Cancer patients who smoke have significantly lower levels of irinotecan and its active metabolite than non-smokers.  They also had much less toxicity leading researchers to question whether or not they are at risk for treatment failure.

Analyzing the available dose of irinotecan in the blood of both smokers and non-smokers, scientists found less drug for smokers.  In addition, smokers had an almost 40 percent reduction in the level of SN-38.  Irinotecan is converted to SN-38 by body enzymes, and SN-38 attacks cancer cells. 

Only 6 percent of smokers being treated with irinotecan developed serious low white cell counts (neutropenia) compared to 38 percent of non-smokers in the study.  There was no significant difference in diarrhea.

Jessica M. van der Bol and her colleagues in the Netherlands, Sweden, and the United States speculated that cigarette smoke interferes with the enzymes that metabolize irinotecan.  They concluded,

This study indicates that smoking significantly lowers both the exposure to irinotecan and treatment-induced neutropenia, indicating a potential risk of treatment failure. Although the underlying mechanism is not entirely clear, modulation of CYP3A and uridine diphosphate glucuronosyltransferase isoform 1A1 may be part of the explanation. The data suggest that additional investigation is warranted to determine whether smokers are at increased risk for treatment failure.

SOURCE:  van der Bol et.al. Journal of Clinical Oncology, Volume 25, Number 19, July 1, 2007.

WHAT THIS MEANS FOR PATIENTS

If you are receiving Camptosar® (irinotecan or CPT-11) chemotherapy and smoke, talk to your doctor about dosage.  Stopping smoking might make the treatment more effective for you.

In a randomized, doubled-blinded study, Chinese herbal medicine was compared to a placebo in managing the side effects of chemotherapy.  While there was a significant difference in nausea among those taking the herbal medicine, there was no effect on serious anemia, low white cell counts, or reduced blood platelets.

To provide consistency, patients with early stage breast or colon cancer were randomly assigned to one of three Chinese medicine herbalists who prescribed a package of active single-item granules or a placebo package with non-therapeutic herbs with artificial smell and taste similar to the active herbal medicine.

Taking herbs decreased moderate nausea significantly from 35.7 percent to 14.6 percent.  However, none of the severe chemo effects on the blood were impacted — anemia, leukopenia, neutropenia, or thrombocytopenia.

TSK Mok and team concluded,

Traditional CHM does not reduce the hematologic toxicity associated with chemotherapy. CHM, however, does have a significant impact on control of nausea.

SOURCE:  Mok et. al. Annals of Oncology, Volume 18, Number 4, April 2007.

WHAT THIS MEANS FOR PATIENTS

This study tried to control for many different varieties of Chinese herbal medicine by limiting prescriptions to three herbalists.  It also controlled for the placebo effect by randomly providing a similar, non-active treatment.

The study does not provide any information about whether or not the herbal medicine affected the effectiveness of the chemotherapy.

Patients are strongly urged to discuss any medication, herb, or vitamin that they are taking during chemotherapy with their oncologist.  Herbs can and do both reduce treatment effectiveness and increase some side effects.

Women with mutated genes for hereditary non-polyposis colon cancer (Lynch Syndrome) are at increased risk for both endometrial and ovarian cancer, as well as colon cancer.  A hysterectomy to remove uterus and ovaries is sometimes recommended to reduce the risk.

Researchers at the University of California at San Francisco and Stanford University considered the benefits of three different strategies to prevent endometrial and ovarian cancer in women with Lynch Syndrome.

• Annual gynecologic exams
• Annual screening with gynecological exams, transvaginal ultrasound, endometrial biopsy, and measurement of CA 125 in the blood beginning at age 30
• Prophylactic surgery to remove ovaries, fallopian tubes, and uterus (Hysterectomy with Bilateral Salpingo-oophorectomy)

Using Surveillance, Epidemiology and End Results (SEER) data from 1988 to 2001, they found that surgery was most effective in preventing both ovarian and endometrial cancer, following by screening,

• Ovarian cancer would be diagnosed in .0056 percent of women who had surgery, endometrial cancer in .0060 percent.
• 3.7 percent of those who had annual screenings would get ovarian cancer during their lives, 18.4 percent would get endometrial cancer.
• With annual gyn exams 8.3 percent would get ovarian cancer and 48.7 percent would be diagnosed with endometrial cancer during their lifetimes.

Writing for the research team, Lee-may Chen, MD, pointed out,

When comparing prophylactic surgery with the screening option, one would need to perform 75 surgeries to save one woman’s entire life. For cancer prevention, however, only 28 and 6 prophylactic surgeries would need to be performed to prevent one case of ovarian and endometrial cancer, respectively.

She concluded,

Risk-reducing hysterectomy and bilateral salpingo-oophorectomy may be considered in women with Lynch/HNPCC to prevent gynecologic cancers and their associated morbidities.

SOURCE:  Chen et. al. Obstetrics and Gynecology, Volume 110, Issue 1, July 1, 2007.

WHAT THIS MEANS FOR PATIENTS

Women who carry a gene for Lynch Syndrome hereditary non-polyposis colon cancer may want to consider surgery to reduce their risk of ovarian or endometrial cancer.  An alternative to surgery is annual screening with with transvaginal ultrasound, uterine biopsy, and measurement of CA-125.   

Although removal of the ovaries and fallopian tubes greatly reduces risk of ovarian cancer, it does not prevent it entirely.  Ovarian cancer can develop within the peritoneal cavity even when there are no ovaries.

Your Representative and Senators will be working in their district offices during the upcoming August Congressional Recess (August 6-31) and we need you to reach out to them while they’re home. House and Senate leaders have requested far less than the amount needed to advance crucial cancer research.

WE NEED YOU!! Tell Congress to keep their promise and properly fund cancer research.

Here are some ideas on how to get the message out about proposed funding levels for cancer research to your Representative and Senators while they are home in the district.

1. Option 1: CALL your Representatives and Senators at their district office today and tell them that the current funding level for the NIH, which includes the NCI, won’t work and needs to be fixed. Click here for their phone numbers

2. Option 2: Attend a public meeting or event where your Representative and Senators may be at.

3. Option 3: Drop by their district office. You may not be able to sit down with your Member of Congress, but you should be able to at least speak with a staff member.

4. Option 4: If time is short, send an E-MAIL to your Representative and Senators today.

Materials:

Click here for talking points developed by C3: Colorectal Cancer Coalition.

SPEAK OUT TODAY!!

For more information please contact Joe Arite, Policy and Grassroots Manager at Joe.Arite@FightColorectalCancer.org

Don’t forget to visit C3: Colorectal Cancer Coalition’s Advocacy Blog

Joel Siegel, entertainment editor and film critic for ABC News, died of colon cancer last Friday, June 29, 2007.  He was 63.

In 1997, the same year he learned he had colon cancer, he also found out that he was to become a father for the first time.  Fearing that his son might have to grow up not knowing his father, Siegel wrote Lessons for Dylan to share those things he wanted his son to know. 

DEAR DYLAN:
They are words you don’t easily forget, “I don’t have good news.” Especially when they’re said by a doctor who’s just finished giving you a colonoscopy.

Talking about dealing with staying “positive and serene through days of discomfort” during radiation treatments and chemotherapy, Siegel wrote,

I pictured my grandmother. I’d see her face, I’d try to feel her hands, her long fingers, wrinkled as if she’d spent too much time in the pool. She, too, had colon cancer. She was diagnosed at 80 and lived till 90 and died of something else.

Chemotherapy ended at the same time Dylan was born, and Siegel had several good months,

I had about three great months. My hair came back. Darker. My colostomy was reversed. That was nice. It took major surgery and I had to figure out a new diet and relearn muscle control and Easter Sunday at friends I ran out of my diapers and had to borrow one of Dylan’s, but life was getting better. My CT-scans were clean, I was getting better.

But then the cancer returned.  He wrote in Lessons for Dylan,

Dylan was happy and gurgling. Ena was painting. I was feeling good. Things were going well.

And the witch came back.

In 1991 Siegel and actor Gene Wilder founded Gilda’s Club to support people living with cancer in honor of Wilder’s wife Gilda Radner who died of ovarian cancer.

He is survived by his wife Eva Swansea and son Dylan.