Colorectal cancer patients who receive fluorouracil-based adjuvant chemotherapy have similar survival rates whether the chemotherapy is delivered by vein or by mouth (regionally), to a specific area of the body (systemically), or by a combined regimen of both methods, according to a new study, which appears in the May 19 issue of the Journal of the National Cancer Institute.
Each year, about 1 million people worldwide are diagnosed with colorectal cancer and about half that number dies from the disease. After tumors are removed surgically, many patients are treated with fluorouracil-based adjuvant chemotherapy. Whether the chemotherapy should be delivered regionally or systemically, however, has been controversial.
In the journal, Jean Grem, M.D., professor of oncology and hematology, UNMC Department of Internal Medicine, published an editorial about the study.
In the editorial, she discusses the difficulty in studying the various regimens of adjuvant chemotherapy available for treating colorectal cancer. “The clinical research strategy for the adjuvant therapy of colon cancer must be focused, yet flexible, to accommodate the evolving status of available novel therapies,” Dr. Grem said.
Dr. Grem directs the Gastrointestinal Oncology Program and the Oncology Drug Development Program at UNMC.
To test the effectiveness of both methods of chemotherapy, Roberto Labianci, M.D., of the Ospedali Riuniti in Bergamo, Italy, and colleagues conducted a randomized clinical trial of 1,084 patients with colon cancer stage B or C. After surgery, the patients received the regional regimen, the systemic regimen, or regional followed by systemic chemotherapy.
Survival rates after 5 years — 74 percent for the regional regimen, 78 percent for the systemic regimen, and 73 percent for the combination—were similar for all three groups, as were rates of survival without recurrences or second malignancies. However, only 9 percent of patients who received the regional regimen experienced an adverse reaction to the chemotherapy compared with 47 percent who received the systemic regimen.
“The main result of this study is that the combination [systemic plus regional] regimen did not provide an additive benefit and, in fact, was similar to that of the chemotherapy delivered by either the [regional] regimen or the [systemic] regimen alone. Overall survival and event-free survival rates were similar among all three groups,” the authors wrote.
The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute.