Japanese study shows HAI effective in reducing liver metatases in Stage III colon cancer

Patients with Stage II and III colon cancer were randomly assigned to receive a three-week continuous infusion of 5-FU via hepatic arterial infusion along with surgery or no HAI.

There was a significant decrease in liver metatases in patients receiving HAI at the time of their colon resection surgery, along with a decrease in recurrence and an increase in survival. There was no decrease in metatases outside the liver. These effects were seen only in Stage III patients and were not significant in those with Stage II disease.

Toxicities appeared to be mild.

Sotaro Sadahiro, M.D. and his colleagues at Tokai University School of Medicine, Isehara, Kanagawa, Japan report their findings in Cancer Volume 100, Issue 3 , Pages 590 - 597 (Published online by The American Cancer Society on December 12, 2003)

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Early trial of oxaliplatin and capecitabine shows effectiveness in advanced colorectal cancer.

A phase II trial of oxaliplatin and the oral drug capecitabine showed a 37.1% partial response rate in 35 enrolled patients. Progression-free survival was projected to be 6.9 months.

Initially 13 patients were treated with 2000 mg/meter-squared of capecitabine, but this dose proved very toxic with hospitalizations for diarrhea and dehydration. 62% of the first set of patients experienced grades 3 and 4 diarrhea.

A reduced dosage of 1500 mg/meter-squared was better tolerated by the next 35 patiients with about 20% having grades 3 and 4 diarrhea. At the lower dose, four patients required hospitalization for diarrhea, 1 for febrile neutropenia, and 1 for ventricular fibrillation.

Anthony F. Shields, M.D, Ph.D led the study at the Karmanos Cancer Institute in Detroit. Patients were also enrolled at the University of Michigan, the Lombardi Cancer Center at Georgetown University, and Fox Chase Cancer Center in Philadelphia.

Results were published in Cancer Volume 100, Issue 3 , Pages 531 - 537 (Published online by the American Cancer Society, December 12, 2004)

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Smokers have higher risk for colorectal cancer.

American College of Gastroenterology -- December, 2003

A study of nearly 2000 patients undergoing screening colonoscopy has identified smoking as a signficant risk for colorectal cancer and polyps. The risk for current smokers -- those who are still smoking or who have quit within the past ten years -- is greater than the risk of having a family history of the disease.

Researchers found a higher incidences of all types of adenomas as well as cancers. The cancers were primarily on the left side of the colon.

Joseph Anderson MD and his colleagues at Stony Brook University, New York, published the results of their study in The American Journal of Gastroenterology Volume 98, Issue 12 , December 2003,
Pages 2777-2783.

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Families of patients who die at home with hospice support are more satisfied with overall care.

Journal of the American Medical Association -- January 7, 2004

Researchers from Brown University and the University of Massachusetts interviewed family members of nearly 1,600 people who had died. About two-thirds of them had died in an institution -- hospital or nursing home. The others died at home, and about half of them had home hospice services.

The interviewers asked about physical comfort, emotional support, physician communication, respect for the dying person, and support for the family.

When hospice care was provided, 70% of families rated overall care as "excellent." Less than 50% of families of those dying in institutions or with home health care services rated care that high.

Joan M. Teno, MD and her research team concluded, " Many people dying in institutions have unmet needs for symptom amelioration, physician communication, emotional support, and being treated with respect. Family members of decedents who received care at home with hospice services were more likely to report a favorable dying experience."

JAMA 2004;291:88-93.

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Should oxaliplatin regimens replace irinotecan as standard first-line therapy for metastatic colon cancer?

American Cancer Society -- January 13, 2004

A recent study published in The Journal of Clinical Oncology (Vol. 22, No. 1: 23-30) has shown better survival for oxaliplatin regimens compared to irinotecan. The article suggests that oxaliplatin should replace the current irinotecan therapy as standard first line treatment.

Patients were randomly assigned to one of three treatments: Irinotecan and bolus 5FU plus leucovorin (IFL), oxaliplating and infused 5FU plus leucovorin (FOLFOX) or irinotecan and oxaliplatin (IROX).

Researchers were studying the time it took before the cancer got worse, how many patients had a response to the treatment, how long patients survived, and how toxic the treatments were.

For the FOLFOX arm median time before disease progressed was 8.7 months, 45% of patients responded to treatment, and median survival time was 19.5 months. For IFL time to progression was 6.9 months, response rate was 31%, and survival time was 15.0 months. For IROX those figures were 6.5 months, 35%, and 17.4 months. The FOLFOX regimen had significantly lower rates of severe nausea, vomiting, diarrhea, low white blood counts with fever, and dehydration. The oxaliplatin caused sensory neuropathy and low white counts.

The study did not include an arm with irinotecan and continuously infused 5FU (FOLFIRI).

The ACS News article continues to discuss the evolution of colorectal cancer chemotherapy.

Read the article from the ACS News Center.

Read the Journal of Clinical Oncology abstract.

Smoking increases risk of death from colorectal cancer, particularly in women younger than 50.

American Cancer Society -- December 1, 2003

Researchers at Northwestern University analyzed evidence from the Chicago Heart Association Detection Project in Industry study which has followed 39,299 men and women for anaverage of 26 years. The group was divided into men, women, and men and women under age 50.

There was an increased risk for men and women of all ages, but the greatest risk was for women under 50.

Susan M. Gapstur, Ph.D published their results in Cancer Volume 100, Issue 2 , Pages 288 - 293.

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Randomized trials show similar results whether FOLFOX6 precedes or follows FOLFIRI regimen for advanced colorectal cancer.

American Society for Clinical Oncology -- January 15, 2004

Randomized trials in France compared first-line therapy that combined leucovorin and continous infusion 5FU combined with either irinotecan (Arm A) or oxaliplating (Arm B). When cancer progressed, the patient was switched to the other drug so that all patients in the trial received both regimens.

Median survival in the arm that began with FOLFIRI was 21.5 months, median survival in the FOLFOX6 arm was 20.6 months.

The researchers concluded, " Both sequences achieved a prolonged survival and similar efficacy. The toxicity profiles were different."

A. deGramont and colleagues published their results in The Journal of Clinical Oncology Vol 22, No 2 (January 15), 2004: pp. 229-237.

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Phase II trials show Combination of irinotecan and capecitabine effective first-line treatment

American Cancer Society -- December 8, 2003

A multi-center research study in Italy has shown a combination of irinotecan (CPT-11 or CamptosarTM) and the oral drug capecitabine (XelodaTM) to be effective in treating advanced colon cancer.

140 patients were enrolled in the study, 46% showed an objective response. Eight percent (8%) were complete responses.

Treatment was in 3 week cycles with capecitabine given on days 2-15 and irinotecan given either in one large dose on day one (Arm A) or split into two doses and given on day 1 and day 8 (Arm B). As enrollment progressed, doses of both drugs were lowered to reduce side effects.

55 patients were treated with the higher doses, with the most frequent serious (Grades 3-4) adverse effect being diarrhea. Twenty-seven percent of those patients had severe diarrhea. After doses were lowered, diarrhea improved as did "hand and foot syndrome."

Arm A was more effective than Arm B: In Arm A there were 47% objective responses with 9% complete response. Arm A patients had a median of 8.3 months before their cancer progressed. In Arm B, responses were 44%, with 8% being complete. Median time to progression was 7.6 months.

The authors conclude, "The capecitabine and irinotecan combination was a highly active first-line therapy in metastatic CRC. An acceptable safety profile was observed after dose reduction, particularly when irinotecan was administered on 1 day."

Results of the study were published in Cancer 2004;100:279-87. ? 2003 American Cancer Society.

Read the abstract of the Cancer article here.