Colorectal Cancer

This special “annual highlights” supplement to Oncology News International is acompilation of some of the major advances in the management of gastrointestinalcancers during 2003–2004, as reported in ONI. Guest editor Dr. James L. Abbruzzesecomments on the reports included herein and discusses advances in the clinicalmanagement of GI cancers, with a focus on developments in targeted therapy, newcombinations, adjuvant therapy, and what to watch for in 2004.

This special “annual highlights” supplement to Oncology News International is acompilation of some of the major advances in the management of gastrointestinalcancers during 2003–2004, as reported in ONI. Guest editor Dr. James L. Abbruzzesecomments on the reports included herein and discusses advances in the clinicalmanagement of GI cancers, with a focus on developments in targeted therapy, newcombinations, adjuvant therapy, and what to watch for in 2004.

This special “annual highlights” supplement to Oncology News International is acompilation of some of the major advances in the management of gastrointestinalcancers during 2003–2004, as reported in ONI. Guest editor Dr. James L. Abbruzzesecomments on the reports included herein and discusses advances in the clinicalmanagement of GI cancers, with a focus on developments in targeted therapy, newcombinations, adjuvant therapy, and what to watch for in 2004.

CHICAGO-An advanced three-dimensional (3D) fly-through-reality form of virtual colonoscopy is an effective frontline screening tool for an average-risk, asymptomatic population, according to a prospective, multicenter trial. "It is accurate for finding clinically important polyps, and it is comparable in sensitivity to the accepted gold standard of conventional colonoscopy," Perry Pickhardt, MD, associate professor of radiology, University of Wisconsin, Madison, said at a press conference at the 89th Annual Meeting of the Radiological Society of North America (RSNA).

SALT LAKE CITY-Compared with patients with locally advanced rectal cancer who receive chemoradiotherapy postoperatively, those who receive chemoradiotherapy preoperatively have a downstaging of their cancer at surgery, a lower rate of local recurrence, a higher rate of sphincter preservation when tumors are low lying, and a lower rate of adverse effects, according to early results of the German Rectal Cancer Study (CAO/ARO/AIO-94). Lead author Rolf Sauer, MD, director of the Strahlenklinik, Erlangen, Germany, presented the results at the 45th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO plenary session, abstract 2).

BETHESDA, Maryland—Newly released data show that the nation’s mortality rate for all cancers combined, which declined between 1994 and 1998, remained stable from 1998 through 2000. However, the mortality rate for the four leading malignancies in the United States—lung, female breast, prostate, and colorectal—continued to decline in the late 1990s, according to the "Annual Report to the Nation on the Status of Cancer, 1975-2000."

CHICAGO-The XELOX regimen, which combines oral capecitabine (Xeloda) and oxaliplatin (Eloxatin), was safe and "highly active" in a phase II study of 35 elderly patients with advanced colorectal cancer. On behalf of the Southern Italy Cooperative Oncology Group, Pasquale Comella, MD, of the National Tumor Institute, Naples, presented the study in a poster at the 39th Annual Meeting of the American Society of Clinical Oncology (abstract 2939).

The 5th University of Texas M. D. Anderson Cancer Center Investigators’Workshop was held on July 24-28, 2002, in San Diego, California.The purpose of these annual workshops has been to review the latest data onnew agents, with a particular focus on the broadly used agent irinotecan (CPT-11,Camptosar).

Irinotecan (CPT-11, Camptosar) is one of the new generation ofchemotherapeutic agents that has activity in advanced colorectal cancer.It has antitumor efficacy as a single agent, and also has beencombined with fluorouracil (5-FU) and leucovorin (IFL) to treat thesepatients. Randomized studies have confirmed the superiority of IFL to5-FU and leucovorin alone with regard to patient survival, time toprogression, and tumor response rate. The optimal schedule for combiningthese agents remains uncertain, but in the United States, theschedule of IFL weekly for 4 consecutive weeks repeated every 6 weeks,according to the schedule reported by Saltz et al, has been widely used,although with some toxicity (especially myelosuppression and diarrhea).In an attempt to improve the tolerability of IFL, some haveadvocated modifying the schedule of IFL to weekly for 2 weeks, withrepeated cycles every 21 days. Twenty-three patients with advancedcolorectal cancer have been treated on this schedule at a single institution.Therapy was well tolerated, with 35% of patients experiencinggrade 3/4 neutropenia, two of whom had episodes of febrile neutropenia,and 9% with grade 3/4 diarrhea. The median relative dose intensityof irinotecan administered in the first 18 patients treated with thisregimen was 94%. These data support the hypothesis that modifying theschedule of administration of IFL improves the tolerability and abilityto deliver the regimen, but must be confirmed by randomized prospectivestudies, which may also attempt to evaluate the role of bolus 5-FUin the treatment of advanced colorectal cancer.

ROCHESTER, New York-Control of colon cancer may be mediated in part by the patient’s immune system, suggesting that treatments that enhance this innate capability could aid in reducing mortality. This is the principal conclusion taken from work carried out by Alok Khorana, MD, and his colleagues at the James P. Wilmot Cancer Center, University of Rochester Medical Center, and presented at the American Association for Cancer Research 94th Annual Meeting (abstract 512).

This special supplement to Oncology News International includes 28 reportswith updated information on clinical trials investigating capecitabine and other agents inthe treatment of advanced colorectal and breast cancers, and other solid tumors.The reports summarize selected presentations from the 39th Annual Meeting of theAmerican Society of Clinical Oncology (ASCO) and related educational symposiaheld in conjunction with ASCO.

This special supplement to Oncology News International includes 28 reportswith updated information on clinical trials investigating capecitabine and other agents inthe treatment of advanced colorectal and breast cancers, and other solid tumors.The reports summarize selected presentations from the 39th Annual Meeting of theAmerican Society of Clinical Oncology (ASCO) and related educational symposiaheld in conjunction with ASCO.

Anal cancer accounts for 1.5% of digestive system malignancies inthe United States. In the past 30 years, substantial progress has beenmade in understanding the pathophysiology and treatment of thedisease. Anal cancer was once believed to be caused by chronic localinflammation of the perianal area, and treatment was abdominoperinealresection. From epidemiologic and clinical studies, we nowknow that the development of anal cancer is associated with humanpapillomavirus infection and that the disease has a pathophysiologysimilar to that of cervical cancer. Less invasive treatments have alsobeen developed, and the majority of patients with anal cancer can nowbe cured with preservation of the anal sphincter using concurrentexternal-beam radiation therapy and fluorouracil (5-FU)/mitomycin(Mutamycin) chemotherapy. Current areas under investigation includethe incorporation of platinum agents into the chemotherapyregimen and the use of cytologic screening studies for high-riskpopulations.

Radiation therapy alone is an adequate treatment for some patients with rectal cancer, according to a study published in a recent issue of the International Journal of Radiation Oncology, Biology, Physics (54:142-149, 2002).

The US Senate Health, Education, Labor, and Pensions Committee has passed the Eliminate Colorectal Cancer Act (S.710), legislation introduced by Sen. Jesse Helms (R-NC) and Sen. Edward M. Kennedy (D-Mass). The bill, with the companion

Small bowel adenocarcinoma is a relatively rare malignancy. Only limited information is available on the incidence, prognosis, and role of chemotherapy in the treatment of this disease. We present a review of currently

Sanofi-Synthelabo recently announced that its platinum-based drug oxaliplatin (Eloxatin) has been approved by the US Food and Drug Administration (FDA) for use in combination with infusional fluorouracil (5-FU)/leucovorin in advanced colorectal cancer patients whose disease has recurred or progressed after bolus 5-FU/leucovorin plus irinotecan (CPT-11, Camptosar) therapy. The FDA approval is based on the response rate and improved time to tumor progression observed in an ongoing trial. Data that demonstrate a clinical benefit, such as improvement in disease-related symptoms or an increase in survival are not yet available.

Patients with advanced colorectal cancer who received the FOLFOX4 regimen (fluorouracil [5-FU], leucovorin, oxaliplatin [Eloxatin]) responded significantly better to treatment, had fewer severe side effects, and lived months longer than did patients

LOS ANGELES-PET/CT fusion imaging can improve the diagnostic certainty and localization of colorectal cancer, compared with PET alone, according to a retrospective review presented at the 49th Annual Meeting of the Society of

ORLANDO-Adjuvant fluorouracil (5-FU)-based chemotherapy for stage II-III colon cancer has been associated with a trend toward decreased survival for patients whose tumors show high-frequency microsatellite instability (MSI-H). This

ORLANDO-The National Initiative on Cancer Care Quality (NICCQ) has presented preliminary results from its ongoing survey of breast and colorectal cancer patients in five cities. The study, now in its second year, was prompted by a 1999 Institute of Medicine report that found serious gaps in the quality of care for many people.

A 75-year-old attorney presents with intermittent rectal bleeding. He had refused routine sigmoidoscopy in the past. His primary care physician was his friend, and he had convinced him to at least send in stool specimens for occult blood testing. Three years ago, his primary care physician informed him that "several" of the tests were positive and that he required evaluation. The patient refused and his doctor retired.

A study published in the journal Cancer (94:2327-2332, 2002) suggests that African-Americans who have colon cancer and live in poverty are at much greater risk of dying from the disease.

The US National Cancer Institute Gastrointestinal Intergroup has contributed to the development of chemotherapy and radiation regimens for the treatment of stage II and III rectal cancer. The first Intergroup trial demonstrated improvement in relapse-free and overall survival for patients who received protracted venous infusion fluorouracil (5-FU) with radiation compared to those treated with bolus 5-FU.

EAST MELBOURNE, Australia-A new prospective study has confirmed the usefulness of 18F-FDG PET in treatment planning for patients with confirmed or suspected colorectal cancer recurrence. In this study, 60% of planned surgeries were found to be unnecessary as the result of PET.

WESTBURY, New York-E-Z-Em, Inc. has begun marketing its InnerviewGI workstation for virtual colonoscopy procedures. The product is able to render three-dimensional (3D) images in just seconds and provides imaging professionals with multiple 3D view options (see figures below), as well as synchronized 2D and 3D views of the colon, the company said in a news release. InnerviewGI is powered by Vital Images’ Vitrea 2 software and features real-time navigation of 3D volume data.

Studies of a new treatment strategy for colorectal cancer using a therapeutic cancer vaccine technology have begun enrolling patients at several trial sites around the United States and Canada.

The multistep process of carcinogenesis, which can take many years, provides many opportunities for intervention to inhibit disease progression. Effective chemoprevention agents may reduce the risk of cancer by inhibiting the initiation stage of carcinoma through induction of apoptosis or DNA repair in cells harboring mutations, or they may act to prevent promotion of tumor growth. Similarly, chemoprevention may entail blocking cancer progression to an invasive phenotype.

One of the most important prognostic factors in colorectal cancer is the presence or absence of regional lymph node metastases. In many instances, micrometastatic disease may not be found on routine pathologic analysis using hematoxylin and eosin staining, but may be discovered only with immunohistochemical methods or polymerase chain reaction assay.

The Fourth Investigators’ Workshop sponsored by The University of Texas M. D. Anderson Cancer Center was held on July 25-29, 2001, in Colorado Springs, Colorado.