A trial looking at chemotherapy and panitumumab before surgery for bowel cancer (FOxTROT)

Cancer type:

Bowel (colorectal) cancer

Colon cancer

Status:

Results

Phase:

Phase 3

This trial looked at whether having chemotherapy and panitumumab before surgery helps stop bowel cancer coming back.

The trial was supported by Cancer Research UK. It was open for people to join between 2008 and 2016. The research team first presented some early results at a conference in 2019.

They are due to publish more results in 2023.

More about this trial

Doctors usually treat bowel (colorectal) cancer with surgery. Many people also have chemotherapy after surgery to help stop the cancer coming back. But sometimes the cancer starts to grow again.

In this trial, the researchers looked at giving some chemotherapy before surgery (neoadjuvant chemotherapy). They hoped it would make the cancer smaller and easier to remove. And treat any cancer cells that had moved away from where the cancer started.

Some of the people taking part also had a drug called panitumumab (Vectibix) before surgery. This is a type of targeted treatment called a monoclonal antibody.

We already knew from research that panitumumab is only helpful for people who don’t have a change (mutation) to a gene called RAS. So that part of the trial was only for people who had a normal RAS gene.

The main aims of the trial were to find out:

if having some chemotherapy before surgery helps stop bowel cancer coming back
if panitumumab helps stop bowel cancer coming back in people with normal RAS genes

Summary of results

The results so far show that chemotherapy before surgery for bowel cancer could be a useful treatment option.

The trial team are due to publish more results in 2023. We will update this page as soon as we can when these results are available.

About this trial

More than 1,000 people with bowel cancer took part in this trial. They were all due to have surgery and chemotherapy.

To begin with they were put into 1 of 2 treatment groups at random. One group would have chemotherapy before and after surgery. The other would have chemotherapy after surgery, but not before.

People in the group having chemotherapy before surgery who had a normal RAS gene were then divided into 2 sub groups at random. One group would have panitumumab as well as chemotherapy before surgery, the other would not.

In total 1,052 people were put in 3 treatment groups:

Group A – 555 people had chemotherapy, then surgery and then more chemotherapy
Group B – 143 people had chemotherapy and panitumumab, then surgery and then more chemotherapy
Group C - 354 people had surgery and then chemotherapy

895_foxtrot.png

Results

In 2019, the research team presented the first analysis of the results. The information below is a summary of these early results.

The team looked at how many people’s cancer had continued to grow or had come back after surgery. They found it was:

more than 1 out of 10 people (14%) who’d had treatment before and after surgery
just less than 2 out of 10 people (18%) who’d had treatment after surgery but not before

895_foxtrot_2.png

They also looked at the number of people whose cancer could not be completely removed during the operation. They found it was:

33 people (5%) who’d had treatment before surgery
34 people (10%) who hadn’t had treatment before surgery

Side effects

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

They found that people who had some chemotherapy before surgery were less likely to have problems such as an infection, or to need another operation. They were also more likely to have a shorter stay in hospital.

Conclusion

The research team concluded that chemotherapy before surgery to remove bowel cancer is a useful treatment option. They suggest it could be used for this group of patients. But more work needs to be done to find out about the long term benefits.

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.