Higher Bar Set for Trials in Advanced Colorectal Cancer

Editor’s note: This article describes the results of a clinical trial—a research study with volunteer patients. The goal of the trial was to compare four different treatments for metastatic colorectal cancer (mCRC). All patients took a combination of chemotherapy drugs; either FOLFIRI [which combines folinic acid, fluorouracil and irinotecan] or FOLFOX [folinic acid, 5-fluorouracil and oxaliplatin]. Patients also took a targeted drug alongside the chemo; either bevacizumab (aka Avastin) or cetuximab (Erbitux). All four treatment combinations resulted in similar survival times—a median of 29 months. Compared to other clinical trials, this is a relatively long survival time. Based on these results, oncologists will now have more options for treating their patients according to patients’ preferences and side effects.

“Patients with KRAS wild-type metastatic colorectal cancer (mCRC) receiving first-line treatment with a chemotherapy backbone plus bevacizumab or cetuximab survived for a median of 29 months, the longest median survival time reported in a major trial of these severely ill patients.

“Importantly, survival times were the same, whether patients received the anti–vascular endothelial growth factor bevacizumab (Avastin, Genentech) or the anti–epidermal growth factor receptor (EGFR) cetuximab (Erbitux, Bristol-Myers Squibb), or whether they received FOLFOX or FOLFIRI, results from the long-awaited Phase III CALGB/SWOG 80405 trial showed.

“ ‘What this tells us is that either FOLFIRI [folinic acid, fluorouracil and irinotecan] or FOLFOX [folinic acid, 5-fluorouracil and oxaliplatin] with either bevacizumab or cetuximab are perfectly reasonable options,’ said Alan P. Venook, MD, the Madden Family Distinguished Professor of Medical Oncology and Translational Research at the University of California, San Francisco.”


Phase III Trial Shows Improved Survival with TAS-102 in Metastatic Colorectal Cancer Refractory to Standard Therapies

“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.


First Treatment for Pain Caused by Chemotherapy

Conventional chemotherapy can damage nerves, causing pain and numbness, particularly in the hands and feet. Called neuropathy, this side effect can last months or even years after the completion of chemotherapy and there are currently no effective treatments. A new JAMA study shows that chemotherapy-induced neuropathy can be lessened with a drug called duloxetine (Cymbalta), which has also been shown to alleviate neuropathy in people with diabetes. The new study included 231 people who reported pain of at least 4 (on a scale of 0 to 10) after treatment with oxaliplatin or taxanes such as paclitaxel. Nearly 60% of those treated with duloxetine reported pain relief and those who had been treated with oxaliplatin may have benefited the most.


First Treatment for Pain Caused by Chemotherapy

Conventional chemotherapy can damage nerves, causing pain and numbness, particularly in the hands and feet. Called neuropathy, this side effect can last months or even years after the completion of chemotherapy and there are currently no effective treatments. A new JAMA study shows that chemotherapy-induced neuropathy can be lessened with a drug called duloxetine (Cymbalta), which has also been shown to alleviate neuropathy in people with diabetes. The new study included 231 people who reported pain of at least 4 (on a scale of 0 to 10) after treatment with oxaliplatin or taxanes such as paclitaxel. Nearly 60% of those treated with duloxetine reported pain relief and those who had been treated with oxaliplatin may have benefited the most.


First Treatment for Pain Caused by Chemotherapy

Conventional chemotherapy can damage nerves, causing pain and numbness, particularly in the hands and feet. Called neuropathy, this side effect can last months or even years after the completion of chemotherapy and there are currently no effective treatments. A new JAMA study shows that chemotherapy-induced neuropathy can be lessened with a drug called duloxetine (Cymbalta), which has also been shown to alleviate neuropathy in people with diabetes. The new study included 231 people who reported pain of at least 4 (on a scale of 0 to 10) after treatment with oxaliplatin or taxanes such as paclitaxel. Nearly 60% of those treated with duloxetine reported pain relief and those who had been treated with oxaliplatin may have benefited the most.