Gastrointestinal Cancer

ORLANDO-Adjuvant fluorouracil (5-FU)-based chemotherapy for stage II-III colon cancer has been associated with a trend toward decreased survival for patients whose tumors show high-frequency microsatellite instability (MSI-H). This

Recent trials have established the IFL combination (fluorouracil [5-FU], leucovorin, and irinotecan [CPT-11, Camptosar]) as a new standard first-line therapy for patients with metastatic colorectal cancer. Median survival for such patients treated with IFL still ranges from approximately 14 to 18 months, however, underscoring the need for new agents with novel mechanisms of action.

ORLANDO-Combination therapy with irinotecan (CPT-11, Camptosar) and capecitabine (Xeloda) has the potential to become a mainstay of treatment for colorectal cancer, according to David J. Kerr, MD, Rhodes Professor of Therapeutics and Clinical Pharmacology and director of the National Translational Cancer Research Network, Oxford University

LONDON, Ontario-A Canadian study is evaluating the safety and efficacy of single-agent capecitabine(Xeloda) among patients with advanced colorectal cancer deemed unsuitable for more aggressive treatment with bolus fluorouracil (5-FU)/leucovorin/irinotecan (also known as CPT-11, Camptosar).

ROCHESTER, Minnesota-An interim analysis of the North American Intergroup Study N9741 suggests that oxaliplatin (Eloxatin, investigational in the United States) plus infusional fluorouracil (5-FU)/leucovorin (FOLFOX) may be the new standard of care for patients with metastatic colorectal cancer.

PORTLAND, Oregon-In a phase II trial of patients with unresectable or metastatic colorectal cancer, celecoxib (Celebrex) given with irinotecan (CPT-11, Camptosar), fluorouracil (5-FU), and leucovorin (IFL) appears to reduce toxicity, Charles D. Blanke, MD, associate professor of medicine, Oregon Health & Science University, said at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 505).

OXFORD, UK-The combination of capecitabine (Xeloda) and irinotecan (Camptosar) appears to be an effective, easy-to-use, and well-tolerated treatment for patients with metastatic colorectal cancer, according to results of a phase I/II trial conducted by British and Dutch researchers.

DETROIT-A phase II trial of capecitabine (Xeloda) plus oxaliplatin (Eloxatin, investigational in the United States) supports European data suggesting that the combination is active in advanced colorectal cancer, and with manageable toxicity.

Fujirebio Diagnostics recently announced that its CA 19-9 radioimmunoassay for monitoring of pancreatic cancer patients received marketing clearance from the US Food and Drug Administration (FDA). The CA 19-9 radioimmunoassay is the first

Imatinib mesylate (Gleevec) has a lasting effect on advanced gastrointestinal stromal tumors (GISTs), while greatly reducing

ORLANDO-Compared with the standard first-line chemotherapy treatment for advanced colorectal cancer, patients treated with the FOLFOX4 regimen containing the investigational agent oxaliplatin lived longer and had fewer side effects.

A study published in the journal Cancer (94:2327-2332, 2002) suggests that African-Americans who have colon cancer and live in poverty are at much greater risk of dying from the disease.

Drs. Ahrendt and Pitt should be congratulated on a comprehensive and well-presented review of the surgical management of pancreatic cancer. Unfortunately, pancreatic cancer continues to be a major cause of cancer-related death. The majority (80%) of patients still present with unresectable locally advanced or metastatic disease.

Adenocarcinoma of the pancreas remains a lethal malignancy: The majority of patients with pancreatic cancer continue to present with advanced disease and die within a year of diagnosis. Despite this grim fact, some progress has been made over the past decade, particularly in the surgical management of patients with resectable and advanced disease. This well-constructed review by Drs. Ahrendt and Pitt succinctly details the advances that have been made and highlights many of the unresolved issues.

It is with great pleasure that I comment on the excellent article authored by Drs. Ahrendt and Pitt, who have provided a well-written, succinct, up-to-date review focusing on adenocarcinoma of the pancreas. The authors introduce the topic, discuss preoperative staging and assessment of resectability, cover the critical issues regarding resectional therapy and palliative surgery, and provide data on the results of such therapy, including mortality, morbidity, and quality-of-life outcomes. Emphasizing the importance of this topic, the authors note that pancreatic cancer is the fifth leading cause of cancer death in the United States.

Pancreatic cancer is the fifth leading cause of cancer death in the United States, with an overall survival rate of 3%. Unfortunately, only a minority of patients present with localized disease amenable to surgical resection.

Drs. Ahrendt and Pitt should be congratulated on a comprehensive and well-presented review of the surgical management of pancreatic cancer. Unfortunately, pancreatic cancer continues to be a major cause of cancer-related death. The majority (80%) of patients still present with unresectable locally advanced or metastatic disease.

Preoperative or postoperative pelvic radiation plus concurrent fluorouracil-based chemotherapy is standard adjuvant treatment for patients with T3 and/or N1/2 rectal cancer. Newer chemotherapeutic regimens have been developed for the treatment of patients with metastatic disease.

The US National Cancer Institute Gastrointestinal Intergroup has contributed to the development of chemotherapy and radiation regimens for the treatment of stage II and III rectal cancer. The first Intergroup trial demonstrated improvement in relapse-free and overall survival for patients who received protracted venous infusion fluorouracil (5-FU) with radiation compared to those treated with bolus 5-FU.

Over the past decade, patients with locally advanced rectal cancer at The University of Texas M. D. Anderson Cancer Center have been managed with preoperative chemoradiation. Patients achieving a complete clinical response to preoperative chemoradiation have had better pelvic tumor control, sphincter preservation, and overall survival than those with gross residual disease. Some patients achieving a complete clinical response have even had rectal-preserving surgery (full-thickness local excision).

EAST MELBOURNE, Australia-A new prospective study has confirmed the usefulness of 18F-FDG PET in treatment planning for patients with confirmed or suspected colorectal cancer recurrence. In this study, 60% of planned surgeries were found to be unnecessary as the result of PET.

The combination of irinotecan (CPT-11, Camptosar) and gemcitabine (Gemzar) produced a 1-year survival rate of 27%, which is greater than that reported for gemcitabine alone in previous studies in patients with advanced pancreatic cancer (15% and 18% 1-year survival rates, respectively). These study results were published in a recent issue of the Journal of Clinical Oncology (20:1182-1191, 2002).

Studies of a new treatment strategy for colorectal cancer using a therapeutic cancer vaccine technology have begun enrolling patients at several trial sites around the United States and Canada.

The multistep process of carcinogenesis, which can take many years, provides many opportunities for intervention to inhibit disease progression. Effective chemoprevention agents may reduce the risk of cancer by inhibiting the initiation stage of carcinoma through induction of apoptosis or DNA repair in cells harboring mutations, or they may act to prevent promotion of tumor growth. Similarly, chemoprevention may entail blocking cancer progression to an invasive phenotype.

Recent combinations of chemotherapy have significantly improved the response rate and survival time for patients with metastatic colorectal cancer.

Tumor angiogenesis is a complicated process that is regulated by numerous factors simultaneously and in a coordinated fashion.

Cyclooxygenase-2 (COX-2) is the enzyme that normally synthesizes prostaglandins during an inflammatory response.

The prognosis for patients with metastatic colorectal cancer is poor. Use of irinotecan (CPT-11, Camptosar) results in modest response rates of approximately 20% in refractory patients diagnosed with this advanced stage of disease and offers a side-effect profile that improves on that of previous standard treatments.

Capecitabine (Xeloda) and irinotecan (CPT-11, Camptosar) both have demonstrated single-agent activity in patients with colorectal cancer.

Lorus Therapeutics announced recently that it has initiated a phase III trial to evaluate the macrophage activator Virulizin for the treatment of advanced pancreatic cancer. The company will present the results of this trial to the US Food and Drug Administration (FDA) in a new drug application at the completion of the study.