FOxTROT
Does preoperative oxaliplatin-fluoropyrimidine chemotherapy improve outcomes versus postoperative chemotherapy alone in operable locally advanced colon cancer?
Trial design and population
Population: 1,053 patients with radiologically staged T3–4, N0–2, M0 operable colon cancer.
Treatment vs comparator: Six weeks preoperative oxaliplatin-fluoropyrimidine followed by 18 postoperative weeks vs 24 postoperative weeks.
Registry: ISRCTN87163246
Key results
Residual/recurrent disease by 2 years 16.9% vs 21.5% (rate ratio 0.72, 95% CI 0.54–0.98; p=0.037). Complete resection 94% vs 89%. Approximate NNT 22 to avoid one residual/recurrent event by 2 years.
Residual or recurrent disease · 2 years
Bars are scaled to the larger reported value. Median survival differences are not NNTs.
Absolute effect
Endpoint/time horizon: Residual or recurrent disease · 2 years. NNT is not calculated from median survival or hazard ratios; use fixed-time absolute risks only. NNH not calculated without a defensible fixed-time excess-harm risk difference.
Safety, burden and QoL
About 4.3% allocated to neoadjuvant treatment developed obstructive symptoms requiring expedited surgery. Also consider neuropathy, cytopenias, diarrhoea and surgical delay.
QoL and discontinuation percentages are not asserted without full source-table verification; source-level QoL/toxicity audit remains a QC item.
Subgroups, maturity and limitations
Selective strategy for radiologically locally advanced disease, not all operable colon cancers. NNT is approximate and specific to the 2-year endpoint.
Distinguish prespecified from exploratory subgroup analyses and mature from immature endpoints. Verify current guideline context before applying historical trial findings.
Current-practice context · 21 October 2026
Confirm current guidelines, regulatory status, biomarkers, prior treatment, comorbidities and patient goals. Full clinical freshness and source-level QoL audit remain pending.