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Rectal Cancer - Recurrent/Relapsed
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Folic Acid May Be Beneficial in Patients with Recurrent Colorectal Adenoma Who Are Folate Deficient (11/20/2009)
Researchers affiliated with the Health Professional Follow-Up Study and the Nurses’ Health Study have reported that folic acid supplementation in patients with recurrent colorectal adenoma was not protective or harmful in most patients. However, patients who were folate deficient had a significant 39% decrease in adenoma recurrence. The details of this study appeared in an early online publication on October 28, 2009 in the American Journal of Clinical Nutrition.
Early Skin Treatment Reduces Skin Reactions in Colorectal Cancer Patients Treated with Vectibix® (8/25/2008)
Among patients with colorectal cancer, skin treatment beginning on the day prior to therapy with Vectibix® (panitumumab) significantly reduces skin side effects associated with Vectibix compared with skin treatment after side effects occur. These results were presented at the 10th World Congress on Gastrointestinal Cancer held in Spain in June 2008.
More Fruits and Veggies, Less Meat Reduces Colorectal Cancer (8/14/2008)
Researchers affiliated with the NIH-AARP Diet and Health Study have reported that individuals who consume a diet that is rich in vegetables, fruits, whole grains, and healthy oils, contains sufficient dietary calcium and vitamin D, and is low in solid fats, added sugar, and red meats have a significantly reduced risk of developing colorectal cancer. These results were recently published in the July 1, 2008 issue of the American Journal of Epidemiology.
Radiofrequency Ablation Effective for Lung Tumors (7/22/2008)
Researchers involved in a multicenter international trial have reported that the use of radiofrequency ablation for the treatment of lung cancer or pulmonary metastases provides an effective and safe therapeutic option for selected patients. These results were recently published in the July 7, 2008 issue of Lancet Oncology.
Patients with KRAS Mutation Do Not Benefit from EGFR Inhibitors (6/20/2008)
Several presentations at the 2008 annual meeting of the American Society of Clinical Oncology (ASCO) reported confirmatory data that treatment with epidermal growth factor receptor (EGFR) inhibitors such as Erbitux® (cetuximab) and Vectibix® (panitumumab) is only effective among patients with the normal KRAS gene, while those with a mutated KRAS gene demonstrate virtually no response to these agents. In essence, global consent was achieved at this year’s ASCO that all patients eligible for EGFR-targeted therapies should first undergo KRAS testing prior to initiation of therapy.
Erbitux® Alone Improves Outcomes in Refractory Colorectal Cancer (11/26/2007)
Researchers from Canada, Australia, New Zealand, and Singapore have reported that Erbitux (cetuximab) alone improves overall survival and progression-free survival in patients with relapsed and refractory advanced colorectal cancer. The details of this study were published in the November 15, 2007 issue of the New England Journal of Medicine.
Xeloda®, Eloxatin® and Tarceva® Effective for Previously Treated Metastatic Colorectal Cancer (4/28/2006)
Researchers from the Dana Farber Cancer Center have reported that the combination of oral Xeloda (capecitabine), intravenous Eloxatin (oxaliplatin) and oral Tarceva (erlotinib) is an effective palliative regimen for patients with previously treated metastatic colorectal cancer. The details of this phase II study appeared in the April 20, 2006 issue of the Journal of Clinical Oncology.
Cetuximab (Erbitux®) And Camptosar® More Effective Than Cetuximab Alone For Colorectal Cancer (6/10/2003)
In an oral session of the 39th annual meeting of the American Society of Clinical Oncology in June of 2003, researchers from Europe reported that the combination of Erbitux® plus Camptosar® more than doubled the response rate in Camptosar® refractory epithelial growth factor receptor (EGFR)-positive colorectal cancer patients. compared to Erbutux® alone. Erbitux® is a monoclonal antibody that binds to the extracellular domain of EGFR, competitively inhibiting the binding of extracellular ligand. When Erbitux™ is bound, it appears to stimulate internalization of EGFR.
Antiangiogenic Drug, Bevacizumab (Avastin"), Improves Response of Colorectal Cancer to Combination Chemotherapy (6/10/2003)
At the 2003 meeting of the American Society of Clinical Oncology, Dr. Herbert Hurwitz from Duke University Medical Center presented the results of a randomized multi-center trial demonstrating the effectiveness of Avastin™ plus combination chemotherapy for the treatment of metastatic colorectal cancer. This paper was presented as a late breaking oral presentation and the abstract has not yet been published. The summary of this study was published in the ASCO Daily News for June 2, 2003.
Rectal Cancer Outcomes Improve when Institutions Treat More Patients (5/21/2003)
Researchers reported an inverse relationship between the number of patients treated for rectal cancer and outcome as measured by permanent colostomies, 30 day survival, and 2 year survival. These results are based on analysis of data from California hospitals and were published in the May 21, 2003 issue of the
Journal of the National Cancer Institute. (1)
Single Agent Gemzar® or Navelbine® Equally Effective and Less Toxic Than Combination for Treatment of Elderly with NSCLC (3/19/2003)
Until recently, many elderly patients with metastatic non-small cell lung cancer (NSCL) were treated only with supportive care. It is estimated that only 20% of elderly patients with advanced lung cancer ever receive chemotherapy. Previous studies, however, have suggested that palliative chemotherapy in this group of patients increased the average survival by approximately one month and the one year survival by 9%. These results are comparable with those achieved in younger patients with this disease treated with chemotherapy. As a generality, combination chemotherapy offers better palliation for patients with locally advanced or metastatic NSCLC than do single agents. However, the situation is less clear for patients older than age 70 years because of existing co-morbidities. In the March 2003 issue of the
Journal of the National Cancer Institute, Italian researchers reported the results of a randomized trial which suggests that single agent chemotherapy is as effective as combination chemotherapy for elderly patients with NSCLC.
Randomized Trial Does Not Show Benefit For Intra-Arterial Chemotherapy For Colorectal Cancer Metastatic to Liver (2/3/2003)
The liver is the most frequent site of metastasis for patients with colorectal cancer and is the second most frequent cause of cancer death in this patient population. There have been a variety of treatments used for the majority of patients with colorectal cancer metastatic to the liver who are inoperable, including: intravenous chemotherapy, intra-arterial chemotherapy, interferon-alfa, conformal radiation therapy, radioactive lipitiol, liver transplantation, embolization, chemoembolization, cryotherapy, radiation-delivering microspheres and radiofrequency ablation. The most commonly used methods are intravenous chemotherapy with 5-FU and folinic acid or the same drugs administered intra-arterially. There are theoretical reasons to suggest that direct intra-arterial chemotherapy should be more effective and less toxic than intravenous administration. However, intra-arterial infusions require placement of a catheter into the hepatic artery and maintenance of this catheter for the duration of treatment.
Radiofrequency Ablation Superior to Cryosurgery for Treatment of Inoperable Primary or Secondary Liver Cancer (1/9/2003)
Currently, the only curative treatment option for primary or secondary liver cancer is surgical resection. However, only a small percentage of patients are eligible for surgery because the majority of patients have cancer that has replaced too much of the liver or spread outside the liver to other parts of the body. There are several non-surgical options for palliative treatment of inoperable primary or secondary liver cancer including percutaneous cryosurgery and percutaneous radiofrequency ablation. Cryosurgery utilizes extremely low temperatures to destroy cancers while radiofrequency ablation entails the use of an electric current that is passed into the area of cancer. Both techniques use ultrasound, computerized tomography (CT) scan, or magnetic resonance imaging (MRI) to place a needle probe into the cancer. Although both cryosurgery and radiofrequency ablation have been shown to be effective treatments for inoperable primary or secondary liver cancer, there have been no direct comparisons of these techniques. In the December 2002 issue of
Archives of Surgery, French researchers have compared the two techniques and concluded that percutaneous radiofrequency ablation produces more long lasting remissions than percutaneous cryosurgery.
Yttrium 90 Labeled Microspheres Enhance Palliation of Liver Metastasis (11/27/2002)
Patients with large bowel cancer frequently have metastasis to the liver. Whenever possible, such lesions are removed surgically. However, the majority of patients with bowel cancer metastatic to the liver have inoperable lesions. Treatment of patients with bowel cancer metastatic to the liver includes systemic chemotherapy, hepatic artery chemotherapy and embolization. More recently, microspheres containing radioactive yttrium 90 (SIR-Spheres®) have been evaluated, usually in combination with hepatic artery infusion. These microspheres produce high levels of local radiation in the area of injection. Recently, researchers from Australia compared the efficacy of hepatic artery chemotherapy with hepatic artery chemotherapy plus the infusion of SIR-Spheres®. They reported their findings in the December 2002 issue of the
Annals of Oncology.
Further Evidence That a High Dietary Fiber Diet Does Not Prevent Recurrence of Colon Polyps (11/7/2002)
In non-randomized trials, it has been suggested that diets high in bran fiber and low in fats prevent the development of colon cancer by preventing the development of adenomatous polyps. Similar findings have been made in regard to diets high in fiber from fruits and vegetables. In 2000, the Phoenix Colon Cancer Prevention Network published results of a randomized trial casting doubt on these observations.
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In this study, published in The New England Journal of Medicine, the researchers randomly allocated 1,429 men and women, ages 40 to 80 years, who had previously had one or more colorectal adenomatous polyps to receive a high-fiber wheat bran dietary supplement or a low-fiber wheat bran dietary supplement. The results demonstrated that approximately 50% of persons from both groups developed additional polyps. It was concluded that a dietary supplement of wheat bran did not reduce the risk for developing pre-cancerous adenomatous polyps of the colon and rectum.
Intensive Eloxatin™, Camptosar®, 5 FU and Leucovorin Regimen Promising for Metastatic Colon Cancer (9/30/2002)
For the past two decades, the standard palliative treatment for patients with metastatic colon cancer has been 5 FU and leucovorin. Over the past several years, Camptosar® has been evaluated and found to be equivalent or better than 5-FU/leucovorin. More recently, Eloxatin" has also emerged as a very active agent for the treatment of colon cancer. The exact sequence of administration of these active drugs for the treatment of patients with colon cancer is unknown. One approach is to administer all active drugs up front in order to obtain the maximum initial response. In some situations, a maximum initial response to chemotherapy could allow some inoperable patients to become operable. Researchers in Italy have evaluated a regimen of intensive treatment with the combination of Eloxatin", Camptosar®, 5 FU and leucovorin. They reported their results in the October 2002 issue of the
Journal of Clinical Oncology.
Dutch Prospective Study Confirms Increased Risk of Colorectal Cancer with Low Dietary Folate Intake (9/24/2002)
An adequate intake of folic acid is achieved by eating fresh fruits and vegetables. In previous retrospective studies, researchers have documented an approximate 35% increase in the risk of colorectal cancer in persons who consume the lowest amount of folic acid, compared to persons who consume the highest amount of folic acid. These observations have led to three large ongoing clinical trials evaluating chemoprevention of colorectal cancer with folic acid supplements. In the September 2002 issue of Cancer, Dutch researchers report the first prospective study of dietary folic acid intake on the incidence of colon and rectal cancer. This study started in 1986 and has a 7.3 year follow-up. Since 1986, the researchers have followed 120,852 men and women aged 55-69 years. There were 760 colon cancers and 411 rectal cancers during the follow-up period. For men and women, the risk of colon cancer was reduced by 27% in persons with the highest folic acid intake, compared to the lowest intake. For rectal cancer there were no differences in women, but men with high folic acid intake had a 34% reduction of cancer rates. The researchers found no differences in outcomes when they analyzed for the form of folic acid (i.e. whether it was in the form of polyglutamates or monoglutamates). They also found suggestive evidence that men who consume higher amounts of alcohol combined with inadequate intakes of folate and methionine are at a higher risk of developing rectal carcinoma.
Obesity is a Risk Factor for Colorectal Cancer in Premenopausal but not Postmenopausal women (9/19/2002)
Obesity in men has been associated with an increased incidence of colorectal cancer. However, studies in women have failed to show this association. Researchers from the Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine believe that the failure to show an association between obesity and colorectal cancer in women is because age has not been taken into consideration. In the August 2002 issue of the journal
Gut, researchers report that premenopausal obese women have a two-fold increase in the incidence of colorectal cancer.
Swiss Study Confirms Ability of Virtual Colonoscopy to Detect Lesions 10 mm or Greater in Size (9/5/2002)
Virtual colonoscopy, also called colonography, is a technique that uses rapid computerized tomography (CT) scanning with conventional or electron beam (EB) machines combined with sophisticated computer programs. Patients undergoing virtual colonoscopy have the same extensive bowel purging as those undergoing actual colonoscopy and have the same insufflation of air to outline the bowel. The important part of this approach is the computer programs that can produce images of the colon that mimic an actual colonoscopy. Virtual colonoscopy has been evaluated more and more over the past several years in order to determine how virtual colonoscopy compares to actual colonoscopy. This is important since actual colonoscopy is the best way to detect and monitor pre-malignant polyps, but is limited by the need for heavy sedation or anesthesia and a small but definite risk of perforation of the bowel. In addition, there are not enough skilled physicians to perform colonoscopy on all individuals who should have it done for screening for colon cancer. A previous study from the U.S. clearly demonstrated that almost all lesions in the colon that were 10 mm or greater could be detected by virtual colonoscopy, but not smaller lesions.
St. John's Wort (SJW) Interferes With the Metabolism of Irinotecan (8/23/2002)
One of the major concerns about the use of alternative or complimentary medicines is the interactions with conventional treatments for cancer. Patients and physicians have to be cognizant of the interactions of alternative or complementary therapies with chemotherapeutic agents used to treat cancer. St. John's Wort (SJW) is an herbal medicine used to treat depression. Unfortunately, SJW has an effect on the cytochrome P450 enzyme system and drug-transporting proteins. St. John’s Wort induces the expression of the cytochrome P450 CYP3A4 isoform in intestinal and hepatic cells and induces the expression of MDR1 P-glycoprotein in intestinal cells. Irinotecan is eliminated via CYP3A4- and P-glycoprotein-mediated routes. Thus, SJW could interfere with the action of irinotecan in patients with colon cancer. Researchers in Holland determined the effects of SJW on the metabolism of irinotecan in 5 patients and reported their results in the August 20, 2002 issue of the
Journal of the National Cancer Institute. They concluded that patients with colon cancer receiving irinotecan should not receive SJW.
Eloxatin® (Oxaliplatin) Approved for Colorectal Cancer in the United States (8/15/2002)
The Food and Drug Administration approved Eloxatin® (oxaliplatin) for the treatment of colorectal cancer. The standard chemotherapy combination for metastatic colorectal cancer is 5-FU/LV plus Camptosar® (irinotecan). Eloxatin® is approved for use in combination with 5-fluorouracil (5-FU)/leucovorin (LV) for advanced colorectal cancer that has progressed or recurred following therapy with Camptosar®/5-FU/LV.
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Virtual Colonoscopy Detects Larger Neoplasms of Colon (8/6/2002)
Virtual colonoscopy is a technique that uses rapid computerized tomography (CT) scanning with conventional or electron beam (EB) machines combined with sophisticated computer programs. Patients undergoing virtual colonoscopy have the same extensive bowel purging as those undergoing actual colonoscopy and have the same insufflation of air to outline the bowel. The important part of this approach is the computer programs that can produce images of the colon that mimic an actual colonoscopy. Virtual colonoscopy has been evaluated more and more over the past several years in order to determine how virtual colonoscopy compares to actual colonoscopy. This is important since actual colonoscopy is the best way to detect and monitor pre-malignant polyps, but is limited by the need for heavy sedation or anesthesia and a small but definite risk of perforation of the bowel. In addition, there are not enough skilled physicians to perform colonoscopy on all individuals who should have it done for screening for colon cancer.
Capecitabine and Oxaliplatin is an Active Drug Combination for Treatment of Advanced Colorectal Cancer (4/24/2002)
The results of a Swiss study evaluating the combination of capecitabine and oxaliplatin for treatment of advanced colorectal cancer were recently published in the
Journal of Clinical Oncology.
Advanced Age is not a Contraindication to Adjuvant Chemotherapy for High-Risk, Resected Colon Cancer (4/22/2002)
Researchers in Pennsylvania have concluded that advanced age is not a barrier to receiving adjuvant chemotherapy for high risk cancer of the colon. Adjuvant chemotherapy is the standard of care for patients with stage III cancer of the colon. However, it is unclear whether or not toxicities outweigh benefits in elderly patients. Thus, elderly patients with resected stage III colon cancer often do not receive adjuvant chemotherapy.
Gene Therapy with ONYX-015 Shows Responses in Patients with Colon Cancer Metastatic to the Liver (4/19/2002)
ONYX-015 is a tumor-selective, modified adenovirus that has been genetically engineered to replicate in and kill cancer cells that have abnormal p53 pathway while sparing normal cells that have functioning p53 protein. P53, a protein that protects the cell from developing into a tumor cell, is the most commonly altered gene in human cancer.
Mortality from Major Cancer Surgery and Morbidity From Prostate Surgery Lower in High Volume Hospitals Than in Low Volume Hospitals (4/16/2002)
There were two reports in the April 11 issue of the
New England Journal of Medicine which strongly support the concept that patients facing major cancer surgery should select a high volume hospital near where they live.
St John’s Wort Interferes with Action of Camptosar® in Patients with Colorectal cancer (4/12/2002)
Camptosar® (CPT-11) is an important drug for the treatment of advanced colorectal cancer. Its metabolism is extremely complex, with the involvement of several enzymes and drug-transporting proteins. Cytochrome P450 isozyme 3A4 (CYP3A4) mediated oxidation of CPT-11 is the principal elimination route of CPT-11 and leads to the formation of a series of inactive compounds, including APC.
Four Weeks of Anticoagulation Better Than One Week Following Cancer Surgery (4/5/2002)
Researchers from Sweden, Italy, England and Israel have reported in the March 28 issue of the
New England Journal of Medicine that prolonged anticoagulation versus one week of anticoagulation is better for patients undergoing abdominal cancer surgery.
Plasma Free Metanephrines Best Test for Excluding or Confirming Pheochromocytoma (4/3/2002)
A multicenter international study has determined that plasma free metanephrines provide the best test for excluding or confirming the diagnosis of pheochromocytoma. The data establishing this was published in the March 20 issue of the
Journal of the American Medical Association.
Women Experience Greater Toxicity With 5-FU-Based Chemotherapy for Colorectal Cancer (3/21/2002)
Researchers from the US and Canada have evaluated the toxicities in men and women associated with fluorouracil (5-FU)–based chemotherapy given on 5 consecutive days at doses of 370 to 450 mg/m2. They analyzed data from 1,093 women and 1,355 men treated with 5-FU. They found an increased incidence of stomatitis, leukopenia, alopecia and diarrhea but not of nausea, and vomiting in women. Half of the women experienced severe toxicity compared to only a third of the men (P < .0001). The differences were consistent across treatment cycles. Response rates and survival distributions were the same for both sexes. These researchers concluded that women experience toxicity more frequently and with more severity than men following 5-FU–based chemotherapy in a 5-day bolus schedule. They also suggest “these data raise the question of whether the recommended initial dose of 5-FU–based chemotherapy for women shouldbe lower than that for men”.
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