Gastrointestinal Cancer

Irinotecan (Camptosar) is a topoisomerase I inhibitor with demonstrated antitumor activity against a wide variety of malignancies. Phase II studies have shown that this agent has significant single-agent activity against both chemotherapy-naive and fluorouracil (5-FU)-refractory colorectal cancer. Phase III studies now indicate that irinotecan/5-FU/leucovorin combinations have antitumor activity superior to standard 5-FU/leucovorin regimens alone. These irinotecan-based combinations are now entering clinical trials for the adjuvant treatment of resected stage III colon cancer. It is hypothesized that the superior antitumor activity of these irinotecan-based combinations seen in the metastatic setting will translate into improved survival and increased cure rates in these earlier-stage patients. [ONCOLOGY 14(Suppl 14):47-50, 2000]

Two randomized phase III trials with irinotecan as second-line treatment of metastatic colorectal cancer have shown that irinotecan (CPT-11, Camptosar) significantly improves survival when compared with best supportive care or continuous infusion of fluorouracil (5-FU) after failure of 5-FU.

Fifteen patients with metastatic colorectal cancer were treated with irinotecan (CPT-11, Camptosar) at 300 to 350 mg/m2 every 21 days and thalidomide (Thalomid) at 400 mg/d. Of the 15 patients, 11 were in a pilot study and 4

HOUSTON-Colorectal cancer mortality has declined slightly in the last 10 years, and the decrease appears to be accelerating. This decline is due in large part to screening and early detection, said Patrick M. Lynch, MD, associate professor of medicine, University of Texas M.D. Anderson Cancer Center.

PHILADELPHIA-Pancreatic cancer patients usually lose 25% of their body mass within 4 months of diagnosis and die within 6 months. But early work from Scotland on supplementation with eicosapentaenoic acid (EPA) seems to suggest that the fatty acid may stabilize weight and add months to the lives of pancreatic cancer patients.

One of the more promising chemotherapeutic agents for patients with metastatic colorectal cancer is oxaliplatin (Eloxatin), a third-generation platinum derivative with a unique mechanism of action. Preclinical studies

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.