Adjuvant therapy is given after surgery in order to decrease the risk of recurrence and improve overall long term survival. Adjuvant therapy can comprise cytotoxic and non-cytotoxic drugs as well as radiotherapy, the latter being of great interest for other Groups within the Department of Oncology.
Great progress has been made in the adjuvant colorectal cancer field over the last 25 years as we can now save a further 15-20 lives per 100 patients treated compared with surgery alone. However treatment is often delivered at great cost, both in terms of financial cost in a resource restricted environment, and toxic cost in terms of morbidity and mortality of patients undergoing such treatment. Therefore it is imperative that we not only improve the panoply (array) of drugs we can offer but also refine our ability to predict which patients will gain most benefit from which drugs. Additionally we need to predict which patients will suffer greatest toxicity, allowing us to dose reduce drugs a priori, or in some cases to avoid certain drugs altogether.
Throughout all of our large scale trials we collect blood and DNA for genetic profiling and also tumour tissue. This allows us to carry out highly powerful translational research and lends us the scope to define the biomarkers as outlined above. In addition to furnishing our own research, these huge biobanks with extremely clean and reliable clinical data can be mined by other researchers.
Recent and planned trials include:
- QUASAR2: Assessing the addition of bevacizumab (Avastin®) in the adjuvant treatment of colorectal cancer.
- SCOT: Assessing whether 3 months of adjuvant therapy can give equivalent efficacy compared to the standard 6 months of chemotherapy in the adjuvant treatment of colorectal cancer, thereby reducing toxic and financial cost.
- COLOSELECT: A planned multinational trial looking at the efficacy of aspirin and vitamin D in biomarker-selected populations of colorectal cancer.