Gastrointestinal Cancer

Historically, the treatment of squamous cell carcinoma of the anal canal has been an abdominoperineal resection (APR), resulting in loss of the anus and rectum with need for a permanent colostomy.

BERLIN-The failure of a major colon cancer trial to reach its primary endpoint surprised even the most seasoned gastrointestinal cancer investigators. Overall survival was not improved when cetuximab (Erbitux) was added to a first-line oxaliplatin-based regimen (Eloxatin), according to phase III COIN trial at ECCO/ESMO 2009.

Common variants of the gene that determines human blood type are associated with an increased risk of pancreatic cancer, according to a study by scientists at the National Cancer Institute (NCI) and colleagues from many universities and research institutions. The study, published online August 2, 2009, in Nature Genetics, is consistent with an observation first made more than 50 years ago.

Young adults who are overweight or obese have an increased risk of pancreatic cancer, according to a study out of M.D. Anderson Cancer Center. In addition, the Houston-based researchers found that obesity at an older age is associated with a lower overall survival rate for patients with pancreatic cancer.

ORLANDO-Preliminary data suggested that Novartis’ RAD001 is moderately active in stabilizing the progression of HCC, according to a poster presentation at ASCO 2009 (abstract 4587). In this phase I trial, researchers in Taiwan enrolled 36 advanced HCC patients whose disease was not suitable for local therapy or had progressed after local therapy.

Since the early 1990s, postoperative adjuvant chemoradiotherapy was widely viewed as the main approach to treat patients with stage II and III rectal cancer. Over the past few years, significant efforts have shifted towards developing neoadjuvant approaches, which combine chemotherapy with radiotherapy prior to surgical resection.

SAN FRANCISCO-Routine KRAS testing in colon cancer patients received a major boost in January when ASCO issued a provisional clinical statement in favor of pretreatment genetic screening in metastatic disease. But KRAS is only the first step toward personalized medicine in colorectal cancer, according to reports presented at the 2009 Gastrointestinal Cancers Symposium. In fact, colon cancer treatment is headed in the same direction as breast cancer, with other genetic polymorphisms emerging as both predictive and prognostic.

Colorectal cancer is the second leading cause of cancer-related deaths in the United States. According to the most recent data from NCI, the relative five-year survival rate among metastatic colorectal cancer patients is 8%. While colorectal cancer can metastasize to other organs, including the lung, the liver is the most frequent site of metastasis. Metastases to the liver occur in approximately 50% of colorectal cancer patients and account for at least two-thirds of all colorectal cancer deaths.

SAN FRANCISCO-Two agents dramatically delayed the time to disease progression in metastatic neuroendocrine tumors, according to reports at the 2009 Gastrointestinal Cancers Symposium.

STOCKHOLM-For rectal cancer patients, a multidisciplinary team is critical to success because it increases the possibility of a curative resection, Andres Cervantes, MD, associate professor of medicine at University Hospital, Valencia, Spain, said at ESMO 2008. “Every patient should be treated within an expert multidisciplinary team,” he emphasized.

The treatment of older patients with colorectal cancer is not always straightforward. As highlighted in the article by Dr. Ades, the heterogeneity of physiologic aging, the increasing prevalence of comorbid disease with age, and changing preferences with aging make counseling about adjuvant therapy more complex for older patients than for younger patients.

States population will be over 65 years old, with 2% of the population over 84. The corresponding projections for 2050 are 21% and 5%, respectively.[1] These projections underscore the aging of the population, with most recent estimates of life expectancy hitting a record high of 78.1 years.[2] With Americans living longer than ever before, physicians are already seeing larger numbers of elderly patients with cancers whose incidence increases with age, including colon cancer.

Exiqon A/S has released its miRNAbased prognostic test designed to identify stage II colon cancer patients who may be at significantly higher risk for recurrence and for whom adjuvant chemotherapy may be warranted.

Excellent safety, efficacy, and tolerability profiles have resulted in the rapid integration of oral tyrosine kinase inhibitors into most facets of the treatment of gastrointestinal stromal tumors (GIST).

In the pre-imatinib era, surgery was the only effective treatment for gastrointestinal stromal tumor (GIST). However, this treatment modality was often either not possible or insufficient for cure due to the aggressive nature of this disease.

Gastrointestinal stromal tumors (GISTs) originate from the interstitial cells of Cajal or a precursor and are the most common mesenchymal neoplasms of the gastrointestinal (GI) tract.[1] Although GISTs often present as localized masses, they are typified by a high risk of metastatic relapse, most commonly in the liver and peritoneum.

Davies/Goldberg Article Reviewed. The past decade has seen exciting developments in the field of colorectal cancer, particularly in the setting of advanced disease.

In this case report, we discuss the presentation, workup, and therapeutic management of a 40-year-old man who presented with borderline resectable, periampullary pancreatic cancer and underwent a margin-negative resection following neoadjuvant chemoradiotherapy.

Colorectal cancer is the third most common cancer in the United States.[1] In 2008, an estimated 148,810 new cases of colorectal cancer will be diagnosed and nearly 50,000 people will die of the disease.

Davies/Goldberg Article Reviewed. The complexity of treatment options that now exist for patients with newly diagnosed metastatic colorectal cancer has increased dramatically over the past decade.

Prior to the publication of the German CAO/ARO/AIO 94 trial, the conventional adjuvant approach for patients with clinically resectable, ultrasonographically diagnosed T3 (uT3) and/or node-positive rectal cancer was initial surgery and, if pathologically confirmed T3 (pT3) and/or node-positive, postoperative combined chemotherapy plus radiation. The German trial confirmed that compared to postoperative therapy, the preoperative approach was associated with significantly lower local recurrence rates, less acute and chronic toxicity, and an increased incidence of sphincter preservation.

Prior to the mid-1980s, patients with rectal cancer usually underwent surgery alone, resulting in high rates of pelvic failure with subsequent morbidity and death.

Minsky and Guillem should be commended for this excellent review and for addressing major areas of controversy in the management of rectal cancer.

In a change from its previous recommendation, the US Preventive Services Task Force now recommends that adults aged 50 to 75 be screened for colorectal cancer using annual high-sensitivity fecal occult blood testing, sigmoidoscopy every 5 years with fecal occult testing between sigmoidoscopic exams, or colonoscopy every 10 years. According to the Task Force, good evidence exists that using these methods save lives.

Localized pancreatic cancer, whether resectable or unresectable, is a separate entity from metastatic pancreatic cancer. Multiple studies have demonstrated that even in the setting of unresectable disease, the progression-free and overall survival of patients with localized pancreatic cancer exceeds that associated with metastatic pancreatic cancer.

Surgical resection offers the only potential cure for pancreatic adenocarcinoma. Unfortunately, while perioperative outcomes have improved dramatically in recent years, few patients present with tumors that are amenable to resection, and even after resection of apparently localized disease, long-term survival is poor.

Despite advances in endoscopic and other screening techniques, less than half of US adults at risk for colorectal cancer undergo adequate screening. As a consequence, approximately half of all new cases of colorectal cancer are diagnosed in later stages.

Sorafenib is indicated for the treatment of patients with advanced renal cell cancer, and patients with unresectable hepatocellular cancer. Sunitinib is indicated for the treatment of patients with advanced renal cell cancer, and patients with gastrointestinal stromal tumor (GIST) after disease progression on imatinib mesylate (Gleevec).

Researchers from the Leeds Institute of Molecular Medicine at the University of Leeds assessed the quality of colon cancer surgery and noted that there was marked variability in the plane of surgery achieved in colon cancer.

Gemcitabine (Gemzar)-based regimens have been the mainstay of front-line treatment for patients who present with advanced pancreatic cancer over the past decade, but most medical oncologists throw their hands up in frustration when considering what therapeutic options a patient is left with once he or she has progressed beyond first-line therapy. This is not without reason-as nicely summarized in the review article by Almhanna and Kim, studies in the published medical literature focusing on treatment of pancreatic cancer in the salvage setting have generally been small and have shown very modest clinical efficacy, characterized by low response rates and progression-free survival of a few months at best.