Gastrointestinal Cancer

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

Standard adjuvant therapy for transmural (T3) and/or node-positive rectal cancer is pelvic radiation therapy plus fluorouracil (5-FU)-based chemotherapy. Randomized trials are in progress to help determine the ideal

In a laboratory study using an experimental peritoneum model of gastrointestinal cancer, the UFTP [tegafur and uracil (UFT) plus cisplatin] regimen was shown to provide a survival benefit compared with the UFTM (UFT plus

The oral fluoropyrimidines have proved to be active in colorectal cancer in Japan and, recently, in the United States and Europe. Continuous oral administration simulates protracted fluorouracil (5-FU) continuous

A staple of summer, the common housefly may be a reservoir for Helicobacter pylori, the bacterium responsible for some

WASHINGTON-“A positive family history is the most common risk factor for large bowel malignancy other than age,” Randall W. Burt, MD, of the University of Utah Health Sciences Center, said at a symposium on colorectal cancer at Digestive Disease Week, sponsored by the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy.

PHILADELPHIA-Biologic tumor markers, in combination with the Duke’s anatomic staging system, may point the way toward the individualization of colo-rectal cancer treatment, says Daniel G. Haller, MD, of the University of Pennsylvania Medical Center.

Although candidate genes for hereditary pancreatic cancer have been identified (Figure 1), namely p16 and BRCA2, pancreatic cancer patients having an inherited predisposition will not be easy to recognize on clinical grounds.

WASHINGTON--The colorectal cancer rate continues to rise in African-American men while dropping for whites of both sexes and for black women, reported David S. Alberts, MD, associate dean for research, Arizona Cancer Center of the University of Arizona College of Medicine, Tucson.

The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative extent of disease evaluation, and role of the surgeon in

This special series on cancer and genetics is compiled and edited by Henry T. Lynch, MD, director of the Hereditary Cancer Institute, professor of medicine, and chairman of the Department of Preventive Medicine and Public Health, Creighton University School of Medicine, and director of the Creighton Cancer Center, Omaha, Nebraska. Part I of this three-part series on pancreatic cancer appeared in June 1997. Part II (below) reviews the gene mutations thought to contribute to the development of hereditary pancreatic cancer, and Part III will explores the clinical recognition of a hereditary predisposition to pancreatic cancer.

The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative extent of disease evaluation, and role of the surgeon in

CHICAGO--After many years of frustration, there may finally be a reason for guarded optimism about the development of effective therapy for patients with advanced stage pancreatic cancer, Mace Rothenberg, MD, said at the 9th annual meeting of the Network for Oncology Communication and Research, based in Atlanta.

Hereditary nonpolyposis colorectal cancer (HNPCC) is a dominantly inherited syndrome that is estimated to be responsible for between 0.5% to 5% of all colorectal cancers.[1] The syndrome is caused by germline mutations in any of at least four mismatch repair genes.

FORT LAUDERDALE, Fla--Clinicians now have at their disposal more accurate staging technologies for pancreatic cancer than were available in the past.

HOUSTON--A new tumor-selective agent may permit delivery of higher levels of 5-fluorouracil (5-FU) with lower toxicity, said Richard Pazdur, MD, of M.D. Anderson Cancer Center. A phase III trial of capecitabine is ongoing in colorectal cancer, and it is also under study for the treatment of breast cancer.

ROCKVILLE, Md--In the first report issued under its new Evidence-based Practice Initiative, the Agency for Health Care Policy and Research (AHCPR) has reaffirmed that early detection and treatment provide the primary means of preventing death from colorectal cancer.

Dr. Rich presents a comprehensive overview of adjuvant therapy for advanced operable rectal cancer. He emphasizes the roles of infusional chemoradiation in both the adjuvant setting and as sole therapy. Unless otherwise specified, the following comments pertain to clinically resectable B2-C (T3, N0-N1) adenocarcinoma of the rectum.

The use of adjuvant irradiation combined with systemic chemotherapy, or "chemoradiation," in the management of patients with operable rectal cancer has enabled more conservative surgery to be performed. Chemoradiation

CHICAGO--With an overall response rate of only 2.8% to drugs tested on more than 1,200 colorectal cancer patients over the last 20 years, new drug development has given gastrointestinal oncologists little to be enthusiastic about.

Until 1980, the greatest advances in the management of rectal cancer were technical ones. Whereas in the past most patients with rectal cancer underwent an abdominoperineal resection, it became possible in the 1980s to maintain intestinal continuity in the majority of patients with a low anterior resection and colorectal anastomosis and, more recently, with a low anterio resection and coloanal anastomosis. These advances were due, in part, to the development of stapling devices, which allowed surgeons to perform anastomoses that were technically difficult to perform by hand. More importantly, it became clear that in tumors identified at a relatively early stage, retrograde tumor spread was uncommon, and a 2-cm distal margin was generally adequate.

Dr. Enker offers an orderly presentation of many of the factors related to sphincter-preserving operations, quality of life, and outcome in the surgical management of the patient with rectal cancer. From the practical perspective of a very experienced surgeon, he provides broad guidelines for sphincter-conservation surgery that both the surgeon and nonsurgeon should find useful.

This review nicely summarizes the current state of combined-modality therapy for resectable rectal cancer, largely covering trials currently in progress in the United States. Although the article's title is "Multidisciplinary management of resectable rectal cancer," it really doesn't emphasize how multiple specialists manage rectal cancer patients per se, and thus, the article would probably be more appropriately titled, "Combined-modality therapy in resectable rectal cancer." It would have been interesting if the article had included more details on how radiation oncologists, medical oncologists, and surgeons can cooperate to deliver combined-modality therapy in higher proportions of patients with resectable rectal cancer, but this is a minor criticism.

The standard adjuvant therapy for resectable T3 and/or N1-2 rectal cancer is pelvic radiation therapy plus fluorouracil (5-FU)-based chemotherapy. Two randomized intergroup trials, INT 0114 and INT 0144, will help