Fluorouracil plus Levamisole as Effective Adjuvant Therapy after Resection of Stage III Colon Carcinoma: A Final Report

TLDR

The study aimed to evaluate whether adjuvant levamisole alone or levamisole plus fluorouracil improves cure rates in stage III colon cancer and concluded that the combination should become standard therapy for such patients. In a randomized, multicenter trial, 929 patients who had undergone curative resection of stage III colon cancer were assigned to observation, levamisole alone (50 mg orally TID for 3 days, then every 2 weeks for 1 year), or levamisole plus fluorouracil (450 mg/m² IV daily for 5 days, then weekly for 48 weeks) to compare recurrence and death rates. Over a median 6.5‑year follow‑up, fluorouracil plus levamisole lowered recurrence by 40 % and death by 33 % (P < 0.0001 and 0.0007, respectively), with only mild toxicity, excellent compliance, and no late side effects, whereas levamisole alone produced negligible benefit.

Abstract

To determine the effectiveness of two adjuvant therapy regimens in improving surgical cure rates in stage III (Dukes stage C) colon cancer.Randomized, concurrently controlled clinical trial.Major cancer centers, universities, and community clinics affiliated with the North Cancer Treatment Group, the Southwest Oncology Group, and the Eastern Cooperative Oncology Group.Those who had had curative-intent resections of stage III colon cancer in the previous 1 to 5 weeks.Patients were assigned to observation only, to levamisole alone (50 mg orally three times/d for 3 days, repeated every 2 weeks for 1 year), or to this regimen of levamisole plus fluorouracil (450 mg/m2 body surface area intravenously daily for 5 days and then, beginning at 28 days, weekly for 48 weeks).Rates of cancer recurrence and death. Early- and late-treatment side effects.With all 929 eligible patients able to be followed for 5 years or more (median follow-up, 6.5 years), fluorouracil plus levamisole reduced the recurrence rate by 40% (P < 0.0001) and the death rate by 33% (P = 0.0007). Levamisole reduced the recurrence rate by only 2% and the death rate by only 6%. With few exceptions, toxicity was mild and patient compliance was excellent. No evidence of late side effects was seen.Fluorouracil plus levamisole is tolerable adjuvant therapy to surgery; it has been confirmed to substantially increase cure rates for patients with high-risk (stage III) colon cancer. It should be considered standard treatment for all such patients not entered into clinical trials.