“A new kind of cancer study supports the idea that traditional treatment can be turned on its head, with patients given targeted therapy based not on where their tumors started but on their own genetic mutations.
“Researchers used a targeted melanoma drug to treat patients with a range of cancers, from lung cancer to brain cancer, who weren’t being helped by traditional chemotherapy any more. Even though they had many different types of tumors, they all had one thing in common — a genetic mutation called BRAFV600.
“It’s a mutation familiar to doctors who treat melanoma, the deadliest form of skin cancer. It’s seen in about half of melanoma cases. A pill called vemurafenib, sold under the brand name Zelboraf, specifically targets the mutation. It helps about half of patients with melanoma who have the mutation.
“The same mutation is sometimes seen in colon cancer, lung cancer, thyroid cancer, brain tumors and some blood cancers.”
Chimeric antigen receptor (CAR) T-cell therapy is a new, immune system-based cancer treatment that has garnered recent media attention. In a clinical trial, CAR T-cell treatment left no signs of tumors in 70% to 90% of children and adults with the aggressive blood cancer acute lymphocytic leukemia (ALL). ALL is almost always fatal, and the results observed with CAR T-cell treatment are nothing short of spectacular. Continue reading…
Country musician Wade Hayes had no idea he had colon cancer until it was almost too late. He’d had telltale signs: bleeding and lethargy—which is caused by anemia due to blood loss—for a couple of years. But these symptoms began when he was only 40 years old, a decade younger than when initial colon cancer screening is recommended. And he had no family history of the disease. Taking all of this into account, a doctor friend attributed Wade’s bleeding to his heavy weightlifting. Continue reading…
The gist: A drug used to treat stomach cancer may also help treat people with advanced colorectal cancer. The drug, called Cyramza, was tested in a clinical trial—a research study with volunteer patients. The trial involved patients who had not been treated successfully with other approaches.
“Eli Lilly and Co’s LLY.N Cyramza stomach-cancer drug prolonged survival of patients with advanced colon cancer in a late-stage study, the U.S. drugmaker said on Friday.
“Based on favorable data from the Phase III study, Lilly said it would ask regulators in the first half of 2015 to approve Cyramza in patients with colorectal cancer that has spread to other parts of the body. It plans to present detailed results from the trial at a scientific meeting next year.
“The 1,000-patient global study, called RAISE, involved patients who had previously failed to adequately benefit from Roche Holding AG’s ROG.VX Avastin and other standard treatments.
“Patients taking Cyramza along with chemotherapy showed a statistical improvement in survival, compared with those in the study who took a placebo and chemotherapy.”
“Patients with intestinal polyps have a lower risk of dying from cancer than previously thought, according to Norwegian researchers.
“This group of patients may therefore need less frequent colonoscopic surveillance than what is common today. As a potential concequence, the researchers argue, health service resources may be diverted to other, patient groups.
“The findings were released today in The New England Journal of Medicine (NEJM).”
American Gastroenterological Association | Aug 28, 2014
This article describes the results of a clinical trial—a research study with volunteer patients. The trial tested adding a third drug to a standard two-drug chemotherapy treatment for colorectal cancer. The standard treatment consists of the drugs fluorouracil and leucovorin. It is given to patients after tumor-removal surgery to keep the cancer from coming back (recurrence). In the trial, a third drug called irinotecan was added. The researchers found that stage III patients whose tumors tested positive for a genetic change called CIMP benefitted from the irinotecan addition. Stage III CIMP-negative patients did not.
“When added to the standard chemotherapy treatment — fluorouracil and leucovorin — adjuvant irinotecan therapy improved overall survival rates for patients with the CpG island methylator phenotype (CIMP). CIMP is seen in about 10 to 20 percent of colorectal cancers. Patients with CIMP-negative tumors, however, exhibited significant harm from the addition of irinotecan — overall survival was 68 percent compared with 78 percent for those receiving the standard treatment alone.
“Our results serve as an example that the molecular characterization of individual tumors may help to determine the most appropriate treatment for patients with colon cancer,” said lead study author Stacey Shiovitz, MD, from the department of medicine, University of Washington, Seattle, WA, and the clinical research division of Fred Hutchinson Cancer Research Center, also in Seattle. “Based on our findings, identification of a tumor’s CIMP status should play a greater role in the clinical setting.”
“The new combination agent TAS-102 is able to improve overall survival compared to placebo in patients whose metastatic colorectal cancer is refractory to standard therapies, researchers said.
” ‘Around 50% of patients with colorectal cancer develop metastases but eventually many of them do not respond to standard therapies,’ said Takayuki Yoshino of the National Cancer Centre Hospital East in Chiba, Japan, lead author of the phase III RECOURSE trial. ‘The RECOURSE study shows that TAS-102 improves overall survival in these patients compared to placebo. I believe that this agent will become one of the standards of care in the refractory setting of metastatic colorectal cancer in Japan and worldwide.’
“TAS-102 is a novel nucleoside anti-tumour agent consisting of trifluridine (FTD) and tipiracil hydrochloride (TPI). FTD is the active component of TAS-102 and is directly incorporated into cancer DNA, leading to DNA dysfunction. However, when FTD is taken orally it is largely degraded to an inactive form. TPI prevents the degradation of FTD. This mechanism of action is different to that of fluoropyrimidine, oxaliplatin and irinotecan…
“Douillard concluded: ‘In RECOURSE, TAS-102 was tested in patients who had received all types of chemotherapy available for colorectal cancer. I would probably move this drug into an earlier line of treatment and I would also combine it with either irinotecan or oxaliplatin.’ ”
Editor’s note: This story discusses the results of a clinical trial that tested a new treatment for colorectal cancer in volunteer patients. The trial tested whether the treatment—called TAS-102—benefits people with metastatic cancer that has not responded to standard treatment. Some patients in the trial were treated with TAS-102, and for comparison, some were given a “fake” placebo treatment. The results showed that patients treated with TAS-102 survived longer than patients who took the placebo.
“For patients with KRAS wild-type untreated colorectal cancer, adding cetuximab or bevacizumab to combination chemotherapy offers equivalent survival, researchers said at the ESMO 16th World Congress on Gastrointestinal Cancer in Barcelona.” ‘The CALGB/SWOG 80405 trial was designed and formulated in 2005, and the rationale was simple: we had new drugs —bevacizumab and cetuximab— and the study was designed to determine if one was better than the other in first-line for patients with colon cancer,’ said lead study author Alan P. Venook, distinguished Professor of Medical Oncology and Translational Research at the University of California, San Francisco, USA.
“The CALGB/SWOG 80405 trial studied patients whose tumours were KRAS wild-type at codons 12 and 13. Patients received mFOLFOX6 or FOLFIRI at the discretion of their doctor and were randomised to cetuximab (578 patients) or bevacizumab (559 patients).
” ‘There was no meaningful difference in outcome between treatment arms,’ said Venook. ‘In both arms patients lived close to 30 months. About 10% of patients lived more than 5 years. Overall patients did much better than anticipated and it was indifferent to the type of treatment.’ ”
Editor’s note: This story discusses the results of a clinical trial that tested a treatment for colorectal cancer in volunteer patients without mutations in the KRAS gene in their tumors (as detected by molecular testing). The goal of the trial was to compare two chemotherapy drugs—bevacizumab and cetuximab—to see whether one is better than the other as a first-line colorectal cancer for so-called “KRAS wild-type” colorectal cancer. The results showed that there was no significant difference between the two.
“Recent reports have shown that colon cancer rates have fallen by 30 percent over the past decade, particularly in people over age 50, because of the effectiveness of colonoscopies and awareness efforts surrounding the condition.
“Martha Ferguson, MD, UC Cancer Institute physician, associate professor at the UC College of Medicine and UC Health Colon and Rectal surgeon, says that these numbers are promising but that there are still misconceptions that are causing people to forgo their colonoscopy.
” ‘Colonoscopies are recommended every 10 years for average-risk people beginning at age 50—earlier if there is a family history of colon cancer,’ Ferguson says. ‘However, some people think that a colonoscopy is going to be a miserable, painful test, and that isn’t the case.’ “