Tom’s story as a patient who has had a ‘complete response’ to neoadjuvant treatment and joined the Deferral of Surgery clinical trial.
I was diagnosed with bowel cancer (T3N?M0), with a 4 cm tumour a few cm from the opening to my backside. I had 12 weeks of chemotherapy (CAPOX), then 5 weeks of chemo radiotherapy. Shortly after my chemo radiotherapy I had a CT and MRI which showed considerable shrinkage of the tumour. I was then offered the opportunity to join the Deferral of Surgery trial at the Royal Marsden Hospital, which has been sponsored by the Pelican Cancer Foundation for the last 8 years.
At about 13 weeks after my radiotherapy I had a further CT, MRI, PET and Flexible Sigmoidoscopy. The camera examination showed no sign of any remaining tumour, and the CT, MRI and PET were also clear, with the MRI showing scar tissue.
As a result I have had no surgery to date, and instead I am regularly checked with camera examinations, MRI’s, CT’s, digital rectal examinations and CEA blood tests. If any of these checks identify that the tumour has reappeared, I will then have surgery. Due to the location of the tumour, I would need to have a permanent colostomy bag.
These checks are still part of the Deferral of Surgery trial and take place in the Royal Marsden. For me joining the trial has meant regular trips to London for check-ups, the reassurance of regular check-ups by consultants, a greater understanding of bowel cancer treatment options and continued involvement with a Trial which can potentially save many patients from major surgery and permanent stomas.
There are estimates that around 20% of patients who have chemo radiotherapy before surgery have a complete response – this means that the tumour has disappeared and they no longer need to have surgery.
At the moment there is no way of telling which patients are most likely to have a ‘complete response’ and Pelican are supporting a new trial called the TRIGGER Trial which is aimed at trying to identify patients who could safely avoid surgery.