Last year in the UK over 60,000 cancer patients enrolled on clinical trials aimed at improving cancer treatments and making them available to all.
A trial looking at oxaliplatin and 5FU chemotherapy before surgery for cancer of the food pipe
This trial looked at oxaliplatin to shrink cancer of the food pipe (also called the oesophagus or gullet) before surgery.
More about this trial
Doctors treat cancer of the food pipe (oesophageal or gullet cancer) with chemotherapy, radiotherapy or surgery.
You have surgery to remove the cancer if the cancer hasn’t spread to other parts of the body (metastasised). You might have chemotherapy before surgery to shrink the cancer. This is neoadjuvant chemotherapy.
For this doctors usually use cisplatin and 5FU. But research had shown that oxaliplatin might be better than cisplatin. It works in the same way as cisplatin but has fewer side effects.
The aims of this trial were to find out:
- how oxaliplatin affects the cancer cells
- what the side effects are
Summary of results
The team found there was a varied response of oesophageal cancer to oxaliplatin and 5FU.
This was a phase 2 trial.
In this trial, everyone had 2 treatments of oxaliplatin and 5FU before surgery to remove their cancer. Researchers took tissue samples from everyone before and after having chemotherapy.
The team compared the samples from 30 people to see what happened to the
- those that appeared not to be affected by treatment and had very small changes in the genes of the cancer cells
- those that appeared to have a strong response to chemotherapy (with many gene changes (
mutations) before chemotherapy but only a few afterwards)
- a small number of cancers that had many gene changes before chemotherapy, but many different ones afterwards
The researchers say the 2nd group were passing through a ‘genetic bottleneck’. This is where a cancer had many different mutations before treatment, but only a few were left behind afterwards (suggesting most of the cancer had gone).
Normally before surgery doctors use a scan to assess the response of the cancer to chemotherapy (clinical response). And after surgery the cancer tissue that was removed is looked at under a microscope (pathological response). Generally, these ways meet with a good pathological response having a tight bottle neck. But the team found some people in whom it didn’t.
A few people seemed to have a pathological response under the microscope, without a bottle neck. Most importantly, a few people seemed to have a genetic response with a bottleneck but without a pathological response.
As there is a delay between chemotherapy and surgery, all people had a scan (
This is important, as it suggests that the cancer was responding to the chemotherapy. But part of it was able to grow back quickly after it stopped responding. The research team suggested that extra treatment may be helpful for these people.
Overall, the results suggest that response to chemotherapy is complicated and very difficult to predict. However, it may be better to assess response using tissue samples and scans together:
- before starting treatment
- during treatment
- after treatment
This might allow treatment to become more personalised.
We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (
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.
Professor Mark Middleton
Experimental Cancer Medicine Centre (ECMC)
Oxford Radcliffe Hospitals NHS Trust