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Shorter chemotherapy could benefit patients

06 June 2011

Tim Maughan - webProfessor Tim Maughan

Bowel cancer patients could benefit from shorter initial periods of chemotherapy and planned ‘treatment holidays’, a Cardiff-led study has found.

While survival rates were unaffected by the break in treatment, the researchers found there were benefits in quality of life, including less time spent in chemotherapy, fewer hospital visits and reduced side-effects.

A collaboration led by Professor Tim Maughan, Professor of Cancer Studies, School of Medicine, on behalf of the MRC Clinical Trials Unit, conducted the largest study to date of advanced colorectal cancer. The team enrolled nearly 2500 previously untreated patients from 111 hospitals across the UK and Ireland.

The researchers investigated whether it might be possible to shorten the duration of initial chemotherapy from six months to 12 weeks. Chemotherapy would then restart when there was evidence that the disease was progressing. A group of patients receiving standard continuous chemotherapy was compared to a group receiving the same chemotherapy with planned treatment holidays (intermittent chemotherapy).

The findings, published online in The Lancet Oncology, showed that intermittent chemotherapy did not increase or significantly decrease survival for patients with normal levels of blood platelets. For three-quarters of patients with normal platelet counts, time off chemotherapy was associated with improved quality of life (less time on chemotherapy, fewer hospital visits, and reduced neuropathy and hand-foot syndrome). However, for patients with a raised platelet count, there was a five-month reduction in survival and impaired quality of life. A platelet count was therefore identified as a potentially valuable predictor before deciding to start intermittent chemotherapy.

In The Lancet Oncology article, the research team comment: "There seems to be a large subpopulation of patients for whom intermittent therapy provides similar survival benefit and can be recommended. This provides evidence for an option that oncologists should discuss with their patients.

"If confirmed in other datasets, the easily measurable marker of a raised platelet count at initiation of chemotherapy would be a helpful and cost-effective predictive biomarker for identification of patients in whom continuous therapy might be preferable in order to maximise symptom control and survival."

The same trial has also found that the targeted therapy cetuximab does not improve survival rates when added to standard chemotherapy for advanced colorectal cancer.

The unexpected results, published online today in a separate paper in the The Lancet, show that even the group of patients with a genetic mutation observed to respond to treatment in other settings, did not benefit from the addition of cetuximab.