Gastrointestinal Cancer

During the past decade, advances have been made in the adjuvant treatment of resectable rectal cancer. Postoperative combined-modality therapy significantly improves local control and survival. Recent Intergroup

LOS ANGELES--A second-generation topo-isomerase I inhibitor, RFS 2000, has led to significantly improved survival in patients with advanced pancreatic carcinoma, according to interim results of an ongoing phase II study presented at an ASCO poster session.

PHILADELPHIA--"Six months of 5-fluorouracil (5-FU) and leucovorin should be the new standard adjuvant therapy for patients with node-positive, high-risk colon cancer," Daniel Haller, MD, said at the annual ASCO meeting.

In order for the immune system to protect against cancer, it must recognize tumors as "non-self." Markers present on the surface of tumors, known as antigens, allow the immune system to recognize tumors as non-self. However, in order for the

LOS ANGELES--Irinotecan (Camptosar), also known as CPT-11, should be standard therapy for patients whose metastatic colorectal cancer has become resistant to fluorouracil (5-FU), David Cunningham, MD, said at the plenary session of the American Society of Clinical Oncology (ASCO) annual meeting. Dr. Cunningham is head of the Gastrointestinal Cancer Unit, Royal Marsden Hospital, London, UK.

NEW ORLEANS--In a mouse model of colon cancer, the anti-inflammatory drug celecoxib prevented formation of tumors and caused regression of existing tumors, according to research presented at the 89th annual meeting of the American Association for Cancer Research (AACR).

NEW ORLEANS--Five recent discoveries could have a big effect on colorectal cancer prevention, early detection, and treatment, Margaret Tempero, MD, deputy director of the UNMC/Eppley Cancer Center, Omaha, Nebraska, said at a public forum held at the 89th annual meeting of the American Association for Cancer Research.

Drs. Weber and Petrelli review much of the literature regarding patient outcomes after local excision alone, as well as local excision plus chemoradiotherapy, in patients with various stages of low rectal adenocarcinoma. The authors apparently were unaware that the Radiation Therapy Oncology Group (RTOG) experience with local excision plus chemoradiation, which antedated the Cancer and Leukemia Group B (CALGB) study, will soon be in print to provide further multi-institutional support for these methods along with much greater follow-up. They also omitted our long-term data (median follow-up of survivors is 67 months) showing the very low locoregional recurrence rates in patients with T2 cancers treated by local excision and chemoradiotherapy.[1]

In this extensive review of the literature, Weber and Petrelli have nicely placed into perspective and documented the methods used in and results of most of the studies on local excision for rectal cancer. Although I agree with many of their conclusions, it is difficult for me to agree with the title of their article, "Local excision for rectal cancer: An uncertain future."

Adenocarcinoma of the rectum remains a significant public health challenge, with 39,000 new cases and 8,500 deaths predicted for 1998. Radical surgery, the current standard therapy, frequently necessitates the formation of

BETHESDA, Md--When it comes to avoiding colon cancer, Grandma was right: Eat your vegetables, take vitamins, and forget that burger, for goodness sakes. Edward Giovannucci, MD, conveyed this basic message at a workshop on preventing colon cancer, held in conjunction with the American Society of Preventive Oncology (ASPO) annual meeting.

BETHESDA, Md--Understanding the complex association of lifestyle and colon cancer risk requires evaluating a number of different behavioral factors, and these may best be studied as clusters rather than individual items, Martha Slattery, PhD, MPH, said at the American Society of Preventive Society (ASPO) meeting.

BETHESDA--Diet, physical activity, obesity, and aspirin use all influence the risk of colon cancer, according to both the underlying biology and evidence from epidemiologic studies, Graham Colditz, MD, DrPH, associate professor of medicine, Harvard Medical School, said at the American Society of Preventive Oncology (ASPO) annual meeting.

WASHINGTON--The advent of Medicare-funded colorectal cancer screening this year followed on the heels of new colorectal screening guidelines issued last year. Some of the physicians and researchers who developed those guidelines gathered in Washington to celebrate the new Medicare benefit.

COLUMBUS, Ohio--Rectal cancer is treated with a wide variety of operations and adjuvant therapy. This variety makes extensive preoperative evaluation mandatory, said Karamjit Khanduja, MD, chief of the Division of Colon and Rectal Surgery, Mt. Carmel Health, Columbus, Oho.

FORT LAUDERDALE, Fla--The National Comprehensive Cancer Network (NCCN) colon cancer screening guidelines committee came to "a remarkable degree of consensus on the recommendations," Stephen Gruber, MD, PhD, MPH, said at the group’s third annual conference. The NCCN is a coalition of 16 leading US cancer centers.

PARIS--Hepatic intraarterial (HIA) chemotherapy coupled with aggressive resection may improve the outlook for patients with liver metastases from colorectal cancer, Nancy Kemeny, MD, of Memorial Sloan-Kettering Cancer Center, said at the Eighth International Congress on Anti-Cancer Treatment (ICACT).

ORLANDO--A new high dose rate/intraoperative radiation therapy (HDR-IORT) delivery system utilizing the Harrison, Anderson, Mick (HAM) applicator is proving effective in treating primary unresectable and locally advanced, recurrent rectal cancer.

Scientists at the American Health Foundation’s Nutritional Carcinogenesis Division, under the direction of Dr. Bandaru S. Reddy, division chief and associate director of the Foundation’s Naylor Dana Institute, Valhalla, New York, and Dr. Karen Seibert of Searle Research & Development, St. Louis, Missouri, described an exceptionally strong inhibitor of colon cancer development in an animal model assay in the February 1, 1998, issue of Cancer Research.

PHILADELPHIA-Thomas Jefferson University’s new Familial Colorectal Cancer Registry is collecting information and blood and tissue samples from families with a higher-than-normal risk of colon cancer, to aid researchers looking for genetic markers of the disease and to provide genetic counseling and genetic testing, if appropriate, to participants.

A genetic mutation in the adenomatous polyposis (APC) gene found in 7% of Ashkenazi Jewish families in the United States does not necessarily lead to colon cancer, according to a study in the December 15, 1997, issue of Cancer Research.

Researchers from the University of Wurzburg in Germany have determined that a simple antibody test may be as effective in detecting Helicobacter pylori infection as the more invasive procedures that are currently used. They reported their findings

Over the past 7 years, 58 saline-filled tissues expanders (TEs) have been temporarily placed in 57 patients. The

The enormous influence of the surgeon on outlook in cancer was stressed by Professor Cornelis van de Velde of the Department of Surgery, Leiden University Medical Center, the Netherlands, during the 1997 European Cancer Conference.

CHICAGO-Recent clinical evidence clearly indicates that primary care physicians should offer colon cancer screening to all patients over age 50. “If you are not having this discussion, if you are not making this offer, you will be viewed as providing incomplete care,” said Steven H. Woolf, MD, MPH, professor of family practice, Medical College of Virginia, Richmond.

HAMBURG-The challenge in the treatment of pancreatic cancer “is to take systemic therapy one step further, whether it’s with new drugs or with novel approaches based on new biologic information,” Margaret Tempero, MD, of the University of Nebraska Medical Center, Omaha, said at the Ninth European Cancer Conference (ECCO 9), sponsored by the Federation of European Cancer Societies.

HAMBURG-A 10-center phase III trial from the Netherlands has revealed that adjuvant vaccine therapy not only reduces the risk of recurrence but also prolongs relapse-free survival in patients with Duke’s B2, B3, or C colon cancer, Dr. J.B. Vermorken reported at the Ninth European Cancer Conference (ECCO 9).

Therapeutic options for patients with advanced colorectal cancer who have failed treatment with fluorouracil (5-FU) are limited. Responses have been reported in this setting with a protracted venous infusion of 5-FU. Daily oral therapy with tegafur and uracil (UFT) plus leucovorin (LV) has the potential to mimic the pharmacology of continuous infusion 5-FU. Therefore, we undertook a phase II study of a 28-day schedule of a combination chemotherapy regimen containing oral UFT/leucovorin in patients with measurable metastatic colorectal cancer who had failed treatment with bolus 5-FU. In addition, we sought to determine whether coadministration of UFT and leucovorin alters the bioavailability of these agents. In a pretreatment phase, each patient underwent sequential pharmacokinetic sampling following a single dose of UFT alone, leucovorin alone, and the combination of UFT plus leucovorin. The preliminary results of this trial suggest that tegafur pharmacokinetics are not affected by coadministration of leucovorin and that folate pharmacokinetics are not affected by UFT. [ONCOLOGY 11(Suppl 10):22-25, 1997]

To evaluate the significance of postoperative adjuvant chemotherapy using mitomycin C (MMC) and UFT (tegafur and uracil) in combination, the Japanese Foundation for Multidisciplinary Treatment of Cancer conducted a prospective randomized controlled trial with 834 patients who had undergone curative resection for rectal cancer (T3 or T4 tumors and/or N1, N2, or N3 disease). The patients were randomly allocated to a treatment group (MMC/UFT, 416 patients) and a control group (surgery only, 418 patients). For patients in the treatment group, 20 mg of MMC was sprinkled on the operating field upon completion of surgery. MMC was intravenously injected at 6 mg/m2 on day 7, and then each month after surgery for 6 months. UFT was administered orally at 400 mg/day for 1 year. Although no difference was observed in the 5-year survival rate between the two groups, the 5-year disease-free survival rate in the MMC/UFT group was 69.1%, which was significantly higher than in the control group (59.3%, P = .005). The 5-year cumulative local recurrence rate was significantly lower in the MMC/UFT group (11.6%) than in the control group (19.0%) (P = .0071). We conclude that the adjuvant use of long-term oral UFT and intermittent intravenous MMC improves the disease-free survival rate of patients with curatively resected rectal cancer. [ONCOLOGY 11(Suppl 10):40-43, 1997]

Adjuvant chemotherapy has been shown to alter the natural history of patients with resected colon cancer. Two regimens (fluorouracil [5-FU] plus levamisole (Ergamisol) and 5-FU plus leucovorin) have been found most