Gastrointestinal Cancer

The current standard of care for patients with stage T3 rectal cancer is adjuvant combined-modality treatment with radiation and fluorouracil (5-FU)-based chemotherapy. Although data from randomized phase III trials comparing

Oxaliplatin (Eloxatin) has demonstrated significant activity in a variety of tumor types in addition to colorectal cancer. Several studies have reported on the effectiveness of oxaliplatin as single-agent treatment or in

No adequate second- or third-line therapy is available in the United States for patients with metastatic colorectal cancer and disease progression following treatment with fluorouracil (5-FU)-based therapy and an irinotecan (CPT-

Colorectal cancer is one of the leading causes of cancer death. The mainstay of chemotherapy in colorectal cancer patients for the past 40 years has been fluorouracil (5-FU). Oxaliplatin (Eloxatin) is a novel platinum compound with promising activity in colorectal cancer. As a single agent, oxaliplatin has produced response rates of 12% to 24% in patients with previously untreated advanced colorectal cancer, and 10% to 11% in patients with relapsed or refractory advanced colorectal cancer. In phase II trials, oxaliplatin combined with 5-FU, with or without leucovorin, was associated with response rates of 60% and higher when used as front-line therapy, and when used in patients with relapsed or refractory advanced colorectal cancer, response rates ranged from 25% to 50%. In the front-line setting, two randomized trials of 5-FU and leucovorin, with or without oxaliplatin, demonstrated that the addition of oxaliplatin significantly increases response rate and time to tumor progression, but not survival, over 5-FU plus leucovorin alone. The reasons for this discrepancy are unclear, and several possibilities are being considered. Additional phase III trials are underway to clarify the contribution of oxaliplatin in the treatment of patients with locally advanced and metastatic colorectal cancer. [ONCOLOGY 14(Suppl 11):9-14, 2000]

Therapy of hepatocellular carcinoma in cirrhotic patients is challenging. Liver dysfunction, portal hypertension, third spacing, thrombocytopenia, and neutropenia limit the choice of chemotherapeutic agents. However, the abundant vascularity of hepatocellular carcinoma presents an attractive target for antiangiogenic therapy, potentially tolerable even in cirrhotics.

BOSTON-Despite the pessimism of many experts, patients can benefit from surgery for locoregional recurrence of colorectal cancer, according to a 12-year retrospective study presented by Julio Garcia-Aguilar, MD, PhD, at the American Society of Colon and Rectal Surgeons (ASCRS) annual meeting.

BOSTON-A hybrid approach mixing laparoscopic and open procedures in surgery for rectal cancer may allow patients a faster recovery, Richard L. Whelan, MD, said at the American Society of Colon and Rectal Surgeons annual meeting. The approach uses laparoscopic methods for splenic flexure takedown in the area near the diaphragm at the start of the operation and switches to open surgery for removal of the cancer from the rectum.

BOSTON-Preoperative CT scans may be a cost-effective way to improve management of colon cancer patients through earlier identification of those who have liver metastases, Richard S. Swanson, MD, said at the American Society of Colon and Rectal Surgeons (ASCRS) annual meeting.

BOSTON-Surgeons at the University of Texas–Southwestern Medical Center (UT-SW), Dallas, have documented a rising incidence of colorectal cancer among people aged 40 to 49. They presented the results of the retrospective study at the American Society of Colon and Rectal Surgeons (ASCRS) annual meeting.

This year, approximately 40% of the 28,300 patients diagnosed with pancreatic carcinoma in the United States will present with locally advanced disease. Radiotherapeutic approaches are often employed, as these patients

This year, approximately 40% of the 28,300 patients diagnosed with pancreatic carcinoma in the United States will present with locally advanced disease. Radiotherapeutic approaches are often employed, as these patients

This year, approximately 40% of the 28,300 patients diagnosed with pancreatic carcinoma in the United States will present with locally advanced disease. Radiotherapeutic approaches are often employed, as these patients

SAN DIEGO-Hepatocellular carcinoma (HCC) is increasing in the United States, while survival rates have not improved substantially, Andrew Mason, MD, of the University of New Mexico Health Sciences Center, Albuquerque, said at the annual meeting of the American Gastroenterological Association (AGA), held during the Digestive Disease Week conference.

SAN DIEGO-First-degree relatives of colorectal cancer patients are at increased risk of getting the disease themselves, and it is generally recommended that they have colorectal cancer screening beginning at age 40. A new study suggests that educational interventions by phone and mail may increase screening rates in this high-risk population.

BOSTON-Benign anorectal disease should be treated as a possible marker for precancerous anal lesions in men who have sex with men, Stephen E. Goldstone, MD, said at the American Society of Colon and Rectal Surgeons annual meeting.

BOSTON-HIV-positive patients often cannot tolerate treatment for anal squamous cell carcinoma and have a worse prognosis than other patients, according to two studies presented at the American Society of Colon and Rectal Surgeons (ASCRS) annual meeting.

Adjuvant chemotherapy has been shown to alter the natural history of resected colon cancer. Two regimens (fluorouracil [5-FU] plus leucovorin and 5-FU plus levamisole) have been found to prolong disease-free survival and overall survival in affected patients.

Postoperative combined-modality therapy with fluorouracil (5-FU) and radiation therapy is accepted practice for high-risk rectal cancer. Postoperative pelvic radiotherapy alone may improve pelvic control, but is not associated with an improvement in survival.

In the United States and Europe, the combination of oral UFT plus leucovorin has been reported to produce objective responses and survival rates similar to those achieved with standard intravenous 5-fluorouracil plus leucovorin in patients with metastatic colorectal cancer, with reduced toxicity.

UFT (with leucovorin) and irinotecan both have single-agent activity in colorectal cancer, with non–cross-resistant mechanisms of action. Combining these drugs would be anticipated to increase response rates while maintaining the advantages of a regimen based on an orally administered fluoropyrimidine.

This was an open lable, pilot translational clinical pharmacology study of a brief (7 day) course of UFT, 300 mg/m²/day, in combination with leucovorin, 90 mg/day, in six patients with newly diagnosed advanced colorectal cancer.

The use of combined modality regimens has been well established in the treatment of stages II and III rectal cancer. The most common chemotherapy regimens used include continuous-infusion 5-FU delivered with the help of a central venous catheter and the use of portable pumps.

This is an open-label, nonrandomized phase I trial to determine the safety and maximum tolerated dose of irinotecan with a fixed dose of UFT plus oral leucovorin in patients with advanced or metastatic colorectal cancer.

CHARLESTON, South Carolina-‘‘Highly censored data” from a multicenter phase II trial of irinotecan (Camptosar)/gemcitabine (Gemzar) suggest that this combination, known as IrinoGem, “is well tolerated and active in advanced and metastatic pancreatic cancer,” Caio Max S. Rocha Lima, MD, reported at a clinical investigators’ workshop. IrinoGem is now being compared to gemcitabine alone in an international multicenter phase III randomized trial involving 75 institutions and 350 patients with locally advanced or metastatic pancreatic adenocarcinoma.

BIRMINGHAM, Ala-New oral agents being tested in clinical trials for the treatment of colorectal cancer show promise of improving the efficacy of 5-fluorouracil (5-FU) in combination regimens. A review of several agents under study-capecitabine (Xeloda), UFT (a combination of uracil plus ftorafur [Tegafur]), and S-1-was presented by Robert B. Diasio, MD, at a clinical investigators’ workshop.

NEW ORLEANS-A meta-analysis of two independent phase III randomized multicenter studies “further strengthens the conclusion that the combination of irinotecan (CPT-11, Camptosar)/fluorouracil (5-FU)/leucovorin represents a new reference standard in the first-line treatment of patients with metastatic colorectal cancer,” said Leonard Saltz, MD, associate attending physician, Division of Solid Tumor Oncology, Memorial Sloan-Kettering Cancer Center.

PHILADELPHIA-“Most people would agree that standard-of-care for frontline treatment of advanced colorectal cancer (CRCA) should now be irinotecan (Camptosar) plus 5-fluorouracil/leucovorin (5-FU/LV),” stated Daniel G. Haller, MD, at an investigators’ workshop sponsored by the University of Texas M. D. Anderson Cancer Center and Pharmacia Oncology. As the basis for this assessment, Dr. Haller of the University of Pennsylvania Cancer Center in Philadelphia, cited presentations made earlier this year.

NEW ORLEANS-New data demonstrate that the recently approved combination of irinotecan (Camptosar), 5-fluorouracil (5-FU), and leucovorin (LV) in-creases overall survival when used as first-line therapy in patients with metastatic colorectal cancer, without a significant increase in side effects.

VILLEJUIF, France-Infusions of oxaliplatin, 5-fluorouracil (5-FU), and leucovorin (LV) timed to circadian rhythms are better tolerated and have better anticancer activity in patients with metastatic colorectal cancer than the same drugs infused traditionally at a constant rate, said Francis Lévi, MD, PhD, chairman of the International Organization for Cancer Chronotherapy in the Department of Medical Oncology, Hôpital Paul Brousse, Villejuif, France.

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.