Gastrointestinal Cancer

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

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