AXIS--a suitable case for treatment. UK Coordinating Committee on Cancer Research (UKCCCR) Colorectal Cancer Subcommittee.

Journal article

Decisions about the role of adjuvant therapy in the management of colorectal cancer are rarely taken on the basis of sound scientific evidence. This is not because surgeons are capricious, but because sound scientific evidence is, unfortunately, a little thin on the ground. Since the first randomised trial in the UK was initiated some 15 years ago, less than 1% of the 26,000 cases of colorectal cancer each year have been entered into randomised clinical trials and a similar situation exists elsewhere. A recent overview of all of the published evidence worldwide from trials of radiotherapy in rectal cancer identified trials involving in total only some 5,000 patients. The individual trials were all too small to detect reliably (or refute reliably) any realistically moderate improvement in survival and, even when combined, their results are equivocal (Buyse et al., 1988). It is thus hardly surprising that surgeons are divided in their views of whether or not radiotherapy is a useful adjuvant treatment in this disease. A similar situation exists when considering the role of chemotherapy where, again, there is considerable uncertainty about whether adjuvant chemotherapy has any effect on mortality at all and, if it does have an effect, no consensus about the likely size of that effect. Recently, however, evidence that chemotherapy usually with 5-fluorouracil (5-FU) containing regimens - can moderately improve survival has been accumulating. The most promising treatments that have been examined are a 1-week post-operative infusion of 5-FU through the portal vein (Taylor et al., 1985), 18 months systemic administration of MOF (Fisher et al., 1988; Wolmark et al., 1988) and a year of systemic 5-FU given in conjunction with levamisole (Moertel et al., 1990). There is clearly a need for a more precise definition of the effect of adjuvant therapy on long term survival and so, in November 1989, the UKCCCR launched AXIS, an international randomised trial designed to be large enough to get definite evidence about any survival benefit of intraportal 5-FU and of perioperative radiotherapy. Even a moderate improvement in survival in this disease would be important because, since colorectal cancer is so common, an improvement of 'only' 5% in 5-year survival (say from 50% to 55%) could save many thousands of lives each year.

Authors: Gray, R; James, R; Mossman, J; Stenning, S

• Publication status: Published
• Journal: British journal of cancer
• Volume: 63
• Issue: 6
• Pages: 841-845
• Publication date: 1991-06-01
• DOI: 10.1038/bjc.1991.187
• EISSN: 1532-1827
• ISSN: 0007-0920
• Language: English
• Keywords: Humans; Clinical Trials as Topic; Colonic Neoplasms; Combined Modality Therapy; Rectal Neoplasms