Gastrointestinal Cancer

This was an open lable, pilot translational clinical pharmacology study of a brief (7 day) course of UFT, 300 mg/m²/day, in combination with leucovorin, 90 mg/day, in six patients with newly diagnosed advanced colorectal cancer.

The use of combined modality regimens has been well established in the treatment of stages II and III rectal cancer. The most common chemotherapy regimens used include continuous-infusion 5-FU delivered with the help of a central venous catheter and the use of portable pumps.

This is an open-label, nonrandomized phase I trial to determine the safety and maximum tolerated dose of irinotecan with a fixed dose of UFT plus oral leucovorin in patients with advanced or metastatic colorectal cancer.

CHARLESTON, South Carolina-‘‘Highly censored data” from a multicenter phase II trial of irinotecan (Camptosar)/gemcitabine (Gemzar) suggest that this combination, known as IrinoGem, “is well tolerated and active in advanced and metastatic pancreatic cancer,” Caio Max S. Rocha Lima, MD, reported at a clinical investigators’ workshop. IrinoGem is now being compared to gemcitabine alone in an international multicenter phase III randomized trial involving 75 institutions and 350 patients with locally advanced or metastatic pancreatic adenocarcinoma.

BIRMINGHAM, Ala-New oral agents being tested in clinical trials for the treatment of colorectal cancer show promise of improving the efficacy of 5-fluorouracil (5-FU) in combination regimens. A review of several agents under study-capecitabine (Xeloda), UFT (a combination of uracil plus ftorafur [Tegafur]), and S-1-was presented by Robert B. Diasio, MD, at a clinical investigators’ workshop.

NEW ORLEANS-A meta-analysis of two independent phase III randomized multicenter studies “further strengthens the conclusion that the combination of irinotecan (CPT-11, Camptosar)/fluorouracil (5-FU)/leucovorin represents a new reference standard in the first-line treatment of patients with metastatic colorectal cancer,” said Leonard Saltz, MD, associate attending physician, Division of Solid Tumor Oncology, Memorial Sloan-Kettering Cancer Center.

PHILADELPHIA-“Most people would agree that standard-of-care for frontline treatment of advanced colorectal cancer (CRCA) should now be irinotecan (Camptosar) plus 5-fluorouracil/leucovorin (5-FU/LV),” stated Daniel G. Haller, MD, at an investigators’ workshop sponsored by the University of Texas M. D. Anderson Cancer Center and Pharmacia Oncology. As the basis for this assessment, Dr. Haller of the University of Pennsylvania Cancer Center in Philadelphia, cited presentations made earlier this year.

NEW ORLEANS-New data demonstrate that the recently approved combination of irinotecan (Camptosar), 5-fluorouracil (5-FU), and leucovorin (LV) in-creases overall survival when used as first-line therapy in patients with metastatic colorectal cancer, without a significant increase in side effects.

VILLEJUIF, France-Infusions of oxaliplatin, 5-fluorouracil (5-FU), and leucovorin (LV) timed to circadian rhythms are better tolerated and have better anticancer activity in patients with metastatic colorectal cancer than the same drugs infused traditionally at a constant rate, said Francis Lévi, MD, PhD, chairman of the International Organization for Cancer Chronotherapy in the Department of Medical Oncology, Hôpital Paul Brousse, Villejuif, France.

SAN DIEGO-Virtual colonoscopy is an accurate screening tool for colorectal cancer in lesions greater than 10 mm with good patient tolerance, Richard J. Farrell, MD, said at the American Gastroenterological Association meeting held during the Digestive Disease Week conference.

FLINT, Michigan-The debate continues on the use of sentinel lymph node (SLN) mapping in colon cancer. How many nodes need to be analyzed to improve the outcome for this patient group? The current thought is the more nodes harvested, the better the predictive value, and Dr. Thomas LeVoyer made the case that removing more nodes yields a better survival benefit.

BOSTON-Interim results from an ongoing multicenter study suggest that an irinotecan (Camptosar) dosing regimen of every 3 weeks for patients with 5-fluorouracil (5-FU)-refractory colorectal cancer may be associated with a lower incidence of grade 3-4 late diarrhea when compared to a four-times-a-week schedule. The results were presented at the 36th ASCO Annual Meeting.

PHILADELPHIA-Nearly 45% of all cases of colon cancer have lymph node involvement. Surgical resection is the gold standard of treatment, with adjuvant chemotherapy used in an attempt to improve survival in patients with late-stage disease, but the outlook is often dismal.

NEDLANDS, Australia-If the implications of an Australian study are validated in further prospective studies, microsatellite instability (MSI) could potentially predict those patients with Dukes’ C and possibly Dukes’ B colorectal cancer who will respond best to chemotherapy.

LOS ANGELES-A new angiogenesis signaling inhibitor called SU5416 can be safely used with 5-fluorouracil (5-FU) and leucovorin to treat metastatic colorectal cancer, according to results presented at the 36th annual meeting of the American Society of Clinical Oncology (ASCO).

LONDON-Early trial results from the Royal Marsden GI Collaborators, in the United Kingdom, show that 12 weeks of protracted venous infusion 5-fluorouracil (PVI 5-FU) results in the same efficacy as 6 months of bolus 5-FU for colorectal cancer. This results in less toxicity and impairment of quality of life (QOL).

Laparoscopic colorectal surgery is being utilized increasingly for benign diseases. Recent published series have proven that morbidity and mortality from laparoscopic procedures are superior to those seen after traditional open

SAN DIEGO-“More awareness for colorectal cancer can save lives,” Today Show anchor Katie Couric said via live satellite feed to attendees of the American Gastroenterological Association (AGA) plenary session, held during the Digestive Disease Week conference.

FORT LAUDERDALE, Fla-More patients are candidates for sphincter-saving operations under the revised National Comprehensive Cancer Network (NCCN) practice guidelines for rectal cancer.

SAN FRANCISCO-RhuMAb VEGF (recombinant humanized monoclonal antibody to vascular endothelial cell growth factor) in combination with 5-fluorouracil/leucovorin chemotherapy (5-FU/LV) is well tolerated and may increase response rates and prolong time to disease progression in previously untreated metastatic colorectal cancer, as compared with 5-FU/LV alone.

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