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

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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. It was supported by Cancer Research UK.

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.
 
This trial was open for people to join between 2008 and 2016, and the research team first presented the results at a conference in 2019.
 
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

 The research team presented the first analysis of the results in 2019. They looked at the results for groups A and B together, and compared them to group C.

They plan to compare the people who had panitumumab (group B) with those who didn’t (group A) in a separate analysis. We hope to update this page when those results are available.
 
Results
When the team looked at how many people’s cancer had continued to grow or had come back after surgery, 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

 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.

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Prof Dion Morton

Supported by

Bobby Moore Fund (BMF)
Cancer Research UK
Experimental Cancer Medicine Centre (ECMC)
NIHR Clinical Research Network: Cancer

Other information

This is Cancer Research UK trial number CRUK/07/014.

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Freephone 0808 800 4040

Last review date

CRUK internal database number:

895

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Cara took part in a clinical trial

A picture of Cara

"I am glad that taking part in a trial might help others on their own cancer journey.”

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