Trial shows some benefit of adjuvant chemo for early colorectal cancer

(14 January 2008: VIDYYA MEDICAL NEWS SERVICE) -- A large European trial designed to determine the value of adjuvant chemotherapy after surgery for stage II colorectal cancer has found that patients receive "small but definite benefit" in both survival and risk of recurrence, say researchers at the University of Birmingham in England.

The QUick And Simple And Reliable (QUASAR) Trial Collaborative Group, led by Dr. Richard Gray, reported results on 3,239 patients after 5.5 years median follow-up in the December 15, 2007, Lancet. Compared with observation alone, patients receiving chemotherapy had an 18-percent reduction in risk of death, which, in a population whose mortality rate is about 20 percent, conferred an absolute reduction of 3.6 percent at 5 years. The 22-percent reduction in risk of recurrence occurred almost completely in the first 2 years, and then leveled off.

"Chemotherapy seems to prevent a proportion of recurrences and deaths rather than just delaying them," wrote the authors, "which makes the life-years gained more substantial, especially for younger patients."

Drs. David Cunningham and Naureen Starling of the Royal Marsden Hospital in Surrey wrote in an editorial that the QUASAR results do not fully resolve all of the issues in this population, and that "identification of patients most likely to benefit from therapy remains important." Subgroup analyses are underway.

Better information about these groups, they wrote, may help patients and physicians assess the risk/benefit ratio among the three options currently in use: fluorouracil with oxaliplatin, fluoropyrimidine, or observation. These newer drugs and combinations have largely supplanted the drugs tested in QUASAR.

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