Xeloda and oxaliplatin (XELOX) is an effective, first-line therapy for metastatic colorectal cancer

Researchers in Europe, led by Jim Cassidy MD, treated patients with metastatic colorectal cancer with capecitabine (Xeloda) and oxaliplatin as the first treatment for their cancers. Response rates, time to progression of tumors, and overall survival were similar to that of the FOLFOX4 regimen.

The regimen included intravenous oxaliplatin on day 1 of each cycle followed by oral capecitabine twice a day for the next 14 days.

Fifty-three of ninety-six patients (55%) showed an objective response to the treatment. After at least 24 months of follow-up median time to cancer progression was 7.7 months and overall survival was 19.5 months.

Toxicities were similar to the FOLFOX4 regimen except for lower problems with blood cell counts. Grade 3 or 4 neutropenia was 7%. Most adverse events were mild to moderate. Most common side effects was acute sensory neuropathy which was experienced by 85% of patients.

The researchers concluded that XELOX is a highly effective first line treatment for metastatic colorectal cancer. Because it is an oral regimen, rather than the pump required for continuous infusion 5-FU, it is likely to be preferred by both patients and health care providers.

They wrote, "Capecitabine has the potential to replace FU/LV in combination with oxaliplatin for MCRC."

The results of the study appear in Journal of Clinical Oncology, Vol 22, No 11 (June 1), 2004: pp. 2084-2091.

Read the study abstract in the Journal of Clinical Oncology.

Experimental drug -- BMS-247550 -- shows no effectiveness in metastatic colorectal cancer and had significant side effects.

There were no partial or complete response to BMS-247550 in a Phase II trial where the drug was given alone to 25 patients with colorectal cancer. BMS-247550 is a epothilone B analog.

The median time before tumors began growing again was 11 weeks.

Serious side effects included grade 3/4 neutropenis in nearly half of patients and 3/4 leukopenia in over one third. About 10% of patients had a sensitivity reaction and 20% had grade 3/4 neuropathy.

The researchers concluded, "Single-agent BMS-247550 (40 mg/m2) administered every 21 days demonstrated no activity in advanced colorectal cancer. Peripheral neuropathy was treatment-limiting."


Read the study abstract in Annals of Oncology

New colorectal cancer therapies are effective but expensive

New drugs to treat colorectal cancer have almost doubled life expectancy for people with advanced cancers. While none can promise a cure, using them in combination with traditional 5FU and leucovorin reduces the size of tumors and extends life.

Erbitux (cetuximab) adds a median time of two months, but costs nearly $31,000 for eight weeks of treatment for the drug alone. Avastin (beveacizumab) costs $21,397 for the same eight weeks. In contrast, eight weeks of treatment with 5FU and leucovorin costs $63 for the drug. All costs are based on the average wholesale price (AWP) of the medicine

Read an article about the NEJM article in USA Today.

Read an article from Reuters on Yahoo.

Here is a link to the commentary by Deborah Schrag, M.D., M.P.H. in the New England Journal of Medicine

Most states fail the Colorectal Cancer Report Card

Will your insurance pay for colorectal cancer screening?

Although screening can actually prevent colorectal cancer by finding polyps before they ever become cancer, insurance coverage for this vital health test is uneven.

The American Gasroenterological Association (AGA)in collaboration with the National Colorectal Cancer Research Association (NCCRA) has issued a report card that grades the states for legislation that mandates insurance coverage for screening.

Only 19 states passed. Twelve received an A for requiring coverage that met the guidelines of the AGA and the American Cancer Society and for specifically referring to those guidelines. Three states were given a B for requiring coverage but not mentioning the AGA-ACS recommendations in the legislation, thus not requiring adherence to any updates or new information.

California and Wyoming got C's for requiring coverage but having very vague and non-specific guidelines. Oklahoma recommends, but does not require coverage for a D.

The rest of the states -- nearly two-thirds have no screening legislation at all.

The federal government also does not require insurance coverage for screenings. Medicare does pay for screenings according to the AGA-ACS, but Medicaid coverage varies from state to state.

You can learn more about what the law is in your state and how you can change an F to an A.

Find out how your state scores and what you can do to improve it.