Gastrointestinal Cancer

Dr. Fakih and colleagues provide a detailed and thoughtful review of the role of chemoradiation in anal cancer treatment. They have included a comprehensive description of the epidemiology and risk factors for the development of squamous cell carcinoma of the anal canal, including the strong association with human papillomavirus (HPV) infection and increased incidence in human immunodeficiency virus (HIV)-positive individuals.

Although anal cancer is a rare disease, its incidence is increasing in men and women worldwide. The most important risk factors are behaviors that predispose individuals to human papillomavirus (HPV) infection or immunosuppression. Anal cancer is generally preceded by high-grade anal intraepithelial neoplasia (HGAIN), which is most prevalent in human immunodeficiency virus (HIV)-positive men who have sex with men. There is a general consensus that high-risk individuals may benefit from screening. Meta-analysis suggests that 80% of anal cancers could be avoided by vaccination against HPV 16/18. Nearly half of all patients with anal cancer present with rectal bleeding. Pain or sensation of a rectal mass is experienced in 30% of patients, whereas 20% have no tumor-specific symptoms. According to the Surveillance Epidemiology and End Results (SEER) database, 50% of patients with anal cancer have disease localized to the anus, 29% have regional lymph node involvement or direct spread beyond the primary, and 12% have metastatic disease, while 9% have an unknown stage. Clinical staging of anal carcinoma requires a digital rectal exam and a computed tomography scan of the chest, abdomen, and pelvis. Suspicious inguinal lymph nodes should be subject to pathologic confirmation by fine-needle aspiration. The 5-year relative survival rates are 80.1% for localized anal cancer, 60.7% for regional disease, and 29.4% for metastatic disease. Part 2 of this two-part review will address the treatment of anal cancer, highlighting studies of chemoradiation.

Confusion over important prognostic indicator may lead to unnecessary treatment.

A novel IGF-receptor inhibitor stabilized disease in a majority of pancreatic cancer patients, according to a report at the 2010 GI Cancers Symposium.

Four years ago, at least five years of statin use was found to be associated with a 53% reduction in the risk of colorectal cancer and that association still stands, according to a coauthor of one of the initial studies to make the statin-cancer connection.

A primer on managing the chemorefractory patient from Eric Van Cutsem, MD, PhD.

Screening is the key to protecting those at risk for pancreatic cancer, according to presenters at the 2010 Gastrointestinal Cancers Symposium.

Fluorouracil, oxaliplatin (Eloxatin), and bevacizumab (Avastin) for first-line therapy is preferred in metastatic colon cancer.

This review summarizes the current data on efficacy and rationale of adjuvant treatment for hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT). The authors review prognostic factors for disease recurrence and adjuvant therapy after OLT, including systemic chemotherapy, intra-arterial chemoembolization, immunosuppressant effects, and sorafenib (Nexavar). Several interesting questions are raised in the article, including: (1) When is the best time to apply systemic chemotherapy?

In this issue of ONCOLOGY, Kim et al discuss adjuvant therapy after liver transplantation to decrease recurrence of hepatocellular carcinoma (HCC). Liver transplantation offers the best overall and recurrence-free survival for the treatment of stage I and II HCC. The landmark study in 1996 by Mazzaferro demonstrated that liver transplantation of patients with one lesion less than 5 cm or with up to three lesions but all less than 3 cm (the Milan criteria) resulted in low recurrence rates and similar survival to patients without HCC.[1]

BERLIN-A pair of colon cancer trials using panitumumab (Vectibix) not only proved the efficacy of the drug in patients with nonmutated KRAS but also highlighted the importance of ascertaining KRAS status. Trial 181 evaluated panitumumab in combination with FOLFIRI as a second-line treatment for metastatic colorectal cancer, while trial 203 paired the anti-EGFR agent with FOLFOX4 as first-line treatment.

Annick Van den Abbeele, MD, couldn’t believe her eyes. Dr. Van den Abbeele, the chief of radiology at Boston’s Dana-Farber Cancer Institute, had seen the patient just a month earlier. At that time, the 35-year-old woman had a gastrointestinal stromal tumor in her abdomen that was so large, she looked six months’ pregnant. But at the patient’s follow up FDG-PET study, the tumor was completely gone.

Dr. Czito and colleagues provide an intriguing overview on adapting and using more technically advanced techniques to deliver radiation therapy for anal cancer patients. The paper starts with a brief history of the treatment of anal cancer, moving from abdominoperineal resection to combined-modality therapy with radiation and chemotherapy and discusses the trials showing that combined chemoradiotherapy is superior to radiation alone in terms of local control and colostomy-free survival.[1,2] Adding mitomycin to fluorouracil (5-FU) has been scrutinized for increasing toxicity but has been shown to decrease colostomy rates compared to cisplatin/5-FU or 5-FU alone.[3,4]

The combined-modality care of the patient with colon or rectal cancer metastatic to the liver demands a team approach. It is little wonder that there is much confusion about this topic, given the number of unique treatment options that are delivered in a sequential and reiterative process. The concept of multidisciplinary approaches to complex cancer challenges has been adopted for a variety of tumor types and situations.

The management of patients with colorectal cancer that has metastasized to the liver is a common clinical problem

Historically, the treatment of squamous cell carcinoma of the anal canal has been an abdominoperineal resection (APR), resulting in loss of the anus and rectum with need for a permanent colostomy.

BERLIN-The failure of a major colon cancer trial to reach its primary endpoint surprised even the most seasoned gastrointestinal cancer investigators. Overall survival was not improved when cetuximab (Erbitux) was added to a first-line oxaliplatin-based regimen (Eloxatin), according to phase III COIN trial at ECCO/ESMO 2009.

Common variants of the gene that determines human blood type are associated with an increased risk of pancreatic cancer, according to a study by scientists at the National Cancer Institute (NCI) and colleagues from many universities and research institutions. The study, published online August 2, 2009, in Nature Genetics, is consistent with an observation first made more than 50 years ago.

Young adults who are overweight or obese have an increased risk of pancreatic cancer, according to a study out of M.D. Anderson Cancer Center. In addition, the Houston-based researchers found that obesity at an older age is associated with a lower overall survival rate for patients with pancreatic cancer.

ORLANDO-Preliminary data suggested that Novartis’ RAD001 is moderately active in stabilizing the progression of HCC, according to a poster presentation at ASCO 2009 (abstract 4587). In this phase I trial, researchers in Taiwan enrolled 36 advanced HCC patients whose disease was not suitable for local therapy or had progressed after local therapy.

Since the early 1990s, postoperative adjuvant chemoradiotherapy was widely viewed as the main approach to treat patients with stage II and III rectal cancer. Over the past few years, significant efforts have shifted towards developing neoadjuvant approaches, which combine chemotherapy with radiotherapy prior to surgical resection.

SAN FRANCISCO-Routine KRAS testing in colon cancer patients received a major boost in January when ASCO issued a provisional clinical statement in favor of pretreatment genetic screening in metastatic disease. But KRAS is only the first step toward personalized medicine in colorectal cancer, according to reports presented at the 2009 Gastrointestinal Cancers Symposium. In fact, colon cancer treatment is headed in the same direction as breast cancer, with other genetic polymorphisms emerging as both predictive and prognostic.

Colorectal cancer is the second leading cause of cancer-related deaths in the United States. According to the most recent data from NCI, the relative five-year survival rate among metastatic colorectal cancer patients is 8%. While colorectal cancer can metastasize to other organs, including the lung, the liver is the most frequent site of metastasis. Metastases to the liver occur in approximately 50% of colorectal cancer patients and account for at least two-thirds of all colorectal cancer deaths.

SAN FRANCISCO-Two agents dramatically delayed the time to disease progression in metastatic neuroendocrine tumors, according to reports at the 2009 Gastrointestinal Cancers Symposium.

STOCKHOLM-For rectal cancer patients, a multidisciplinary team is critical to success because it increases the possibility of a curative resection, Andres Cervantes, MD, associate professor of medicine at University Hospital, Valencia, Spain, said at ESMO 2008. “Every patient should be treated within an expert multidisciplinary team,” he emphasized.

The treatment of older patients with colorectal cancer is not always straightforward. As highlighted in the article by Dr. Ades, the heterogeneity of physiologic aging, the increasing prevalence of comorbid disease with age, and changing preferences with aging make counseling about adjuvant therapy more complex for older patients than for younger patients.

States population will be over 65 years old, with 2% of the population over 84. The corresponding projections for 2050 are 21% and 5%, respectively.[1] These projections underscore the aging of the population, with most recent estimates of life expectancy hitting a record high of 78.1 years.[2] With Americans living longer than ever before, physicians are already seeing larger numbers of elderly patients with cancers whose incidence increases with age, including colon cancer.

Exiqon A/S has released its miRNAbased prognostic test designed to identify stage II colon cancer patients who may be at significantly higher risk for recurrence and for whom adjuvant chemotherapy may be warranted.

Excellent safety, efficacy, and tolerability profiles have resulted in the rapid integration of oral tyrosine kinase inhibitors into most facets of the treatment of gastrointestinal stromal tumors (GIST).

In the pre-imatinib era, surgery was the only effective treatment for gastrointestinal stromal tumor (GIST). However, this treatment modality was often either not possible or insufficient for cure due to the aggressive nature of this disease.