A pill to tackle bowel cancer

A smart tablet for advanced bowel cancer, which is expected to transform treatment of the disease, has just been launched in Britain.

The drug, called Xeloda, takes effect only when it reaches the site of a tumour, has fewer side-effects than existing treatments and is more likely to make tumours shrink.

It is also the first pill for advanced bowel cancer, which usually has to be treated in hospital using intravenous therapy.

The advance should help many of the 34,000 patients in the UK who discover they have bowel cancer each year. It's the second biggest cancer killer, affecting men and women equally.

A new case is diagnosed every 15 minutes. The worst aspect of the disease is that half of all patients will develop metastases - the advanced stage where the cancer spreads beyond the large bowel - and will ultimately die from the disease.

But these patients will benefit most from Xeloda, an oral chemotherapy agent. The only curative measure for bowel cancer is surgery if the tumour is discovered early.

In patients with metastatic cancer which has spread, removal of the secondary tumours in the liver, for example, can lead to prolonged survival.

However, many patients are diagnosed beyond this stage which means surgical intervention is not always possible, so chemotherapy and radiotherapy are used.

Unlike traditional chemotherapy, Xeloda targets abnormal cells, leaving healthy tissues alone and minimising side-effects.

It targets an enzyme that makes the tumour produce a cancer-killing agent, unlike infused therapy which visits other body sites in addition to the tumour.

Recent trials involving 1,200 patients worldwide showed that Xeloda, also known as capecitabine, was as effective as standard chemo-therapy, significantly safer and achieved better shrinkage of tumours.

There were important differences in side-effects, such as mouth ulcers and life-threatening infections, which led to fewer Xeloda patients being hospitalised for treatmentrelated side-effects compared with standard treatment.

The European regulatory body approved the drug, manufactured by Roche, which is also used in some countries for advanced breast cancer.

But it could be referred to the Government's 'rationing' body NICE (the National Institute for Clinical Excellence), which is considering whether three other drugs for colorectal cancer should be approved on the NHS.

Cancer expert Professor Jim Cassidy, from Aberdeen Royal Infirmary, said: 'The approval of Xeloda represents a significant step forward in the treatment of patients with metastatic colorectal cancer, one of the most resistant forms of the disease.'

He said the oral treatment reduces the number of times patients need to attend hospital, allowing patients more time at home with their family.

'Xeloda is kinder to patients. Because its mechanism of action targets the tumour tissue, patients typically experience fewer complications such as mouth ulcers, diarrhoea and severe infections'.

Dr Rob Glynne-Jones, Macmillan lead clinician in gastrointestinal cancer at Mount Vernon Hospital, Middlesex, has prescribed the drug to individual patients prior to licensing.

Work carried out by Dr Glynne-Jones showed the drug, which has not yet been priced, saved 'hundreds of hours of work' by specialist nurses because it replaced infused treatment on the wards.

Julia King, 53, from Chipping Norton, Oxfordshire, was diagnosed with bowel cancer in 1997 after two years of medical tests, several visits to the doctor and diagnosis of other disorders ranging from anaemia to depression.

In July 1997 she had the tumour removed and began intravenous (IV) chemotherapy, followed by radiotherapy, and more IV chemotherapy.

But the cancer returned in May 1998 and she had a pump fitted in her stomach to administer the chemotherapy until she had a second operation to remove tumours from her liver.

She was offered Xeloda last April, on a special licence basis, and was initially reluctant because she had been through sickness, weight and hair loss with previous chemotherapy.

But she hasn't looked back: her tumour growth has halted - now at its lowest level since being diagnosed - and she has a better quality of life.