Hope for patients with advanced bowel cancer

Early results of North American trials of chemotherapy drug oxaliplatin

For patients with bowel cancer that has spread to other organs despite treatment there has been little hope until now. However, early results of trials in North America of a chemotherapy drug called oxaliplatin, given in conjunction with two standard drugs, 5-FU and leucovorin, delay tumour progression by 70% compared with the control component of the study. There is also a significant improvement in the symptoms these patients experience.

Dr Mace Rothenberg from the Vanderbilt-Ingram Cancer Centre, Nashville, USA, lead a multi-centre trial in the USA involving 821 patients with advanced bowel – or colorectal – cancer to compare three different treatment strategies: 5-FU and leucovorin, oxaliplatin alone, or a combination of the drugs.

The delay in the progression and the shrinkage of the tumour lasted for a minimum of four weeks. “Both the delay in time to tumour progression and the reduction in tumour-related symptoms are very encouraging,” said Dr Rothenberg, speaking at the European Society of Medical Oncology Congress in Nice, France, today (21 October 2002). “We found that patients suffered less from pain, weight loss and fatigue with the combination therapy.”

The interim data from 463 patients were so promising that the US Food and Drug Administration gave its approval in August this year for oxaliplatin to be given to patients with advanced colorectal cancer that had progressed following first-line treatment. In Europe, however, oxaliplatin has been available since 1996. The drug is manufactured by Sanofi-Synthelabo in France.

Oxaliplatin can cause nausea, diarrhoea, anaemia and increased risk of infection, but on balance, the benefits appear to outweigh the side effects. 5-FU is given by intravenous drip and research is underway to find other easier means of delivery.

Bowel cancer affects nearly 150,000 people in the USA and around 35,000 people in the UK each year. It can arise in any part of the colon or rectum and is a leading cause of death.

“This trial should be fully mature in about six months. At that point we will know more about the impact of the oxaliplatin, 5-FU and leucovorin combination on the survival of patients with recurrent colorectal cancer,” said Dr Rothenberg.