Cetuximab shows moderate activity when given alone to patients whose colorectal cancer has progressed on irinotecan.

Metastatic colorectal cancer patients whose tumors were positive for epidermal growth factor receptors (EGFR+) were given weekly cetuximab as a single agent. All patients had previously received irinotecan or airinotecan combination therapy.

Of the 57 patients enrolled in the study, 5 (9%) had a partial response, 21 (37%) experienced stable disease. Median survival was 6.4 months.

Nearly all patients (86%) had an acne-like rash. The rash was serious (grade 3) in 18%. In addition, more than half of patients (56%) experienced fatigue, malaise, and lethargy -- serious in 9%.

Three patients had an allergic reaction during treatment. One was able to continue with therapy, but the other two had to stop cetuximab.

Leonard Saltz MD and his colleagues at Memorial Sloan-Kettering Cancer Institute in New York report their findings in the April 1, 2004 Journal of Clinical Oncology.

The study authors conclude, "Cetuximab on this once-weekly schedule has modest activity and is well-tolerated as a single agent in patients with chemotherapy-refractory colorectal cancer whose tumors express the epidermal growth factor receptor. Further studies of cetuximab will evaluate the use of cetuximab in conjunction with first-line and adjuvant treatments for this disease."

Read an abstract in Journal of Clinical Oncology.

Why don't doctors recommend colorectal cancer screening to all their eligible patients?

Nearly 900 primary care physicians in a large California HMO were surveyed to see how many of their patients had been screened for colorectal cancer and what barriers there were to screening in their practices.

Only 79% of standard risk patients had been screened. The median rate for recommending fecal occult blood test was 90%, flexible sigmoidoscopy 70%, and colonoscopy 8%.

Doctors identified lack of reimbursement and lack of systems to remind them and patients of the need for screening as two factors that lowered rates. Poor patient compliance and lack of patient understanding about the risks and benefits of screening were also noted.

Some physicians cited a perceived lack of effectiveness of FOBT as a barrier, although this was not true for sigmoidoscopy.

Dr. Gareth S. Dulai of the Greater Los Angeles Veterans Administration Healthcare Systems and colleagues reported their findings in an online advance of the May 1, 2004 edition of Cancer.

Read the Reuters Health article on Medscape.

Read an article on Ivanhoe

Emend (R) added to standard therapy reduces nausea and vomiting over several cycles of chemotherapy

Researchers added aprepitant (Emend) to the standard combination of ondansetron (Zofran) and dexamethasone used to prevent nausea and vomiting during chemotherapy. In two large, phase III multi-center trials, patients receiving cisplatin treatments were randomly assigned to either the standard ondansetron and dexamethazone or to receive the standard plus aprepitant.

Cisplatin was chosen to test the new anti-nausea combination because it almost always causes significant nausea and vomiting without intervention.

Since nausea and vomiting tend to get worse with each treatment cycle, the researchers wanted to know if aprepitant would still prevent nausea as treatment continued.

During the first cycle 61% of patients in the aprepitant arm of the trial had no vomiting and no significant nausea compared to 46% of patients in the standard arm. By the sixth treatment cycle, 59% of patients receiving Emend still had no vomiting and little nausea compared to 41% on the usual therapy.

Dr. R. deWit and colleagues report their findings in the February 2004 issue of the European Journal of Cancer.

Read a Reuters article about the study.

Read the study abstract on PubMed.

Surgery combined with chemotherapy can improve long term survival in colorectal cancer patients with peritoneal carcinomatosis

NEW YORK (Reuters Health) Mar 16, 2004

Surgeons at Wake Forest University treated 77 colorectal cancer patients with many small tumors on their peritoneum,the membrane that covers abdominal organs. Ordinarily, patients with peritoneal carcinamatosis have a very grim prognosis. However, 17% of the treated patients have survived at least five years. When doctors were able to remove all signs of cancer, 34% lived five years or more.

Patients received both cytoreductive surgery (CS) to remove as much tumor from the peritoneum as possible followed by heated chemotherapy solution pumped into their abdomens (intraperitoneal hyperthermic chemotherapy --IPHC).

Patient CEA levels dropped significantly after surgery, from an average of 31.2 preoperatively to 6.9.

Doctors were able to remove all visible tumor in 37 of the 77 patients. A third of these patients survived five years and are considered cured. The average survival time of the entire group of 37 was 28 months.

Factors that made successful treatment less likely included poor performance status, bowel obstruction, malignant ascites, and incomplete resection of gross disease.

The surgery is not easy for patients. There was a morbidity rate during surgery of 30% and 12% of patients died.

Dr. Perry Shen, lead study investigator, said that while CS-IPHC is "not a treatment for all patients with peritoneal cancer, selected patients may benefit from improved quality of life and extended survival," The researchers recommend a larger, multi-center study to confirm their findings.

Results were reported in the February, 2004 issue of Annals of Surgical Oncology.

Read the Reuters article.
Read the abstract in Annals of Surgical Oncology.

Chemotherapy without follow-up surgery can lead to long-term remission in some patients with liver metatases

Some patients who initially have liver metatases (LM) that cannot be removed surgically are treated with chemotherapy with the goal of reducing the size, number, or location of tumors so they can be resected. Liver surgery normally follows chemotherapy even when tumors have disappeared from imaging studies.

Surgeons in France followed 104 patients who had surgical removal of liver mets that were initially unresectable. After chemotherapy, 15 patients showed a dramatic improvement and no sign of mets were found on ultrasound, CT-scans, or MRI. Of those 15, surgeons found tumors in 4 during surgery; the other 11 had no detectable disease. Eight of the 11 had no further recurrence at a median follow-up time of 31 months.

The 3 patients who did have recurrence had it at 5, 5, and 8 months after surgery.

The study authors believe that surgical treatment of liver disease that has disappeared from imaging may not always be necessary.

Dominique Elias, MD, PhD and her colleagues conclude: "The disappearance of LM after chemotherapy on high-quality imaging studies and after intra-operative liver exploration resulted in their definitive cure in approximately 70% of cases. The current dogma stipulating an obligatory resection of the initially affected part of the liver is no longer acceptable."

Their work is reported in Journal of Surgical Oncology Volume 86, Issue 1 , Pages 4 - 9
Published Online: 22 Mar 2004

Read the abstract in Journal of Surgical Oncology.

Hormone replacement therapy has mixed colorectal cancer benefit

Women who took combination estrogen plus progestin hormone replacement therapy had a reduced risk of getting colorectal cancer. However, those who did get cancer were more likely to have an advanced case.

The Women's Health Initiative randomly assigned 16,608 postmenopausal women to receive combination HRT or a placebo. In the placebo group there were 72 invasive cancers diagnosed, while there were 43 cancers in the hormone group. Screenings for cancer were similar for both groups.

However, women receiving hormone therapy had significantly more positive lymph nodes and a larger percentage (76.2%) had either disease that had spread to lymph nodes or was metastatic. 48.2% of women receiving placebo had advanced disease.

Results of the study were published in the March 4, 2004 New England Journal of Medicine.

Read a discussion of the study on Medscape Medical News.

Read the study abstract in The New England Journal of Medicine.

Colorectal cancer metatases outside the liver may not be contraindication for liver surgery

Society of Surgical Oncology - February 9, 2004

The presence of cancer outside the liver has been considered a contraindication for surgery to remove colorectal cancer liver metatases. However, surgeons in France believe that this should not always be so. In The Annals of Surgical Oncology they report on a study of patients who had complete resections of all tumor outside of their livers (R0) at the same time they had surgery to remove liver metatases.

In their study 75 patients had complete resections (R0) of tumors outside the liver at the same time as their liver surgeries. They represent 25% of all patients undergoing liver surgery to remove all signs of cancer during the time of the study.

Patients were followed for a median period of 4.9 years. The survival rate at 3 years was 45%, and 28% survived five years.

Patients did best who had no more than one metatasis outside of the liver and who had fewer than 5 liver metatases. About half of patients in the study were not able to have all signs of cancer surgically removed.

The study authors conclude: "Extrahepatic disease in colorectal cancer patients with liver metastases should no longer be considered as a contraindication to hepatectomy. However, this intended R0 resection cannot be performed in 50% of laparotomized patients, and negative prognostic factors for surgery include the presence of multiple extrahepatic disease sites or more than five liver metastases."

Dominique Elias, MD, PhD and his colleagues at the Gustave Roussy Institute in France published their study in The Annals of Surgical Oncology 11:274-280 (2004).

Read the abstract in The Annals of Surgical Oncology.