surgery combined with chemotherapy

According to Public Health France, colorectal cancer is one of the most common cancers. Second cause of death by cancer, more than 40,000 new cases of colorectal cancer are recorded each year in France. A recent study evaluated the value of chemotherapy before or following surgery in patients with locally advanced colon cancer. Results.

Colon cancer, what is the benefit of chemotherapy before surgery?

The cancer colorectal is one of the most common cancers in France. Five stages of cancer are defined by the specialists, the cancer being able to evolve schematically in three stages:

• A localized tumour;
• A locally advanced tumour, i.e. extending to nearby lymph nodes;
• A metastatic tumor, which has spread to other organs, such as the liver.

Treatments for colorectal cancer include surgery, chemotherapy, and targeted therapies. In what order can these different treatments intervene to optimize the patient’s prognosis? Currently the recommendations recommend chemotherapy following surgery. A recent study evaluated the positioning of chemotherapy before and/or following surgery in patients with locally advanced colon cancer.

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Shrink the colon tumor before operating it

This study was conducted in British, Danish and Swedish patients with stage T3-4, N0-2, M0 colon cancer (according to the radiological classification of colorectal cancer) (average age 63 years). These patients were randomly divided into two groups:

• A NAC group of 699 patients who received 6 weeks of chemotherapy (oxaliplatin and fluoropyrimidine) before surgerythen 18 weeks postoperatively;
• A control group of 354 patients who received 24 weeks of chemotherapy only following tumor resection surgery.

Meanwhile, patients with RAS-wildtype tumors might also benefit from targeted therapy with panitumumab. Half of the patients received this targeted therapy during preoperative chemotherapy, the other half did not. Of the 699 patients in the NAC group, 87% completed the protocol to completion. 98% of patients in the NAC group and 99% of patients in the control group underwent colon tumor resection surgery.

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Preoperative chemotherapy, a new treatment option for locally advanced colon cancer?

4% of patients in the NAC group presented signs requiring surgery before the end of the 6 weeks of preoperative chemotherapy. Preoperative chemotherapy allowed to reduce the number of postoperative complicationsbut also to induce tumor regression. This reduction of the tumor thanks to the preoperative chemotherapy made it possible to have better results with the surgery, with a more complete resection (less tumor residues following surgery), 94% in the NAC group versus 89% in the control group.

The implementation of the NAC protocol resulted in a reduction in the number of residual or recurrent disease within two years of diagnosis, with only 17% of patients affected in the NAC group versus 21.5% in the control group. Tumor regression by preoperative chemotherapy was found to be strongly correlated with the absence of recurrence in the two years. The use of targeted therapy with panitumumab did not improve the benefit of the NAC protocol. These new data indicate that the implementation of six weeks of preoperative chemotherapy leads to better results during surgery and better control of the disease. This preoperative chemotherapy might be considered as a new, safe and effective treatment option in the management of locally advanced colon cancer.

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Estelle B., Doctor of Pharmacy

Sources

– Preoperative Chemotherapy for Operable Colon Cancer. ascopubs.org Accessed January 24, 2023