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Gastrointestinal Cancer

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November 1st 1999

Gastric cancer is often advanced and unresectable at diagnosis. Even when a curative resection is possible, the 5-year survival rate for patients with T2 or higher tumors is less than 50%. Survival rates are even lower if lymph node metastases are present at surgery. Many phase III trials of adjuvant therapy have been conducted around the world during the past 4 decades, but their interpretation varies in the East and West. In the West, postoperative treatment modalities have not proven to be superior to postsurgical observation alone. Thus, at present, the routine use of postoperative therapy should be discouraged. In the Orient, however, routine use of postoperative chemotherapy and/or immunotherapy is common after a surgical procedure. Further investigations that correlate treatment response with molecular markers are needed. Improved clinical trial designs, including better preoperative staging, standardized surgical techniques, inclusion of adequate numbers of patients, and the continued use of a surgery-alone control group, are essential. In addition, the incorporation of newer active agents, radiotherapy, and new strategies, such as preoperative therapy and selection of patients based on tumor biology, would result in much-needed advances. Less toxic approaches with novel mechanisms of action, such as antiangiogenesis therapy, tumor vaccines, monoclonal antibodies, and matrix metalloproteinase inhibitors, also hold promise. [ONCOLOGY 13(11):1485-1494, 1999]


CME Content


WASHINGTON-Rats with chemically induced colon cancer that were fed orange juice for 4 weeks had a significantly lower incidence of colon cancer tumors than those receiving water, in a study at Michigan State University, East Lansing. Maurice R. Bennink, PhD, professor of food science and human nutrition, presented the results at the American Institute for Cancer Research 9th Annual Research Conference.

NEW YORK-An innovative clinical trial to be conducted at Columbia University is now recruiting patients with advanced pancreatic cancer. The patients will test the effectiveness of the “Gonzalez regimen,” which combines a strict diet of fresh fruits, vegetable juices, dietary supplements, and pancreatic enzyme extracts with a “detoxification” program. John Chabot, MD, a surgical oncologist at Columbia, is the principal investigator.

PHILADELPHIA-Results of a phase I/II study showed that Virulizin, an investigational monocyte and macrophage activator, has clinical activity in treating advanced pancreatic cancer comparable to that of gemcitabine (Gemzar) and with a “much better” safety profile, Changnian Liu, MD, PhD, of the University of Nebraska Medical Center, reported at the annual meeting of the American Association for Cancer Research.

ORLANDO-The delivery of neurolytic chemicals to the celiac plexus, guided by endoscopic ultrasound, has been shown to be an effective, convenient, and safe technique to provide pain relief for pancreatic cancer patients.

NEW YORK-An innovative clinical trial to be conducted at Columbia University is now recruiting patients with advanced pancreatic cancer. The patients will test the effectiveness of the “Gonzalez regimen,” which combines a strict diet of fresh fruits, vegetable juices, dietary supplements, and pancreatic enzyme extracts with a “detoxification” program. John Chabot, MD, a surgical oncologist at Columbia, is the principal investigator.

ORLANDO-Researchers from the Johns Hopkins University Hereditary Colorectal Cancer Registry have identified what they believe is a previously unrecognized hereditary cancer syndrome. Patients with this syndrome, a variant of hereditary nonpolyposis colorectal cancer (HNPCC), exhibit cafe au lait spots and develop their malignancies at a much earlier age than do other HNPCC patients.

BETHESDA, Md-Enrollment has begun in a randomized phase III trial to test two promising new drugs, irinotecan (Camptosar), also known as CPT-11, and oxaliplatin (an experimental platinum), as initial therapy for advanced colorectal cancer. The National Cancer Institute (NCI) expects that all of the more than 500 centers in the United States and Canada participating in the study will be enrolling patients by summer’s end.

BALTIMORE-A series of colon cancer case studies presented at a meeting on clinical cancer genetics at Johns Hopkins University illustrated the complexity, medical and otherwise, that accompanies genetic testing for cancer.

NEW YORK-An innovative clinical trial to be conducted at Columbia University is now recruiting patients with advanced pancreatic cancer. The study will test the effectiveness of the “Gonzalez regimen,” which combines a strict diet of fresh fruits, vegetable juices, dietary supplements, and pancreatic enzyme extracts with a “detoxification” program. John Chabot, MD, a surgical oncologist at Columbia-Presbyterian Cancer Center, is the principal investigator.

ASCO-The addition of irinotecan, also known as CPT-11 (Camptosar), to standard first-line therapy significantly increased progression-free survival and antitumor response in patients with metastatic colorectal cancer, according to the preliminary results of a randomized, open-label phase III trial presented at the 35th Annual Meeting of the American Society of Clinical Oncology (ASCO). Irinotecan is currently FDA approved for second-line treatment of metastatic colorectal cancer.

ORLANDO, Fla-Sharp dissection through a plane between the visceral and parietal layers of the pelvic fascia permits a clean removal of the entire rectum and mesorectum, and greatly decreases local recurrence of rectal cancer, Warren E. Enker, MD, reported at the 52nd Annual Cancer Symposium of the Society of Surgical Oncology (SSO). Typically, he said, patients have been treated with blunt dissection, resulting in inadequate mesorectal excision.