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FOxTROT Trial: Neoadjuvant Chemotherapy for Operable Colon Cancer

By: Sarah Campen, PharmD
Posted: Thursday, August 22, 2019

For patients with operable colon cancer, neoadjuvant chemotherapy improved the 2-year failure rate, although this improvement fell short of statistical significance (P = .11). However, the results of the FOxTROT trial did suggest that neoadjuvant chemotherapy is safe and seems to be associated with less major postoperative morbidity. Matthew T. Seymour, MD, of the National Institute for Health Research Clinical Research Network, Leeds, United Kingdom, and colleagues presented these findings at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 3504).

In this international, randomized, controlled trial, 1,052 patients with operable, nonobstructed colon cancer were randomly assigned 2:1 to either the novel sequence of 6 weeks of leucovorin, fluorouracil, and oxaliplatin (FOLFOX) neoadjuvant chemotherapy, surgery, and then 18 weeks of FOLFOX or the control sequence of surgery followed by 24 weeks of FOLFOX. Additionally, patients with RAS wild-type disease assigned to the novel arm could optionally be subrandomly assigned 1:1 to receive or not receive panitumumab during the neoadjuvant chemotherapy phase.

In the intent-to-treat analysis, the 2-year rate of relapse or persistent disease was 13.6% in the novel arm and 17.2% in the control arm (P = .08). Evidence of histologic regression was seen in 59% patients after neoadjuvant chemotherapy, including some pathologic complete responses.

Key findings for patients in the novel sequence arm included no increased perioperative morbidity, significant downstaging of disease, fewer postoperative complications, and fewer cases of incomplete resection. “Neoadjuvant chemotherapy for colon cancer improves surgical outcomes and can now be considered as a treatment option,” concluded Dr. Seymour and colleagues.

Disclosure: The study authors’ disclosure information can be found at coi.asco.org.



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