You can read their report on the NICE website. They say that there is limited evidence for the safety of this type of operation, and it is not clear how well it works. But it may be helpful for some people with liver cancer. People having the surgery must have full information about the possible risks and benefits.
Surgery to remove cancer spread to the lungs
If bowel cancer has only spread to the lungs, it may be possible to have surgery to remove it. But you can only have this surgery if you are fit enough. Doctors want to find out more about how having this surgery affects quality of life after the operation, and to confirm that it helps people to live longer. The PulMICC trial is looking into the pros and cons of this type of surgery.
The POSiCC trial is looking at diet advice with or without food supplement drinks before surgery for bowel cancer. We know that people who have bowel cancer often lose weight as a result of their illness. This may lead to problems because the body is weaker and finds it harder to cope with cancer treatment. The aim of the trial is to see if people who have the food supplement drinks before surgery, as well as diet advice, have fewer complications than people who have the standard diet advice.
The EPA colo study is looking at a fish oil supplement called eicosapentaenoic acid or EPA to see if it improves recovery after surgery for bowel cancer. If you have surgery to treat bowel cancer, you may have some muscle wasting which may affect how quickly you recover from surgery. EPA is an omega 3 fatty acid found in fish oil and oily fish. Researchers believe that EPA may improve recovery after surgery by preserving muscle that often wastes away after major surgery or due to cancer. In this study, half the people taking part will take EPA before surgery and for 3 weeks afterwards. The other half will take dummy capsules (placebos).
Both these trials have closed and we are waiting for the results.
You can find out more about surgery trials for bowel cancer on our clinical trials database.
Some specialists see their patients regularly after treatment has finished, but some do not. Follow up varies a lot between different hospitals and doctors are not sure what is best. Seeing patients more often and having certain tests may help the doctors to diagnose bowel cancer that has come back (recurred) more quickly. But having regular tests can be stressful for patients.
Currently there is limited evidence that diagnosing a recurrence of bowel cancer earlier will improve survival rates.
The FACS trial has been looking at the best way to follow up patients after treatment for early bowel cancer. The trial team found that regular CT scans and CEA blood tests increased the number of people who could have further surgery to try and cure cancer that had come back. However, after an average follow up of less than 5 years, doing extra follow up tests didn't seem to make a difference to how long people lived in the short term. The researchers say it is too soon to know if this has an impact on long term survival. You can read the results of the FACS trial on our clinical trials database.
Research has shown that aspirin may lower the risk of dying from cancer, and it may lower the risk of some cancers spreading to other parts of the body. But more research is needed. Cancer Research UK is helping fund the world's largest clinical trial looking at aspirin to stop cancer coming back. The ADD-Aspirin trial wants to find out if taking aspirin every day for 5 years can stop or delay an early cancer from returning. 11,000 people who have had, or are having, treatment for bowel, breast, oesophagus (food pipe), prostate or stomach cancer will take part. The trial will run for up to 12 years. It will compare 2 groups of people taking different doses of aspirin and a group taking dummy tablets (placebo).
Bowel cancer is sometimes diagnosed when it causes a blockage in the bowel, which makes you feel very unwell. In this situation you would usually have emergency surgery to relieve the blockage and allow your bowel to start working again. Doctors often treat bowel cancer with surgery. But emergency surgery is more difficult than surgery that is planned. There is a higher risk of complications and it is more likely that you will need to have a colostomy (a stoma).
In the CReST trial the researchers want to see if it is possible to delay surgery by putting a tube called a stent into the bowel to relieve the blockage (endoluminal stenting). The stent opens up the bowel so that the waste from food you have digested can pass through. You may be able to join this trial if you have a suspected bowel cancer that is causing a blockage on the left hand side of your bowel.
Doctors want to find out if stenting before you have an operation can
- Reduce the complications of surgery
- Reduce the number of people who need a stoma
- Help people to live longer
This trial has now closed and we are waiting for the results.
Biological therapies act on processes in cells or change the way that cells signal to each other. They can stimulate the body to attack or control the growth of cancer cells. We have detailed information about biological therapies.
There are many biological therapies being looked at in clinical trials, including
Cetuximab (Erbitux) works by blocking a growth factor called epidermal growth factor (EGF). Some bowel cancer cells have EGF receptors. When triggered, the EGF receptors tell the cell to grow and divide into more cells. So, cetuximab is a growth factor blocker. You can find information about cetuximab as a treatment for bowel cancer on our page about biological therapies for bowel cancer.
We know from trials that having cetuximab with chemotherapy makes chemotherapy work better. So researchers are looking at the best way of combining cetuximab with chemotherapy. You can find trials looking at cetuximab for bowel cancer on our clinical trials database. We have described some of these trials briefly below.
The COIN-B trial found that cetuximab is safe to have as either continuous or intermittent treatment for advanced bowel cancer. The researchers found that fewer people having continuous cetuximab stopped treatment because of their cancer getting worse. And on average, they also had a longer period of time before their cancer started to get worse. Larger phase 3 trials are needed to confirm these findings. You can read the results of the COIN-B trial on our website.
The E-SCOUT trial is looking at combining cetuximab with chemotherapy. The people taking part in this trial have bowel cancer that has spread locally or to other parts of the body (metastatic). This trial has closed and we are waiting for the results.
Doctors often treat people with advanced bowel cancer who are under 65 with fluorouracil (5-FU) and leucovorin (folinic acid) and cetuximab. But older people often only have 5-FU and leucovorin. The EORTC 40085 trial is looking to see if adding cetuximab to 5-FU and leucovorin is a better treatment for people over 70. This trial has now closed and we are waiting for the results.
Bevacizumab (Avastin) is a biological therapy licensed in the UK to treat advanced bowel cancer. Avastin blocks a growth factor protein called VEGF. VEGF triggers blood vessels to grow. This is called angiogenesis. All cancers need to grow their own blood supply. Avastin stops tumours from making blood vessels.
The BOXER trial looked at giving bevacizumab with oxaliplatin and capecitabine to people whose bowel cancer had spread to the liver but nowhere else in the body. It found that adding bevacizumab to chemotherapy was safe and worked well. It shrank the cancers more than chemotherapy alone and allowed more people to have surgery.
A large study called QUASAR 2 is looking at whether adding bevacizumab to capecitabine chemotherapy after surgery for early stage cancer (adjuvant treatment) helps people to live longer. This trial has closed and we are waiting for the results.
Panitumumab (also known as Vectibix) is another type of monoclonal antibody. It is licensed in Europe for treating people with bowel cancer that has spread and standard chemotherapy has not worked. But it has not been approved to be used within the NHS. In England doctors may be able to fund panitumumab through the Cancer Drugs Fund. As with cetuximab, to have panitumumab, your bowel cancer cells must have EGF receptors.
Some bowel cancers have changes (mutations) in genes such as K-RAS and N-RAS. Whether these genes are normal or mutated can affect how well certain treatments such as panitumumab work. The PICCOLO trial recently looked at how well panitumumab worked as a treatment for bowel cancer that had come back. People on this trial had a standard course of irinotecan, or irinotecan with panitumumab, or irinotecan with ciclosporin. Ciclosporin is not an anti cancer drug but it might reduce the side effects of irinotecan.
The first part of the trial looked at irinotecan and panitumumab. For people with a normal K-RAS gene, the research team found that the cancer was significantly more likely to reduce in size and take longer to start growing again in people who had pamitumumab. The research team found no benefit in having panitumumab in people that had a mutation in the K-RAS gene or one of several related genes. The second part of the trial looked at irinotecan and ciclosporin. From their results, the research team could not be confident that ciclosporin and a lower dose of irinotecan was as effective as irinotecan alone. The number of people who had diarrhoea was similar in each group, but fewer people who had irinotecan and ciclosporin needed treatment for it.
Doctors are trying panitumumab as part of the FOxTROT trial. This is looking at whether having chemotherapy before surgery, and adding panitumumab, helps to stop or delay bowel cancer coming back. The people having panitumumab have cancer cells with the normal K-RAS gene.
The EORTC 40091 trial is looking at chemotherapy with either panitumumab or bevacizumab for people having surgery for bowel cancer that has spread to the liver. The researchers want to find out how well panitumumab or bevacizumab works alongside FOLFOX chemotherapy, and to learn more about the side effects. This trial has closed and we are waiting for the results.
A trial is looking at dalotuzumab for rectal cancer that has spread. If rectal cancer spreads, you may have irinotecan chemotherapy with the monoclonal antibody cetuximab. Doctors want to see if irinotecan and dalotuzumab is a better combination. This phase 2 trial has closed and we are waiting for the results.
Xilonix is another type of monoclonal antibody. It may help to stop or slow down cancer growth. It may also help to reduce some symptoms of advanced bowel cancer such as muscle wasting (loss of muscle mass), loss of appetite, tiredness and pain. A trial is looking at Xilonix for bowel cancer that has grown despite standard treatment. The people taking part have bowel cancer that cannot be removed with surgery, or has spread to other parts of the body. The researchers want to find out if Xilonix can reduce muscle wasting and other symptoms in people with bowel cancer, to learn more about the side effects of the drug, and see if it improves quality of life. This trial has closed and we are waiting for the results.
Pazopanib (Votrient) is a new type of growth factor blocker (tyrosine kinase inhibitor). You take it as a tablet. The aim of the treatment is to stop tumour cells growing their own blood vessels. Doctors have tested it as a treatment for several other cancer types and it is now also in early stage clinical trials for advanced bowel cancer.
The DREAM trial is looking at adding a growth blocker (tyrosine kinase inhibitor) to the standard treatment of chemotherapy and radiotherapy for rectal cancer. The trial is looking at 2 different tyrosine kinase inhibitors – cediranib (AZD2171) and AZD6244. Some people taking part have had cediranib and some people have had AZD6244. The trial aims to find the highest dose of each drug that people can have safely at the same time as chemoradiotherapy. The researchers also want to find out how the drugs affect cancer growth. This trial has closed and we are waiting for the results.
Axitinib works by targeting a protein called vascular endothelial growth factor (VEGF). The AXMUS C trial is looking at axitinib for bowel cancer that has spread to another part of the body. The researchers want to find out how well axitinib works for people with advanced bowel cancer and to learn more about the side effects.
Vemurafenib is a type of biological therapy called a cancer growth blocker. There are many different types of growth factors and they all do different things. Vemurafenib stops cells producing a protein called BRAF, which makes some cells grow and divide. Some cancers make too much BRAF due to a change in the BRAF gene. Doctors already use vemurafenib to treat melanoma skin cancer if the cells have a change to the BRAF gene. The main aim of the VE-BASKET trial is to find out if vemurafenib helps people with other types of cancer, including advanced bowel cancer, when the cells have a specific change to the BRAF gene. The people taking part in this trial with advanced bowel cancer have vemurafenib alongside cetuximab. This trial has now closed and we are waiting for the results.
This works by blocking several different growth factor proteins. The international CORRECT study looked at regorafenib for advanced bowel cancer that had continued to grow after standard treatments. 760 people took part in this phase 3 trial. The results showed regorafenib improved overall survival compared to a dummy drug (placebo) and best supportive care. The average length of time people lived was just over 6 months in the regorafenib group and 5 months in the placebo group. The most common side effects include hand and foot syndrome, tiredness, diarrhoea, high blood pressure and skin rash.
As a result of this trial, regorafenib is now licensed for bowel cancer that has spread to another part of the body and has continued to grow despite other treatments. It is not currently available on the NHS.
A trial is looking at veliparib with chemotherapy for bowel cancer that has spread to another part of the body. Veliparib is a type of PARP inhibitor. This means it blocks an enzyme called PARP, which helps damaged cells repair themselves. Doctors hope if they stop PARP working, the cancer cells will not be able to repair themselves and die. Half the people taking part will have veliparib with FOLFIRI chemotherapy with or without bevacizumab. The other half will have a dummy drug (placebo) with FOLFIRI, with or without bevacizumab.
Aflibercept stops cancers forming blood vessels. It is licensed alongside FOLFIRI chemotherapy for people with bowel cancer that has spread to other parts of the body, and they have already had oxaliplatin chemotherapy. It is not widely available on the NHS. But the Scottish Medicines Consortium (SMC) have said doctors can use it within the NHS in Scotland.
The CAPITAL trial is comparing aflibercept and capecitabine chemotherapy with capecitabine on its own. This is an early trial for people with advanced bowel cancer. The researchers want to find out the best dose of capecitabine to have with aflibercept, and to learn about the side effects of having the 2 drugs together.
Researchers have developed a new type of monoclonal antibody called RO5083945. A trial is looking at RO5083945 to see if it can help people who have already had chemotherapy for bowel cancer that has spread. They are giving RO5083945 alongside FOLFIRI chemotherapy and comparing this with FOLFIRI and another monoclonal antibody called cetuximab. They hope that RO5083945 may be able to stop or slow down the growth of bowel cancer cells. And it may also help the immune system to attack cancer cells.
MGN1703 is a type of immunotherapy. This means it uses the immune system to help kill cancer cells. The IMPALA trial is looking at MGN1703 for bowel cancer that has spread to another part of the body and can't be removed with surgery. The researchers want to find out if it can increase the length of time people live and stop the cancer spreading further, and to learn about the side effects and if it improves quality of life.
This drug works by blocking certain proteins on cancer cells that send signals telling cancer cells to divide. The FOCUS 4 trial is looking at different treatments, including biological therapies such as AZD8931, for different subtypes of bowel cancer. The people taking part have bowel cancer that cannot be removed with surgery or has spread to another part of the body.
The PANTHER trial is looking at AZD8931 with FOLFIRI chemotherapy for bowel cancer that cannot be removed with surgery, has come back after surgery or has spread to another part of the body. The researchers want to find the best dose of AZD8931, learn about the side effects and to see if the combination of drugs is better than chemotherapy alone.
Scientists can attach cancer drugs or radioactive atoms to monoclonal antibodies. The antibodies then carry these treatments straight to the cancer cells to kill them. The researchers hope that this targeted treatment will work better than regular chemotherapy or radiotherapy. The treatment may also mean that other healthy cells in your body don't get damaged, so there could be fewer side effects.
Resveratrol is a type of chemical called an antioxidant. It occurs naturally in some foods, such as grapes and peanuts. Antioxidants can stop genes inside cells becoming damaged, and may help to prevent cancer. In the laboratory resveratrol has been shown to help kill bowel cancer cells. Doctors want to find out more about what happens to resveratrol in the body after it is eaten or drunk.
There is a small study looking at resveratrol and the effects it might have on bowel cancer cells in the body. People on this trial took resveratrol for 8 days before their operation to remove bowel cancer. The tumour cells are being looked at in the laboratory. This study has closed and we are waiting for the results.
Curcumin is a plant extract found in the spice turmeric. Research has shown that curcumin can help shrink tumours in the laboratory. It has also been used in several studies involving patients with a range of conditions, including cancer.
The CUFOX trial is looking at curcumin with FOLFOX chemotherapy for bowel cancer that has spread to the liver. The main aims of this early trial are to find out the best dose of curcumin to give with FOLFOX chemotherapy and how well this combination works, to learn about the side effects of curcumin with chemotherapy and to see if curcumin can help reduce some of the side effects of FOLFOX such as numbness and tingling in the hands and feet (peripheral neuropathy).
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