{"entity":{"id":"paper-foxtrot-preoperative-chemotherapy-colon-jco-2023","kind":"paper","name":"Preoperative chemotherapy for operable colon cancer: mature results of an international randomized controlled trial (FOxTROT)","aka":[],"tldr":"Six weeks of chemotherapy before the colon cancer operation, rather than all of it afterwards, shrank tumours, left fewer incomplete resections and cut two-year recurrence from 21.5 to 16.9 percent.","summary":"FOxTROT randomly allocated patients with radiologically staged T3-4, N0-2, M0 colon cancer 2:1 to six weeks of oxaliplatin-fluoropyrimidine chemotherapy before surgery plus eighteen afterwards, or to 24 weeks afterwards; patients with RAS wild-type tumours could also be randomised 1:1 to panitumumab or not during the preoperative phase. The primary end point was residual or recurrent disease within two years, with surgical morbidity, histopathological stage, regression grade, completeness of resection and cause-specific mortality as secondary outcomes.\n\nOf 699 patients allocated to neoadjuvant chemotherapy, 674 (96 percent) started and 606 (87 percent) completed it; 30 (4.3 percent) developed obstructive symptoms requiring expedited surgery, but serious postoperative complications were fewer than in the control group.","asOf":"2026-09-24","links":[{"label":"J Clin Oncol 2023","url":"https://doi.org/10.1200/JCO.22.00046"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/36657089/"},{"label":"Europe PMC full text (PMC10022855)","url":"https://europepmc.org/article/MED/36657089"}],"tags":["colorectal-evidence"],"related":["paper-mosaic-oxaliplatin-adjuvant-colon-nejm-2004","paper-niche-2-neoadjuvant-colon-nejm-2024"],"cancers":["colorectal","colon-cancer"],"sections":["chemotherapy","surgery"],"technologies":["cytotoxic-chemotherapy"],"targets":[],"drugs":["folfox","capox","oxaliplatin","panitumumab"],"companies":[],"institutions":[],"pathways":[],"terms":["neoadjuvant-adjuvant","msi"],"trials":[],"people":[],"bottlenecks":["b-surgery-radiation-innovation"],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2023,"doi":"10.1200/JCO.22.00046","pmid":"36657089","authors":"Morton D, Seymour M, Magill L, et al.","paperType":"rct","findings":["Residual or recurrent disease within two years: 16.9 percent (118 of 699) with neoadjuvant chemotherapy against 21.5 percent (76 of 354); rate ratio 0.72 (95 percent CI 0.54 to 0.98, p=0.037).","Histopathologically complete resection in 94 percent (648 of 686) against 89 percent (311 of 351), p<0.001.","Marked T and N downstaging and histological tumour regression, all p<0.001.","Panitumumab did not enhance the benefit from neoadjuvant chemotherapy.","Little benefit was seen in mismatch repair-deficient tumours."],"whatItMeans":"A UK-led trial that moved part of colon cancer chemotherapy in front of the operation, and showed that tumour regression grade after six weeks predicts recurrence, which is the basis for using the response itself to choose what follows.","caveats":["A 2:1 randomisation with a composite two-year endpoint rather than overall survival.","4.3 percent of patients needed expedited surgery for obstruction during the preoperative window.","Mismatch repair-deficient tumours gained little, and immunotherapy is now the neoadjuvant option for that group."],"changedPractice":true,"participants":1053},"route":"/key-papers/paper-foxtrot-preoperative-chemotherapy-colon-jco-2023/","neighbours":{"paper":[{"id":"paper-niche-2-neoadjuvant-colon-nejm-2024","kind":"paper","name":"NICHE-2: a single dose of ipilimumab and two of nivolumab before surgery clears dMMR colon cancer in most patients","route":"/key-papers/paper-niche-2-neoadjuvant-colon-nejm-2024/"},{"id":"paper-mosaic-oxaliplatin-adjuvant-colon-nejm-2004","kind":"paper","name":"Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer (MOSAIC)","route":"/key-papers/paper-mosaic-oxaliplatin-adjuvant-colon-nejm-2004/"}],"cancer":[{"id":"colon-cancer","kind":"cancer","name":"Colon cancer (adenocarcinoma of the colon)","route":"/cancers/colon-cancer/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"},{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"}],"drug":[{"id":"capox","kind":"drug","name":"CAPOX (capecitabine, oxaliplatin)","route":"/drugs/capox/"},{"id":"folfox","kind":"drug","name":"FOLFOX (5-FU, leucovorin, oxaliplatin)","route":"/drugs/folfox/"},{"id":"oxaliplatin","kind":"drug","name":"Oxaliplatin","route":"/drugs/oxaliplatin/"},{"id":"panitumumab","kind":"drug","name":"Panitumumab","route":"/drugs/panitumumab/"}],"term":[{"id":"msi","kind":"term","name":"Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)","route":"/terms/msi/"},{"id":"neoadjuvant-adjuvant","kind":"term","name":"Neoadjuvant / adjuvant / perioperative","route":"/terms/neoadjuvant-adjuvant/"}],"bottleneck":[{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}],"roadmap":[{"id":"colorectal-roadmap","kind":"roadmap","name":"Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation","route":"/roadmaps/colorectal-roadmap/"}]}}