A study to determine the feasibility of molecular selection of therapy in patients with metastatic colorectal cancer

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When cancer of the bowel is not completely removable by surgery, or when the cancer has spread to somewhere else in the body, chemotherapy, a form of drug treatment which aims to kill cancer cells, may be given. Usually, the specific chemotherapy that is offered to a patient is chosen on how well it works on average in patients.There are in all five types of medicine which have been shown to work in colorectal cancer. The most commonly used chemotherapy for bowel cancer is called ?5FU?, which is also known as ?fluorouracil?. Our previous study (called FOCUS) showed that the combination of 5FU and irinotecan, a new drug, gave the best results, so this is being used as the standard treatment in this research. This will allow us to compare the usual treatment against different combinations of medicines.In recent years two new treatments have been developed which are not standard chemotherapy. These are called cetuximab and bevacizumab (monoclonal antibodies), which specifically act on special proteins associated with the growth of the cancer. In this trial we will be comparing ways of using all these drugs in the best way by testing the treatments that we think will work best for the type of tumour that participants have, according to molecular testing. These tests will identify the cancer as one of four ?types?.For each type of cancer, we will be comparing the effects of different treatment plans. Patients will be randomly allocated to three different treatments to discover which is best; one is the usual course of treatment that would be offered. The other two plans are those which the tumour sample tests suggest might be better than the usual treatment for that particular type of bowel cancer. The treatment is given on a regular basis, every two weeks and continues for at least six months, provided the cancer remains under good control and there are no unpleasant side effects.Participants of the trial will also be asked for permission to use the tumour sample they have already given in future scientific studies. Specifically, we will look at other possible tests of proteins or of genes that may predict which treatment would work best for individual patients. In addition, we will ask participants for a blood sample for further research purposes.