scout

Gastrointestinal Cancer

Latest News


CME Content


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.

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.

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.

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.

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.

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.

As Drs. Nakakura and Choti point out, the incidence of hepatocellular carcinoma (HCC) is rising in many countries including the United States, mainly as the result of a steady increase in hepatitis C infections. Unfortunately, it now seems that the hepatitis C virus is more carcinogenic than the hepatitis B virus, judging from the frequency with which HCC develops among patients with hepatitis C- vs hepatitis B-induced cirrhosis.[1] Numerous studies have demonstrated changes in various oncogenes and tumor suppressor genes, but no consistent sequence of genetic changes has emerged similar to the adenoma-carcinoma sequence in colon cancer.

Hepatocellular carcinoma (HCC) is the most common solid organ tumor worldwide. In recent decades, diagnosis and treatment of this cancer has evolved significantly. The article by Drs. Nakakura and Choti summarizes many of the advances in this field, delineates the current evidence-based treatment options, and defines promising areas for future study.

NEW ORLEANS-A prospective study in colorectal cancer patients has found that sentinel lymph node (SLN) mapping correctly predicts the presence or absence of nodal metastases, with a very low incidence of skip metastases (disease in a non-SLN), as it does in melanoma and breast cancer.

WASHINGTON-Pharmacia & Upjohn’s Camptosar (irinotecan) has won FDA approval for use as a first-line agent in metastatic colorectal cancer, in combination with fluorouracil (5-FU) and leucovorin. [See ONI April 2000, page 3 for the ODAC review.] The agent was approved as a follow-up colorectal cancer treatment in 1996.

Damjanov and Meropol review the status of several oral fluoropyrimidine drugs that are currently undergoing clinical testing for the treatment of colorectal cancer. Meta-analysis indicates an 8% improvement in the overall response rate and a survival advantage of 0.8 months with infusional vs bolus fluorouracil (5-FU)-arguably small differences. The incidence of grade 3-4 diarrhea, mucositis, and myelosuppression is < 10% with infusional 5-FU, although hand-foot syndrome is commonly associated with this therapy. The prevailing strategy for the development of oral 5-FU drugs employs multiple daily dosing for periods of 2 to 4 weeks followed by a 1- or 2-week break in order to mimic the protracted infusional schedule.UFT

The article by Damjanov and Meropol elegantly outlines the rationale behind the preclinical development of several potential new oral chemotherapy options for patients with advanced colorectal carcinoma and the available data from clinical trials in advanced colorectal cancer that evaluated the activity and safety of these agents. The authors relate the history of fluorinated pyrimidine therapy in colorectal cancer and the pharmacologic challenges to delivering effective oral therapy in a such a way that the chemistry behind the processes becomes readily intelligible. They note that the erratic absorption and blood levels associated with orally administered fluorouracil (5-FU) led to the current approaches to oral therapy.