Latest chemotherapy drugs help people with bowel cancer live longer
Publication Date:24/09/2007
New combinations of chemotherapy drugs could extend the lives of people with advanced bowel cancer by as much as eight months, a new study suggests. But the benefits of chemotherapy have to be balanced against serious side effects.
What do we know already?
More than 36,000 people in the UK are diagnosed with bowel cancer each year. About 3 in 10 of these are diagnosed with advanced cancer that has spread outside their bowel to other parts of their body.
Advanced bowel cancer is difficult to treat, but doctors can use surgery, chemotherapy and radiotherapy to control it for as long as possible. New and better treatments mean that people with advanced bowel cancer now live longer than at any time in the past.
However, the exact benefit of newer chemotherapy drugs isn't clear. Also, any advantage from living longer has to be weighed against the unpleasant side effects that chemotherapy can have. Researchers have now looked at the results of hundreds of studies to get a better picture of the risks and benefits of new types of chemotherapy.
What does the new study say?
Chemotherapy for advanced bowel cancer often includes the drugs fluorouracil and leucovorin (also called folinic acid). The researchers imagined a patient who might live for a year while taking these drugs. Adding the drugs irinotecan (brand name Campto) and bevacizumab (Avastin) would help that imaginary patient live for an extra eight months, the researchers say. Adding the drug oxaliplatin, plus either bevacizumab or irinotecan, would mean nearly an extra five months. Adding irinotecan or oxaliplatin on their own would add nearly two months.
However, these benefits have to be weighed against the side effects. The combination of drugs that helped people live longest had an 85 in 100 chance of causing serious health problems. And there's between a 1 in 100 and 2 in 100 chance of a split in the wall of your bowel, which would need emergency surgery. There's also a risk of a blood clot in your veins, which can be dangerous if it gets stuck in your lungs. Unpleasant, but less serious side effects include diarrhoea, a sore mouth and feeling sick.
Where does the study come from?
The study was done by researchers at the University of Ioannina School of Medicine in Greece. It appeared in a journal called The Lancet, which is published by a company called Elsevier.
How reliable are the findings?
A big problem with the study is that it didn't compare the different kinds of chemotherapy directly. This makes the results less reliable. Suppose researchers do two studies, one for drug A and another for drug B. Drug A helps most of the people who take it, but drug B only helps a few patients.
It might seem likely that drug A is better, but it may not be. Perhaps, in the original studies, drug A was tested in young people with a mild illness. But drug B was given to older people who were seriously unwell. So the results were affected by differences between the groups of people who took the drugs.
When researchers compare drugs indirectly across several studies, it's hard to account for things like this. Differences between groups of people might not be as obvious as their being younger or healthier, but could still affect the results.
The new study is a useful guide about which kinds of chemotherapy might work best. But researchers need to compare the treatments directly to be sure.
What does this mean for me?
Deciding on treatments for advanced bowel cancer can be very difficult. Chemotherapy may help you live longer, but this has to be weighed against the side effects. Travelling to and from hospital for treatment can be very tiring. It's important to talk to your specialist about what your options are and what you can expect from treatment. Many people also find it helpful to talk over their treatment with a relative or friend.
In the UK, NHS treatment for bowel cancer includes chemotherapy with fluorouracil and leucovorin (folinic acid), along with either irinotecan (Campto) or oxaliplatin.
Bevacizumab (Avastin) is available in the UK, but isn't recommended for use on the NHS.
What should I do now?
If you're being treated for bowel cancer and have questions about your treatment, you can make an appointment to talk to your cancer nurse or specialist.
If you're worried about bowel cancer, make sure you take part in a screening programme. In England, people aged between 60 and 69 are offered screening every two years, using a home test. If you're older than this, you won't be offered screening, but you can ask for it. There's also a screening system in Scotland for people aged between 50 and 74. Screening programmes are being planned in Wales and Northern Ireland.
If you're at a higher risk of bowel cancer for any reason, perhaps because of a family history of the disease, make an appointment to talk to your doctor. You may need screening more often, or from a younger age.
If you're not eligible for screening on the NHS, you can choose to be tested privately. It's a good idea to discuss this with your GP.
If you are ever worried about bowel symptoms for any reason, talk to your doctor as soon as you can.
To read more, see our information on bowel cancer.
News Archive
© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
