Fluorouracil plus levamisole as effective adjuvant therapy after resection of stage III colon carcinoma: a final report

Ann Intern Med. 1995 Mar 1;122(5):321-6. doi: 10.7326/0003-4819-122-5-199503010-00001.


Objective: To determine the effectiveness of two adjuvant therapy regimens in improving surgical cure rates in stage III (Dukes stage C) colon cancer.

Design: Randomized, concurrently controlled clinical trial.

Setting: Major cancer centers, universities, and community clinics affiliated with the North Cancer Treatment Group, the Southwest Oncology Group, and the Eastern Cooperative Oncology Group.

Patients: Those who had had curative-intent resections of stage III colon cancer in the previous 1 to 5 weeks.

Intervention: 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).

Measurements: Rates of cancer recurrence and death. Early- and late-treatment side effects.

Results: 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.

Conclusion: 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.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Chemotherapy, Adjuvant
  • Colonic Neoplasms / drug therapy*
  • Colonic Neoplasms / mortality
  • Colonic Neoplasms / surgery
  • Female
  • Fluorouracil / adverse effects
  • Fluorouracil / therapeutic use*
  • Follow-Up Studies
  • Humans
  • Levamisole / adverse effects
  • Levamisole / therapeutic use*
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Neoplasm Staging
  • Survival Rate


  • Levamisole
  • Fluorouracil