Gastrointestinal Cancer

SAN DIEGO-It has been suggested that laparoscopic surgical techniques may increase malignant cell spread, due primarily to peritoneal insufflation. A study conducted at the Colorectal Cancer Unit, Institut de Malalties Digestives, Hospital Clinic, Barcelona, Spain, has found that the type of surgery is not a determining factor in colorectal cancer spread.

NCI Colorectal Cancer Group Outlines a Decade of Research Goals

SAN DIEGO-Despite the egalitarian nature of health maintenance organizations (HMOs), minority and low-income patients enrolled in such plans may not receive the same colorectal cancer surveillance care as whites and higher income patients.

The article, “Management of Hepatocellular Carcinoma,” by Drs. Nakakura and Choti, is an excellent, comprehensive overview of the treatment modalities used for one of the most challenging cancers. The thoroughness of this review underscores the current frustration of the clinician in the management of this disease and the inadequacies of available therapies. The authors list more than 17 treatments for the various stages of this disease. However, if any one of the therapies mentioned offered cure to a majority of patients, there would be little need for more review articles or randomized controlled trials. There are few cancers that command such a vast array of differing therapies from so many different specialties.

Hepatocellular carcinoma (HCC) is responsible for a significant amount of morbidity and mortality throughout the world. In many countries, including the United States, a definite increase in the incidence of HCC has been

As Drs. Nakakura and Choti point out, the incidence of hepatocellular carcinoma (HCC) is rising in many countries including the United States, mainly as the result of a steady increase in hepatitis C infections. Unfortunately, it now seems that the hepatitis C virus is more carcinogenic than the hepatitis B virus, judging from the frequency with which HCC develops among patients with hepatitis C- vs hepatitis B-induced cirrhosis.[1] Numerous studies have demonstrated changes in various oncogenes and tumor suppressor genes, but no consistent sequence of genetic changes has emerged similar to the adenoma-carcinoma sequence in colon cancer.

Hepatocellular carcinoma (HCC) is the most common solid organ tumor worldwide. In recent decades, diagnosis and treatment of this cancer has evolved significantly. The article by Drs. Nakakura and Choti summarizes many of the advances in this field, delineates the current evidence-based treatment options, and defines promising areas for future study.

AstraZeneca has announced the launch of a new website that will help keep researchers and physicians up to date on

NEW ORLEANS-A prospective study in colorectal cancer patients has found that sentinel lymph node (SLN) mapping correctly predicts the presence or absence of nodal metastases, with a very low incidence of skip metastases (disease in a non-SLN), as it does in melanoma and breast cancer.

Patients with metastatic colorectal cancer may benefit from therapy with the oral anticancer agent capecitabine

WASHINGTON-Pharmacia & Upjohn’s Camptosar (irinotecan) has won FDA approval for use as a first-line agent in metastatic colorectal cancer, in combination with fluorouracil (5-FU) and leucovorin. [See ONI April 2000, page 3 for the ODAC review.] The agent was approved as a follow-up colorectal cancer treatment in 1996.

Microsatellite Instability Linked to Longer Colon Cancer Survival

Damjanov and Meropol review the status of several oral fluoropyrimidine drugs that are currently undergoing clinical testing for the treatment of colorectal cancer. Meta-analysis indicates an 8% improvement in the overall response rate and a survival advantage of 0.8 months with infusional vs bolus fluorouracil (5-FU)-arguably small differences. The incidence of grade 3-4 diarrhea, mucositis, and myelosuppression is < 10% with infusional 5-FU, although hand-foot syndrome is commonly associated with this therapy. The prevailing strategy for the development of oral 5-FU drugs employs multiple daily dosing for periods of 2 to 4 weeks followed by a 1- or 2-week break in order to mimic the protracted infusional schedule.UFT

The article by Damjanov and Meropol elegantly outlines the rationale behind the preclinical development of several potential new oral chemotherapy options for patients with advanced colorectal carcinoma and the available data from clinical trials in advanced colorectal cancer that evaluated the activity and safety of these agents. The authors relate the history of fluorinated pyrimidine therapy in colorectal cancer and the pharmacologic challenges to delivering effective oral therapy in a such a way that the chemistry behind the processes becomes readily intelligible. They note that the erratic absorption and blood levels associated with orally administered fluorouracil (5-FU) led to the current approaches to oral therapy.

Hepatocellular carcinoma (HCC) is one of the world’s most common cancers. It is closely associated with cirrhosis, especially that due to viral hepatitis. The incidences of viral hepatitis and HCC are rising steadily in the United

The US Food and Drug Administration (FDA) has approved irinotecan (Camptosar) as first-line therapy for patients with metastatic colorectal cancer in conjunction with fluorouracil (5-FU) and leucovorin. The approval follows unanimous

SAN FRANCISCO-Research conducted at New York Medical College, Valhalla, shows that acetaminophen may prevent early biologic changes that can lead to colon cancer.

ORLANDO-A number of therapies now in clinical trials may make a difference in outcome for patients with pancreatic cancer, and some may indefinitely prolong survival, Alexander S. Rosemurgy II, MD, said at the Joint Cancer Conference of the Florida Universities. The conference is sponsored by the Univerity of South Florida College of Medicine and presented by the H. Lee Moffitt Cancer Center & Research Institute, University of Florida Shands Cancer Center, and University of Miami Sylvester Comprehensive Cancer Center..

Hepatocellular carcinoma is a major public health problem worldwide, although at present it remains a relatively uncommon cancer in the United States. As pointed out by Dr. Venook in his elegant review of the topic, most hepatocellular carcinomas progress locoregionally. Hepatic failure is the most common mode of death for patients with this disease. For this reason, regional management strategies would appear to be attractive. Dr. Venook is to be commended for an accurate review of the literature regarding this issue. Unfortunately, that literature suffers from many limitations.

In his review, Dr. Venook correctly argues that, in the majority of pa;tients, hepatocellular carcinoma results from underlying liver disease; the most common culprit is cirrhosis, which, in turn, is frequently related to hepatitis B and/or hepatitis C exposure and alcohol abuse. Given that patient outcomes are determined by the “interplay between tumor growth and adequate hepatic reserve,” and that most patients with hepatocellular carcinoma eventually die of liver failure, Dr. Venook argues that there is a good rationale for locoregional tumor control of hepatocellular carcinoma. Locoregional therapies may include hepatic intraarterial (HIA) chemotherapy, transarterial chemoembolization, Lipiodol chemo-embolization, radiation therapy (conformal external radiation therapy or intraarterially delivered radiation), or ablative procedures. These therapies are less aggressive than conventional resectional therapies, such as cryosurg-ery, percutaneous ethanol injection, radiofrequency ablation, and other intratumoral therapies.

Since hepatocellular carcinoma almost always develops in patients with underlying hepatitis or cirrhosis of the liver, it cannot be viewed as a single disease. Not only does the biology of the cancer vary depending on the underlying etiology of the liver disease-hepatitis B, hepatitis C, or cirrhosis of another etiology-but also patient outcomes are determined by the interplay between tumor growth and

CHICAGO-Using a patient’s own tumor cells to produce immunity against further cancer growth may improve survival in some patients, researchers have found in the first randomized multicenter test of immunotherapy in colon cancer. The 7-year, 412-patient trial, conducted by the Eastern Cooperative Oncology Group, shows the promise of adjuvant active specific immunotherapy in stage II/ III colon cancer, said lead author Jules E. Harris, MD, of Rush-Presbyterian-St. Luke’s Medical Center.

NEW YORK-Patients with advanced colorectal cancer have a median survival of only 12 months with single-agent chemotherapy. New drugs and new drug combinations are being tested in an attempt to find more effective treatments for the disease. A panel of researchers discussed trials of raltitrexed (Tomudex) in combination with other drugs at the Chemotherapy Foundation Symposium XVII.

NEW YORK-A monoclonal antibody (MoAb) is being studied as monotherapy and in combination with standard fluorouracil (5-FU) in two large phase III trials of stage III colon cancer. The drug is edrecolomab (Panorex), a murine IgG2a MoAb that recognizes the 17-1A antigen, which is preferentially expressed on adenocarcinomas.

NEW YORK-Gemcitabine (Gem-zar), approved for the treatment of advanced pancreatic cancer, may have value as a modulator of standard chemotherapy in advanced colorectal cancer, Stefan Madajewicz, MD, said at the Chemotherapy Foundation Symposium XVII. Dr. Madajewicz, professor of medicine and chief of neoplastic diseases, Division of Medical Oncology, SUNY Health Center, Stony Brook, NY, reported on phase I/II trials of gemcitabine in colorectal cancer used in combination with fluorouracil (5-FU) and folinic acid.

Although surgery remains the only curative option for patients with gastrointestinal (GI) malignancies, the use of adjuvant chemotherapy and/or localized radiation is considered standard therapy for patients who present with

Preliminary clinical data presented at a poster session of the 1999 annual meeting of the American Society of Clinical Oncology (ASCO) revealed that a significant number of patients with advanced colorectal cancer respond to first-line treatment with raltitrexed (Tomudex) in combination with oxaliplatin. The response rate of 59% suggests that this regimen may be one of the more active combinations under current investigation for the disease.

NEW YORK-Although it is often not possible to offer curative treatment in pancreatic cancer, significant improvements have taken place nonetheless, said Ephraim S. Casper, MD, chief medical oncologist, Memorial Sloan-Kettering Cancer Center at St. Clare’s Hospital, Denville, NJ.

NEW YORK-A new oral combination chemotherapy regimen is as effective as intravenous fluorouracil (5-FU) and leucovorin, the current treatment standard, but with a superior safety profile. Speaking at the Chemotherapy Foundation Symposium XVII, Paulo Hoff, MD, assistant professor of medicine, M.D. Anderson Cancer Center, described the use of an oral regimen combining uracil/tegafur (UFT) and leucovorin as first-line treatment of metastatic colorectal cancer.

NEW YORK-The folate antagonist trimetrexate (TMTX) may be useful as a biochemical modulator of fluorouracil (5-FU) in the treatment of advanced colorectal cancer, according to preliminary results of a phase III trial conducted by the European TMTX Study Group and discussed at the Chemotherapy Foundation Symposium XVII