Gastrointestinal Cancer

BETHESDA, Md-Evidence of a relationship between diet and the origins of colorectal cancer is tantalizing but shadowy, two longtime researchers said at the Colorectal Cancer Prevention and Treatment conference, co-sponsored by the Cancer Research Foundation of America and the American Digestive Health Foundation.

CHARLESTON, South Carolina-Irinotecan/gemcitabine combinations have looked sufficiently promising for pancreatic cancer in phase II trials that researchers are proceeding with randomized phase II and phase III studies, Caio Max S. Rocha Lima, MD, told those attending the Vanderbilt University Symposium. Dr. Rocha Lima is assistant professor of medicine in the Hematology Oncology Division at the Medical University of South Carolina in Charleston.

NEW YORK-The biologic response modifier virulizin, which has in vitro and preclinical activity in a variety of cancers, has exhibited possible activity in pancreatic cancer in phase I and II clinical trials, said Michael P. Thirlwell, MD, director, Department of Oncology, McGill University, Montreal.

Colorectal cancer is the second leading cause of cancer-related death in the United States. An estimated 135,400 new cases and 56,700 deaths from colorectal cancer are expected during 2001. Since the mid-1990s, national guidelines have

NEW YORK-Irofulven, the first of the acylfulvenes, a new class of cytotoxic agents, is being studied in a number of solid tumors, including a phase III trial in advanced pancreatic cancer, said Raymond Taetle, MD, clinical professor of medicine and pathology, University of Arizona, Arizona Cancer Center, Tucson.

In their article, Drs. Wagman and Minsky provide an excellent overview of the current status of local treatment strategies for early rectal cancer. They have rightly pointed out that while minimal surgery is an attractive option, it must be balanced against the highly curable outcomes of radical surgical resection. Expanded experience with stapling devices has extended the level at which safe and satisfactory anastomoses can be accomplished in the distal rectum. The promise of enhanced preservation of rectal, urinary, and sexual functions makes local treatment strategies an attractive option. The most important aspect of disease management using this approach remains the process of patient selection.

The article by Drs. Khayat and Gil-Delgado outlines the exciting new developments in the treatment of advanced colorectal cancer with irinotecan (CPT-11 [Camptosar]) and oxaliplatin. Although the development of these drugs provides an alternative to fluorouracil (5-FU) in the treatment of this common tumor, it is still unclear how to optimally integrate these promising compounds into therapy for colorectal cancer.

Since its development in 1957, fluorouracil (5-FU) has been the central component in the treatment of colorectal cancer. Over the past several decades, innumerable permutations of fluorouracil biomodulation have been studied. Indeed, rarely has a drug been so well understood in terms of its mechanisms and metabolism, and rarely has such an understanding been so extensively exploited in clinical strategies. But despite these efforts, overall progress in the management of advanced colorectal cancer has been modest.

Gemcitabine (Gemzar) and irinotecan (CPT-11, Camptosar) are active cytotoxic drugs against pancreatic cancer. Preclinical data evaluating the combination of gemcitabine and irinotecan suggest dose-dependent synergistic

The treatment of advanced colorectal cancer over the past 4 decades has required the use of intravenous chemotherapy, most typically fluorouracil (5-FU). The possibility of providing

As the chemotherapy horizons have expanded in colorectal cancer with development of oxaliplatin (Eloxatin) and irinotecan (CPT-11, Camptosar), so too have our approaches to therapy. Numerous immunotherapy and gene

NEW YORK-Although no complete responses occurred in patients with advanced pancreatic cancer in a study of DX-8951F (exatecan mesylate, Daiichi Pharmaceuticals), those who were treatment-naïve survived longer than usual, and stable disease was observed in 39%, Eileen M. O’Reilly, MD, reported at the Chemotherapy Foundation Symposium XVIII.

NEW YORK-Because pivotal studies failed to show a survival advantage, oxaliplatin did not receive FDA approval as first-line therapy of metastatic colorectal cancer last year.

In the largest prospective study of cigarette smoking and colorectal cancer mortality, researchers from the American Cancer Society report finding strong evidence that cancers of the colon and rectum are, in part, smoking related.

Capecitabine (Xeloda) is the first orally available fluoropyrimidine approved for use in patients with cancer. It was initially approved for use in metastatic breast cancer, but significant data also support its use in the management

Randomized studies have tested a variety of strategies to improve the activity of 5-fluorouracil (5-FU) in colorectal cancer patients. Results from 14 randomized trials comparing 5-FU administered via intravenous ( IV) bolus either

Significant emphasis has been placed recently on designing more effective fluorouracil (5-FU)-based combination protocols for gastrointestinal cancer. Promising results were seen with 5-FU/leucovorin in combination with

NEW YORK-An irinotecan (Camptosar) plus gemcitabine (Gemzar) combination known as IrinoGem was associated with low toxicity, median survival of 6 months, and a 1-year survival rate of 27%, according to results from a phase II study presented at the Chemotherapy Foundation Symposium XVIII.

BOSTON-Neoadjuvant therapy for adenocarcinoma of the rectum is well tolerated and can produce substantial downstaging and high curative resection rates, according to a retrospective study presented at the American Society of Colon and Rectal Surgeons (ASCRS) annual meeting. The manuscript of the study has been accepted for publication in Diseases of the Colon and Rectum.

NEW YORK-The combination of oxaliplatin (investigational) and irinotecan (Camptosar) as front-line treatment for colorectal cancer is feasible and potentially synergistic, preliminary data from an M.D. Anderson Cancer Center phase I/II trial suggests.

Ateam of European researchers recently reported that the addition of oxaliplatin to the standard regimen for advanced colorectal cancer of fluorouracil (5-FU) and leucovorin doubled the response to therapy and significantly prolonged progression-free survival, compared to leucovorin and 5-FU alone.

Irinotecan (CPT-11, Camptosar) is a semisynthetic water-soluble derivative of the plant alkaloid camptothecin. This review will focus on the potential use of irinotecan in combination with fluorouracil (5-FU) in the preoperative combined-modality treatment of advanced rectal cancer.

Fluorouracil (5-FU) has remained the standard therapy for the treatment of advanced colorectal cancer for over 40 years. Unfortunately, only a minority of patients experience objective clinical response.

Synergy with no overlapping toxicities has been demonstrated for the combination of irinotecan ( Camptosar, CPT-11) and gemcitabine (Gemzar) in vitro. Results of a single-institution phase I study in which patients with

Irinotecan (Camptosar) is a topoisomerase I inhibitor with demonstrated antitumor activity against a wide variety of malignancies. Phase II studies have shown that this agent has significant single-agent activity against both chemotherapy-naive and fluorouracil (5-FU)-refractory colorectal cancer. Phase III studies now indicate that irinotecan/5-FU/leucovorin combinations have antitumor activity superior to standard 5-FU/leucovorin regimens alone. These irinotecan-based combinations are now entering clinical trials for the adjuvant treatment of resected stage III colon cancer. It is hypothesized that the superior antitumor activity of these irinotecan-based combinations seen in the metastatic setting will translate into improved survival and increased cure rates in these earlier-stage patients. [ONCOLOGY 14(Suppl 14):47-50, 2000]

Two randomized phase III trials with irinotecan as second-line treatment of metastatic colorectal cancer have shown that irinotecan (CPT-11, Camptosar) significantly improves survival when compared with best supportive care or continuous infusion of fluorouracil (5-FU) after failure of 5-FU.

Fifteen patients with metastatic colorectal cancer were treated with irinotecan (CPT-11, Camptosar) at 300 to 350 mg/m2 every 21 days and thalidomide (Thalomid) at 400 mg/d. Of the 15 patients, 11 were in a pilot study and 4

HOUSTON-Colorectal cancer mortality has declined slightly in the last 10 years, and the decrease appears to be accelerating. This decline is due in large part to screening and early detection, said Patrick M. Lynch, MD, associate professor of medicine, University of Texas M.D. Anderson Cancer Center.

PHILADELPHIA-Pancreatic cancer patients usually lose 25% of their body mass within 4 months of diagnosis and die within 6 months. But early work from Scotland on supplementation with eicosapentaenoic acid (EPA) seems to suggest that the fatty acid may stabilize weight and add months to the lives of pancreatic cancer patients.

One of the more promising chemotherapeutic agents for patients with metastatic colorectal cancer is oxaliplatin (Eloxatin), a third-generation platinum derivative with a unique mechanism of action. Preclinical studies