Adjuvant chemotherapy for colon cancer offers no survival benefit after 10 years

August 03, 2004

In 1988, a team of researchers reported that, for patients with colon cancer, postoperative chemotherapy was associated with better 5-year disease-free and overall survival than surgery alone. However, this survival benefit disappeared after 10 years, according to an update of that same clinical trial that appears in the August 4 issue of the Journal of the National Cancer Institute.

In 1977, the National Surgical Adjuvant Breast and Bowel Project (NSABP) began a randomized clinical trial, NSABP protocol C-01, to evaluate the efficacy of adjuvant chemotherapy or postoperative immunotherapy after surgery compared with surgery alone in colon cancer patients. More than 1000 patients with Dukes' stage B and C colon cancer who had surgery for their cancer were given either no further treatment, chemotherapy, or immunotherapy. Patients who were given chemotherapy had better 5-year disease-free and overall survival compared with the surgery-only group, whereas patients who were given immunotherapy had only better 5-year overall survival. Neither the three-drug chemotherapy regimen nor the immunotherapy regimen is in common use any longer.

Roy E. Smith, M.D., of the NSABP in Pittsburgh, and colleagues evaluated the follow-up data collected after 10 years. They found that the disease-free and overall survival benefit for patients who received chemotherapy had disappeared after 10 years. The immunotherapy regimen had a beneficial effect on 10-year overall survival but not disease-free survival. This improvement was associated with fewer deaths from conditions other than colon cancer among the older patients in the trial.

It should be noted, however, that because the chemotherapy and immunotherapy used in this trial are no longer recommended for colon cancer, it is possible that the newer chemotherapy regimens would be better than surgery alone, the authors write.

In an editorial, Jean Grem, M.D., of the University of Nebraska Medical Center in Omaha, notes that neither of the regimens tested in this trial are currently in clinical use, so there is a need to find appropriate surrogate end points for colon cancer trials to expedite the clinical testing phase of potential new agents. She suggests the possibility of using 3-year disease-free survival as a surrogate end point for 5-year overall survival, noting that its advantages include "allowing more timely completion of trials, and more rapid implementation of new trials testing promising new therapies."
-end-
Contacts:
  • Article: Lisa Louis, The Regional Cancer Center, 814-838-0420, llouis@trcc.org
  • Editorial: Vicky Cerino, UNMC Public Affairs, 402-559-5190, vcerino@unmc.edu

    Citations:
  • Article: Smith RE, Colangelo L, Wieand HS, Begovic M, Wolmark N. Randomized Trial of Adjuvant Therapy in Colon Carcinoma: 10-year Results of NSABP Protocol C-01. J Natl Cancer Inst 2004;96:1128-32.
  • Editorial: Grem J. Adjuvant Therapy for Colon Cancer: A Historical Perspective. J Natl Cancer Inst 2004;96:1116-7.

    Note: The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage. Visit the Journal online at http://jncicancerspectrum.oupjournals.org/.

    Journal of the National Cancer Institute

    Related Cancer Articles from Brightsurf:

    New blood cancer treatment works by selectively interfering with cancer cell signalling
    University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

    UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
    A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

    Breast cancer treatment costs highest among young women with metastic cancer
    In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

    Cancer mortality continues steady decline, driven by progress against lung cancer
    The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

    Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
    Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

    Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
    The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

    Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
    Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

    More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
    An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

    New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
    Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

    American Cancer Society outlines blueprint for cancer control in the 21st century
    The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

    Read More: Cancer News and Cancer Current Events
  • Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.