Gastrointestinal Cancer

COLORADO SPRINGS-Researchers from two large North American Intergroup colorectal cancer trials found an unexpectedly high rate of toxic deaths in trials containing irinotecan (Camptosar). No such problems had been apparently observed by oncologists using the combination of irinotecan, 5-fluorouracil (5-FU), and leucovorin (LV) (IFL) in routine clinical practice, and no such problems had been identified in the pivotal registration and European studies.

CHICAGO-A "dealer’s choice" rectal cancer trial in which treatment would be chosen by the physician and patient together has been proposed by the National Cancer Institute (NCI) Gastrointestinal Intestinal Intergroup. The Intergroup now includes research groups from the American College of Surgeons Oncology Group, Cancer and Leukemia Group B, the Eastern Cooperative Oncology Group, the North Central Cancer Treatment Group, the NCI Canada, the National Surgical Adjuvant Breast and Bowel Project (NSABP), the Radiation Therapy Oncology Group, and the Southwest Oncology Group.

WINSTON-SALEM, North Carolina-Preliminary data from a phase II trial of induction irinotecan (Camptosar)/gemcitabine (Gemzar) followed by twice-weekly gemcitabine and radiation in patients with locally advanced pancreatic cancer show partial responses in 2 of 7 evaluable patients. There were no local progressions, and median time to progression of 6 months, according to A. William Blackstock, MD. Dr. Blackstock is assistant professor at Wake Forest University, Winston-Salem, North Carolina, and at the University of North Carolina at Chapel Hill.

PORTLAND, Oregon-"Very preliminary data suggest that cyclooxygenase-2 (COX-2) inhibitors can be safely used in combination with irinotecan (Camptosar), and even more preliminary data suggest that such combinations are active in advanced colorectal cancer," reported Charles Blanke, MD. He explained that COX-2 is overexpressed in the majority of human colorectal cancers. Dr. Blanke is director of the GI Malignancy Program at the Oregon Cancer Institute in Portland.

HOUSTON-Colon cancer researchers are studying a variety of cell surface molecules and receptors as potential targets for new treatments aimed particularly at preventing or treating metastatic disease. Lee Ellis, MD, professor of surgery and cancer biology at the University of Texas M. D. Anderson Cancer Center in Houston, discussed his group’s current work in three new areas: angiopoietins as a target for blocking tumor angiogenesis, integrins, and the insulin growth factor-1 (IGF-1) system.

SAN FRANCISCO-In an effort to extend the activity of gemcitabine (Gemzar) against pancreatic cancer, researchers have paired an investigational chimeric monoclonal antibody, IMC-C225 (cetuximab) with the standard chemotherapy. IMC-C225 selectively binds to epidermal growth factor receptor (EGFR).

SAN FRANCISCO-In advanced colorectal cancer, the combination of oxaliplatin (investigational) and irinotecan (Camptosar) is beneficial as a first-line therapy, according to phase II clinical trial results presented at the 37th Annual Meeting of the American Society of Clinical Oncology (abstract 538).

TAMPA, Florida-Phase II studies have shown that the combination of irinotecan (Camptosar) and gemcitabine (Gemzar) are well tolerated and active in advanced or metastatic pancreatic cancer, and this combination is now being tested in randomized phase II and phase III trials, said Caio Max S. Rocha Lima, MD. Dr. Rocha Lima is assistant professor of medicine at the University of South Florida’s H. Lee Moffitt Cancer Center in Tampa, Florida.

BIRMINGHAM, England-Combining capecitabine (Xeloda) and irinotecan (Camptosar) is feasible at doses effective for treating colorectal cancer, according to David Kerr, MD, DSc. He reviewed early capecitabine/irinotecan trials and said that the combination should be evaluated in phase III trials against metastatic cancer, as adjuvant treatment, and using oral formulations of both drugs. Dr. Kerr is professor of clinical oncology at the CRC Institute for Cancer Studies, Birmingham, England.

HOUSTON-M. D. Anderson Cancer Center researchers have launched a phase I trial combining pelvic radiation, irinotecan (Camptosar), and celecoxib (Celebrex) in patients with metastatic rectal cancer. Christopher H. Crane, MD, assistant professor of radiation oncology at the University of Texas M. D. Anderson Cancer Center described the research leading up to this trial

NEW YORK CITY-Promising early data are emerging from a phase II colon cancer trial of irinotecan (Camptosar) plus cetuximab (IMC-C225), a chimeric monoclonal antibody that targets the epidermal growth factor receptor (EGFR), reported Leonard Saltz, MD. He is associate attending physician on the Gastrointestinal Oncology Service at Memorial Sloan-Kettering Cancer Center in New York City.

SAN FRANCISCO-A new approach to stimulating the immune system against a cancer antigen has produced a clinical response in a small number of colorectal cancer patients enrolled in a phase I/II trial, according to a poster presented at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO).

SAN FRANCISCO-A retrospective study of patients with locally advanced rectal cancer suggests that maintaining high hemoglobin levels after preoperative chemoradiation could improve 5-year survival.

Pancreatic cancer is a disease seen predominantly in elderly patients. Compared to younger patients, older patients are more likely to present with early-stage disease and, therefore, may be candidates for aggressive local

Pancreatic cancer is a disease seen predominantly in elderly patients. Compared to younger patients, older patients are more likely to present with early-stage disease and, therefore, may be candidates for aggressive local

STI571 (Gleevec) is a member of the 2-phenylaminopyrimidine family of adenosine triphosphate (ATP) binding site inhibitors of protein tyrosine kinase. It potently inhibits the tyrosine kinase activity of Abl and Bcr-Abl,[1-3] platelet-derived growth factor receptor (PDGF-R), and Kit (stem cell factor receptor).[4-6]

Pancreatic cancer is a disease seen predominantly in elderly patients. Compared to younger patients, older patients are more likely to present with early-stage disease and, therefore, may be candidates for aggressive local

NUTLEY, NJ-The FDA has approved Roche’s Xeloda (capecitabine) for the first-line treatment of metastatic colorectal cancer when treatment with fluoropyrimidine therapy alone is preferred. Combination chemotherapy has shown a survival benefit, compared with intravenous fluorouracil (5-FU)/leucovorin alone, and no survival benefit has been show with Xeloda monotherapy.

NEW YORK-When John Huggins, EdD, of Louisville, Kentucky, developed rectal bleeding shortly before his 50th birthday, he promptly called his primary care physician. After a digital rectal exam, the physician told him he had an anal abrasion that was nothing to worry about. "But I did worry because the signs did not go away," the assistant director of student services for Jefferson County Public Schools said at a Cancer Research Foundation of America press briefing on colorectal cancer.

The article entitled "Neoadjuvant Strategies for Pancreatic Cancer," by Drs. Evans, Wolff, and Crane, is an excellent review of past and current developments in adjuvant therapy for pancreatic cancer. In addition to a thorough literature review, the authors draw on their own extensive experience in neoadjuvant therapy for pancreatic cancer at M. D. Anderson Cancer Center.

We have made much progress over the past 30 years in the surgical management of pancreatic cancer, and perioperative mortality rates are low in centers with experience in the treatment of this disease. However, surgical resection is clearly limited in achieving local and systemic control of pancreatic cancer, and chemoradiation will likely become a part of any successful pancreatic cancer treatment program.

This report by Drs. Evans, Wolff, and Crane is a well-written and concise description of their extensive experience with the treatment of pancreatic cancer. They and others at the M. D. Anderson Cancer Center should be congratulated for their innovative, methodical, and thoughtful approach to the treatment of this lethal disease.

Recent prospective and retrospective data suggest that the use of multimodality therapy combining pancreaticoduodenectomy with postoperative adjuvant chemotherapy (fluorouracil) and external-beam radiation

ASCO-STI-571 (imatinib mesylate, Gleevec), which received swift approval by the Food and Drug Administration for the treatment of chronic myelogenous leukemia (CML), is showing equally striking activity in patients with advanced gastrointestinal stromal tumors (GISTs), scientists reported at the plenary session of the 37th Annual Meeting of the American Society of Clinical Oncology.

NASHVILLE, Tennessee-Encouraging results from phase II and III clinical trials of irinotecan (Camptosar) in colorectal cancer over the past several years as well as future directions for research were reviewed by Mace L. Rothenberg, MD. He is associate professor of medicine and Ingram Associate Professor of Cancer Research at Vanderbilt University Medical Center, Nashville.

PHILADELPHIA-A phase II study in patients with locally advanced rectal cancer showed that the combination of irinotecan (Camptosar), fluorouracil (5-FU), and concomitant radiation given preoperatively is well tolerated and appears to have enhanced activity. Reporting the results, Edith Peterson Mitchell, MD, noted that ongoing phase II studies will determine the pathologic response rates and patterns of disease recurrence. Dr. Mitchell is clinical professor of medicine, Division of Medical Oncology, Kimmel Cancer Center of Thomas Jefferson University, Philadelphia.

NEW YORK-The camptothecin analog rubitecan (9-nitrocamptothecin) is safe and active in advanced pancreatic cancer, the combined experience from two phase II trials suggests.

WASHINGTON-Colorectal cancer screening rates have risen slightly since 1997 but remain at low levels, according to a report by the Centers for Disease Control and Prevention. The report compared data from the 1999 Behavioral Risk Factor Surveillance System (BRFSS)-a random-digit phone survey of residents of the United States and Puerto Rico-with findings from the 1997 BRFSS. Respondents over age 50 were asked about colorectal cancer screening.

NEW YORK-To increase colorectal cancer screening, the American Cancer Society (ACS) is encouraging the use of at least one of the four recommended screening tests. Previously, for persons of average risk, annual fecal occult blood test (FOBT) and flexible sigmoidoscopy every 5 years were only recommended in combination.

NEW ORLEANS-Colorectal cancer cells are shed into the stool, providing a potential means for early detection using noninvasive approaches. A multi-center research effort has evaluated a set of three genetic markers that may indeed constitute a reliable genetic mutation analysis of stool, signifying cancer