BiCCC - Preventing relapse in high-risk bowel cancer patients following surgery

Colorectal cancer, also known as bowel cancer, accounts for over 2000 cancer diagnoses in Wales each year. Bowel cancer can often require a mix of treatments, such as surgery, chemotherapy and radiotherapy, but around a quarter of patients with intermediate stage disease will relapse after surgery and there are few, if any, methods to prevent this. One potential solution is to encourage the patient’s own immune system to kill any remaining cancer cells after surgery to prevent these cells growing into a new tumour.

Cancer Research Wales is funding a clinical trial called BiCCC (Brief intervention with Cyclophosphamide in Colorectal Cancer), which is investigating the use of the drug cyclophosphamide to prevent relapse of bowel cancer. In a previous Cancer Research Wales funded clinical trial, TaCTiCC, Professor Godkin’s team showed that low doses of cyclophosphamide could increase anti-cancer immune responses. This in turn led to prolonged survival of advanced stage bowel cancer patients and, since there were few or no side effects, a better quality of life too.

In the BiCCC trial, the team will give intermediate stage bowel cancer patients a 4-week course of low dose cyclophosphamide after their surgery and will compare the number of relapses to a group of patients not given the drug. The expectation is that the treated patients will have a significantly lower rate of relapses.

To better understand how this effect occurs, blood samples will be taken from the group of patients treated with cyclophosphamide to analyse their immune cells and see how effective they are at killing cancer cells. 

This trial has the potential to give future bowel cancer patients a safe new method to prevent dangerous relapses while preserving their quality of life.