Study offers new hope for colon cancer cases

Colon cancer is a leading cause of cancer deaths in both men and women, occurring most frequently in men and women older than 50.

Colon cancer is most common in people who smoke, eat a high-fat diet, and have a family history of colorectal cancer. However, majority of colon cancers occur in people older than 50 with no known risk factors other than age.

The landmark X-ACT study (Capecitabine in Adjuvant Colon Cancer Therapy), published recently in the New England Journal of Medicine, shows that capecitabine, an innovative oral chemotherapy, is an effective alternative to the current standard chemotherapy, intravenous 5-fluorouracil/leucovorin (i.v. 5-FU/LV) in the adjuvant treatment (post-surgery) of colon cancer.

These results show that capecitabine could replace i.v. 5-FU/LV as the standard treatment therapy in this setting.

"The data show the potential of capecitabine to prolong cancer-free life for more patients with early stage colon cancer. Clinicians can be confident that they are providing patients with an effective therapy that can be taken in the comfort of their own home," said study investigator and lead author Prof. Chris Twelves of the University of Leeds and Bradford Hospitals Trust in the United Kingdom.

"Furthermore, on average, with capecitabine a patient only needs eight hospital visits compared to 30 if treated with standard chemotherapy," Twelves said.

Adjuvant chemotherapy is the standard treatment approach for stage III colon cancer where chemotherapy is given in order to destroy any cancerous cells remaining in the body after the tumor has been surgically removed.

The landmark global X-ACT study is the first published large-scale clinical trial to demonstrate the benefits of capecitabine in an adjuvant setting in patients with colon cancer, successfully meeting its primary endpoint of demonstrating at least equivalent disease free survival. The study showed the following breakthrough findings:

• Proven efficacy: confirmed capecitabine to be at least as effective as standard chemotherapy. Three-year disease-free survival rates were 64.2 percent for patients treated with capecitabine, compared to 60.6 percent for those treated with i.v. 5-FU/LV.

• A prolonged cancer-free life: relapse-free survival rates are significantly higher with capecitabine than with standard intravenous chemotherapy.

• Tolerability: less predefined serious side effects which can be effectively managed.

Capecitabine is licensed in over 90 countries worldwide, including European countries, the United States, Japan, Australia and Canada.

Although the exact cause of colon cancer is unknown, most cases begin as polyps – small, pre-cancerous growths on the inner wall of the colon or rectum.

If not removed, some polyps can develop into cancer. However, the polyps are easily detected with screening tests, and often they can be removed during the same procedure.

Colon cancer, especially in its early stages, may not cause any symptoms. When present, symptoms may include:

• A change in bowel habits;

• Blood in the stool that is either bright red or very dark;

• Stools that are narrower than normal;

• Abdominal discomfort, such as gas pain, fullness, cramps, and bloating;

• Unexplained weight loss; and

• Fatigue.

Experts believe that many colorectal cancer cases can be prevented by having regular screening tests and having pre-cancerous colorectal polyps removed.

Screening tests, such as fecal occult blood test, flexible sigmoidoscopy, barium enema, and colonoscopy, are recommended after age 40 for those who have a high risk of colorectal cancer, and after age 50 for everyone else.