Copernicus

This trial looked at whether it was useful for people with cancer of the back passage (rectal cancer) to have chemotherapy before surgery.

Radiotherapy, followed by surgery and chemotherapy is the standard treatment for rectal cancer. Research has shown that for some cancers giving chemotherapy before and after surgery can help to delay the cancer coming back.

In this trial doctors gave people the same amount of radiotherapy and chemotherapy as standard treatment but some of the chemotherapy was given before surgery.

The researchers wanted to find out:

• if it was possible to give chemotherapy before surgery
• if having chemotherapy before and after surgery helped to delay rectal cancer coming back
• about the side effects.

Results

The trial team found it was possible to give chemotherapy before surgery to remove rectal cancer.

This was a phase 2 trial. Everyone had chemotherapy before surgery to remove their rectal cancer. 60 people joined the trial and 57 of those had chemotherapy, radiotherapy then surgery. The average gap between finishing their radiotherapy and having surgery was 7 days. 3 people didn’t have surgery.

The cancer was completely removed in all 57 people. After surgery 45 people had more chemotherapy and 12 didn’t.

The researchers have followed up the people who had surgery for at least 1 year after surgery to see how they are.

The worst side effect of the chemotherapy and radiotherapy before surgery was a significant drop in white blood cells causing an increased risk of infection.

The trial team concluded that it is possible to give chemotherapy before surgery for rectal cancer. A larger phase 3 trial is being considered to study this further.