The purpose of the annual investigators’
workshops sponsored by The University of Texas M. D. Anderson Cancer Center has
been to review the latest data on new agents, with a particular focus on the
broadly used agent irinotecan (CPT-11, Camptosar). Investigators from around the
world are invited to present current research. The forums are highly interactive
and frank, thus allowing stimulation of new ideas and directions.
The 3rd Investigators’ Workshop was held on July 13-16,
2000, in St. Croix, US Virgin Islands. Five separate scientific sessions were
miscellaneous tumors including lymphomas; and
novel uses of topoisomerases including enhancement of
In addition to stimulating research, the workshops also foster
the development of enduring material for wider distribution to those who did not
attend this workshop. Three publications are intended as the result of this most
recent workshop. This first volume is devoted to GI malignancies. Successive
monthly volumes will be devoted to breast malignancies (volume 2), and novel
agents in lung and other malignancies (volume 3).
In This Issue: Insights and Trends
Leading off this volume, Daniel Haller provides an update on
chemotherapy of advanced colorectal carcinoma and reviews the most current
trials conducted in the United States and Europe. He concludes that not only
have new agents like irinotecan become part of the front-line therapy of
advanced colorectal carcinoma, but oxaliplatin is also being widely used for
this purpose in some European countries. Dr. Haller emphasizes the potential
value of biomarkers for selecting specific and rational chemotherapy for
Henry Pitot and Richard Goldberg discuss future directions in
adjuvant therapy of stage III colon carcinoma. They note that future trials may
demonstrate that incorporating newer agents (irinotecan among them) may prove to
be the standard of care in the adjuvant setting. Both authors also state that
oral fluoropyrimidines have acceptable side effects and are being investigated
in the adjuvant setting.
Robert Diasio describes the current status of oral chemotherapy
for colorectal carcinoma. He reviews all of the current results with
capecitabine (Xeloda), uracil and tegafur (UFT) in conjunction with leucovorin
(the combination known as Orzel), S-1, and BOF A-2. He also provides a succinct
review of the mechanism of action and various targets for these agents. Dr.
Diasio concludes by stating that more oral agents are likely to be developed in
the future for this group of colorectal patients.
Jordan Berlin illuminates new directions in the treatment of
colorectal carcinoma. His emphasis is on the development of novel therapies,
such as immunotherapy (including monoclonal antibodies) and gene therapy, as
well as prospective investigation of new molecular targets that may afford
New developments in the area of prevention of colorectal
carcinoma are reviewed by Patrick Lynch. He relates his own work with familial
adenomatous polyposis (FAP) with the cyclooxygenase-2 (COX-2) inhibitor,
celecoxib (Celebrex), demonstrating its ability to regress polyps. His extensive
review on this subject is supported by numerous references.
Eileen O’Reilly and David Ilson discuss their experience with
the combination of cisplatin (Platinol) and irinotecan in patients with
esophageal carcinoma. Having demonstrated that it is an active combination, they
have expanded their investigations by adding radiotherapy or another
chemotherapeutic agent to this combination.
Jaffer Ajani and colleagues discuss their results with the same
combination of cisplatin and irinotecan in untreated patients who have advanced
gastric carcinoma. The data suggest that it is an active combination, as
previously reported by two Japanese groups.
Also presented are results of an ongoing randomized phase III
study with a combination of gemcitabine (Gemzar) and irinotecan in patients with
advanced pancreatic carcinoma. Caio Rocha Lima and co-workers describe the study
design and rationale for using this drug combination in patients with locally
advanced or metastatic pancreatic cancer and no previous systemic therapy; the
control arm represents treatment with gemcitabine.
Tyvin Rich and Alexander Kirichenko discuss the schedule and
timing of the administration of irinotecan with radiotherapy. They make a case
for properly timing irinotecan when it is administered concurrently with
radiotherapy, speculating that proper timing would not only increase
cytotoxicity but reduce normal tissue toxic effects.
In conclusion, I believe that the data presented at The
University of Texas M. D. Anderson Cancer Center Investigators’ Workshop
accurately presents current insights, trends, and practices in relevant areas of
oncology. I hope you will find this information useful in designing new
investigations and educating your colleagues, in addition to contributing to the
better management of patients.