Elderly patients with metastatic colorectal cancer respond well to a combination of oxaliplatin and oral UFT

Italian researchers treated 47 patients over the age of 70 with oxaliplatin and UFT, an oral drug that combines Tegafur with uracil. More than half of them (51%) had a response to the treatment, and another 38% had stable disease.

The median time before the cancer worsened (TTP or time to progression) was 8 months, ranging from 3 months to more than 19 month. Overall median survival time was 14.1 months. The treatment was safe, with most side effects mild to moderate. Most patients maintained quality of life throughout therapy.

Geraldo Rosati and his team reported their results in Oncology (Vol. 69, No. 2, 2005).

Conclusions: These results confirmed that this tested chemotherapy combination is active with acceptable tolerability and QoL maintenance in elderly patients with advanced or MCRC.

Read the study abstract in Oncology.

Erbitux treatment may cause profound fatigue because of insufficent magnesium

Erbitux (cetuximab) causes severe fatigue and other symptoms of low magnesium levels in some colorectal cancer patients. Testing for magnesium and calcium levels and providing supplemental magnesium can reduce problems. Symptoms get better when treatment ends.

Researchers explain that cetuximab affects the kidney which may be no longer able to reabsorb magnesium resulting in its being excreted in urine and lost. After observing a patient with extreme fatigue and weakness who was being treated with Erbitux and Camptosar (irinotecan), they measured magnesium levels in his blood and found them unusually low. Replacing magnesium with IV supplements improved the situation and allowed him to continue on his treatment.

The team at Memorial Sloan Kettering Cancer Center reviewed a series of 154 colorectal cancer patients who had been treated with cetuximab and found 6 with serious low magnesium levels and 2 with extremely serious levels. They suggest:

Because EGFR is strongly expressed in the kidney, particularly in the ascending limb of the loop of Henle where 70% of filtered magnesium is reabsorbed, EGFR blockade may interfere with magnesium transport. Because symptoms may be rapidly ameliorated with supplementation, we suggest that, when fatigue or hypocalcemia is encountered during cetuximab therapy, serum magnesium level be measured and repleted
as necessary.

When patients are extremely fatigued during Erbitux treatment measuring magnesium levels and replacing magnesium if necessary may help.

Research observations are reported in the August 17, 2005 issue of the Journal of the National Cancer Institute.

Read the study abstract from the Journal of the National Cancer Institute.

Removing the primary tumor may not be best strategy when colorectal cancer has spread.

When colorectal cancer without symptoms has spread to the liver, not removing the primary tumor in the colon may be the best approach according to a French study.

Between 1997 and 2001 27 patients with asymptomatic colorectal cancer with liver mets were treated initially with chemotherapy rather than having their primary tumor removed. Researchers matched this group with another 32 patients with similar chatacteristics but who were initially treated with surgery to remove the primary tumor. Matched characteristics included age, sex, performance status, primary tumour location, number of liver metastases, nature of irresectable disease and type of chemotherapy.

The 2 year survival rate for the chemotherapy group was 41% compared to 44% in the group that had surgery initially. In the resection group, there were no surgical deaths but 6 patients (19%) had complications after their operations. Four of the 27 chemotherapy patients did develop a bowel obstruction. Average time in the hospital for the chemotherapy group was 11 days. The surgical resection group spent an average of 22 days hospitalized.

Bernard Nordlinger and his team at the Ambroise Paré Hospital in Boulogne concluded:

Systemic chemotherapy without resection of the bowel cancer is the option of choice because, for most patients, it is associated with a shorter hospital stay and avoids surgery without a detrimental effect on survival.

Read the study abtract in the British Journal of Surgery -- published online July 21,2005.

Boniva (ibandronate) reduces serious problems in colorectal cancer patients with bone mets

In a recent study, a single injection of ibandronate (Boniva) helped prevent fractures and other complications of colorectal cancer bone metastases. Ibandronate is a drug often used to treat osteoporosis.

Researchers compared an injection of ibandronate to a placebo in 30 patients. Seventy-eight percent of patients in the placebo group had a fracture or other skeletal complication compared to 39 percent of those who received ibandronate. The research team defined a skeletal event as a fracture, spinal compression, or a need to treat a metastasis with radiation therapy or surgery.

Time to bone lesion progression in treated patients was 279 days compared to 93 days in those receiving a placebo. Treated patients also had fewer skeletal events each year.

Antonios Hatzopoulos, MD led a team from Athens, Greece and reported their results at the Multinational Association of Supportive Care in Cancer (MASCC)International Symposium in Geneva on July 2, 2005. They concluded that ibandronate may be an effective way to prevent complications from bone metastases but cautioned that larger studies are needed to confirm the results.

Read and article about the study on Doctor's Guide.

Go to the MASCC web site for more information about the International Symposium.

Virtual colonoscopy can find significant medical problems outside the colon

In addition to finding colon cancer or polyps within the colon itself, virtual colonoscopy can screen the surrounding abdomen and pelvis for cancer and other serious conditions.

Five hundred men were examined with virtual colonoscopy -- computed tomographic colonography or CTC -- in a study at the Veterans Affairs Medical Center in San Francisco. Of those, 9 percent had clinically important findings outside their colon including aneurysms and suspicious masses in abdominal organs.

Men in the study included both those at average risk for colorectal cancer (39 percent) and another 61 percent at high risk. There was no significant difference in the number of additional clinical important findings in men of average or high risk.

The cost to follow up suspicious problems was extremely low, averaging $28,12 per CTC ezam. Radiation exposure for the exams was no greater than a non-contrast CT-scan of the abdomen and pelvis.

Judy Yee, M.D., Chief of Radiology at the Veterans Affairs Medical Center led the study which now has more than three and a half years of follow-up. Her results are published in the August 2005 issue of Radiology.

Dr. Yee says,

"The chance of finding cancer outside the colon may be as significant as the chance of finding cancer inside the colon,"

Read the study abstract in Radiology.

Read a news release from the Radiological Society of North American which publishes Radiology.

Read an article about the study in Science Daily.

Women's preference for a female endoscopist is a barrier to screening

Almost half of women (43%) in a recent study said that they would prefer having a colonoscopy done by a woman endoscopist. Almost all of the women (87%) in the group who wanted a female doctor were willing to wait more than a month for an appointment with one, and 14% were willing to pay more. Seventy-five percent indicated that embarrassment was the reason for their preference.

Five percent (5%) would refuse to have colonoscopy if it could not be done by a woman.

Stacy B. Menees M.D. and her team from the University of Michigan interviewed 200 women waiting for a primary care appointment in four different offices, asking them to complete a questionnaire about their experiences and preferences with colorectal cancer endoscopy screening.

In an article in the August 2005 issue of Gastrointestinal Endoscopy, they concluded:

Women patients frequently prefer a woman endoscopist, and this preference is reported as being strong enough to delay the procedure and to incur personal expense. It is an absolute barrier to endoscopy according to 5% in this subset of women surveyed. Interventions must be made in the primary care setting to address this issue and to increase the participation of women patients in CRC screening.

Read the abstract in Gastrointestinal Endoscopy.

Patients with advanced cancer do not always understand that the goal of their treatment is not a cure.

Researchers in Australia interviewed patients with advanced cancer who were receiving palliative treatment for their cancer to find out how much the patients understood about their diagnosis and the goals of their treatment. Patients responded twice, at the beginning of the study and 12 weeks later.

Twenty percent of studied patients considered their disease non-life treatening. Twenty-nine percent (29%) believed that the goal of treatment was to cure their cancer. Only forty-six percent (46%) correctly understood that the intent of treatment was not cure. Patients in the last six months of life were more likely to understand that treatment goals were not curative.

The research team in the medical oncology unit at Canberra Hospital wrote:

"Many patients with advanced cancer do not understand the goals of treatment. Excessive optimism may lead to impaired decision making. Further empirical research into information transfer and predictors of accurate patient understanding would assist clinicians in their discussions of prognosis and potential treatment outcomes with patients."

Read an abstract of the study in the early online edition of European Journal of Cancer Care.

Combination of oxaliplatin and Iressa appears to be ineffective in colorectal cancer

Researchers at the University of Chicago Medical Center have decided not to go on with a planned Phase II trial of oxaliplatin and gefitinib (Iressa) when there were no objective responses in patients in a Phase I trial.

Their results are reported in the August 2005 issue of the American Journal of Clinical Oncology where they wrote, "The authors conclude that the combination of gefitinib plus oxaliplatin is inactive in advanced colorectal cancer."

Read the study abstract in PubMed from the National Library of Medicine.