A study looking at chemotherapy and surgery for bowel cancer that has spread to the liver (EPOC B)

Cancer type:

Bowel (colorectal) cancer

Colon cancer

Rectal cancer

Status:

Results

Phase:

Pilot

This study looked at the best way to have chemotherapy and surgery for bowel cancer that has spread to the liver. It was supported by Cancer Research UK.

More about this trial

Bowel cancer (colorectal cancer) can sometimes spread to the liver (liver metastases). People in this situation often have chemotherapy, followed by surgery to remove the cancer in the liver, and then more chemotherapy.

But researchers wondered if it was better for them to have surgery first, and then all the chemotherapy afterwards.

In this study doctors compared having chemotherapy before and after surgery, with only having chemotherapy after surgery.

The aims of the study were to find out:

if having all the chemotherapy after surgery is better than having some chemotherapy first
more about the side effects
if people with bowel cancer that has spread to the liver want to take part in the study

Summary of results

The research team were not able find enough patients to take part to draw any firm conclusions from this study.

The study was open for people to join between 2011 and 2013, and the research team presented the results at a conference in 2015.

About this study

Everyone taking part in this study had bowel cancer that had spread to their liver. They were all due to have surgery to remove the cancer in their liver.

The research team had hoped to find more than 70 people to take part, but only 20 people agreed to join the study.

The research team looked at the information from the EPOC B study together with information from a similar study called ATTACHE. The ATTACHE study was open in Australia. That study team also found it hard to recruit people, and only 8 people took part.

The information here is from the combined results of these two studies. They recruited 28 people in total.

Everyone taking part was put into one of two treatment groups at random:

13 people were in group A – they had surgery first and then chemotherapy
15 people were in group B – they had some chemotherapy first, then surgery, then more chemotherapy

Results

Of the 13 people in group A who had surgery first:

11 (85%) had surgery
9 (69%) had at least some chemotherapy after surgery
7 (54%) had all their planned chemotherapy

There were 2 people in this group who didn’t have surgery as planned. One person decided they didn’t want to take part. And the research team found that, after further tests, the other didn’t meet the entry criteria to join the study.

Of the 15 people in group B who had some chemotherapy first:

all 15 had chemotherapy to begin with
10 (67%) had surgery
8 (53%) had at least some chemotherapy after surgery
7 (47%) had all their planned chemotherapy

There were 5 people in this group who didn’t have surgery as planned. They were all unable to have surgery because their cancer had grown and could not be removed with an operation.

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Side effects

The research team looked at how many people had side effects after their operation.

Of the 11 people who had surgery in group A, 5 people (45%) had side effects. And 2 (18%) of these had more serious side effects.

Of the 10 people who had surgery in group B, 9 people (90%) had side effects. And 5 (50%) of these had more serious side effects.

The team also looked at how many people had side effects from chemotherapy.

Of the 9 people in group A who had chemotherapy after surgery, 8 people (89%) had side effects. And 2 (22%) of these people had more serious side effects.

Of the 15 people in group B who had chemotherapy, 11 people (73%) had side effects. And 3 (20%) of these people had more serious side effects.

Finding people to take part

The research team found that it was difficult to find people to take part in this study.

They think this could be because some doctors already prefer one treatment option, and some prefer the other. So they don’t want to put patients in a trial where the treatment is decided at random.

Conclusion

The research team concluded that the results suggest people who have chemotherapy after surgery may have fewer side effects from their operation. But that a similar number of people in each group finished treatment as planned. This study was too small to draw any firm conclusions about which treatment is best.

They also concluded that it would not be possible run a larger trial comparing these two treatments.

Where this information comes from

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item

) but may not have been published in a medical journal. The figures we quote above were provided by the research team. We have not analysed the data ourselves.